Usefulness of Morning Home Blood Pressure Measurements in Older and Younger Japanese Adults with Type 2 Diabetes Mellitus: Results of a 10-Year, Prospective, Longitudinal Study - American Geriatric Society

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Geriatric Infectious Diseases: Current Concepts on Diagnosis and Management - American Geriatric Society

New information on infectious diseases in older adults has become available in the past 20 years. In this review, in-depth discussions on the general problem of geriatric infectious diseases (epidemiology, pathogenesis, age-related host defenses, clinical manifestations, diagnostic approach); diagnosis and management of bacterial pneumonia, urinary tract infection, and Clostridium difficile infection; and the unique challenges of diagnosing and managing infections in a long-term care setting are presented.

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Association Between Serum β2-Microglobulin Levels and Prevalent and Incident Physical Frailty in Community-Dwelling Older Women - American Geriatric Society

Objectives

To investigate whether higher serum β₂-microglobulin (B2M) levels, a kidney function marker, are associated with prevalent and incident frailty in community-dwelling older women.

Design

Cross-sectional and longitudinal analyses of a prospective cohort.

Setting

Population-based cohort study in Tokyo, Japan.

Participants

Community-dwelling women aged 75 and older with adequate data for assessing frailty status (N = 1,191) and a subset of participants without baseline frailty but with repeated frailty assessment at 2 and 4 years of follow-up.

Measurements

The primary predictor was B2M level. Outcomes were prevalent and incident frailty during the 4-year follow-up period. Frailty was defined as presence of three of the five Fried criteria: weight loss, exhaustion, weakness, slowness, and low physical activity. Adjusted odds ratios for the main confounders were obtained using logistic regression. Discrete-time Cox proportional hazards models were used to determine the risk of developing frailty.

Results

The study included 241 (20.2%) women with prevalent frailty at baseline and 139 (21.1%) with incident frailty during the 4-year follow-up. On multivariate analysis adjusted for multiple potential confounders, the odds of prevalent frailty were 2.5 times as great with B2M levels of 1.9 to 2.1 mg/L as with levels less than 1.6 mg/L and 2.0 times as great with B2M levels of 2.2 mg/L or more. In the unadjusted model, B2M levels of 1.9 to 2.1 mg/L were associated with a greater incidence of frailty than B2M levels of less than 1.6 mg/L (hazard ratio = 1.72, 95% confidence interval = 1.04–2.86). In the multivariate analysis adjusted for potential confounders, no significant association was noted between the highest B2M quartile and incident frailty.

Conclusion

Higher B2M levels were independently associated with greater frailty at baseline in older adults but only slightly associated with greater risk of incident frailty over 4 years of follow-up.

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Limitations of Conclusions of Systematic Review and MetA-Analysis Because of Exclusion of Groups Most at Risk - American Geriatric Society

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Reply to “Limitations of Conclusions of Systematic Review & Meta-analysis Due to Exclusion of Groups Most at Risk” - American Geriatric Society

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New American Food Products, LLC Issues Allergy Alert on Weigels’s Mountain Valley and Royal Farms Market Place- Milk Chocolate Vanilla Caramels due to Undeclared Peanuts - FDA Safety Alerts & Drug Recalls

The recall was initiated due to concerns of the possible presence of peanuts. People who have an allergy or severe sensitivity to specific types of allergen, such as peanuts, run the risk of serious life threatening allergic reactions if they consume the product being recalled.

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NSE Products, Inc. Issues Allergy Alert on Undeclared Milk in Ageloc TR90 Protein Boost - FDA Safety Alerts & Drug Recalls

NSE Products, Inc. is recalling all ageLOC TR90 Protein Boost because it contains milk in the formula, which is not declared on the label. People who have an allergy or severe sensitivity to milk run the risk of a serious or life-threatening allergic reaction if they consume this product.

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Marich Confectionery Co. Issues Allergy Alert On Potential Undeclared Almonds In Product - FDA Safety Alerts & Drug Recalls

Marich Confectionery of Hollister, California is voluntarily recalling 4.25oz Valentine Chocolate Caramel Hearts UPC CODE 797817-44440-9 because it may contain Triple Chocolate Toffee which contains almonds. People who have an allergy or severe sensitivity almonds run the risk of serious or life-threatening allergic reaction if they consume these products.

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Mark Your Calendars: January 31st is quickly approaching - CMS Blog

If you still need health coverage for 2017, you have until January 31^st to sign up for coverage through HealthCare.gov. Through the website you can review your choices and see if you qualify for financial help. Issuers have confirmed that consumers who select a plan and pay their first premium will have coverage for 2017. And, insurers have signed contracts to provide coverage through 2017.

Consumers who want coverage – whether you are new to the Health Insurance Marketplace or have previously enrolled in health coverage – can visit HealthCare.gov, update your information, or add it for the first time, and select a plan. You may also compare plans online or on your mobile device. You can review the core plan features like cost-sharing and provider networks.

When you log onto HealthCare.gov, you need three pieces of information – your zip code, family size, and household income – to see what plans are available to you and to get an estimate of how much the plans cost. If you had coverage through HealthCare.gov for 2016, you can come back to update your information and compare your options for 2017. If you have questions or want to talk through your options with a trained professional, enrollment specialists are available all day, every day, at 1-800-318-2596. Free, confidential, in-person assistance is also available at enrollment sites and events in your state. Visit localhelp.healthcare.gov to find assistance in your community.

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FDA confirms elevated levels of belladonna in certain homeopathic teething products - FDA Press Releases

The U.S. Food and Drug Administration announced today that its laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label. The agency is warning consumers that homeopathic teething tablets containing belladonna pose an unnecessary risk to infants and children and urges consumers not to use these products.

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Antibacterial fatty acids destabilize hydrophobic and multicellular aggregates of biofilm in S. aureus - Journal of Antibiotics

Antibacterial fatty acids destabilize hydrophobic and multicellular aggregates of biofilm in S. aureus

The Journal of Antibiotics 70, 115 (February 2017). doi:10.1038/ja.2016.76

Authors: Zulfiqar Ali Mirani, Shagufta Naz, Fouzia Khan, Mubashir Aziz, Asadullah, Muhammad Naseem Khan & Seema Ismat Khan

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Antibiotic combinations for controlling colistin-resistant Enterobacter cloacae - Journal of Antibiotics

Antibiotic combinations for controlling colistin-resistant Enterobacter cloacae

The Journal of Antibiotics 70, 122 (February 2017). doi:10.1038/ja.2016.77

Authors: Thais Bergamin Lima, Osmar Nascimento Silva, Keyla Caroline de Almeida, Suzana Meira Ribeiro, Dielle de Oliveira Motta, Simone Maria-Neto, Michelle Brizolla Lara, Carlos Roberto Souza Filho, Alicia Simalie Ombredane, Celio de Faria Junior, Nadia Skorupa Parachin, Beatriz Simas Magalhães & Octávio Luiz Franco

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CD101, a novel echinocandin with exceptional stability properties and enhanced aqueous solubility - Journal of Antibiotics

CD101, a novel echinocandin with exceptional stability properties and enhanced aqueous solubility

The Journal of Antibiotics 70, 130 (February 2017). doi:10.1038/ja.2016.89

Authors: B Radha Krishnan, Kenneth D James, Karen Polowy, B J Bryant, Anu Vaidya, Steve Smith & Christopher P Laudeman

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Polyols, not sugars, determine the structural diversity of anti-streptococcal liamocins produced by Aureobasidium pullulans strain NRRL 50380 - Journal of Antibiotics

Polyols, not sugars, determine the structural diversity of anti-streptococcal liamocins produced by Aureobasidium pullulans strain NRRL 50380

The Journal of Antibiotics 70, 136 (February 2017). doi:10.1038/ja.2016.92

Authors: Neil PJ Price, Kenneth M Bischoff, Timothy D Leathers, Allard A Cossé & Pennapa Manitchotpisit

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Activity of tick antimicrobial peptide from Ixodes persulcatus (persulcatusin) against cell membranes of drug-resistant Staphylococcus aureus - Journal of Antibiotics

Activity of tick antimicrobial peptide from Ixodes persulcatus (persulcatusin) against cell membranes of drug-resistant Staphylococcus aureus

The Journal of Antibiotics 70, 142 (February 2017). doi:10.1038/ja.2016.101

Authors: Naruhide Miyoshi, Emiko Isogai, Keiichi Hiramatsu & Takashi Sasaki

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Microbacterium lacusdiani sp. nov., a phosphate-solubilizing novel actinobacterium isolated from mucilaginous sheath of Microcystis - Journal of Antibiotics

Microbacterium lacusdiani sp. nov., a phosphate-solubilizing novel actinobacterium isolated from mucilaginous sheath of Microcystis

The Journal of Antibiotics 70, 147 (February 2017). doi:10.1038/ja.2016.125

Authors: Bing-Huo Zhang, Nimaichand Salam, Juan Cheng, Han-Quan Li, Jian-Yuan Yang, Dai-Ming Zha, Qi-Gen Guo & Wen-Jun Li

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Synthesis and biological evaluation of lipophilic teicoplanin pseudoaglycon derivatives containing a substituted triazole function - Journal of Antibiotics

Synthesis and biological evaluation of lipophilic teicoplanin pseudoaglycon derivatives containing a substituted triazole function

The Journal of Antibiotics 70, 152 (February 2017). doi:10.1038/ja.2016.80

Authors: Zsolt Szűcs, Magdolna Csávás, Erzsébet Rőth, Anikó Borbás, Gyula Batta, Florent Perret, Eszter Ostorházi, Réka Szatmári, Evelien Vanderlinden, Lieve Naesens & Pál Herczegh

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Three structurally-related impurities in norvancomycin drug substance - Journal of Antibiotics

