Posts Tagged ‘medical education’

Analysis of Utilizing LPBI Group’s Scientific Curation Platform as an Educational Tool: New Paradigm for Student Engagement

Author: Stephen J. Williams, Ph.D.



Use of LBPI Platform for Educational Purposes

Goal:  to offer supplemental information for student lessons in an upper level Biology course on Cell Signaling and Cell Motility with emphasis on disease etiology including cancer, neurological disease, and cardiovascular disease.

Course:  Temple University Department of Biology course Cell Signaling and Motility Spring semester 2019. Forty five students enrolled.

Methodology:  Each weekly lesson was presented to students as a PowerPoint presentation.  After each lesson the powerpoint presentation was originally meant to be disseminated to each class-registered student on the students Canvas account.  Canvas is a cloud based Learning Management Software developed by educational technology company Salt Lake City, Utah company Infrastructure, Inc.  According to rough figures, Canvas® charges a setup fee and at least $30 per user (for a university the size of Temple University: 55,000 students at $30 each = 1.6 million a semester for user fees only).

As a result of a technical issue with uploading the first week lesson on this system, I had informed the class that, as an alternative means, class presentation notes and lectures will be posted on the site www.pharmaceuticalintelligence.com as a separate post and searchable on all search engines including Google, Twitter, Yahoo, Bing, Facebook etc. In addition, I had informed the students that supplemental information, from curated posts and articles from our site, would be added to the class lecture post as supplemental information they could use for further reading on the material as well as helpful information and reference for class projects.

The posted material was tagged with #TUBiol3373 (university abbreviation, department, course number) and disseminated to various social media platforms using our system.  This allowed the students to enter #TUBiol3373 in any search engine to easily find their lecture notes and supplemental information.

This gave students access to lectures on a mobile platform which was easily discoverable due to our ability to do search engine optimization. (#TUBiol3373 was among the first search results on most popular search engines).

From a technical standpoint,  the ease at which posts of this nature can be made as well as the ease of including links to full articles as references as well as media has been noted.  Although students seem to navigate the Canvas software with ease, they had noticed many professors have issues or problems with using this software, especially with navigating the software for their needs.   LBPI’s platform is an easily updated, accessible, and extensive knowledge system which can alleviate many of these technical issues and provide the added value of incorporating media based instructional material as well as downloadable file and allow the instructor ability to expound on the presented material with commentary.  In addition due to the social nature of the platform, feedback can be attained by use of curated site statistics and commentary sections as well as online surveys.



After the first week, all 45 students used LBPI platform to access these lecture notes with 17 out of 45 continuing to refer to the site during every week (week 1-4) to the class notes.  This was evident from our site statistics as well as number of downloads of the material.  The students had used the #TUBIol3373 and were directed to the site mainly from search engines Google and Yahoo.  In addition, students had also clicked on the links corresponding to supplemental information which I had included, from articles on our site.  In addition, because of the ability to incorporate media on our site, additional information including instructional videos and interviews were included in lecture posts, and this material was easily updated on the instructor’s side.

Adoption of the additional material from our site was outstanding, as many students had verbally said that the additional material was very useful in their studies.  This was also evidenced by site statistics owing to the secondary clicks made from the class lecture post going to additional articles, some not even included as links on the original post.

In addition, and  more important, students had incorporated many of the information from the additional site articles posted and referenced in their class group projects.  At end of semester a survey was emailed to each student  to assess the usefulness of such a teaching strategy. Results of the polling are shown below.

Results from polling of students of #TUBiol3373 “Cell Signaling & Motility” Class

Do you find using a web based platform such as a site like this an easier communication platform for posting lecture notes/added information than a platform like Canvas®? (5 votes)

Answer Votes Percent  
Yes 2 40%  
Somewhat but could use some improvement 2 40%  
No 1 20%  
Did not use web site 0 0%  


Do you find using an open access, curated information platform like this site more useful than using multiple sources to find useful extra study/presentation materials? (6 votes)

Answer Votes Percent  
Yes 5 83%  
No 1 17%  


Did you use the search engine on the site (located on the top right of the home page) to find extra information on topics for your presentations/study material? (5 votes)

Answer Votes Percent  
Yes 4 67%  
No 1 17%  
Did not use web site 1 17%  


Were you able to easily find the supplemental information for each lecture on search engines like Google/Yahoo/Bing/Twitter using the hashtag #TUBiol3373? (6 votes)

Answer Votes Percent  
Yes I was able to find the site easily 4 67%  
No 1 17%  
Did not use a search engine to find site, went directly to site 1 17%  
Encountered some difficulty 0 0%  
Did not use the site for supplemental or class information 0 0%  


How did you find the supplemental material included on this site above the Powerpoint presented material for each of the lectures? (7 votes)

Answer Votes Percent  
Very Useful 4 57%  
Did not use supplemental information 2 29%  
Somewhat Useful 1 14%  
Not Useful 0 0%  

How many times did you use the information on this site (https://www.pharmaceuticalintelligence.com) for class/test/project preparation? (7 votes)

Answer Votes Percent  
Frequently 3 43%  
Sparingly 2 29%  
Occasionally 1 14%  
Never 1 14%  








Views of #TUBiol3373 lessons/posts on www.pharmaceuticalintelligence.com                    


Lesson/Title Total # views # views 1st day # views 2nd day % views day 1 and 2 % views  after 1st 2 days
Lesson 1 AND 2 Cell Signaling & Motility: Lessons, Curations and Articles of reference as supplemental information: #TUBiol3373 60 27 15 93% 45%
Lesson 3 Cell Signaling And Motility: G Proteins, Signal Transduction: Curations and Articles of reference as supplemental information: #TUBiol3373 56 12 11 51% 93%
Lesson 4 Cell Signaling And Motility: G Proteins, Signal Transduction: Curations and Articles of reference as supplemental information: #TUBiol3373 37 17 6 48% 31%
Lesson 5 Cell Signaling And Motility: Cytoskeleton & Actin: Curations and Articles of reference as supplemental information: #TUBiol3373 13 6 2 17% 15%
Lesson 8 Cell Signaling and Motility: Lesson and Supplemental Information on Cell Junctions and ECM: #TUBiol3373 16 8 2 22% 13%
Lesson 9 Cell Signaling: Curations and Articles of reference as supplemental information for lecture section on WNTs: #TUBioll3373 20 10 3 28% 15%
Curation of selected topics and articles on Role of G-Protein Coupled Receptors in Chronic Disease as supplemental information for #TUBiol3373 19 11 2 28% 13%
Lesson 10 on Cancer, Oncogenes, and Aberrant Cell Signal Termination in Disease for #TUBiol3373 21 10 2 26% 20%
Totals 247 69 46 31% 62%


Note: for calculation of %views on days 1 and 2 of posting lesson and supplemental material on the journal; %views day1 and 2 = (#views day 1 + #views day 2)*100/45 {45 students in class}

For calculation of %views past day 1 and 2 = (total # views – day1 views – day2 views) * 100/45

For calculation in total column last two columns were divided by # of students (45) and # of posts (8)


Overall class engagement was positive with 31% of students interacting with the site during the course on the first two days after posting lessons while 61% of students interacted with the site during the rest of the duration of the course.  The higher number of students interacting with the site after the first two days after lecture and posting may be due to a higher number of students using the posted material for study for the test and using material for presentation purposes.

Engagement with the site for the first two days post lecture ranged from 93% engagement to 22% engagement.  As the class neared the first exam engagement with the site was high however engagement was lower near the end of the class period potentially due to the last exam was a group project and not a written exam.  Students appeared to engage highly with the site to get material for study for the written exam however there still was significant engagement by students for purposes of preparation for oral group projects.  Possibly engagement with the site post 2 days for the later lectures could be higher if a written exam was also given towards the end of the class as well.  This type of analysis allows the professor to understand the level of class engagement week by week.

The results of post-class polling confirm some of the conclusions on engagement.  After the final grades were given out all 45 students received an email with a link to the poll.  Of the 45 students emailed, there were 20 views of the poll with 5-7 answers per question.  Interestingly, most answers were positive on the site and the use of curated material for learning and a source of research project material.   It was very easy finding the posts using the #classname and most students used Google to find the material, which was at the top of Google search results.  Not many students used Twitter or other search engines.  Some went directly to the site.  A majority (71%) found the material useful or somewhat useful for their class presentations and researching topics.

