Tag Archives: IOM

IOM Unveils Hot Reads in Time for Summer

In case you’re looking for something more meaningful to read this summer than Fifty Shades of Grey or Abraham Lincoln: Vampire Hunter, The Institute of Medicine has released some dandy reports suitable for reading or for hiding those trashy beach novels.

First up, in May, IOM released Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. The report focuses on five critical goals for preventing obesity:

  • integrating physical activity into people’s daily lives,
  • making healthy food and beverage options available everywhere,
  • transforming marketing and messages about nutrition and activity,
  • making schools a gateway to healthy weights, and
  • galvanizing employers and health care professionals to support healthy lifestyles.

The committee outlined specific strategies include: requiring at least 60 minutes per day of physical education and activity in schools, industry-wide guidelines on which foods and beverages can be marketed to children and how, expansion of workplace wellness programs, taking full advantage of physicians’ roles to advocate for obesity prevention with patients and in the community, and increasing the availability of lower-calorie, healthier children’s meals in restaurants.

Also in May, IOM published Ethical and Scientific Issues in Studying the Safety of Approved Drugs. In response to the passage of the Food and Drug Administration Act in 2007, the FDA asked the IOM to evaluate scientific and ethical aspects of safety studies for approved drugs. The IOM concluded that the FDA’s current approach to drug oversight in the postmarket setting is not systematic enough and does not ensure that benefits and risks of drugs are assessed consistently over the drug’s life cycle.  “Adopting a regulatory framework that is standardized across all drugs, yet flexible enough to adapt to regulatory decisions of differing complexity, could help make the agency’s decision-making process more predictable, transparent, and proactive. These changes could allow the FDA to better anticipate postapproval research needs and improve drug safety for all Americans.”

Finally, for the ambitious reader, the IOM had just released the discussion paper A CEO Checklist for High-Value Health Care. Despite risking costs, healthcare remains suboptimal in many areas. “To aid and accelerate the system-wide transformation necessary, we have assembled what we are calling “A CEO Checklist for High-Value Care” (the Checklist). The Checklist’s 10 items reflect the strategies that, in our experiences and those of others, have proven effective and essential to improving quality and reducing costs. They describe the foundational, infrastructure, care delivery, and feedback components of a system oriented around value, and represent basic opportunities—indeed obligations—for hospital and health care delivery system CEOs and Boards to improve the value of health care in their institutions.”

The 10 items include:

  • Governance priority—visible and determined leadership by CEO and Board
  • Culture of continuous improvement—commitment to ongoing, real-time learning
  •  IT best practices—automated, reliable information to and from the point of care
  • Evidence protocols—effective, efficient, and consistent care
  • Resource utilization—optimized use of personnel, physical space, and other resources
  • Integrated care—right care, right setting, right providers, right teamwork
  • Shared decision making—patient–clinician collaboration on care plans
  • Targeted services—tailored community and clinic interventions for resource-intensive patients
  • Embedded safeguards—supports and prompts to reduce injury and infection
  • Internal transparency—visible progress in performance, outcomes, and costs

Kerri Wachter (On Twitter @knwachter)


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Filed under Drug And Device Safety, Health Policy, health reform, IMNG, Primary care

Fighting Over the SGR: The Policy & Practice Podcast

The Medicare Payment Advisory Commission (MedPAC) is recommending that Congress throw out the Sustainable Growth Rate (SGR) formula currently used in setting Medicare physician payments. Under that formula, physicians are due to have their Medicare payments cut by about 30% on Jan. 1. But while doctors are unanimous in their loathing of the SGR, there are differing opinions about how to solve the problems with how Medicare pays physicians.

Courtesy Wikimedia Commons/Psychonaught/Creative Commons License

Check out the Policy & Practice podcast to hear how MedPAC wants to pay for its SGR fix and what objections physician groups are raising about the plan. This week’s podcast also features news on the Institute of Medicine’s recommendations on what should be included in an essential package of health insurance benefits for health plans operating in the state health insurance exchanges in 2014.

Take a listen:

Join us next week as we follow the deliberations of the Joint Select Committee on Deficit Reduction and what it means for Medicare and other health programs.

— Mary Ellen Schneider  (@MaryEllenNY)

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Filed under Health Policy, health reform, IMNG, Podcast

Debt Debate Rages On: The Policy & Practice Podcast

Courtesy flickr user SqueakyMarmot (CC)

As Republicans and Democrats battle over a solution to the nation’s debt crisis, doctors’ groups are voicing their desire to see a permanent solution to the Sustainable Growth Rate formula (SGR) as part of that package. Some physicians see the debt ceiling debate as the last chance for quite a while to reach a real solution.

Meanwhile, government official revealed several new Affordable Care Act initiatives including Consumer Oriented and Operated Plans — or CO-OPs — and bundled payments for Medicare.

Also, at the behest of the Health and Human Services department, an expert panel of the Institute of Medicine released its list of recommended preventive health care services for women. Under the ACA, health plans must cover preventive services proscribed by HHS without cost sharing beginning in 2014. The list of recommendations includes birth control, emergency contraception, gestational diabetes screening, HPV testing for women over 30, and STD counseling.

Listen to this week’s podcast for more and share your thoughts.

Check back next week for updates on debt ceiling talks and health reform implementation.

—Frances Correa (@FMCReporting on Twitter)

Image courtesy of flickr user SqueakyMarmot, used under a Creative Commons license.

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Filed under Family Medicine, Health Policy, health reform, IMNG, Obstetrics and Gynecology, Podcast, Practice Trends, Primary care

NCI’s Cancer Research Gambit

If the National Cancer Institute (NCI) is able to pull it off, the landscape for cancer research and clinical trials will be vastly different by 2014.