Three structurally-related impurities in norvancomycin drug substance

The Journal of Antibiotics 70, 158 (February 2017). doi:10.1038/ja.2016.115

Authors: Zhibo Jiang, Xuan Lei, Minghua Chen, Bingya Jiang, Linzhuan Wu, Xuexia Zhang, Zhihui Zheng, Xinxin Hu, Xuefu You, Shuyi Si, Lifei Wang & Bin Hong

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Validation of the mutant selection window hypothesis with fosfomycin against Escherichia coli and Pseudomonas aeruginosa: an in vitro and in vivo comparative study - Journal of Antibiotics

Validation of the mutant selection window hypothesis with fosfomycin against Escherichia coli and Pseudomonas aeruginosa: an in vitro and in vivo comparative study

The Journal of Antibiotics 70, 166 (February 2017). doi:10.1038/ja.2016.124

Authors: Ai-jun Pan, Qing Mei, Ying Ye, Hong-ru Li, Bao Liu & Jia-bin Li

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Versicones E–H and arugosin K produced by the mangrove-derived fungus Aspergillus versicolor HDN11-84 - Journal of Antibiotics

Versicones E–H and arugosin K produced by the mangrove-derived fungus Aspergillus versicolor HDN11-84

The Journal of Antibiotics 70, 174 (February 2017). doi:10.1038/ja.2016.95

Authors: Feng Li, Wenqiang Guo, Qian Che, Tianjiao Zhu, Qianqun Gu & Dehai Li

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Vestaines, novel vasoactive compounds, isolated from Streptomyces sp. SANK 63697 - Journal of Antibiotics

Vestaines, novel vasoactive compounds, isolated from Streptomyces sp. SANK 63697

The Journal of Antibiotics 70, 179 (February 2017). doi:10.1038/ja.2016.98

Authors: Yuki Hirota-Takahata, Emi Kurosawa, Yoko Ishimoto, Yuko Iwadate, Masaaki Kizuka, Jun Chiba, Toru Hasegawa, Masahiro Tanaka & Hideki Kobayashi

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New aliphatic acid amides from Streptomyces maoxianensis sp. nov. - Journal of Antibiotics

New aliphatic acid amides from Streptomyces maoxianensis sp. nov.

The Journal of Antibiotics 70, 187 (February 2017). doi:10.1038/ja.2016.90

Authors: Jin-Meng Li, Kai Yan, Hui Zhang, Huan Qi, Ji Zhang, Wen-Sheng Xiang, Ji-Dong Wang & Xiang-Jing Wang

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New tenvermectin analogs obtained by microbial conversion with Saccharopolyspora erythraea - Journal of Antibiotics

New tenvermectin analogs obtained by microbial conversion with Saccharopolyspora erythraea

The Journal of Antibiotics 70, 190 (February 2017). doi:10.1038/ja.2016.91

Authors: Xu Wan, Shao-yong Zhang, Hui Zhang, Jun Zhai, Jun Huang, An-liang Chen & Ji-dong Wang

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In vitro activity of tigecycline in combination with rifampin, doripenem or ceftazidime against carbapenem-resistant Klebsiella pneumoniae bloodstream isolates - Journal of Antibiotics

In vitro activity of tigecycline in combination with rifampin, doripenem or ceftazidime against carbapenem-resistant Klebsiella pneumoniae bloodstream isolates

The Journal of Antibiotics 70, 193 (February 2017). doi:10.1038/ja.2016.93

Authors: Yongbo Zhang, Peizhen Li, Yuhan Yin, Fuqiang Li & Qinghua Zhang

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Identification of a prodigiosin cyclization gene in the roseophilin producer and production of a new cyclized prodigiosin in a heterologous host - Journal of Antibiotics

Identification of a prodigiosin cyclization gene in the roseophilin producer and production of a new cyclized prodigiosin in a heterologous host

The Journal of Antibiotics 70, 196 (February 2017). doi:10.1038/ja.2016.94

Authors: Shoko Kimata, Masumi Izawa, Takashi Kawasaki & Yoichi Hayakawa

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Germicidins H–J from Streptomyces sp. CB00361 - Journal of Antibiotics

Germicidins H–J from Streptomyces sp. CB00361

The Journal of Antibiotics 70, 200 (February 2017). doi:10.1038/ja.2016.100

Authors: Ming Ma, Mostafa E Rateb, Dong Yang, Jeffrey D Rudolf, Xiangcheng Zhu, Yong Huang, Li-Xing Zhao, Yi Jiang, Yanwen Duan & Ben Shen

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In silico identification of lysocin biosynthetic gene cluster from Lysobacter sp. RH2180-5 - Journal of Antibiotics

In silico identification of lysocin biosynthetic gene cluster from Lysobacter sp. RH2180-5

The Journal of Antibiotics 70, 204 (February 2017). doi:10.1038/ja.2016.102

Authors: Suresh Panthee, Hiroshi Hamamoto, Yutaka Suzuki & Kazuhisa Sekimizu

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Isolation of a new antibacterial peptide achromosin from Streptomyces achromogenes subsp. achromogenes based on genome mining - Journal of Antibiotics

Isolation of a new antibacterial peptide achromosin from Streptomyces achromogenes subsp. achromogenes based on genome mining

The Journal of Antibiotics 70, 208 (February 2017). doi:10.1038/ja.2016.108

Authors: Issara Kaweewan, Mayumi Ohnishi-Kameyama & Shinya Kodani

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Diapolic acid A–B from an endophytic fungus, Diaporthe terebinthifolii depicting antimicrobial and cytotoxic activity - Journal of Antibiotics

Diapolic acid A–B from an endophytic fungus, Diaporthe terebinthifolii depicting antimicrobial and cytotoxic activity

The Journal of Antibiotics 70, 212 (February 2017). doi:10.1038/ja.2016.109

Authors: Nalli Yedukondalu, Palak Arora, Bhumika Wadhwa, Fayaz Ahmad Malik, Ram A Vishwakarma, Vivek K Gupta, Syed Riyaz-Ul-Hassan & Asif Ali

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A new polysubstituted cyclopentene derivative from Streptomyces sp. HS-NF-1046 - Journal of Antibiotics

A new polysubstituted cyclopentene derivative from Streptomyces sp. HS-NF-1046

The Journal of Antibiotics 70, 216 (February 2017). doi:10.1038/ja.2016.111

Authors: Mei-yue Gao, Huan Qi, Jian-song Li, Hui Zhang, Ji Zhang, Ji-dong Wang & Wen-sheng Xiang

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A new cyano-substituted anthracycline metabolite from Streptomyces sp. HS-NF-1006 - Journal of Antibiotics

A new cyano-substituted anthracycline metabolite from Streptomyces sp. HS-NF-1006

The Journal of Antibiotics 70, 219 (February 2017). doi:10.1038/ja.2016.112

Authors: Xu Wan, Hui-jun Ren, Min-na Du, Huan Qi, Hui Zhang, An-liang Chen & Ji-dong Wang

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Opantimycin A, a new metabolite isolated from Streptomyces sp. RK88-1355 - Journal of Antibiotics

Opantimycin A, a new metabolite isolated from Streptomyces sp. RK88-1355

The Journal of Antibiotics 70, 222 (February 2017). doi:10.1038/ja.2016.113

Authors: Toshihiko Nogawa, Akiko Okano, Chung Liang Lim, Yushi Futamura, Takeshi Shimizu, Shunji Takahashi, Darah Ibrahim & Hiroyuki Osada

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Novel arginine-containing peptides MBJ-0173 and MBJ-0174 from Mortierella alpina f28740 - Journal of Antibiotics

Novel arginine-containing peptides MBJ-0173 and MBJ-0174 from Mortierella alpina f28740

The Journal of Antibiotics 70, 226 (February 2017). doi:10.1038/ja.2016.116

Authors: Teppei Kawahara, Masashi Itoh, Miho Izumikawa, Noriaki Sakata, Toshio Tsuchida & Kazuo Shin-ya

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Fred Meyer Recalls Bakery Fresh Goodness Carrot Cupcakes Due to Undeclared Allergens - FDA Safety Alerts & Drug Recalls

Fred Meyer Stores has recalled Bakery Fresh Goodness Carrot Cupcakes sold in its retail stores because the product may contain milk and soy not listed on the label.

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Carriage House Creations Recalls Carriage House Various Bourbon Basting Sauces and Hot Barbecue Sauce due to Undeclared Soy and Peanuts - FDA Safety Alerts & Drug Recalls

Carriage House Creations issues a voluntary product recall on all Bourbon Basting Sauces, and Hot Barbecue Sauce, due to undeclared soy and peanut ingredients found in the Worcestershire Sauce used in the making of these products. People, who have an allergy or severe sensitivity to soy or peanuts, run the risk of serious or life-threatening reactions if they consume these products.

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Hospira Issues A Voluntary Nationwide Recall For One Lot Of Vancomycin Hydrochloride for Injection, USP Due To The Presence of Particulate Matter Within a Single Vial - FDA Safety Alerts & Drug Recalls

Hospira, Inc., a Pfizer company, is voluntarily recalling one lot of Vancomycin Hydrochloride for Injection, USP (NDC: 0409-6510-01, Lot 591053A, Expiry Date 1NOV2017), to the hospital/retail level due to a confirmed customer report for the presence of particulate matter within a single vial.

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Specialty Commodities, Inc Issues Allergy Alert on Undeclared Cashew Allergen in Dry Roasted Almonds - FDA Safety Alerts & Drug Recalls

Specialty Commodities, Inc. (SCI), a subsidiary of Archer Daniels Midland Company (NYSE: ADM), is recalling a specific lot of dry roasted almonds because they may contain undeclared cashews. People who have an allergy or severe sensitivity to cashews run the risk of a serious or life-threatening allergic reaction if they consume these products.