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3D-printed body parts could replace cadavers for medical training

Reporter: Irina Robu, PhD

Even though, the 3-D printing based tissue modeling is still in early phases it is considered a promising approach for anatomy training. Models that are produced on a computer screen can be reproduced as tangible objects that students can examine and even dissect. According to a recent report in Medical Science Educator, the latest advancement in 3D printing can revolutionize how anatomy students learn.

For now, human cadavers have been the norm for studying human anatomy but they come with financial and logistical concerns both on storage and disposal. However, with the advancement of custom designed 3D organs, made possible by using 3D printing the need to keep large collection of physical models are reduced. With just a 3D printer, a digital model of the organ needed to study can be reproduced either with resin, thermoplastics, photopolymers and other material. Different materials can be used to allow construction of complex models with hard, soft, opaque and transparent conditions. The printed body parts will look exactly the same as the real thing because they are falsely colored to help students distinguish between the different parts of the anatomy including ligaments, muscles and blood vessels. Medical schools and hospitals around the world would be able to buy just an arm or a foot or the entire body depending on their training need.

Furthermore, to customizing anatomy lessons, 3D printed models can be used for teaching pathology/radiology by comparing CT images of the organs to their 3D-printed counterparts which students can examine and understand. Yet, the methods of 3D printing vary by materials used, resolution accuracy, long term stability, cost, speed and more. The printer cost is still a concern at this point partly because 3D bioprinters cost thousands of dollars nonetheless the cost is dropping due to the introduction of innovative printing materials.

Therefore, in order for 3-D printing to become more widely used, costs must be reduced while resolution must continue to improve. Instructors can potentially print one model per student in a material of their choosing that can be dissected. And no matter how much medical science moves with the times, there would always be the requisite skeleton model in the corner of most anatomy rooms.




Additional Resources

Medical Science Educator, June 2015, Volume 25, Issue 2, pp 183–194| Cite as

Anatomical Models: a Digital Revolution



Goodbye to Cadavers?



3-D Printing: Innovation Allows Customized Airway Stents



Exploring 3-D Printing’s Potential in Renal Surgery



How 3-D Printing Is Revolutionizing Medicine at Cleveland Clinic


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Outstanding Awards in Medical Education

Curator: Larry H. Bernstein, MD, FCAP


Medical Faculty Awards


The Harold Amos Medical Faculty Development Program of The Robert Wood Johnson Foundation, formerly known as the Minority Medical Faculty Development Program, was created to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine or dentistry and who will encourage and foster the development of succeeding classes of such physicians and dentists. Four-year postdoctoral research awards are offered to historically disadvantaged physicians and dentists who are committed to developing careers in academic medicine and to serving as role models for students and faculty of similar background.

The program defines the term “historically disadvantaged” to mean challenges facing individuals because of their race, ethnicity, socioeconomic status, or other similar factors.

The program was renamed and expanded in 2004 in honor of Harold Amos, Ph.D., who was the first African-American to chair a department, now the Department of Microbiology and Medical Genetics, of the Harvard Medical School. Dr. Amos worked tirelessly to recruit and mentor countless numbers of minority and disadvantaged students to careers in academic medicine and science. He was a founding member of the National Advisory Committee of the Robert Wood Johnson Foundation’s Minority Medical Faculty Development Program in 1983, and served as the Program’s National Program Director between 1989 and 1993. Dr. Amos remained active with the program until his death in 2003.

The program was further expanded in 2012 to include dental medicine.

Each Amos Scholar selected (up to nine each year) will receive an annual stipend up to $75,000, complemented by a $30,000 annual grant toward support of research activities. Each Scholar will study and conduct research in association with a senior faculty member located at an academic medical center or dental school noted for the training of young faculty and pursuing lines of investigation that are of interest to the Scholar. Scholars are expected to spend at least 70% of their time in research activities.

A distinguished National Advisory Committee assists the Foundation with the program. While these awards are intended to provide four years of support, the National Advisory Committee reviews the progress of each Scholar after the first two years to determine the appropriateness of continuing funding for the full duration of the award.


The Harold Amos Medical Faculty Development Program (AMFDP) opened its doors in 1983 to its first cohort of eight physicians, beginning a three-decade commitment to mentoring individuals from historically disadvantaged and underrepresented backgrounds to become leaders in the field of academic medicine and science. Thirty years and 250 alumni later, program graduates are full professors, chairs of departments, leaders of Institutes within the National Institutes of Health, and individuals nationally and internationally known for their valuable contributions to biomedical research, health services research, and clinical investigation.

At its 2013 annual meeting and reunion, AMFDP celebrated its 30th anniversary. Current scholars and alumni gathered in Atlanta for research presentations, panel discussions, networking and a speed-mentoring event for pre-health and health-profession students. They also honored James R. Gavin III, MD, PHD, who stepped down as national program director after serving in that role for 20 years. Dr. Gavin is succeeded by David S. Wilkes, MD, a Harold Amos program alumnus (’91) who serves as the executive associate dean for research affairs and the August M. Watanabe Professor of Medical Research at the Indiana University School of Medicine. Dr. Wilkes will be the third director in the program’s history.

Risa Lavizzo-Mourey
RWJF President and CEO

“[The scholars’ dedication to their work] is inspiring ‐ not only to me and to everyone at the Foundation, but also to the succeeding classes of physicians and dentists [they are] mentoring. Their unflagging commitment to fostering the development of young medical and dental students keeps this program strong. It creates a next generation of outstanding young physicians and dentists with the skills, the confidence, and the sense of mission to excel and to inspire others in turn.”

James R. Gavin
Former National Program Office Director

“We envisioned this program to have the ability to fulfill a very lofty ambition: to change the face of American medicine. We’ve succeeded beyond what I expected because of what our scholars have done… the impact and the influence that they’ve had. But that has inspired me to dream even bigger. I think we’re ready to move to the next level.”

Alpha Omega Alpha Honor Medical Society, a professional medical organization, recognizes and advocates for excellence in scholarship and the highest ideals in the profession of medicine. Alpha Omega Alpha is to medicine what Phi Beta Kappa is to letters and the humanities and Sigma Xi is to science. Our values include honesty, honorable conduct, morality, virtue, unselfishness, ethical ideals, dedication to serving others, and leadership. Members have a compelling drive to do well and to advance the medical profession and exemplify the highest standards of professionalism.

Fifty-seven members of Alpha Omega Alpha have been Nobel laureates:


2012, Robert J. Lefkowitz (Student Member, 1965)
For studies of G-protein-coupled receptors

2003, Peter Agre (Alumnus Member, 1997)
For the discovery of water channels.

2003, Roderick MacKinnon (Student Member, 1982)
For structural and mechanistic studies of ion channels.

1989, Thomas Cech (Honorary Member, 2011)
For the discovery of catalytic properties of RNA.

1980, Paul Berg (Honorary Member, 1992)
For his fundamental studies of the biochemistry of nucleic acids, with particular regard to recombinant-DNA.

1946, Wendell M. Stanley (Honorary Member, 1938)
For the preparation of enzymes and virus proteins in a pure form.

Physiology or Medicine

2011, Bruce A. Beutler(Faculty Member, 2012)
For the discovery of the dendritic cell and its role in adaptive immunity.

2011, Ralph M. Steinman (Student Member, 1968)
For the discovery of the dendritic cell and its role in adaptive immunity.

2009, Carol W. Greider (Faculty Member, 2009)
For the discovery of how chromosomes are protected by telomeres and the enzyme telomerase.

2002, Sydney Brenner (Honorary Member, 1993)
For discoveries concerning genetic regulation of organ development and programmed cell death.

2001, Sir Paul Maxime Nurse (Honorary Member, 2000)
For discoveries of key regulators of the cell cycle.

2000, Paul Greengard (Honorary Member, 2002)
For discoveries concerning signal transduction in the nervous system.

2000, Eric R. Kandel (Alumnus Member, 1969)
For discoveries concerning signal transduction in the nervous system.

1998, Robert F. Furchgott (Faculty Member, 1967)
For discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

1998, Louis J. Ignarro (Faculty Member, 1990)
For discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

1998, Ferid Murad (Student Member, 1963)
For discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

1997, Stanley B. Prusiner (Student Member, 1968)
For his discovery of prions—a new biological principle of infection.

1994, Alfred G. Gilman (Student Member, 1968)
For the discovery of G-proteins and the role of these proteins in signal transduction in cells.

1992, Edwin G. Krebs (Student Member, 1943)
For discoveries concerning reversible protein phosphorylation as a biological regulatory mechanism.