A year ago, the Institute of Medicine (IOM) at the NCI’s behest, assembled a panel of experts to look at whether there was a way to take the NCI’s  Clinical Trials Cooperative Groups system and streamline them into a more focused and nimbler enterprise.  The Cooperative Groups have existed since 1955 and are the recipients of a portion — though not the majority portion — of the NCI’s research budget.

Via Flickr Creative Commons, Wellcome Library

It is a loose-knit, largely volunteer federation of academic and community medical centers who share knowledge, but compete for the NCI’s grants.  The Coop Groups are considered a very influential and important place to do research. The federal government, private industry and patient advocates all make use of the power of the groups.

But the IOM pointed out in its early 2010 report that the Coop Groups have been suffering — from decreasing funding and duplicative efforts. And, disappointingly, patient recruitment is still hideously low.

Patients are the ultimate losers in this, as the most important questions may not be asked, and it is taking longer to get answers.

Often, such reports become fodder for policy wonks and just gather dust somewhere. They rarely become catalysts for fast action.  Not in this case.  Since that report was issued and the NCI subsequently gave notice that it expects to see major change in the next few years, 7 of the 10 cooperative groups have said they will assimilate into 3 new entities.

At a meeting earlier this week in Washington convened by the National Cancer Policy Forum and the American Society of Clinical Oncology to talk about the process, some of the nation’s leading oncologists were in attendance. They clearly were struggling with the idea that instead of competing with each other for money and attention, they now would be working in a much more collaborative way.

They all acknowledged the reality of the declining pot of gold at the end of the rainbow.  And there was some trepidation about what the new trial system would look like.

“I don’t think any of us in this room know if this is going to work,” said Dr. Peter C. Adamson, a leader in the Children’s Oncology Group (one of the NCI Coop Groups), and oncologist at the Children’s Hospital of Philadelphia.

But plunging ahead without knowing for sure if something will be effective seems to be the stock and trade of oncology. And, if the IOM is to be believed, the cancer research enterprise is not yet terminal, but is entering a late-stage of illness.  The time to act is now.

To read more analysis and news about the drive to retool the Cooperative Groups, you can go here and here.

—Alicia Ault (on Twitter @aliciaault)

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Filed under Health Policy, IMNG, Oncology

The Health Care Worker Protection Paradox


courtesy of creative commons user wallyg via flickr

courtesy creative commons user wallyg via flickr

From an Institute of Medicine workshop on workplace protection against novel A(H1N1) influenza, Washington, D.C.

I spent the last day and a half listening to presentations on various topics related to the transmission of the novel A(H1N1) influenza virus, the filtration properties of surgical masks, and the effectiveness of respirators in preventing the spread of the virus.

This was an information-gathering workshop, so the IOM committee can send a report to the CDC, and the CDC can use the information to decide whether to continue to advise health care workers to wear N95 respirators, which fit tighter to the face than basic surgical masks.

During a public comment period, representatives from several labor unions, a firefighters’ association, and a nurses’ association supported wearing N95 respirators for first responders and health care workers at risk of H1N1 infection.  

Yet the doctor who spoke on behalf of the Society for Healthcare Epidemiology of America and the Infectious Disease Society of America said that her organizations would revise the CDC guidance, because current evidence suggests the H1N1 is transmitted by droplets, and therefore the same precautions as seasonal flu, including use of surgical masks and good hygiene practices are what is needed.

Other than a lack of evidence that they help, why might health care workers resist respirators? Comfort is one reason. But this morning, a doctor from Canada brought up another point–empathy. Some surveys of Canadian health care workers after the SARS epidemic suggested that respirators led to a sense of isolation, and a feeling of not being able to relate to patients or colleagues.

I hadn’t thought about that, but we humans are wired to respond to faces, either positively or negatively.

Maybe that’s the difference between a firefighter who is confronting a scary wall of flame and a physician who is confronting a scared patient.

—Heidi Splete (@hsplete on Twitter)
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Filed under Emergency Medicine, Hospital and Critical Care Medicine, Infectious Diseases, Primary care

Please Don’t Follow the Money

From the Institute of Medicine meeting on comparative effectiveness research:

Photo courtesy Flickr Creative Commons license

Photo courtesy Flickr Creative Commons license

It’s the end of a long day of short speeches from health care “stakeholders” – the Institute of Medicine wanted to find out what clinicians, patients, researchers, and others think the government should do with its $1.1 billion in stimulus money for comparative effectiveness research. One of the many stakeholders testifying at this meeting was Dr. Mohammad Akhter, executive director of the National Medical Association. He asked the panel to consider many of the same issues other speakers mentioned: what the purpose of the research should be, who would conduct the research, and what was the best way of implementing the results. But it was what he mentioned in passing that interested me the most – that his group has “trust issues” with government research funding.

Since the National Medical Association represents minority physicians, I was curious as to what he was talking about – did he mean the infamous Tuskegee experiment? Was he talking about the disparities in minority health outcomes and the lack of minority patients in clinical trials? I followed him out of the meeting to ask why.

No, it turned out to be something else entirely: His concern was whether the ulterior motive was cost savings. There are a lot of instances in which government efforts purport to be about improving patient care and then they turn out to be something else entirely, Dr. Akhter said. He gave peer review organizations as an example – they started out being concerned about professionalism “and then they became punitive. …We should know what the aim of all this is. Is it just about saving money?”

That sentiment was echoed over and over all day. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “We should look at clinical effectiveness, not cost-effectiveness,” said Teresa Lee of AdvaMed, the trade organization for medical device manufacturers. “Cost effectiveness is an important priority, but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: Carmella Bucchino of America’s Health Insurance Plans. “Our industry believes comparative information on cost is equally important….if one intervention is marginally better, we still want to know how much more we’re paying for that benefit.” –Joyce Frieden

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