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Athens Baking Company, Inc. Issues Voluntary Allergy Alert on Undeclared Milk in Harvest Whole Wheat Bread - FDA Safety Alerts & Drug Recalls

Fresno, California (January 22, 2017) – Athens Baking Company, out of an abundance of caution, is issuing a voluntary recall of Trader Joe’s Harvest Whole Wheat Bread (SKU 00132) because it contains undeclared cultured whey, which is made from milk. Only products labeled with “BEST BY: 01/08/17” through “01/27/17” are included in this recall.

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King's Pastry Canada Issues Allergy Alert on Undeclared (Hazelnuts) In Various Cakes - FDA Safety Alerts & Drug Recalls

King's Pastry, located in Ontario, Canada, is voluntarily recalling the following cakes because the products contained tree nut (hazelnut) allergens that were not listed on the product labels. People who have an allergy or severe sensitivity to tree nuts (hazelnut) run the risk of serious or life-threatening allergic reaction if they consume these products.

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Chip’n Dipped Voluntarily Expands Recall to Include 7 More of it’s Dark Chocolate Bars Due to Possible Presence of Undeclared Milk - FDA Safety Alerts & Drug Recalls

Chip’n Dipped of Huntington, NY, is expanding its recall of it’s dark chocolate bars to include, Dark Chocolate Almond, 63% Dark Chocolate, Dark Chocolate Pretzel, Hot Dark Chocolate Habanero, Dark Chocolate Marshmallow, Extra Dark Chocolate 72% & Super Smooth Dark Chocolate 86%. People who have allergies to milk run the risk of serious or life-threatening allergic reactions if they consume these products.

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FDA approves Trulance for Chronic Idiopathic Constipation - FDA Press Releases

The U.S. Food and Drug Administration today approved Trulance (plecanatide) for the treatment of Chronic Idiopathic Constipation (CIC) in adult patients.

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Reply to: Response to “Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care” - American Geriatric Society

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Comment on: “Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data From Two Models of Care” - American Geriatric Society

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Reply to “Defining Outcomes After Hip Fracture: Readmission and Mortality Must Be Considered Separately” - American Geriatric Society

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Use of a Composite Metric to Assess Hospital Performance after Hip Fracture - American Geriatric Society

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Genetic Polymorphisms in Estrogen Metabolic Pathway Associated with Risks of Alzheimer's Disease: Evidence from a Southern Chinese Population - American Geriatric Society

Objectives

To investigate whether genetic variations on the estrogen metabolic pathway would be associated with risk of Alzheimer's disease (AD).

Design

Cross-sectional study.

Setting

Individuals were recruited at the Memory Clinic, Queen Mary Hospital, Hong Kong.

Participants

Chinese individuals with (n = 426) and without (n = 350) AD.

Measurements

All subjects underwent a standardized cognitive assessment and genotyping of four candidate genes on the estrogen metabolic pathway (estrogen receptor α gene (ESR1), estrogen receptor β gene (ESR2), cytochrome P450 19A1 gene (CYP19A1), cytochrome P450 11A1 gene (CYP11A1)).

Results

Apart from consistent results showing an association between apolipoprotein (APO)E and AD, strong evidence of disease associations were found for polymorphisms in ESR2 and CYP11A1 based on the entire data set. For ESR2, significant protective effects were found for A alleles of rs4986938 (permuted P = .02) and rs867443 (permuted P = .02). For CYP11A1, significant risk effects were found for G alleles of rs11638442 (permuted P = .03) and rs11632698 (permuted P = .03). Stratifying subjects according to APOE ε4 status, their genetic effects continued to be significant in the APOE ε4-negative subgroup. Associations between CYP11A1 polymorphisms (rs2279357, rs2073475) and risk of AD were detected in women but not men. Further gene-level analysis confirmed the above association between ESR2 and CYP11A1, and pathway-level analysis highlighted the genetic effect of the estrogen metabolic pathway on disease susceptibility (permuted pathway-level P = .03).

Conclusion

Consistent with previous biological findings for sex steroid hormones in the central nervous system, genetic alterations on the estrogen metabolic pathway were revealed in the Chinese population. Confirmation of these present findings in an independent population is warranted to elucidate disease pathogenesis and to explore the potential of hormone therapy in the treatment of AD.

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Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality - American Geriatric Society

Objectives

To determine the trajectory of handgrip strength (HGS) from age 70 to 90 and its association with mood, cognition, functional status, and mortality.

Design

Prospective follow-up of an age-homogenous representative community-dwelling cohort (born 1920–21) in the Jerusalem Longitudinal Cohort Study (1990–2015).

Setting

Home-based assessment.

Participants

Subjects aged 70 (n = 327), 78 (n = 384), 85 (n = 1187), and 90 (n = 406), examined in 1990, 1998, 2005, and 2010, respectively.

Measurements

Handgrip strength (kg) (dynamometer), low HGS defined as sex-specific lowest quartile grip; geriatric assessment; all-cause mortality (1990–2015).

Results

Mean HGS declined between age 70 and 90 from 21.3 ± 7.2 to 11.5 ± 5.6 kg in women and from 35.3 ± 8.4 to 19.5 ± 8.2 kg in men. Cross-sectional associations were observed between low HGS and poor functional measures (age 70–90), lower educational and financial status, smoking, and diabetes mellitus (ages 78–90). After adjustment for baseline education, self-rated health, physical activity, diabetes mellitus, depression, and cognition, low HGS predicted subsequent activity of daily living dependence from age 78 to 85 (odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.04–6.89) and 85 to 90 (OR = 2.31, 95% CI = 1.01–5.30), whereas the adjusted ORs for activities of daily living difficulty and depression failed to achieve significance. HGS did not predict subsequent cognitive decline. Survival rates were significantly lower in participants with low HGS (Quartile 1) than in those with normal HGS (Quartiles 2, 3, 4) throughout follow-up from ages 78 to 85, 85 to 90, and 90 to 95. Similarly, after adjusting for sex, education, self-rated health, body mass index, hypertension, diabetes mellitus, ischemic heart disease, and smoking, a low HGS was associated with significantly higher mortality.

Conclusions

Mean HGS declined progressively with age, and participants in the lowest age-specific quartile of HGS had a higher risk of subsequent functional decline and mortality.

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A Population-Based Study Examining Injury in Older Adults with and without Dementia - American Geriatric Society

Objectives

To estimate the incidence of and risk factors for injuries in older adults with and without dementia.

Design

Retrospective, population-based cohort study.

Setting

Western Australian Data Linkage System (WADLS).

Participants

Cases included 29,671 (47.9%) older adults aged 50 and older with an index hospital admission for dementia between 2001 and 2011. Comparison participants without dementia included a random sample of 32,277 (52.1%) older adults aged 50 and older from the state electoral roll.

Measurements

Hospital admission to a metropolitan tertiary hospital for at least 24 hours with an injury.

Results

Age-standardized all-cause injury rates for older adults with dementia (≥60) were 117 per 1,000 population and 24 per 1,000 population for older adults without dementia. Falls caused the majority of injuries for both groups (dementia, 94%; without dementia, 87%), followed by transport-related injuries and burns. Multivariate modeling found that older adults with a diagnosis of dementia had more than twice the risk of hospital admission for an injury than those without dementia (incidence rate ratio (IRR) = 2.05, 95% confidence interval (CI) = 1.96–2.15). Other significant risk factors for a hospital admission for injury were age 85 and older (IRR = 1.43, 95% CI = 1.13–1.81), being unmarried (IRR = 1.07, 95% CI = 1.03–1.12), and a history of falls (IRR = 1.03, 95% CI = 1.01–1.06). Women were at lower risk then men of a hospital admission due to an injury (IRR = 0.92, 95% CI = 0.87–0.97).

Conclusions

Older adults with dementia are at greater risk of a hospital admission for an injury. Multifactorial injury prevention programs would benefit older adults with and without dementia, especially those aged 85 and older, living alone, and with a history of previous falls.

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Statement from FDA Commissioner Robert Califf, M.D. announcing FDA Oncology Center of Excellence launch - FDA Press Releases

Today the U.S. Food and Drug Administration is establishing the Oncology Center of Excellence (OCE) and appointing Dr. Richard Pazdur as its director. This will make oncology the first disease area to have a coordinated clinical review of drugs, biologics and devices across the agency’s three medical product centers.

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The Evolving Health Policy Landscape and Suggested Geriatric Tenets to Guide Future Responses - American Geriatric Society

Speculation is rampant about what the new leadership in the White House and continued Republican leadership of both houses of Congress will do about health care. The concordance in party affiliation between President Trump and the congressional majority makes revisions in policy that is relevant to the health of older adults a virtual certainty. Past Republican legislative proposals and the current appointments to lead Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) presage several potential areas of change. However, the influence of the minority, a Congressional Republican focus on balanced budgets, a President who wants to spend, and public reaction to any large proposals all render the outcomes difficult to predict. We outline some of these potential areas of change that are most salient to the care of older adults. As a basis for evaluating the potential impacts, we offer some core Geriatric tenets that could serve as guideposts for reviewing both foreseen and unforeseen future proposals.

This article is protected by copyright. All rights reserved.

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American Geriatrics Society Policy Priorities for New Administration and 115th Congress - American Geriatric Society

In a recent letter sent to then President-Elect Trump and to Senate and House leaders, the American Geriatrics Society (AGS) addressed federal programs and policies that are important to the health, independence, and quality of life of older Americans and their families. This paper is a statement of the Society's core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals.

This article is protected by copyright. All rights reserved.

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D.F. Stauffer Biscuit Co., Inc. Issues Allergy Alert and Voluntary Recall on One Specific Best By Date Of 32oz Original Animal Crackers Due to Undeclared Milk Ingredient - FDA Safety Alerts & Drug Recalls

anuary 18, 2017 – D. F. Stauffer Biscuit Co., Inc. is voluntarily recalling one specific best by date of 32 oz. Original Animal Cracker because they may be packaged with other cookies that contain milk powder. People who are allergic to milk run the risk of serious or life-threatening allergic reactions if they consume this product.