1989, Harold E. Varmus (Student Member, 1964)
For the discovery of the cellular origin of retroviral oncogenes.

1986, Stanley Cohen (Faculty Member, 1987)
For discoveries of growth factors.

1986, Rita Levi-Montalcini (Honorary Member, 1970)
For discoveries of growth factors.

1985, Michael S. Brown (Student Member, 1965)
For discoveries concerning the regulation of cholesterol metabolism.

1985, Joseph L. Goldstein (Student Member, 1963)
For discoveries concerning the regulation of cholesterol metabolism.

1982, Sir John R. Vane (Honorary Member, 1989)
For discoveries concerning prostaglandins and related biologically active substances.

1981, Torsten N. Wiesel (Honorary Member, 1992)
For discoveries concerning information processing in the visual system.

1980, Baruj Benacerraf (Student Member, 1944)
For discoveries concerning genetically determined structures on the cell surface that regulate immunological reactions.

1978, Daniel Nathans (Student Member, 1953)
For discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

1978, Hamilton O. Smith (Alumnus Member, 1979)
For discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

1977, Roger C. Guillemin (Faculty Member, 1967)
For discoveries concerning the peptide hormone production of the brain.

1975, David Baltimore (Honorary Member, 1987)
For discoveries concerning the interaction between tumor viruses and the genetic material of the cell.

1975, Renato Dulbecco (Honorary Member, 1993)
For discoveries concerning the interaction between tumor viruses and the genetic material of the cell.

1974, George E. Palade (Honorary Member, 1993)
For discoveries concerning the structural and functional organization of the cell.

1972, Gerald M. Edelman (Student Member, 1953)
For discoveries concerning the chemical structure of antibodies.

1971, Earl W. Sutherland, Jr. (Student Member, 1940)
For his discoveries concerning the mechanisms of the action of hormones.

1969, Salvadore E. Luria (Honorary Member, 1985)
For discoveries concerning the replication mechanism and the genetic structure of viruses.

1966, Charles B. Huggins (Student Member, 1951)
For his discoveries concerning hormonal treatment of prostatic cancer.

1962, James D. Watson (Honorary Member, 1994)
For discoveries concerning the molecular structure of nucleic acids and its significance for information transfer in living material.

1960, Sir Frank M. Burnet (Honorary Member, 1963)
For the discovery of acquired immunological tolerance.

1959, Severo Ochoa (Honorary Member, 1947)
For the discovery of the mechanisms in the biological synthesis of ribonucleic acid and deoxyribonucleic acid.

1959, Arthur Kornberg (Student Member, 1940)
For the discovery of the mechanisms in the biological synthesis of ribonucleic acid and deoxyribonucleic acid.

1958, Joshua Lederberg (Honorary Member, 1982)
For his discoveries concerning genetic recombination and the organization of the genetic material of bacteria.

1956, Dickinson W. Richards (Student Member, 1922)
For discoveries concerning heart catheterization and pathological changes in the circulatory system.

1955, Axel H. Theorell (Honorary Member, 1960)
For his discoveries concerning the nature and mode of action of oxidation enzymes.

1954, Thomas H. Weller (Student Member, 1940)
For the discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue.

1954, Frederick C. Robbins (Faculty Member, 1967)
For the discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue.

1953, Fritz A. Lipmann (Honorary Member, 1955)
For his discovery of co-enzyme A and its importance for intermediary metabolism.

1950, Philip S. Hench (Alumnus Member, 1925)
For discoveries relating to the hormones of the adrenal cortex, their structure and biological effects.

1947, Carl F. Cori (Honorary Member, 1950)
For the discovery of the course of the catalytic conversion of glycogen.

1944, Joseph Erlanger (Alumnus Member, 1909)
For discoveries relating to the highly differentiated functions of single nerve fibers.

1944, Herbert S. Gasser (Student Member, 1915)
For discoveries relating to the highly differentiated functions of single nerve fibers.

1943, Edward A. Doisy (Honorary Member, 1930)
For his discovery of the chemical nature of vitamin K.

1936, Otto Loewi (Honorary Member, 1942)
For discoveries relating to chemical transmission of nerve impulses.

1934, George H. Whipple (Alumnus Member, 1909)
For discoveries concerning liver therapy in cases of anemia.

1934, George R. Minot (Student Member, 1911)
For discoveries concerning liver therapy in cases of anemia.

1923, Frederick G. Banting (Honorary Member, 1923)
For the discovery of insulin.

1923, John J. R. Macleod (Honorary Member, 1923)
For the discovery of insulin.

Eleven of the nineteen Surgeons General of the United States have been members of Alpha Omega Alpha:

Hugh S. Cumming (University of Virginia, 1922, Alumnus)

Thomas Parran, Jr. (University of Columbia, 1940, Honorary)

Leonard A. Scheele (Wayne State University, 1947, Honorary)

Leroy Edgar Burney (Indiana University, 1960, Alumnus)

William H. Stewart (Louisiana State University School of Medicine in New Orleans, 1972, Faculty)

Jesse Leonard Steinfeld (Virginia Commonwealth University, 1979, Faculty)

Julius B. Richmond (University of Illinois, 1938, Student)

C. Everett Koop (Weill Cornell Medical College, 1989, Alumnus)

Antonia C. Novello (University of Puerto Rico, 1987, Alumnus)

David Satcher (Case Western Reserve University, 1969)

Richard Carmona (University of California, San Francisco, 1980)

Vivek H.Murthy (Yale University School of Medicine, 2003)

National Physician of the Year Awards

The National Physician of the Year Awards recognizes both physicians and leaders in health care whose dedication, talents and skills have improved the lives of countless thousands of people throughout the world. This event is a tribute not only to the awardees but to the excellence of the many thousands of practicing physicians throughout the nation.

John K. Castle, Chairman, and Dr. John J. Connolly, President and CEO, hosted the tenth annual National Physician of the Year Awards on March 23, 2015 at the historic Pierre Hotel in New York City.

2015 National Physician of the Year Awardees

Lifetime Achievement

Michael M.E. Johns, M.D.
Professor, Schools of Medicine and Public Health
Chancellor (2007-2012)
CEO, Woodruff Health Sciences Center (1996-2007)
Emory University

John B. Mulliken, M.D.
Professor of Surgery
Harvard Medical School
Co-Director, Vascular Anomalies Center and Director, Craniofacial Centre
Boston Children’s Hospital

Clinical Excellence

Henry Brem, M.D.
Harvey Cushing Professor
Professor of Neurosurgery, Ophthalmology, Oncology and Biomedical Engineering
Director, Department of Neurosurgery
Director, Hunterian Neurosurgical Research Laboratory
Johns Hopkins University School of Medicine

Kimberly Brown, M.D.
Division Head
Division of Gastroenterology/Hepatology
Henry Ford Healthcare System

Fabrizio Michelassi, M.D., FACS
Lewis Atterbury Stimson Professor and Chairman of Surgery
Weill Cornell Medical College
NewYork-Presbyterian/Weill Cornell Medical Center

National Health Leadership

Anthony and Jeanette Senerchia
The Anthony Senerchia Jr. ALS Charitable Foundation Inc.
and the Ice Bucket Challenge


AAMC Awards

2014 Awards Recipients

NewYork-Presbyterian Hospital


Years before the Affordable Care Act, NewYork-Presbyterian Hospital (NYP) began pioneering models for accountable population-based health care in Washington Heights-Inwood, a predominantly underserved Hispanic neighborhood of more than 200,000. Today, NYP is refining its successful model for adaptability to neighborhoods across the United States. Integral to NYP’s journey is its significant investment in the healthy future of neighborhood children and adolescents. In partnership with Columbia University Medical Center, NYP built a network of school-based health clinics that provide mental health and primary care services to more than 7,000 students.

Learn more about NewYork-Presbyterian Hospital

Charles L. Bardes, M.D.


A dedicated humanist and physician educator, Dr. Bardes has received 27 teaching awards, making him the most decorated teacher in the history of Weill Cornell Medical College. His exemplary career in medical education includes serving as the medicine clerkship director for more than 17 years, until he recently transitioned to focus his efforts on implementation of the school’s new medical education curriculum. Colleagues, students, and patients attest that Dr. Bardes’ success as a medical educator can be attributed to his thoughtfulness and keen awareness of the varied elements that comprise a whole and complete person, in addition to his ability to convey these insights to others.
Learn more about Dr. Bardes
Watch the video spotlight on Dr. Bardes

Bernard Karnath, M.D.


