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Legislation & Regulation
John Carroll

Farzad Mostashari, MD

Slightly less than half of the 114 accountable care organizations (ACOs) in the Medicare Shared Savings Program reported lower spending against their benchmarks. Only 29 of those actually lowered costs enough to qualify for a shared-savings cut. Many questions. Many concerns.

News & Commentary

Which is unfortunate for patients who suffer a heart attack on weekends or off hours. They’re more likely to die than those who get stricken during normal business hours, say researchers. The difference in outcomes “is likely associated with availability of cardiologists” and support staff.

Feature
Peter Boland, PhD
David Gibson, MD

Insured patients are liable for ever-growing out-of-pocket costs that many cannot pay. Each segment of the health care industry will be forced to contend with the unintended consequences of consumer debt, and the resulting dynamic will strain business relations among employees, employers, insurers, and providers.

Peer-Reviewed
Santosh J. Agarwal, BPharm, MS
Gary V. Delhougne, JD, MHA
Levi Citrin, JD
Jill E. Sackman, DVM, PhD

One of the reasons costs rise is because technology keeps getting better. That does not always have be the case, however. MIS is worth adopting, this study indicates, because it has demonstrated both clinical benefits and a reduction in hospital cost per case when used for colectomy, hysterectomy, and thoracic resection. 

News & Commentary

Depression and diabetes have long been associated. A study links diabetes with bulimia, binge eating, and intermittent explosive disorder. A key point: These disorders are often evident long before the appearance of diabetes. Targeting the eating disorder might be the best defense.

Feature
Thomas Reinke

More than 2 million antibiotic-resistant infections occur annually — a huge and chronic problem in health care that’s being addressed in new ways. Insurers and accountable care organizations are starting to work together to help physicians reduce inappropriate prescribing of antibiotics, making them think twice.

Snapshot

There has been a surge in Medicaid rolls thanks to the Affordable Care Act. About 6.3 million more people were deemed eligible as of mid-January. Covering this population presents unique challenges: Almost half have not had insurance for five years or more and 18% say they never had it. 

News & Commentary

Good news: Overall death rates for all childhood and adolescent cancers declined by more than 50% since 1975. Bad news: Survivors are vulnerable to a host of problems as they get older. For instance, some who’ve overcome Hodgkin’s lymphoma have an increased risk of developing lung cancer.

Feature
Thomas Reinke

Tricia Barrett, MHSA

Mental health conditions have not been dealt with during medical treatment. Likewise, people with mental health conditions have not had their medical conditions managed. That’s changing because new ways of providing behavioral health care are being adopted just as the federal rule on parity is taking effect.

Contributing Voices
Steven Peskin, MD
Steven Peskin, MD

Three days of a severe headache that would not respond to the ibuprofen, naproxen, or acetaminophen. "I never get headaches" is what I said multiple times to my wife and to colleagues. The morning of day three, a rash started to appear on my forehead, in the left eyebrow, in the scalp, with swelling around the left eye and swollen lymph nodes at the angle of the jaw on the left. My wife mentioned "shingles". Poor early diagnosis on my part, and, I said "Oh !*#%! that is what I have".  I was starting to feel as if I had been taken out by an NFL linebacker.

Viewpoint
Al Lewis

Al Lewis

When Al Lewis, founder of the Disease Management Purchasing Consortium, went to a specialist, he was bombarded with unneeded options. “Doctors do doctor-type stuff because they’re doctors, and unless you literally take away any payment involved in doing more, they will continue to do what they are trained to do.” 

Tomorrow's Medicine
Thomas Morrow, MD

Thomas Morrow, MD

The key is measuring chemotherapy agents’ efficacy based on aptosis — cell death — as reflected by cells’ changing optical density. A new test produces a report that shows the sensitivity of tumor cells to therapy. The technology may allow individually selected older therapies to become the therapies of the future.

Cover Story
Susan Worley

Randall Krakauer, MD

Too many terminally ill patients receive expensive and aggressive treatment that diminishes quality of life. Medicare weighs whether to go beyond palliative care, while Aetna discovers that a more humane and less costly approach involves allowing curative treatment and loosening admission criteria.

Managed Care Outlook

Improving economic conditions and success fighting heart disease and HIV mean that more people are living longer, better lives. A good thing. However, it also means that dementia rates will explode by 2050. New data from China and Africa bring new concerns.

News & Commentary

It’s a tough audience, too, say researchers, “given that low-income and uninsured patients across the United States generally rate their care much lower.” The study says that 84% of about 4,500 patients surveyed think that PCMHs provide excellent or very good overall quality.

Trends
Michael D. Dalzell

The number of specialty drugs and biologics making it to market slipped from 25 in 2012 to 13 last year. Cancer continues to be a hotbed of specialty drug development. Of the 13 specialty drugs and biologics approved last year, nine carry oncology indications and hefty price tags. None were chemotherapies.

Feature
Frank Diamond

The technology keeps improving, which means that a bigger proportion of the population will have the disease and those people will live longer. Try prevention, say experts. Cholesterol is relatively easy to deal with but only about 70% of Americans get screened every five years. 

Snapshot

About 6 million adults age 18 or older received treatment for a significant mental health illness in 2012, according to government figures. They could be treated as an outpatient or inpatient, and in each category, with or without medication. Only 7.2% percent received all three types of care; the majority received two types.