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Remarks by Andy Slavitt to the CMS staff: A simple thank you - CMS Blog

Below are prepared remarks by Andy Slavitt, CMS Acting Administrator before a CMS All-Staff Meeting on January 17, 2017

Good afternoon and welcome.

I remember about 2 years ago coming here for the first time, sitting down with Aaron Albright at our first all-staff chat. My thoughts today come full circle to my goals and aspirations for CMS and for you — from where we started to where we are now. But, I want to start by talking about how CMS has affected me.

CMS has been my family these last 2 years. I’ve been away from home, living in an apartment, away from my wife and kids. We believed this would allow me to focus on work, without the distraction of home life during the week. What I didn’t see coming was how much CMS would also begin to feel like home. And it began almost instantly as everyone generously welcomed me in as if I had been here forever. I will never forget how you made me feel part of the team.

I recognized how much I had to prove in joining this family. You had all dedicated a great deal of your lives as public servants and I was just beginning. I promised myself that even though I could never match the decades so many of you have contributed here at CMS, my aim would be to try to have the impact of 20 years in the two I had ahead of me by figuring out where I could help the most and then giving it everything I had. I know I didn’t succeed in everything I tried to take on, but the team here at CMS was generous and patient. You welcomed me into your offices when I visited the regions. I asked what could be done to make your work here better and you told me what mattered to you. As I did this, I got to see the impact and vitality of the work up close. I was most impressed with stories of why you have chosen to be here.

You also listened to my opinions when we talked together about what we could become and what we could achieve:

Getting closer to our customers. Executing with passion. Working together in new ways across our silos.  Not being afraid to take on challenges and do our best work. Opening up and exposing ourselves transparently so we could get closer to the action. Closer to where Americans get their care. Listening to all the voices impacted by our work. Measuring ourselves not by our own standards, but by the standards of the outside world. Being self-critical instead of defensive.

You showed me we could do all of these things and I believe that one of the keys to our success has been and will be our culture. The country needs a visible approachable government they can feel confident in, and the health care system needs an approachable and open CMS to partner with them.

I remember standing on this stage two years ago and telling you that these would be the most important and meaningful years of my career. And they have been. I can’t think of a better job and a better place to be of service. I’ve been fortunate to learn from you and work with you. Simply said: my days have been filled with meaning every day at CMS. 

Never forget that for millions of Americans, you are what stands between them and access to better care; to security; and between them and freedom from injuries, sickness, and mental illness. With these patients and consumers in mind, there was nothing, as Acting Administrator, I wouldn’t do, no one I wouldn’t speak up to, no fight I wouldn’t enter.

I hope you felt that the CMS “political leadership team” and I represented CMS well and helped advance the work, all while helping the agency grow with and adapt to the times. I want to pause and thank the political leadership team that will be leaving public service in a few short days. They are an extremely strong group of leaders that have lead with compassion and high integrity. I will be eternally grateful for all that they have done and I’m proud to have worked so closely with each one of them.

It is remarkable, even in my short time here, to step back and think about how much you’ve accomplished. I will read a small subset of what has been accomplished…

• You completed one of the most far reaching implementations in health care– ICD- 10– without a hitch and with wide praise from physicians.

• You began implementing the complex laws in MACRA with class and to accolades.

• You have begun to change how we pay for care, launching, listening and re-launching new approaches to increase quality, improve coordination and teamwork, and reduce unnecessary variation.

• To wide opposition, you fought tooth and nail to enroll people in Marketplace With each bit of adversity, you got better and less likely to lose. Keep this tenacity.

• State-by-state you listened and solved problems so their residents could enjoy access to Medicaid expansion on terms that worked for them and supported principals that mean something to the program. Among many amazing and important things you did to put the principals back into the financing structure of Medicaid, you also made a difference in people’s lives, including a major advance heralded far and wide in the Tribal community.

• You made a commitment to health equity and to vulnerable populations like those people who are dually eligible for Medicare and Medicaid that began with the people and quickly drove into principals and actions.

• You took on tough issues, whether the cost of drugs, disparities among socioeconomic status, measurement, major safety concerns, or fraud. You didn’t back down from protecting people.

• You became the undisputed industry leader in data transparency, driving the industry to improve by providing the tools and listening to their needs.

• You used Medicare payments, quality and programs to accomplish important aims: investments in people with lower socioeconomic status, more investment in primary care and integrated mental health.

• You made a commitment to core operational execution. In responding to Freedom of Information Act requests, case work, appeals, technology, security, contracting or budgeting, and showed measurable progress in these areas.

• Our culture and commitment to one another is sound. Our employee engagement is at peak levels and climbing and we are among the very top across government.

• You demonstrated the power of relationships. Your work on the Hill as a trusted partner; your relationships with the media; the respect you garnered in the White House, with the Secretary, with other agencies, with advocates and partners and so many others represents a stark turnaround in how we are perceived. Frankly, the reputation of CMS feels as strong as ever.

• You invested in the future and peered around corners– whether on fraud prevention, better analysis of Medicare cost trends, prevention models, or cybersecurity. Thanks to our “guardian program” – no major cyber issues have occurred. I won’t be around to ask, but keep it up!

• And what makes me very proud is how you have innovated. Innovation to make sure people are treated with dignity using cool technology. Whether it’s Blue Button, MAGI in the cloud, automated Medicaid enrollment, TMSIS, cms.gov, Fraud prevention 2.0, or Compare site, CMS is a modern tech-enabled customer service organization that delivers the goods.

Not long after the HealthCare.gov challenges, the team started to get a number of successes under our belts. I had the opportunity to tell the White House and the Secretary to give CMS the hard problems, the big challenges, the mission critical projects the health care system is dependent on. And we would deliver. You have.

I am confident you are well positioned for whatever comes next. As strong as CMS is performing, you can do even more.

I had the opportunity to spend time with Seema Verma, the nominee for Administrator of CMS. If confirmed, she is excited to meet and work with the staff and I believe understands the great honor granted to her by the President-elect in appointing her to work at CMS. I told her what she will soon see: you are the strongest workforce in health care and, one could argue, what you deliver is at the highest levels of any government agency.

Welcome her the same way you welcomed me: Listen to the new team’s priorities and teach them yours.

All great organizations have one common trait: They are adaptable. They can take weaknesses and make them strengths. They know how to change with the times. They can absorb new people. Build new units. Find new ways of doing things. CMS has shown itself not to be the rigid organization that characterizes so many organizations—government or private sector. You’re good at what you do, but know how to use it to be nimble and adaptable. This will serve you well.

My ask of you is keep doing these things and more. The President-elect is certainly right on this point — winning feels good. To that I would add “…when your winning helps others.” Rack ‘em and stack ‘em. You keep doing the things we’ve done together—listen to the customer, work as a team, be intentional about your goals.

Let me close with a final note. Yesterday we celebrated Martin Luther King Jr. day. It is a day that always reminds us that for those gains we have made as a country, we need to be vigilant to make sure that no one in this country gets treated as less than an equal. That rights are what we fight for. I know you do that in your work every day.

There are also important rights you as federal employees and as individuals have. At CMS and in our government, no discrimination will ever be tolerated. There can be no intimidation. There will remain equal opportunity for all our people—LGBT, people of color, women, individuals with disabilities. No one can take that away. For those of you that ever have concerns, just speak up. CMS has and will always support you.

On behalf of President Obama, Vice President Biden and Secretary Burwell, I simply say thank you.

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Statement from FDA Commissioner Robert Califf, M.D. announcing new draft guidances on medical product communications - FDA Press Releases

We recognize that there is a high level of interest regarding FDA’s views on communications about medical products. We are committed to an ongoing dialogue with industry and other stakeholders, and, when needed, providing guidance to clarify the agency’s thinking on these issues. Today, the FDA released two separate draft guidances that will each help provide clarity for medical product companies, as well as other interested parties, on FDA’s current thinking and recommendations for a few different types of communications about medical products.

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FDA and EPA issue final fish consumption advice - FDA Press Releases

Today, the U.S. Food and Drug Administration and the U.S. Environmental Protection Agency issued final advice regarding fish consumption. This advice is geared toward helping women who are pregnant or may become pregnant – as well as breastfeeding mothers and parents of young children – make informed choices when it comes to fish that are healthy and safe to eat. (This advice refers to fish and shellfish collectively as “fish.”)

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A sensitive and specific point-of-care detection assay for Zaire Ebola virus

A sensitive and specific point-of-care detection assay for Zaire Ebola virus

Emerging Microbes & Infections 6, e5 (January 2017). doi:10.1038/emi.2016.134

Authors: Xiao-Ai Zhang, Sabrina Li, Jesus Ching, Hui-Ying Feng, Kun Yang, David L Dolinger, Long-Di Zhang, Pan-He Zhang, Wei Liu & Wu-Chun Cao

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The first imported case of Rift Valley fever in China reveals a genetic reassortment of different viral lineages

The first imported case of Rift Valley fever in China reveals a genetic reassortment of different viral lineages

Emerging Microbes & Infections 6, e4 (January 2017). doi:10.1038/emi.2016.136

Authors: Jingyuan Liu, Yulan Sun, Weifeng Shi, Shuguang Tan, Yang Pan, Shujuan Cui, Qingchao Zhang, Xiangfeng Dou, Yanning Lv, Xinyu Li, Xitai Li, Lijuan Chen, Chuansong Quan, Qianli Wang, Yingze Zhao, Qiang lv, Wenhao Hua, Hui Zeng, Zhihai Chen, Haofeng Xiong, Chengyu Jiang, Xinghuo Pang, Fujie Zhang, Mifang Liang, Guizhen Wu, George F Gao, William J Liu, Ang Li & Quanyi Wang

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Data Brief: Sharp reduction in avoidable hospitalizations among long-term care facility residents - CMS Blog

By Niall Brennan, Director of the CMS Office of Enterprise Data and Analytics, and CMS Chief Data Officer; and, Tim Engelhardt, Director of the Federal Coordinated Health Care Office at CMS

 

Data Brief: Sharp reduction in avoidable hospitalizations among long-term care facility residents

For long-term care facility residents, avoidable hospitalizations can be dangerous, disruptive, and disorienting. Keeping our most vulnerable citizens healthy when they are residents of long-term care facilities[1] and reducing potentially avoidable hospital stays has been a point of emphasis for the Centers for Medicare & Medicaid Services (CMS).