A devotee of Sir William Osler, Dr. Karnath is an enthusiastic educator and zealous advocate for patient-centered medicine. Since joining the University of Texas Medical Branch at Galveston (UTMB) faculty in 1997, he has been heavily involved in developing multiple educational curricula and ensuring that it imparts in students the art of the practice and the value of bedside diagnostic skills. Dr. Karnath has a passion for clinical care, which is evident in his dedication to patients. In addition to his clinical practice, he volunteers at St. Vincent’s clinic, the UTMB student-run, free clinic that cares for the medically underserved in Galveston County.
Learn more about Dr. Karnath
Watch the video spotlight on Dr. Karnath

Randall King, M.D., Ph.D.


A consummate researcher, Dr. King initiates investigation and innovation in the laboratory, classroom, and across the curriculum at Harvard Medical School, where he is the Harry C. McKenzie Professor of Cell Biology. Among other achievements, he spurred the development of a postdoctoral training program for scientists interested in education careers, created a fully annotated syllabus with detailed learning objectives for each activity, and established patient clinics to integrate basic science with clinical medicine. Dr. King was also an integral member of a task force that resulted in a major curriculum redesign of the four-year M.D. program. He is a proven leader in educational innovation.
Learn more about Dr. King
Watch the video spotlight on Dr. King

Emma A. Meagher, M.D.


Dr. Meagher has a reputation for being a tireless teacher, mentor, and curricular innovator. In 1999, she redesigned the medical school’s formerly fragmented pharmacology curriculum and developed a global online pharmacology curriculum as part of a partnership with Coursera. Her efforts resulted in a highly effective approach that ensures integrated pharmacology education across all four years of medical education at Perelman School of Medicine at the University of Pennsylvania, where she serves as associate professor. Dr. Meagher’s exceptional talent as an educator has been recognized many times over by her students, fellow faculty, school administrators, and the university.
Learn more about Dr. Meagher
Watch the video spotlight on Dr. Meagher

Cynthia Haq, M.D.


Growing up in Indiana and Pakistan, Cynthia Haq, M.D., took great interest in people around her who were living in poverty. Today, at the University of Wisconsin School of Medicine and Public Health and around the world, she is known for her humanistic and compassionate care of medically underserved populations. Her commitment to improving global health is steadfast. Since her first job as a practicing physician, Dr. Haq has been committed to providing high-quality, patient-centered health care to the most marginalized world citizens, and she helped establish the first family medicine residency programs in Pakistan, Uganda, and Ethiopia.
Learn more about Dr. Haq
Watch the video spotlight on Dr. Haq

Lisa Cooper, M.D., M.P.H.


Dr. Cooper revolutionized the nation’s understanding of how race and ethnicity affect health and patient care. Through her work at Johns Hopkins University School of Medicine, she has identified precise inequities in how racial and ethnic minority patients perceive their health care providers and access the health system. She also has worked diligently to achieve health parity by partnering with these minority populations on community-tailored solutions. The Liberian-born internist’s passion for human dignity and equality began during childhood, when she was witness to and victim of discrimination and violence. Dr. Cooper remains a tireless and dedicated advocate for justice and human equality.
Learn more about Dr. Cooper
Watch the video spotlight on Dr. Cooper

  1. Eugene Washington, M.D., M.Sc.


Since 1979, Dr. Washington, dean of David Geffen School of Medicine at UCLA, has coupled his passion for a better health and health care future with his exceptional talents in clinical investigation, public policy, and leadership to improve the lives of millions of Americans, particularly the medically underserved. A quintessential public servant, he has worked to improve the nation’s health by holding posts with the Centers for Disease Control and Prevention, two academic health centers, and multiple professional and government boards and committees.
Learn more about Dr. Washington
Watch the video spotlight on Dr. Washington

James P. Allison, Ph.D.


As an adolescent, Dr. Allison was a fiercely inquisitive and challenging student—often arguing with his teachers on creationism. Fortunately, his natural inclinations were nurtured and he grew up to be a skilled scientist at The University of Texas MD Anderson Cancer Center where his staunch determination has revolutionized cancer treatment. Dr. Allison’s mother died of lymphoma when he was 11, he lost more than one uncle to cancer, and in 2005, his brother died of prostate cancer, a disease he himself has survived. His tenacity in discovering how science benefits the patient makes him a highly sought-after researcher.
Learn more about Dr. Allison
Watch the video spotlight on Dr. Allison

James O. Woolliscroft, M.D.


Dr. Woolliscroft has been leading medical education transformation for more than three decades. He quickly earned a reputation as a pioneer in medical education upon joining the University of Michigan Medical School faculty in 1980, where he now serves as dean and the Lyle C. Roll Professor of Medicine. Dr. Woolliscroft is a talented mentor who inspires in others a passion for educating. He was among the first to advocate for moving the paradigm of medical education from knowledge acquisition to performance-based metrics, and to champion community settings as core sites for training medical students.
Learn more about Dr. Woolliscroft
Watch the video spotlight on Dr. Wooliscroft



2013 Awards Recipients

University of Wisconsin School of Medicine and Public Health


Since matriculating its first class in 1908, the University of Wisconsin School of Medicine and Public Health (UWSMPH) has dedicated itself to the “Wisconsin Idea”—the notion that the boundaries of the campus are the boundaries of the state. Ever since, UWSMPH has viewed itself as a means to elevate the health of all Wisconsinites through excellent community service in three areas: community partnerships, translational research endeavors, and medical education.

Learn more about the University of Wisconsin School of Medicine and Public Health

Deborah E. Powell, M.D.


Abraham Flexner’s enduring legacy for medical education has been a steadfast commitment to improving medical education. The same can be said of Dr. Powell, dean emerita and professor of laboratory medicine and pathology at the University of Minnesota Medical School, who has spent her career of more than 40 years championing competency-based medical education.

Learn more about Dr. Powell

Stuart Slavin, M.D., M.Ed.


Dr. Slavin has demonstrated a passion for medical education and curricular design during his 26 years in academic medicine. As professor of pediatrics and associate dean for curriculum at the Saint Louis University School of Medicine, Dr. Slavin teaches as much as he works behind the scenes to shape the school’s education program. He recently spearheaded a comprehensive restructuring plan for the four-year undergraduate medical curriculum that was quickly approved and began to be implemented this academic year.

Learn more about Dr. Slavin

Roy Ziegelstein, M.D.


Dr. Ziegelstein of The Johns Hopkins University School of Medicine is regarded as “the doctor’s doctor,” and his record of teaching accomplishments honors that clinical mastery. He currently is vice dean for education and the Sarah Miller Coulson and Frank L. Coulson Jr. Professor of Medicine at Johns Hopkins and executive vice chairman in the Department of Medicine at Johns Hopkins Bayview Medical Center.
Learn more about Dr. Ziegelstein

Cynthia Lance-Jones, Ph.D.


As associate professor of neurobiology and assistant dean for medical student research at the University of Pittsburgh School of Medicine, Dr. Lance-Jones interacts closely with medical students in their first and second years. Her teaching ability is recognized by students not only through outstanding evaluations and attendance to her lectures, but also by the fact that she is one of only three faculty members students request each year to provide review sessions for the United States Medical Licensing Examination Step 1 exam.

Learn more about Dr. Jones

Mikel Henry Snow, Ph.D.


In addition to being professor of cell and neurobiology and chair and director of medical education at Keck School of Medicine of the University of Southern California, Dr. Snow is the director of anatomy, the role for which his students know him best. An innovative and involved educator, he is known for his dynamic, comprehensive lectures and his original study materials, which he continually works to edit and improve.

Learn more about Dr. Snow

Lee Todd Miller, M.D.


The career of Dr. Miller has been guided by his passions for pediatrics, medical education, and addressing health care disparities in underserved communities both at home and abroad. At the David Geffen School of Medicine at the University of California, Los Angeles, he is an esteemed role model and teacher, demonstrating warmth and humanism at all levels.

Learn more about Dr. Miller

Huda Akil, Ph.D.


Dr. Akil once wrote a commentary about being a Syrian girl growing up in Damascus and her dream of becoming a scientist. Today, not only is Dr. Akil the Gardner C. Quarton Professor of Neurosciences in Psychiatry at the University of Michigan Medical School and co-director and senior research professor at the university’s Molecular and Behavioral Neuroscience Institute, but she is a pioneer of what is now called “systems neuroscience,” the understanding of the neurobiology of emotions and the interplay of pain, anxiety, depression, stress, and substance abuse.

