Supreme Court allows healthcare law to largely stand

The Supreme Court on Thursday largely let stand President Obama's health care overhaul, in a mixed ruling that Court observers were rushing to analyze. 

The decision was a striking victory for the president and Congressional Democrats, with a majority, including the conservative chief justice, John G. Roberts Jr., affirming the central legislative pillar of Mr. Obama's term. 

Many observers called the case the most significant before the court since at least the 2000 Bush v. Gore ruling, which decided a presidential election. In addition to the political reverberations, the case helps set the rules for one of the largest and fastest-growing sectors of the economy, one that affects nearly everyone from cradle to grave. 

Read the rest of the NYT article. 

Read the ruling on the official SCOTUS website www.supremecourt.gov - under recent decisions. 

Go to the NYT Health Care Reform and the Supreme Court (Affordable Care Act) special page, which includes updates and audio files of the original case arguments.

Go to the WSJ health page.

Will pay-for-performance work for infection prevention?

Dr. Cindi Crosby - Vice President, Global Medical Affairs, CareFusion ___________________________________________________________________

The pay-for-performance (P4P) movement in the U.S. healthcare system is not new, but the Patient Protection and Affordable Care Act (PPACA) has the potential to usher in the largest federal expansion of P4P to date. A provision of PPACA mandates pilot testing of P4P for certain Medicare providers, beginning no later than January 1, 2016. Even if legal and political challenges result in the repeal of PPACA, momentum for P4P continues as insurance companies and healthcare systems strive to improve health outcomes and reduce costs.

Pros and Cons
Proponents of P4P focus on the logic behind providing incentives to healthcare organizations and providers to meet measurable process improvements or clinical outcomes, such as better management of chronic diseases or reducing infection rates. At first glance, these P4P objectives seem reasonable and desirable in terms of improving clinical outcomes. But detractors of P4P cite a number of problems, including the assumption that financial incentives (or disincentives tied to poor performance) will affect important clinical outcomes associated with morbidity and mortality. (See “Effect Of Pay For Performance On The Management And Outcomes Of Hypertension In The United Kingdom: Interrupted Time Series Study.”) A study published online in New England Journal of Medicine (March 28, 2012) found that hospitals participating in the Medicare Premier Hospital Quality Incentive Demonstration (HQID) had no decrease in 30-day mortality compared to control hospitals over a six-year period. The authors noted that P4P effects on mortality did not differ significantly among conditions for which outcomes were explicitly linked to incentives (i.e., acute myocardial infarction and CABG) and those not linked to incentives (i.e., congestive heart failure and pneumonia). (See “The Long-Term Effect of Premier Pay for Performance on Patient Outcomes.”) As expected, a quick scan of the medical literature shows an evolution from primarily positive articles in the early and mid-2000s, when P4P was a broad goal yet to be widely implemented, to more recent restrained views of actual P4P program outcomes.

Read the full story.
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Crosby’s work in CareFusion’s Medical Affairs Department represents the perfect culmination of a career that has always focused on combining education with research to improve patient care. From her start working in a bone marrow transplant unit at a university medical center to her recent honorary appointment as a research associate in infectious disease in the Department of Microbiology at Queen Elizabeth Hospital in the UK, Crosby’s primary focus has been the clinical application of infection control products to improve patient health outcomes. But Cindi has also always understood the importance of building networks to share information and solve problems. Her education and background as a microbiologist has helped her assemble effective global partnerships with key thought leaders in infection prevention, and she has built on this further by publishing and speaking to share information with those who care for patients.

If you wish to read more of Dr. Crosby’s blogs, then please visit: http://www.carefusion.com/safety-clinical-excellence/perspectives/infection_prevention.aspx.