Over the last several years, with the help from the Affordable Care Act, Medicare and Medicaid have worked with other federal government agencies, states, patient organizations, and others to identify and prevent those health conditions that have caused long-term care residents to be unnecessarily hospitalized. Because of these efforts, we have seen a dramatic reduction in avoidable hospitalizations over the last several years, according to below analysis released by CMS today.

In 2001, the Agency for Healthcare Research and Quality (AHRQ) first identified a set of measures designed to identify hospitalizations that could potentially be avoided with appropriate outpatient care. They include hospital admissions for largely preventable or manageable conditions like bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, and chronic obstructive pulmonary disease. More recently, CMS’s own Office of Enterprise Data and Analytics found that instances of these potentially avoidable hospitalizations (PAH) were disproportionally high among some of our nation’s most vulnerable people, those dually eligible for Medicare and Medicaid living in long-term care facilities.

Treating conditions before hospitalization and preventing these conditions whenever possible would not only help long-term care facility residents stay healthy, but may also save Medicare and Medicaid money. After carefully examining this problem, CMS and others focused on reducing the instances of potentially avoidable hospitalizations from these facilities.

In 2015, Medicare fee-for-service (FFS) beneficiaries living in long-term care facilities had a total of 352,000 hospitalizations. Of this number, Medicare beneficiaries eligible for full Medicaid benefits living in long-term care facilities (LTC Duals) accounted for 270,000 hospitalizations. And, almost a third (approximately 80,000) of these hospitalizations were caused by six potentially avoidable conditions: bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, chronic obstructive pulmonary disease or asthma, and skin ulcers.

Through the concerted effort by CMS and many other to address these potentially avoidable conditions, real progress has been made to improve the health and wellbeing of some of our country’s most vulnerable citizens. In recent years, the overall rate of hospitalizations declined by 13 percent for dually eligible Medicare and Medicaid beneficiaries. But we have seen even larger decreases in hospitalization rates for potentially avoidable conditions among beneficiaries living in long-term care facilities.  Specifically, between 2010 and 2015, the hospitalization rate for the six potentially avoidable conditions listed above decreased by 31 percent for Medicare and Medicaid dually-eligible beneficiaries living in long-term care facilities.

In 2010, the rate of potentially avoidable hospitalizations for dually-eligible beneficiaries in long term care facilities was 227 per 1,000 beneficiaries; by 2015 the rate had decreased to 157 per 1,000.[2] This decrease in potentially avoidable hospitalizations happened nationwide, with improvement in all 50 states. The reduced rate of potentially avoidable hospitalizations means that dually-eligible long-term care facility residents avoided 133,000 hospitalizations over the past five years. 

Percent Change in Medicare Hospitalization Rates Since 2010

Note: FFS (fee-for-service), LTC (long-term care facility), PAH (potentially avoidable hospitalization)

Potentially Avoidable Hospitalization Rates for Dual-Eligible Beneficiaries Living in Long-Term Care Facilities, by State

Note: Labeled states contain facilities in the CMS “Initiative to reduce avoidable hospitalizations among long-term care facility residents”, discussed below.

This success would not be possible without the committed work by those who directly serve older adults and people with disabilities. We also should consider the range of other contributing factors, including:

• An initiative launched in 2011 by the Medicare-Medicaid Coordination Office, CMS Innovation Center, and other partners to reduce avoidable hospitalizations among nursing facility residents in seven sites across the country.[3] This initiative aimed at keeping dually-eligible long-term care residents healthy by focusing on preventable conditions that lead to hospitalizations.[4]
• The AHRQ Safety Program for Long-Term Care significantly reduced catheter-associated urinary tract infections in hundreds of participating long-term care facilities nationwide, which helped prevent a recognized cause of hospitalizations in residents of these facilities.
• This work is in addition to the many other efforts and initiatives, including the Hospital Readmission Reduction Program, and systemic efforts to reduce readmissions through the Partnership for Patients;
• The efforts to align care with quality through Accountable Care Organizations, the Bundled Payments for Care Improvement models, and other delivery system reforms;
• And, finally, the countless other industry-led initiatives focusing on quality improvement and specifically reducing hospitalization rates among long-term care facility residents.

This success shows that a sustained commitment to smarter spending across the entire health care system can yield dramatic results and improve the lives of vulnerable Americans. These results are also consistent with other ongoing collaborative efforts to improve the quality of care patients received through preventing hospital-acquired conditions where approximately 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in health care costs were saved from 2010 through 2015.

Finding the best possible long-term care facility care for a loved one is one of the most difficult decisions family members can make. Family members want to be assured that their loved one will receive the highest quality of care in a healthy environment. And thanks to efforts across the health care industry, and with tools from the Affordable Care Act that allow CMS to improve quality and test innovative strategies, these residents are living in safer, healthier environments.

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[1] Analysis includes residents living in nursing homes or nursing facilities. It does not include residents receiving skilled nursing facility services paid through the Medicare program.

[2] The population of dual-eligible beneficiaries  living in long-term care facilities consists of Medicare FFS beneficiaries with full Medicaid benefits residing in  long-term care  facilities but not receiving skilled nursing facility services. The number of days that beneficiaries met this criteria was annualized so that 365 days was equivalent to one beneficiary. Hospitalizations of long-term care residents were counted as potentially avoidable if the primary diagnosis of the admission was bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, chronic obstructive pulmonary disease or asthma, or skin ulcers.

[3] The seven sites were: Nevada, Nebraska, Montana, New York, Pennsylvania, Indiana, and Alabama. Note that six of these sites have continued into “Phase II” of the Initiative, which launched in October 2016.

[4] For more information, see the Initiative website at: http://ift.tt/21T9c87

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CMS announces extension of 2016 reporting deadline and intends to modify 2017 requirements for reporting eCQM data under the Inpatient Quality Reporting and EHR Incentive Programs for Hospitals - CMS Blog

By Kate Goodrich, MD
Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer

Today, I am pleased to announce that the Centers for Medicare & Medicaid Services (CMS) is notifying eligible hospitals and critical access hospitals participating in the Hospital Inpatient Quality Reporting (IQR) and/or the Medicare Electronic Health Record (EHR) Incentive Programs of a deadline extension.  The extension is for the submission of electronic Clinical Quality Measure (eCQM) data for the 2016 reporting period, pertaining to the fiscal year (FY) 2018 payment determination.  The deadline has been changed from Tuesday, February 28, 2017, to Monday, March 13, 2017, at 11:59 p.m. PT.  This extension is being granted to provide hospitals additional time to submit eCQM data.

CMS also intends to initiate the rulemaking process regarding modifications to the eCQM requirements established in the FY 2017 Inpatient Prospective Payment System (IPPS) final rule in response to concerns raised by stakeholders.  In order to help reduce reporting burdens while supporting the long term goals of these programs, we intend to include proposals regarding the 2017 eCQM reporting requirements for the Hospital IQR and EHR Incentive Programs for eligible hospitals and critical access hospitals in the FY 2018 IPPS proposed rule that we anticipate to be published in the late spring of 2017.

Specifically, in the FY 2018 IPPS proposed rule, CMS plans to address stakeholder concerns regarding challenges associated with hospitals transitioning to new EHR systems or products, upgrading to EHR technology certified to the 2015 Edition, modifying workflows, and addressing data element mapping, as well as the time allotted for hospitals to incorporate updates to eCQM specifications in 2017.  CMS is also considering to propose in future rulemaking to modify the number of eCQMs required to be reported for 2017 as well as to shorten the eCQM reporting period.

We believe that these efforts reflect the commitment of CMS to create a health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the healthcare providers who care for patients.  We continuously strive to work in partnership with hospitals and the provider community to improve quality of care and health outcomes of patients, reduce cost, and increase access to care.

For more information about eCQM reporting for the Hospital IQR and EHR Incentive Programs, please visit the QualityNet.org and the CMS.gov websites.

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Building The Value-Based Health Care System Of The Future Depends On Meeting Clinicians’ Data Needs - CMS Blog

Dr. Vindell Washington, National Coordinator for Health Information Technology (ONC) and Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services (CMS)

Data is the lifeblood of the value-based payment environment. Every time a doctor takes care of a patient, we have an opportunity to use information in ways that help patients get better care. The goal is to use the information from each patient encounter to make the next encounter better – across the entire healthcare system. But it is easier said than done. As we prepare to transition from this administration, we’d like to take stock of what our nation has accomplished and to lay out a potential roadmap for the next administration.

Making data easy to use begins by putting it into secure, private, digital form. During the past seven years, we’ve made remarkable progress towards this goal: in 2015, over 77 percent of office-based physicians reported using a certified electronic health record (EHR) to inform clinical care, while the percentage of office-based physicians with any EHR has doubled since 2008. As we hoped, digital tools have helped us reduce medical errors by, for example, e-prescribing and having fewer follow up items fall between the cracks. But we still have a lot of work to do.

While the tools are improving, some clinicians remain frustrated by the limited usability of their technology and data, from their inability to easily enter and access key information when and where they need it at the point of care to challenges in accessing timely feedback on the quality of care in their practice. We need 21^st century information technology, enabling ready and secure data access, to support a modern, value-based healthcare system.