Learn more about Dr. Akil

Gilbert S. Omenn, M.D., Ph.D.


Dr. Omenn has made significant contributions to the health and health care of Americans by doing everything from leading major public health studies and initiatives to forming actual health policy for the nation. A leader on the national stage, Dr. Omenn has held high-level government appointments during the administrations of Presidents Nixon, Ford, Carter, Reagan, Clinton, and Obama. He also has served as professor of internal medicine, human genetics, and public health at the University of Michigan (U-M) Medical School since 1997 and as CEO of the U-M Health System and executive vice president for medical affairs.

Learn more about Dr. Omenn

Aaron Shirley, M.D.


Becoming the first African-American resident at the University of Mississippi Medical Center (UMMC) in 1965 was just the beginning of the trailblazing career of Dr. Shirley. As the former chairman of community health services at UMMC, he served on the faculty for more than four decades. In 1970, he co-founded the Jackson Hinds Comprehensive Health Center for low-income and uninsured patients that became a model for federally funded community health centers nationwide. Dr. Shirley’s most visible legacy may be the first-of-its-kind Jackson Medical Mall, a once empty and vandalized shopping mall that he believed could become a one-stop shop for medical care and other public services. The mall opened in 1996.

Learn more about Dr. Shirley



TMA Physicians Award Six Outstanding Science Teachers  

May 1, 2015

The Texas Medical Association (TMA) named six Texas science teachers winners of the 2015 TMA Ernest and Sarah Butler Awards for Excellence in Science Teaching. Three first-place prizes were awarded today at TexMed, the association’s annual conference, in Austin. Three second-place awards will be presented in upcoming local ceremonies. These educators help create tomorrow’s physicians by inspiring students in the field of science.

First-Place Winners:

Patricia Kassir of The Bendwood School in Houston, Joseph Morris of All Saints’ Episcopal School in Fort Worth, and Anna Loonam of Bellaire Senior High School in Bellaire are this year’s elementary, middle, and high school first-place winners. (See winner bios below.)TMA awards each top recipient a $5,000 cash prize, and each winner’s school receives a $2,000 resource grant toward its science programs.

Second-Place Winners:

Second-place winners are Laura Wilbanks of Whiteface Elementary School in Whiteface, Carol Raymond of E.A. Young Academy in North Richland Hills, and Theresa Lawrence of Friendswood High School in Friendswood. Second-place winners’ schools each receive a $1,000 resource grant to enhance science classroom learning.

TMA believes awards like this that encourage excellent science teaching are important, as only 32 percent of Texas eighth-graders have achieved proficiency in science, according to the National Science Foundation’s Science and Engineering Indicators 2014 report. Through this award, TMA hopes to help improve these numbers by recognizing innovative teachers and providing them resources to continue motivating and engaging students. Eventually, TMA believes, some of these inspired students will choose medicine as a career. Some already have: Several TMA physician leaders were once taught by teachers who later won this award.

Science professionals fromThe University of Texas Charles A. Dana Center chose finalists from all the nominees, and physicians from TMA’s Educational Scholarship, Loan, and Awards Committee selected the winners.

Patricia Kassir — Elementary School First-Place Winner

Mrs. Kassir teaches the gifted and talented program for medical science to grades 3-5 at The Bendwood School in Houston. She teaches because she wants to “improve the lives of others and foster understanding.” Mrs. Kassir’s career spans decades, disciplines, languages, and countries, including two years teaching English at an Islamic school in Lebanon. An immigrant to America at the age of 7, Mrs. Kassir speaks English, Spanish, French, and some Arabic, and is an expert at reaching out and connecting to students regardless of their background or socioeconomic status. Classes with Mrs. Kassir are filled with debates and interactive labs, from “CSI”-style frog “autopsies” to a mock medical school. “A teacher like Mrs. Kassir is a rarity,” says Jana Bassett, principal at The Bendwood School. “We often joke that as we all age, her students will be addressing our medical needs.” In no place is this more evident than Mrs. Kassir’s own children, who are pursuing their own paths in science, the oldest of whom is a first-year medical student at Baylor College of Medicine.

Joseph Morris — Middle School Winner

Mr. Morris teaches seventh grade life science at All Saints’ Episcopal School in Fort Worth. “I want students to walk into my classroom and immediately become wide-eyed and drawn to something that sparks their curiosity,” he says. “I want questions to fill their minds like, ‘What is that? How does that work?’ and one of my favorites, ‘What is that smell?’ To which I always answer, ‘THAT… is the smell of FUN!’ ” His dedication to his students extends outside the classroom. Together with another All Saints’ teacher, Mr. Morris mentored the school’s Solar Car Club as they built a solar-powered car and drove it from Texas to California for the national Solar Car Challenge. During the two-year long project that earned the team a second-place finish, Mr. Morris’ students learned valuable skills like teamwork, problem solving, and fund raising. “He doesn’t just teach science,” says fellow All Saints’ teacher Lyle Crossley, PhD. “Joe also models and teaches character and integrity.”

Anna Loonam — High School Winner

Mrs. Loonam teaches advanced placement biology at Bellaire Senior High School in Bellaire. She is described as a “legend” within the Bellaire community. Mrs. Loonam encourages students to design their own science experiments, cultivate plants on the school’s “green roof,” and create mini-movies explaining difficult science concepts. “I firmly believe in providing students with opportunities to ‘do science,’ ” she says. Each year, she introduces students to the scientific community by taking them to the Sam Rhine Genetics Update Conference, and hosting Genetics Night, where students explain their research of a genetic disorder to peers, parents, teachers, doctors, medical students, and administrators from Baylor College of Medicine. “As a medical school teacher of a number of Mrs. Loonam’s former students, I have seen first-hand that she is a transformative and innovative teacher who created an intellectual legacy,” says Joseph Kass, MD, JD, a neurology professor at Baylor College of Medicine and father to a student in Mrs. Loonam’s class.

The TMA Ernest and Sarah Butler Awards for Excellence in Science Teaching are supported by the TMA Foundation, the philanthropic arm of TMA, thanks to an endowment established by Dr. and Mrs. Ernest C. Butler of Austin and additional gifts from physicians and their families.

TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans. TMA Foundation is the philanthropic arm of the association and raises funds to support the public health and science priority initiatives of TMA and the family of medicine.

– See more at: http://www.texmed.org/Template.aspx?id=33588#sthash.ImCloNht.dpuf

UCLA Members of the National Academy of Medicine

Known as the Institute of Medicine until July 1, 2015

Name Elected More info
Ronald Andersen 1984 Faculty web page – UCLA Fielding School of Public Health
Ron Brookmeyer 2008 Faculty web page – UCLA Fielding School of Public Health
Alan H. DeCherney 2004 Faculty web page – David Geffen School of Medicine at UCLA
John C. Beck 1980 [Administration]
Robert H Brook 1982 Faculty Web Page – Geriatrics
Carmine D. Clemente 1980 Faculty web page – David Geffen School of Medicine at UCLA
Thomas J. Coates 2000 Faculty web page – AIDS Institute
Sherin U. Devaskar 2012 Faculty web page – Molecular Cellular & Integrative Physiology
Jared M. Diamond 2005 Faculty web page – Geography
Andrew D Dixon 1979 [Emeritus – Dentistry]
James Economou 2014 Faculty web page – UCLA Engineering
David S. Eisenberg 2002 Faculty web page – UCLA-Department of Energy (DOE) Institute for Genomics and Proteomics
Jose J. Escarce 2008 Faculty web page – Center for Health Improvement for Minority Elders
Jonathan E. Fielding 1995 Faculty web page – UCLA Fielding School of Public Health
Patricia Ganz 2007 Profile – Jonsson Comprehensive Cancer Center
Lilian Gelberg 2003 Faculty web page – UCLA Health Services Research Center
Gail G. Harrison 2003 Faculty web page – UCLA Fielding School of Public Health
Jody Heymann 2013 Faculty web page – UCLA Fielding School of Public Health
Louis J. Ignarro 2002 Faculty web page – David Geffen School of Medicine at UCLA
Richard Jackson 2011 Faculty web page – Environmental Health Sciences Institute of the Environment & Sustainability
Robert M. Kaplan 2005 Faculty web page – UCLA Fielding School of Public Health
Emmett B. Keeler 2006 Faculty web page – UCLA Fielding School of Public Health
Charles R. Kleeman 1982 Faculty web page – David Geffen School of Medicine at UCLA
Charles E. Lewis 1973 Faculty web page – David Geffen School of Medicine at UCLA
Roger J. Lewis 2009 Faculty web page – David Geffen School of Medicine at UCLA
John C. Mazziotta 2006 Faculty web page – David Geffen School of Medicine at UCLA
Sherman M. Mellinkoff 1974 Faculty web page – David Geffen School of Medicine at UCLA
M. Jeanne Miranda 2005 Faculty web page – Health Services Research Center
Jack Needleman 2012 Faculty web page – Department of Health Policy and Management
Elizabeth Neufeld 1991 Faculty web page – David Geffen School of Medicine at UCLA
Michael E. Phelps 1986 Faculty web page – California NanoSystems Institute
Roy M Pitkin 1990 Faculty Web Page – Ob Gyn
Thomas H. Rice 2006 Faculty web page – UCLA Fielding School of Public Health
David L. Rimoin 1992 Faculty web page – David Geffen School of Medicine at UCLA
Linda Rosenstock 1995 Faculty web page – UCLA Fielding School of Public Health
Shelley E. Taylor 2003 Faculty web page – Psychology
Cun-Yu Wang 2011 Profile – School of Dentistry
Kenneth B. Wells 1997 UCLA Health System – Physician Directory listing
Owen Witte 2003 Web page – Institute for Stem Cell Biology and Medicine

Last updated September 2015

This listing includes UCLA faculty active in teaching, research or administration, including emeriti and adjunct faculty. See the faculty member’s individual web page for additional information.

Clinical Excellence Awards

The Clinical Excellence Award scheme in England
Commitment awards for consultants in Wales
Distinction awards for consultants in Scotland
Clinical Excellence Awards in Northern Ireland

Background to the CEA scheme

The Clinical Excellence Awards (CEA) scheme is intended to recognise and reward those consultants who contribute most towards the delivery of safe and high quality care to patients and to the continuous improvement of NHS services including those who do so through their contribution to academic medicine.

In particular, awards are made to consultants who:

  • demonstrate sustained commitment to patient care and wellbeing or improving public health
  • sustain high standards of both technical and clinical aspects of service while providing patient-focused care
  • in their day-to-day practice demonstrate a sustained commitment to the values and goals of the NHS by participating actively in annual job planning, observing the private practice code of conduct and showing a commitment to achieving agreed service objectives
  • through active participation in clinical governance contribute to continuous improvement in service organisation and delivery
  • embrace the principles of evidence-based practice
  • contribute to knowledge base through research and participate actively in research governance
  • are recognised as excellent teachers and or trainers and or managers
  • contribute to policy-making and planning in health and healthcare
  • make an outstanding contribution to professional leadership.

Value of awards

Awards can be made for both local and national contributions to the NHS.  Employer-Based Awards Committees (EBAC) assess applications for the employer based awards (levels 1-9). Higher value national awards (9-12) are decided by the Advisory Committee on Clinical Excellence Awards (ACCEA) and its subcommittees. A level 9 award may be awarded by either the EBAC or the ACCEA, depending on the type of achievement being recognised.

National Medical Excellence Awards


Published on 23 Aug 2015

On 21 Aug, Prof Tan Puay Hoon was conferred National Outstanding Clinician Award. Prof Lim Shih Hui & Prof Koh Tian Hai was conferred National Outstanding Clinician Educator Award & National Outstanding Clinician Mentor Award respectively.


The National Medical Excellence Awards is a national-level award to recognise outstanding clinicians and healthcare professionals who made outstanding contributions in the advancement of healthcare, improvement in standards of patient safety and quality of care, which ultimately improve people’s lives.  Launched in 2008, there are currently six categories of awards:

  • National Outstanding Clinician Award
    This award recognises individuals with at least 15 years of service in public of private healthcare establishments, with exceptional contributions to clinical work that advances the safety and quality of patient care, and in addition has supported and facilitated research.  The recipients have also successfully introduced novel or effective treatment methods resulting in high standard of quality healthcare delivery and are recognized by their peers as being master clinicians.
  • National Outstanding Clinician Scientist Award
    This award recognizes individuals with at least 15 years of service in public or private healthcare establishments with outstanding contributions to clinical and translational research work relating to their field of specialty.  The research work has resulted in novel understanding of diseases with potential positive outcome on healthcare delivery.
  • National Outstanding Clinician Mentor Award
    This award recognizes individuals with at least 15 years of service in healthcare industry and health-related work and has contributed substantially in the training of young clinicians and clinician scientists via mentorship or by virtue of academic positions.  The recipient is still an active role model to younger clinicians and clinician scientists.
  • National Outstanding Clincian Educator Award
    This award recognises individuals who have contributed substantially to the training of clinicians or clinician scientists.
  • National Outstanding Clinical Quality Activist Award
    This award recognises medical clinicians, nurses, pharmacists and allied health professionals in the public and private healthcare sectors who have contributed significantly to clinical quality improvement and patient safety and have inspired others likewise.
  • National Clinical Excellence Team Award
    This award recognizes teams or organizations that have undertaken a clinical quality/practice improvement project that has contributed significantly to bridging the gap between knowledge and practice with a strong research element in knowledge translation process, resulting in improved standard of care, health outcomes, high efficiency and/or more effective patient-centred services.  The teams also demonstrated their achievements through successful population of novel care delivery services beyond their own units, wards or departments.

The highlight of the NMEA is the dinner and award ceremony, where the clinical leadership and community gather to celebrate the winners.  MOH partners with a healthcare cluster each year to organise the evening gala.

Information on the 2014 winners and the event is available here.

Celebrating the best medical talents

Seven awards were given to outstanding recipients in six award categories at the National Medical Excellence Awards (NMEA) 2014, held at The Regent Singapore on 28 August 2014. The NMEA is the only award given out by the Ministry of Health (MOH) that recognises contributions from health professionals for innovations in healthcare, patient safety, clinical quality, biomedical research as well as training and education of clinicians.

NMEA 2014 Award Recipients (China)

National Outstanding Clinician Award – Professor Wong Peng Cheang

Professor Wong Peng Cheang from the National University Health System (NUHS)  is a highly regarded pioneer in the fields of infertility and assisted reproduction in Singapore. Prof Wong had been honoured with two prestigious lectureships for his pioneering work in research with the rhesus monkey model to show that Gamete Intra-Fallopian Transfer (GIFT) could be an alternative method to assisted reproduction other than In-Vitro Fertilisation (IVF) and Embryo Transfer (ET). As a member of the World Health Organisation (WHO) Task Force on the Diagnosis and Treatment of Infertility, Prof Wong was also involved in several studies, which were at the forefront of infertility research.

National Outstanding Clinician Scientist Award – Associate Professor Allen Yeoh Eng Juh

Associate Professor Allen Yeoh Eng Juh from NUHS is a prolific clinician-scientist, innovator and entrepreneur, whose work enjoys international recognition. The author of more than 50 papers in leading international medical and scientific journals is widely cited for his work in paediatric leukaemia, and has received many international awards for his research. He is devoted to developing cost-effective treatments to improve treatment outcomes for children with acute leukaemia in Singapore and Asia. A/Prof Yeoh is among the first in the world to show that gene expression profiling of leukaemia cells can accurately diagnose and subtype all the clinically important groups of childhood acute lymphoblastic leukaemia (ALL) with great accuracy enabling better treatment.

National Outstanding Clinician Mentor Award – Professor Chay Oh Moh and Professor Quak Seng Hock

There are two recipients this year. The first is Professor Chay Oh Moh from KK Women’s and Children’s Hospital (KKH). For more than 20 years, Prof Chay has been an outstanding mentor and educator par excellence, making significant contributions to the professional initiation and development of innumerable medical students and residents in the areas of paediatrics and paediatric respiratory medicine, with her teaching, training and mentorship. As the first Academic Chair of the SingHealth-Duke NUS Paediatric Academic Clinical Programme, she established a robust framework that has effectively cultivated strong mentor-mentee relations across all levels of doctors at KKH as well as beyond in SingHealth.

The second recipient is Professor Quak Seng Hock from NUHS. A pioneer in paediatric gastroenterology and hepatology in Singapore, Prof Quak is the principal driver of the Paediatric Liver Transplant Programme. He provided guidance in the training and mentoring of medical students and junior doctors. Prof Quak has trained several overseas fellows in his subspecialty and built up a strong team of specialists, providing one of the best paediatric gastrointestinal and hepatology services in the region, complete with the ability to perform liver transplantation. He is also actively involved in curriculum reformation, playing an integral role in the career development of paediatric trainees. The internal examiner for postgraduate degree in Paediatric Medicine and Family Medicine for the past 20 years, Prof Quak contributes to ensuring the high quality of clinicians.