New Tools

One obstacle is the efforts of some vendors to put up barriers to sharing data. Fortunately, the bipartisan 21^st Century Cures Act, which was enacted in December 2016, takes a significant step toward overcoming that obstacle. The Act advances interoperability through several provisions including the prohibition of information blocking and authorization of penalties of up to $1 million per violation. The law also gives ONC new authority to address usability and interoperability through additional conditions of certification for health information technology (health IT) developers related to: access, use, and exchange of electronic information; usability, security, and business practices; real-world testing; and publishing application programming interfaces (APIs).

We have also launched new tools to address these challenges under the recently established Quality Payment Program (QPP). This program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) uses a number of tools to reward Medicare clinicians for quality of care over quantity of services provided. These tools include a web application and public API designed to help clinicians, registries, and others in the CMS vendor community more easily share and receive feedback about performance. By consolidating previous programs such as the Physician Quality Reporting System (PQRS) and the EHR Incentive Programs (Meaningful Use); creating more ways for clinicians to participate; significantly reducing requirements by reducing the  number of measures; and providing additional flexibility in selecting meaningful measures, QPP also reduces administrative burden.

Yet the Department of Health and Human Services (HHS) recognizes that clinicians work with many payers, not just Medicare alone; in fact, the average physician practice now contracts with 12 different insurers. And that can lead to an additional set of challenges: access to data across disparate payers and settings is variable; the lack of comparability from multiple sources makes it hard to obtain actionable insights to inform care; and clinicians face increased administrative complexity if they participate in alternative payment model programs tied to different payers, each with unique requirements around quality measures, formats, and submission methods.

A Vision For The Future

We must overcome these challenges to enable clinicians to continuously improve quality and to ensure the nation gets more value from each healthcare dollar. That’s why HHS envisions a future where clinicians in a multi-payer environment obtain actionable, reliable, and comprehensive feedback data regardless of who pays for their patients’ care. HHS also envisions streamlined quality reporting, where clinicians collect data as part of the normal course and share it at the push of a button with any authorized party. Finally, HHS will continue to work towards minimizing the financial and administrative burden of collecting and reporting information on clinicians and practices, especially small practices and those in rural and underserved areas.

The federal government should only play a modest role in the ecosystem necessary to support patients and physicians. We believe that ecosystem requires the following six elements to ensure a data-rich, patient-centered, and value-based health care system:

1. Seamless interaction between point of care solutions and other entities, including through the use of standard APIs. Health IT developers can play a key role in this vision by making it easier for clinicians to share data between their EHRs and other applications or services, such as registries, empowering clinicians to assemble the right tools and services for their practice.
2. Growth of third-party entities that can meet provider data access and reporting needs. Clinicians will benefit from a robust marketplace of trusted entities that can perform core functions like facilitating quality reporting to all payers, combining data from disparate sources of care in a medical neighborhood and presenting it in a usable way, and helping clinicians to understand data on their patients—at a reasonable cost. For instance, vendor partners working with select regions participating in the Comprehensive Primary Care initiative have made important progress in recent years by providing aggregate feedback reports including data from both Medicare and commercial payers.
3. Use of low-cost shared services necessary for aggregating and linking data. Value-based payment relies on a variety of core services, such as accurate information on the identity of patients and providers to carry out key tasks like attributing patients to providers. Stakeholders could realize significant efficiencies by coming together around shared governance and financing for such services. Many of the participants in the Center for Medicare and Medicaid Innovation (CMMI) State Innovations Model have taken just such an approach.
4. Greater data transparency and data consolidation. Efforts like state All Payer Claims Databases and Medicare Qualified Entities that bring together data from multiple payers in one place can provide stakeholders with a single place to go for data, while reducing the burden on the payers who want to make their data available.
5. Standardization of key patient data needed for quality measurement. ONC and CMS can assist in fostering ongoing standardization of data for measures as well as development of related tools, such as libraries of data elements that allow new electronic measures to be easily captured, calculated and reported for use by clinicians and consumers.
6. Alignment around how quality is measured and reported across payers. By coming together around common quality measures and reporting mechanisms payers can ensure clinicians have access to more useful, aggregated performance feedback, while increasing the comparability and auditability of measurement results. Efforts such as the Health Care Payment Learning and Action Network, and the Core Quality Measurement Collaborative (which identified 7 core sets of quality measures that CMS and commercial payers have committed to using) have begun to make such alignment possible.

HHS has heard a great deal about the challenges clinicians are facing as they look towards value-based care. As HHS leaders continue this crucial dialogue, we look forward to hearing from you about what’s working today and what’s not, as well as your ideas about what the Federal Government and the private sector can do to make progress in this area.

It’s been a great honor working with the health care community and serving the American public. Working together across the health care landscape, the nation can move towards a truly 21^st century data infrastructure that frees clinicians to confidently transition to value-based payment and realize better care, smarter spending, and healthier people.

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Blue Ridge Beef Recalls Product Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Blue Ridge Beef is voluntarily recalling one (1) of its frozen products due to their potential to be contaminated with Listeria monocytogenes. Listeria can affect animals eating the product. There is a risk to humans from handling contaminated pet products, especially if they have not thoroughly washed their hands after having contact with the products or any surface exposed to these products.

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Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going - American Geriatric Society

Historically, the medical subspecialties have not focused on the needs of older adults. This has changed with the implementation of initiatives to integrate geriatrics and aging research into the medical and surgical subspecialties and with the establishment of a home for internal medicine specialists within the annual American Geriatrics Society (AGS) meeting. With the support of AGS, other professional societies, philanthropies, and federal agencies, efforts to integrate geriatrics into the medical and surgical subspecialties have focused largely on training the next generation of physicians and researchers. They have engaged several subspecialties, which have followed parallel paths in integrating geriatrics and aging research. As a result of these combined efforts, there has been enormous progress in the integration of geriatrics and aging research into the medical and surgical subspecialties, and topics once considered to be geriatric concerns are becoming mainstream in medicine, but this integration remains a work in progress and will need to adapt to changes associated with healthcare reform.

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Association of Dietary Patterns With Global and Domain-Specific Cognitive Decline in Chinese Elderly - American Geriatric Society

Background

Significant differences exist between eastern and western diets, and the way in which Chinese dietary intake relates to specific cognitive domains remains unclear. We aimed to assess the association between dietary patterns (DPs) and cognitive decline in Chinese elderly.

Setting

Participants were recruited from the elderly health checkup program of a teaching hospital in Taipei, Taiwan.

Participants

A total of 475 elders (age ≥65) were included in this prospective cohort study.

Measurements

The outcome comprised the decline of global and domain-specific cognition between baseline (2011-2013) and follow-up (2013-2015). Dietary data from the previous year were collected via a food frequency questionnaire at baseline, and a factor analysis was performed to identify DPs. Multivariable linear regression and logistic regression models were used to assess associations between Chinese DPs and cognitive decline over 2 years adjusting for selected covariates.

Results

Three DPs (vegetable, meat, and traditional) were identified. Moderate- or high-score “vegetable” DP significantly protected against decline of logical memory (recall I: β = 0.16–0.18, odds ratio (OR) = 0.42–0.48; recall II: β = 0.17–0.21); while high-score DP increased executive function decline (β = −0.22). A high-score “meat” DP was related to decline of verbal fluency-total score (β = −0.19); while moderate- or high-score “meat” DP protected against attention decline (β = 0.20–0.22). High-score “traditional” DP protected against decline of logical memory-recall I (β = 0.18). No significant association was observed for global cognition.

Conclusion

These findings suggest that three DPs identified in Chinese elderly were associated with different cognitive domains. Further research is needed to explore the efficacy of dietary interventions in reducing cognitive decline in older adults.

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The Pictsweet Company Announces Voluntary Recall of Pictsweet Farms 12oz Breaded Okra due to Risk of Glass Contamination - FDA Safety Alerts & Drug Recalls

The Pictsweet Company is voluntarily recalling select packages of Pictsweet Farms 12 ounce Breaded Okra after the company learned that some packages may contain glass fragments, which could cause injury if ingested. There has been one minor injury reported in connection with this issue.

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Grange Co-Op Recalls Rogue All Purpose Rabbit Pellets For High Vitamin D Health Risk - FDA Safety Alerts & Drug Recalls

Grange Co-op is initiating a recall of Rogue All Purpose Rabbit Pellets in 25# (25RP) 50# (50RP), 1,500# Tote (RP) no lot codes- purchased between March 1, 2016 and January 12, 2017 in Southern Oregon / Northern California from any Grange Co-op Retail Store or Wholesale Dealer. The recall is being initiated because samples tested by the Oregon Department of Agriculture discovered these products may contain higher than acceptable levels of vitamin D.

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Physio-Control Launches Voluntary Field Action for LIFEPAK 1000 Defibrillator - FDA Safety Alerts & Drug Recalls

Physio-Control announced today that the company is launching a voluntary field action for the LIFEPAK 1000 defibrillator due to reported instances where the device has shut down unexpectedly during patient treatment.

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Golden Flake Snack Foods, Inc., Announces Voluntary Recall of Two Specific Product Code Lots of HOT Thin & Crispy 5.0 oz. Potato Chips Due to Possible Health Risk - FDA Safety Alerts & Drug Recalls

Birmingham, AL: Golden Flake Snack Foods, Inc., is voluntarily recalling a limited quantity of 5 oz. HOT Thin & Crispy Potato Chips with a “Best if Used By” date APR 1417 and Specific Product Code Lot 364 5 or 365 5 (See below).

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Hy-Vee Voluntarily Recalls Several Candy Products Due to Possible Health Risk - FDA Safety Alerts & Drug Recalls

Hy-Vee, Inc., based in West Des Moines, Iowa, is voluntarily recalling several candy trays because they have the potential to be contaminated with Salmonella. The potential for contamination was brought to Hy-Vee’s attention when Palmer Candy Company announced a limited recall of certain chocolate products after it was informed by its supplier, Valley Milk Products LLC, that a milk powder ingredient used in a compound chocolate coating has the potential to be contaminated with Salmonella.