National Outstanding Clinician Educator Award – Associate Professor Chow Wan Cheng

Associate Professor Chow Wan Cheng from Singapore General Hospital (SGH) is a respected clinician, who has gained regional recognition and won multiple awards for her research in chronic viral hepatitis. She actively contributes to the field of hepatology through sharing her insights in medical textbooks, local and international medical journals as well as at key international scientific meetings. Passionate about education and training, A/Prof Chow has not only contributed significantly towards undergraduate and post-graduate medical education, she is also heavily involved in continuous medical educational programmes for clinicians in primary healthcare, as well as in public education, especially in the field of viral hepatitis.

National Outstanding Clinical Quality Activist Award – Associate Professor Ong Biauw Chi

Associate Professor Ong Biauw Chi from SGH was instrumental in leading a network of committed patient safety officers from across the healthcare sector to achieve successful implementation of the WHO “High 5s” Correct Site Surgery protocol, an achievement which put Singapore on the world map for surgical safety. This was a multi-year project that applied a standardised surgical protocol involving mandatory time-out checks in all major operating theaters in public hospitals to ensure the correct surgical procedure is carried out on the correct patient. Despite being heavily involved in hospital and national safety, quality and governance work, A/Prof Ong is equally passionate about teaching, mentoring and inculcating the right values of patient care and safety to the next generation of healthcare specialists.

National Clinical Excellence Team Award

The recipient is the NUHS’ National University Hospital (NUH) team headed by Associate Professor Malcolm Mahadevan. The other team members are: Dr Kuan Win Sen, Professor Lim Tow Keang and Dr Lim Hui Fang. Severe community-acquired pneumonia (SCAP) is a common and potentially fatal condition. Pneumonia was the fourth leading cause for hospitalisation in Singapore in 2011. To reduce the mortality rates for SCAP patients, the team embarked on a quality improvement project in 2008 to develop a multidisciplinary programme that improved pre-ICU resuscitation and reduced hospital mortality for SCAP patients from 23.8% to 5.7%. The team developed and implemented a multifaceted workflow that standardised and optimised the management of SCAP patients at the emergency department. Their efforts reduced ICU admission rates and length of stay in the hospital, which translated to significant savings in hospital bills for the patients.

  1. The full citations of the winners can be found in Annex Aand the fact sheet on NMEA can be found in Annex B.

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1:45PM 11/12/2014 – 10th Annual Personalized Medicine Conference at the Harvard Medical School, Boston

Reporter: Aviva Lev-Ari, PhD, RN


REAL TIME Coverage of this Conference by Dr. Aviva Lev-Ari, PhD, RN – Director and Founder of LEADERS in PHARMACEUTICAL BUSINESS INTELLIGENCE, Boston http://pharmaceuticalintelligence.com


1:45 p.m. Panel Discussion – Oncology


There has been a remarkable transformation in our understanding of the molecular genetic basis of cancer and its treatment during the past decade or so. In depth genetic and genomic analysis of cancers has revealed that each cancer type can be sub-classified into many groups based on the genetic profiles and this information can be used to develop new targeted therapies and treatment options for cancer patients. This panel will explore the technologies that are facilitating our understanding of cancer, and how this information is being used in novel approaches for clinical development and treatment.


Opening Speaker & Moderator:

Lynda Chin, M.D.
Department Chair, Department of Genomic Medicine
MD Anderson Cancer Center     @MDAnderson   #endcancer

  • Who pays for personalized medicine?
  • potential of Big data, analytics, Expert systems, so not each MD needs to see all cases, Profile disease to get same treatment
  • business model: IP, Discovery, sharing, ownership — yet accelerate therapy
  • security of healthcare data
  • segmentation of patient population
  • management of data and tracking innovations
  • platforms to be shared for innovations
  • study to be longitudinal,
  • How do we reconcile course of disease with personalized therapy
  • phenotyping the disease vs a Patient in wait for cure/treatment


Roy Herbst, M.D., Ph.D.    @DrRoyHerbstYale

Ensign Professor of Medicine and Professor of Pharmacology;
Chief of Medical Oncology, Yale Cancer Center and Smilow Cancer Hospital     @YaleCancer

Development new drugs to match patient, disease and drug – finding the right patient for the right Clinical Trial

  • match patient to drugs
  • partnerships: out of 100 screened patients, 10 had the gene, 5 were able to attend the trial — without the biomarker — all 100 patients would participate for the WRONG drug for them (except the 5)
  • patients wants to participate in trials next to home NOT to have to travel — now it is in the protocol
  • Annotated Databases – clinical Trial informed consent – adaptive design of Clinical Trial vs protocol
  • even Academic MD can’t read the reports on Genomics
  • patients are treated in the community — more training to MDs
  • Five companies collaborating – comparison of 6 drugs in the same class
  • if drug exist and you have the patient — you must apply personalized therapy


Lincoln Nadauld, M.D., Ph.D.
Director, Cancer Genomics, Huntsman Intermountain Cancer Clinic @lnadauld @intermountain

  • @Stanford, all patients get Tumor profiles Genomic results, interpretation – deliver personalized therapy
  • Outcomes from Genomics based therapies
  • Is survival superior
  • Targeted treatment – Health economic impact is cost lower or not for same outcome???
  • genomic profiling of tumors: Genomic information changes outcome – adverse events lower
  • Path ways and personalized medicine based on Genomics — integration not yet been worked out

Question by Moderator: Data Management

  • Platform development, clinical knowledge system,
  • build consortium of institutions to share big data – identify all patients with same profile





See more at  http://personalizedmedicine.partners.org/Education/Personalized-Medicine-Conference/Program.aspx#sthash.qGbGZXXf.dpuf




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11:00AM 11/12/2014 – 10th Annual Personalized Medicine Conference at the Harvard Medical School, Boston

Reporter: Aviva Lev-Ari, PhD, RN


REAL TIME Coverage of this Conference by Dr. Aviva Lev-Ari, PhD, RN – Director and Founder of LEADERS in PHARMACEUTICAL BUSINESS INTELLIGENCE, Boston http://pharmaceuticalintelligence.com

11:00 Keynote Speaker – Past, Present and Future of Personalized Medicine

Past, Present and Future of Personalized Medicine

Keynote Speaker

Mirella Marlow, M.A., M.B.A.
Programme Director, Centre for Health Technology Evaluation,
National Institute for Health and Clinical Excellence (NICE) @NICEcomms

PM in the UK

Clinical evidence and cost effectiveness needed for PM

UK Government life sciences policy

Scale of PM:

2013 – 10 million pound

2020 – 60 million pound

Innovative healthcare to promote economic growth

  • Genomics England 100,000  – new scientific discovery and kick start the UK genomics industry
  • BIS – accelerate Skills & Training for the Genomics Industries
  • UK Precision Medicine Catapult development of tests and commercialization of innovation in diagnostics

1 Billion Pound NIHR in UK

  • tissue banks – Biobank
  • Farr Institute – “big data”
  • develop methodologies for starter research

National Institute Care Excellence

– standards for NP

Benefits of PM

  • right treatment
  • responding subgroups
  • earlier treatments
  • dosing
  • reduce side effects

Companion Diagnostics in NICE – Technology Appraisals

  • elevate a test like evaluate a drug ad part of Diagnostics
  • Treatment: GIST — >>Biomarker: KitCD117

Diagnostics assessment Program

  • 9 EGFR-TK – mutation testing –
  • Mutation Analysis Services

NICE support to Companies – Company engagement

  • discuss product pipeline and value proposition
  • orientation to the process
  • Scientific Advice on Clinical Trial Design
  • workshops for Pharma and for Diagnostics — are different
  • online tool being developed – standardize the Advise for Fee — get Accredited Advisors in the Fields of Genomics, Diagnostics
  • Post guidance – evidence gaps, clinical utility and economic evidence
  • Update guidance – research questions guiding Guidance for the industry
  • Indirect Research facilitation: protocol external funding identify clinical context ethics +GCP leading to Publication within 2 years

UK and Genetics: Kirk and Watson on DNA

UK – 60 million patients under one National Universal Health Care System

– See more at: http://personalizedmedicine.partners.org/Education/Personalized-Medicine-Conference/Program.aspx#sthash.qGbGZXXf.dpuf




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8:50AM 11/12/2014 – 10th Annual Personalized Medicine Conference at the Harvard Medical School, Boston

Reporter: Aviva Lev-Ari, PhD, RN


REAL TIME Coverage of this Conference by Dr. Aviva Lev-Ari, PhD, RN – Director and Founder of LEADERS in PHARMACEUTICAL BUSINESS INTELLIGENCE, Boston http://pharmaceuticalintelligence.com

8:50 a.m. – Keynote Speaker – CEO, American Medical Association

The American Medical Association (AMA) has the largest number of practicing physicians of all specialties as its members and the organization plays a very important role in health care policy and education of medical professionals.  AMA has been quite active in assessing the role of personalized medicine in the future of healthcare in all of its facets.  Dr. Madara will talk about the status of AMA’s thinking about personalized medicine and his vision of how it might be able to transform medical care.