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CMS partners with commercial and state insurers to support primary care practices and reduce clinician burden - CMS Blog

By    Dr. Patrick Conway, Acting Principal Deputy Administrator and Deputy Administrator          for Innovation & Quality and
Pauline Lapin, MHS, Director, Seamless Care Models Group, Center for Medicare &                  Medicaid Innovation

Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has committed to supporting clinicians by providing them with actionable data. This is part of the Administration-wide initiative to unlock government data to promote innovation and best practices. Today, we are highlighting one way we have reached this goal and sharing how we plan to use the lessons we’ve learned in future efforts.

With the growing use of health information technology to support care delivery, using data to guide patient care has become increasingly important and common. Not surprisingly, data transparency has become a focus of primary care clinicians. In the past, practices were often left wondering what happened to patients outside of the four walls of their primary care offices. Even when practices do have access to data, clinicians often spend time sifting through multiple reports from different insurers, each with its own set of measures, and format, and much of the data is only applicable to a portion of the clinicians’ patients. Aggregated data allows clinicians to get an overall snapshot of their patient population to identify care gaps and target areas for population health improvement. It also reduces burden and saves staff time, which helps primary care clinicians focus on what they were trained to do: deliver high-quality patient care.

In the Comprehensive Primary Care initiative (CPC), a model from the CMS Innovation Center that ran from 2012 to 2016 and aimed to strengthen primary care, CMS convened payers in seven regions to test whether delivering comprehensive primary care at each CPC practice site — supported by multi-payer payment reform, the continuous use of data to guide improvement, and meaningful use of health information technology — could achieve better care, smarter spending, and healthier people. In three of these regions – Colorado, the greater Tulsa region of Oklahoma, and the Cincinnati-Dayton region of Ohio and Kentucky – CMS and payers collaborated to produce reports that combined privacy-protected patient-level health data from multiple payers into a single report given to participating primary care practices. Payers worked closely with participating CPC practices and CMS to define priorities, governance structures, and refine the format and content of the reports. In turn, data aggregation specialists collaborated with the payers in each region to combine and streamline delivery of that data, ensuring the highest level of security of the health information.

“This was a much anticipated solution to the complexities posed by not having access to consistent claims data, and a continuous desire to improve our approach to meeting CPC Milestones [program requirements],” said Dr. Austin Bailey, Medical Director of University of Colorado Health (UCHealth), which participated in CPC. By having all data in one place, UCHealth practices were able to quickly and easily identify gaps in patient care and see exactly what services their patients were receiving outside of their practices.

“Our practices will continue to leverage the use of aggregated claims data using Stratus [the tool for practices in Colorado] to identify the cost patterns of high risk patients — for example, among our patients with diabetes, is the greatest cost associated with specialists, emergency department utilization, or medications?  Having this information across multiple payers makes it more relevant and helps to build our confidence in selecting the appropriate interventions, identifying trends, and effectively assigning care management resources,” said Dr. Bailey.

Many CPC practices are taking the important skills and lessons they’ve learned into the newest CMS Innovation Center primary care model, Comprehensive Primary Care Plus (CPC+). Built on the foundation of CPC, CPC+ began this month on January 1, 2017, supporting primary care practices located in 14 regions across the country, with over 50 commercial payers and state Medicaid agencies partnering with CMS.

We expect that aggregated data reports will be a top priority for CPC+ practices and partner payers and we look forward to the opportunity to build on the tremendous success we’ve had with data aggregation in CPC. Public and private payers working in partnership with primary care clinicians, engaging patients, and delivering the right data and information is essential to improving our health system and the care delivered to patients.

Vendors and partner payers that participated in CPC data aggregation with CMS, by region:

Colorado
Vendor: Best Doctors, Inc.
Participating payers: Aetna, Anthem Blue Cross Blue Shield, Cigna, Colorado Choice Health Plans, Colorado Department of Health Care Policy and Financing (Medicaid), Medicare fee-for-service, Rocky Mountain Health Plans, UnitedHealthcare

Greater Tulsa region
Vendor: My Health Access Network, Inc.
Participating payers: Blue Cross Blue Shield of Oklahoma, CommunityCare, Medicare fee-for-service, Oklahoma Health Care Authority (Medicaid)

Cincinnati-Dayton region
Vendor: The Health Collaborative
Participating payers: Aetna, CareSource, Buckeye Health Plan, Anthem Blue Cross Blue Shield, Humana, Medical Mutual of Ohio, Medicare fee-for-service, Ohio Medicaid, UnitedHealthcare

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Dutch Valley Food Distributors, Inc. Announces a Voluntary Nationwide Recall of Cappuccino Snack Mix For Potential Salmonella - FDA Safety Alerts & Drug Recalls

As a result of an ingredient supplier recall, Dutch Valley is issuing a recall on Cappuccino Snack Mix due to the potential for it to be contaminated with Salmonella. Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain.

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Tupperware U.S., Inc. Recalls Southwest Chipotle Seasoning Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Tupperware U.S., Inc. of Orlando, Florida, is voluntarily recalling limited quantities of Southwest Chipotle Seasoning, because it has the potential to be contaminated with Salmonella. The product was manufactured for Tupperware by a third party blender of fine spices and seasonings.

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The J.M. Smucker Company Expands Limited Voluntary Recall on Certain Lots of Canned Cat Food Due to Low Levels of Thiamine (Vitamin B1) - FDA Safety Alerts & Drug Recalls

Orrville, OH - The J.M. Smucker Company is expanding the limited voluntary recall on certain lots of 9LivesTM, EverPetTM, and Special KittyTM canned cat food due to possible low levels of thiamine (Vitamin B1).

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Chip’n Dipped Issues Allergy Alert on Undeclared Milk in "Dark Chocolate Crunch Bar" - FDA Safety Alerts & Drug Recalls

Chip’n Dipped of Huntington, NY, is recalling its 2.9-oz. bar, Dark Chocolate Crunch because they may contain undeclared milk. People who have allergies to milk run the risk of serious or life-threatening allergic reactions if they consume these products.

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Slavitt Farewell: Meeting the Moral Test of Government by Building on Progress Made - CMS Blog

Below are the remarks of Acting CMS Administrator Andy Slavitt at the 35^th annual JP Morgan Healthcare Conference in San Francisco, Calif. on January 9, 2016.

***

It’s great to be with you here this afternoon for what will be my last public speech in my current role. Although I will tell you in a minute about an excellent panel at 6 o’clock that I’m really excited for.  Whatever finale speech I had planned in my head in early November will have to wait for another day. I started a new one late in the evening on November 8^th.

It’s been an honor to be a small part of making record progress in the last eight years—progress long overdue for so many. Let’s remember what things were like just a short time ago before the ACA: we had record levels of people without insurance, unsustainable medical cost growth and poor quality health.

Thanks to the hard work of many, over the last eight years, things have finally begun to change. In fact, there hasn’t been a greater stretch of progress in our nation’s health care system as we’ve seen in the last eight years:

• We are covering more Americans: More than 20 million Americans have been newly covered and the uninsured rate is under 9 percent, the lowest it’s ever been.
• We are making advances in quality: It is now safer to use the health care system than it was eight years ago. Across the country, people are getting higher quality care with 95 percent of national quality metrics improved over the last eight years. Thanks to this focus on quality, 125,000 lives have been saved.
• We are bending the cost curve: Our national economy is now projected to spend $2.6 trillion less on health care over the next decade – even as 20 million more people have health coverage. Medicare cost trends have been reduced from 6% pre-Obama to under 2 percent.
• Health care is more affordable for everyone: That’s true if you’re covered through Medicare, where you’re paying less for prescription drugs because the ACA closed the donut hole. It’s true if you get covered through the individual market, where, before the law, most plans didn’t cover maternity care, a third didn’t cover mental health, and almost 1 in 10 didn’t cover prescription drugs. Today, every Marketplace plan covers all of those services by law. And it’s true if you get covered in the employer market, where more than half of people used to have plans with lifetime limits – but now those limits on coverage aren’t allowed.
• We have achieved strong fiscal discipline: During this period, we have reduced the Federal deficit by 2/3 and added a decade to the Medicare Trust Fund.
• And, what it’s all about in the end: Making real gains in the lives of millions of Americans. The share of Americans who can’t afford needed care has fallen by more than a third. Record numbers of people report being able to see a regular physician and fill their prescriptions. As we hear about constantly, every year tens of thousands of lives are being saved.

And the private sector has flourished during the Obama years. Even as we have bent the cost curve and gotten more efficient. I did this analysis on November 8^th. Health care companies outperformed the broader S&P 500 by 15 percent, which itself has more than doubled, since the ACA. And each sector—managed care, health IT, medical devices, hospitals, and pharma all well-outperformed the S&P. The Obama years have surely not been about a “Federal takeover” of our health care system.

The health insurance market is also more stable and growing. We are seeing record enrollment this Open Enrollment despite the obvious headwinds. And, according to S&P, the insurance exchanges are stabilizing after what they call a “one-time adjustment” to underpriced premiums. S&P’s outlook is for Exchanges to break even in 2017—and many are already. These results are from specific tough actions taken in the early stages of this market by companies and states and by our continued focus on improving the rules governing the risk pools.

I have a simple mental model of a before-and-after picture that I used during my years in the private sector that I would use when taking on anything new. Have we made things better for the American people? By so many measures, we have.

Of course, our “after” picture is the new Administration’s—and the new Congress’s— “before” picture. We pass the baton and the job ahead is to improve on the results of the Obama years, where we covered millions more Americans, reduced the deficit, bent the cost curve and, in the private sector, supported the creation of hundreds of billions of dollars in new market cap — and over 2 million new jobs in health care alone.

This is not to say that there aren’t opportunities for improvement. There are. The ACA was intended as the beginning of the journey, not the destination. But any changes need to build on what we’ve already accomplished and move us forward. The American people are going to judge any changes to the ACA based on common sense tests.

Does it provide coverage to at least as many people?

Does it maintain the quality of coverage or does it move us backwards with caps and loopholes?

Does it bend the health care cost curve in the right direction or does it cost American families more money?

And is it fiscally responsible?

If it fails on any of these tests, it is a step backwards.

But if any plan can improve the ACA, we should all embrace it. Let me be clear in saying this. There should be no pride of authorship. It doesn’t matter if a better plan comes from a Democrat or a Republican. We should all have a rooting interest in more progress.

This is what Americans are saying. Since the election, polls are showing that the majority of people, no matter who they voted for, want to build on what we have started, and not start over with a repeal. That should be a clear signal to the incoming Administration– the same one we had—to keep improving the before and after picture—and the lives of the Americans people.

And in overwhelming numbers, people insist on seeing the darn plan before anything happens.

A scheme that repeals the ACA with only the promise to produce a replacement plan later, as some are suggesting, is irresponsible. Millions of Americans and their families would be harmed by this scheme and indeed, many are sharing their fears on social media and calling our call centers, rightfully confused and panicked by this uncertainty.

Not putting a replacement plan forward would create needless chaos for hospitals and insurance companies. They need to begin making decisions on their 2018 participation just a few months from now. In board rooms across the country, there is one way to deal with uncertainty—and that’s by reducing investment and limiting exposure. With no clarity about the future of the individual mandate, premiums would very likely increase and many health plans would reduce their participation or drop out.

One reason people are expressing so much concern is because once a repeal vote happens, a replacement vote is far from guaranteed. In the parlance of Washington, the “pay fors” would disappear. Getting bipartisan support for the creation of a new plan and finding brand new money is infinitely harder than improving existing legislation.

Running CMS, one reason I proactively communicate so aggressively is that I remember what it was like in the real world. If you ask 20 percent of the economy to wait for a replacement and don’t think that will have an impact, you need to get out more.

I think this is why the real world is speaking up at a time when many would prefer to be quiet: the actuarial community, the physician community, cancer patients, hospitals, health plans, insurance commissioners, liberal and conservative policy experts a growing bi-partisan list of governors and Senators are warning us of the perils of quote “repeal now and hope to replace later.”

All of which means that if there is a repeal-only vote, the health care sector must plan as if the ACA will never be replaced. We are all trying to comprehend the impact of such an act. What experts are saying so far:

• The obvious impact is on coverage. An estimated 30 million Americans will become uninsured.
• The loss of pre-existing condition protections will immediately affect 127 million Americans. Not good for people or the emerging gig economy.
• That would be especially challenging because we know this scenario would reduce employment. The hospital sector is already forecasting, and I quote, “massive job losses.” By one estimate, 2.6 million jobs, many of them in small communities around the country, would be lost.
• Hospital bed debt would increase by an estimated $1.1 trillion over the next decade and hospital finances would suffer greatly, with losses estimated at over $165 billion by the middle of the next decade.
• Don’t expect any savings from this. All of this would add $350 billion to the Federal budget deficit and wreak havoc on state budgets.

This is not the before-and-after picture Americans are looking for.

After the repeal conversations, the Medicaid program looms as the next part of the agenda, and therefore the before-and-after picture for the American public. Let’s start with a quick refresher of what the Medicaid program does.

• It’s largely how we cover kids. Medicaid is the leading financier of maternity and prenatal care and about 1/3 of the country’s children (over 30 million) are covered by Medicaid and CHIP;
• Medicaid is how we cover seniors. Half of the long-term care we provide in this country to our seniors is provided by Medicaid;
• And it’s how we cover people with disabilities. More than 40 percent of Medicaid resources covers care for people living with disabilities, which but for a little bad luck would be anyone of us or anyone in our family.

Some in Congress are hoping to change Medicaid to a “block grant” or “per capita” program. This is sometimes described as an opportunity to give more flexibility or control for states to innovate. Don’t let the language deceive you. A block grant has nothing to do with innovation or state control or flexibility– those things are available to states today. Look at Indiana and their HSA-based expansion or Arkansas and their market-competition based expansion. Neither of those needed a block grant to innovate.

In reality, what a block grant does is place a cap on the money the federal government commits to states to run Medicaid. In other words, it takes control from states and gives it to the federal government.

We do have a live Medicaid block grant in Puerto Rico. The Commonwealth has had a block grant system for decades and at one point a few years ago, I think it felt like a windfall. What’s the picture in Puerto Rico right now? Puerto Rico has one-quarter the number of ICU beds per capita as the mainland, and no trauma burn units. American citizens wait to see the doctor, or they don’t go at all. Twice as many people have heart disease, and nearly twice as many report being in fair or poor health. And Puerto Rico’s block grant is hampering its ability to cope with its fiscal crisis and the Zika epidemic. I have never talked to a governor who envies Puerto Rico.

If you’re a governor, what happens when the usual but impossible-to-plan for happens– like the opioid epidemic or a promising new expensive cure for something like Hepatitis C. With no Federal financial support, they are on their own. Whose care gets cut? Kids? Seniors? People with disabilities?

So, if block grants don’t control the cost of care, what does? Medicaid managed care has made this decades-old idea of block grants obsolete. Three-quarters of Medicaid is already capitated or in similar arrangements. And Medicaid is our country’s most efficient health care program, far more so than Medicare Advantage and approximately 20 percent more efficient than commercial insurance on an apples-to-apples basis.

This is not ideological—it is a pragmatic, centrist concern over a before-and-after picture that would harm states and the American public. Congressional proposals for block grants would cut Federal support for Medicaid by 1/3 to ½ by the end of a decade. The Kaiser Family Foundation estimated that would result in 14 to 20 million Americans losing coverage—entirely on top of ACA coverage losses. And those cuts ripple across communities– from small rural hospitals and health centers to large health systems that are in urban areas.

The good news is we have don’t have to take a step backward. The American public expects us to take what is working and build on it. The immensely popular features of the ACA like free preventive care and ending the pre-existing condition limitations should be left alone and the focus should be on a limited number of improvements that spur competition and increase affordability.

Many of these can be implemented at the state level and enjoy bipartisan support. Alaska, with a Republican legislature and an independent governor, recently implemented a reinsurance pool that dramatically reduced rate increases. And states that have expanded Medicaid have a 7 percent lower premium in the Marketplace.

Let’s get back to what we should be focused on as a nation. We have begun a journey over the last seven years to move health care toward what some call a value-based system, but what I might describe in simpler terms as a more relationship-driven health care experience. As I’ve talked to Americans from all over the country and even as I reflect on my own personal experiences, this is one of the most important things we are looking for as patients. We also feel we are losing this—the ability to build relationships with care teams, where a whole episode of our care can be managed end-to-end without abrupt handoffs, and where our doctor knows when something happens to our health and she can connect it to other aspects of our lives.

I’ve had many conversations with physicians over the last year since I made a statement here at JPM that we had lost the hearts and minds of physicians. Many of them say they want to experience the joy of medicine again—to be able to make a living from listening to their patients, coordinating their care, improving their health, and get paid for what works.

Whether you call these ACOs or Medical Homes or Bundled payments frankly doesn’t matter. What matters is that we can develop these innovative practices locally, test them, and spread them.

Converting to a relationship-based system takes work and investment from all parties. We’ve started the process with the broad participation of physicians and patients. Using the CMS Innovation Center, which is part of the ACA, as well as through MACRA, the HITECH Act, and 21^st Century Cures, we are making the investments that unlock research, data, innovation and reduce the burdens and distractions that don’t support care. They demonstrate that we can work in a bipartisan fashion on important issues in health care.

Hospitals, clinics, wearable tech companies, big data companies, population health management and other innovators have a big role to play. Patients and physicians want technology and data to support their relationship, not distract from it. I will be talking about this further with a great panel at 6 o’clock in the Colonial Room.

But let me be clear on this. We will not be able to both re-litigate the past and invest in an innovative future at the same time. I’m sure you are beginning to hear this throughout the presentations today. CEOs, CFOs and boards are all meeting and retreating—their purchasing, capital equipment and building are likely to slow sharply in the first half of the year if we are going through the prolonged uncertainty following a repeal vote. This will stand in the way of building the better system we need and that Americans deserve.

In the end, we have a commitment to improve the lives of Americans and pass the baton to the next team. Each morning at CMS, I would check my inbox first thing to read about the problems that beneficiaries would write me about. Sadly, we never solved every single one of them, but we solved many.

That’s the thing that binds Administrations in our system of government and gives me optimism. It’s the 140 million Americans in the Medicare, Medicaid, Children’s Health Insurance and Marketplace programs that we serve. Just as I worked for them, soon, the new team will work for us. I can tell you, at least for me, something changes when you are working directly for the American people with so much at stake. And I will do everything I can to assist the new team in continuing the progress.

On their first day, the new team will be greeted by words that greeted me the first day I walked into the lovely Humphrey building where the Department of Health & Human Services is located. The words say:

“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.”

Look at our before-and-after picture from a little bit of a distance. Before Medicare and Medicaid, one in three seniors lived below the poverty level. Picture that. One in three of our seniors lived in poverty. Today, that’s fewer than 1 in 10.

Today, thanks to Medicaid and CHIP, 95 percent of children in this country have health insurance. We are holding to the promise we have made to all Americans that as you get older, or if you have a disability, you will be able to access care and your family won’t go broke in the process. And, with the ACA, we have extended that promise of care to include all Americans regardless of their employment, their health status, or their income.

Through this transition, we must continue to work together in the private and public sector to continue to hold to these commitments and improve on them. And we must make sure the conversation around any coming changes in American health care reflects the gravity of their impact on millions of Americans.

Thank you. And now, I’m happy to take some questions.

###

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