Keynote Speaker

James Madara, M.D. @AmerMedicalAssn

Executive Vice President and CEO, American Medical Association

AMA Strategy the context for PM  – Outside looking in View applied

Mission statement: Promote Medicine 167 years since it was established. Societies of MDs – all population of American MDs, are members.

AMA developed:

  • CPT Curation – Billing of Procedures
  • Standard Procedure for Katrina and Emergency Medicine
  • Strategic Plan 110 active Projects to be compressed into three big ideas
  1. Connect clinics with community – OUTCOMES, cooperation with CDC i.e., Diabetes, HTN (KaiserPermanente)
  2. Medical education bring t to 21th century: Competence vs Time-in-Chair, 141 Medical Schools, teaching methods: Gaming/mobile, the lecture Hall in Medicine is poor form for education, Simulation methods, Clinical Research and Basic Research – blend across disciplines, platforms in Silicon Valley to create new TEACHING of MDs, Genomics must be incorporated, shifting from Inpatient to Outpatient to HOME, all training is for Inpatient – Nothing for HOME delivery of Care. 85% of all Medical School responded they need change in Teaching — 11 Excellence Medical Schools selected: Vanderbilt, MI, UCSF, UC Davis…
  3. Make practice of medicine joyous again – installation in MDs Offices, optimize the efficiency of MDs reporting now emphasis on USABILITY

Doing through Partnership: PM in Nutrition is everywhere — it is a HYPE, Gartner Group Hype Cycle was used by the Speaker for an analogy with Personalized Medicine (PM)

SHAKE out for a steady state in PM mitigation the hype

  • Mixed perceptions of Cost effectiveness of Healthcare delivery – Growth of Health Spending by Component:
  • Center on Outcomes and Values: PM redefined: away from behavioral toward procedural (actions): i.e, CV death risk predicted by waist size –

Cost/Behavior: sweet-spots are the following

  • Pharmaconeconomics: Is cost effective and it does not involve behavior
  • Cancer
  • Laboratory Developed Tests (LDTs)

– need be approved by FDA – New challenge in PM

– AMA View: Medical services not Medical Devices, CLIA ensure the quality and Standards, it requires more than guidance, currently FDA has ONLY guidance



– See more at: http://personalizedmedicine.partners.org/Education/Personalized-Medicine-Conference/Program.aspx#sthash.qGbGZXXf.dpuf





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Leaders in Pharmaceutical Business Intelligence Announced New Cardiovascular Series of e-Books at SACHS Associates 14th Annual Biotech In Europe Forum

Reporter: Aviva Lev-Ari, PhD, RN



Please see Further Titles at


Please see Further Information on the Sachs Associates 14th Annual Biotech in Europe Forum for Global Investing & Partnering at:




why-is-twitter-s-logo-named-after-larry-bird--b8d70319daON TWITTER Follow at





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The Affordable Care Act: A Considered Evaluation. The Implementation of the ACA, Impact on Physicians and Patients, and the Dis-Ease of the Accountable Care Organizations.

The Affordable Care Act: A Considered Evaluation. Part II: The Implementation of the ACA, Impact on Physicians and Patients, and the Dis-Ease of the Accountable Care Organizations.

Writer and Curator: Larry H. Bernstein, MD, FCAP


Curator and Editor: Aviva Lev-Ari, PhD, RN 

Article ID #78: The Affordable Care Act: A Considered Evaluation. The Implementation of the ACA, Impact on Physicians and Patients, and the Dis-Ease of the Accountable Care Organizations. Published on 9/13/2013

WordCloud Image Produced by Adam Tubman


This discussion is the second of two distinct chapters. The first is a clarification of what is contained in the Accountable Care Act (ACA), the model of care it is crafted from, the insurance mandate, the inclusion of groups considered high risk and uninsured, the inclusion of groups low risk and uninsured, and the economics involved in going from a fractured for profit health care industry to a more stable coverage for patients with problems in creating a new workable model from an actuarial standpoint, with the built in complexity of not just age, but education, achievement in the workforce, and a consolidating hospital and eldercare industry, the unpredictability of disease evolution, and add on the multicultural and social structures, as well as rapidly evolving communications and computational platforms needed to transform the U.S. Healthcare system.. The second is taken from selected articles on the care process in the New England Journal of Medicine about the cost and consequences for improving quality at lower cost. Dr. Justin Pearlman has chosen this topic to become as the Second Chapter in the Cardiovascular Disease Volume and Dr. Aviva Lev Ari has selected the sub-universe of sources been elaborated on in this Chapter

There are inherent problems at looking at this from a systems point of view, mainly impacted by the relationship of providers to hospitals and clinics, and by the relationships of insurers to the patients and providers in an Accountable Care Organization (ACO) model. These relationships have been evolving for many decades, first with the increased availability of highly skilled medical specialists trained in numerous university-based programs funded by Training Grants from the National Institutes of Health, then a high concentration of these skilled physicians in metropolitan locations, where there was an adequate patient-base for developing groups of refering physicians. Prior to WWII, there were many Asian physicians receiving their postgraduate training in the U.K. The number of foreign graduates coming to the U.S. Increased enormously with the opportunities that opened up in U.S. The first change in medical education that created a science-based professional came after the Flexner Report in 1910, sponsored by the Carnegie Endowment. Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath.The Report (also called Carnegie Foundation Bulletin Number Four) called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to the protocols of mainstream science in their teaching and research. Joseph Goldberger discovered the cause of pellagra in 1916.  When the 1918 influenza pandemic struck Washington, physicians from the then PHS laboratory were pressed into service treating patients in the District of Columbia because so many local doctors fell ill.

goldberger 1916 Pellagra


In 1930, the Ransdell Act changed the name of the Hygienic Laboratory to National Institute (singular) of Health (NIH) and authorized the establishment of fellowships for research into basic biological and medical problems. The roots of this act extended to 1918, when chemists who had worked with the Chemical Warfare Service in World War I sought to establish an institute in the private sector to apply fundamental knowledge in chemistry to problems of medicine. In 1926, after no philanthropic patron could be found to endow such an institute, the proponents joined with Louisiana Senator Joseph E. Ransdell to seek federal sponsorship. The truncated form in which the bill was finally enacted in 1930 reflected the harsh economic realities imposed by the Great Depression. Nonetheless, this legislation marked a change in the attitude of the U.S. scientific community toward public funding of medical research.

bengston_lg nurse in bacteriology lab of NIH


cholera_sm cholera epidemic of 19th century (Koch bacillus)


Vaccines and therapies to deal with tropical diseases were also critically important to the WWII war effort by the PHS. At the NIH’s Rocky Mountain Laboratory in Hamilton, Montana, yellow fever and typhus vaccines were prepared for military forces. In Bethesda as well as through grants to investigators at universities a synthetic substitute for quinine was sought to treat malaria.  Research in the Division of Chemotherapy revealed that sodium deficiency was the critical element leading to death after burns or traumatic shock. This led to the widespread use of oral saline therapy as a first-aid measure on the battlefield. NIH and military physiologists collaborated on research into problems related to high altitude flying. As the war drew to a close, PHS officials guided through Congress the 1944 Public Health Service Act, which defined the shape of medical research in the post-war world. Two provisions in particular had an impact on the NIH. First, in 1946 the successful grants program of the NCI was expanded to the entire NIH. From just over $4 million in 1947, the program grew to more than $100 million in 1957 and to $1 billion in 1974. The entire NIH budget expanded from $8 million in 1947 to more than $1 billion in 1966. Between 1955 and 1968. In this period, there was expansion of the NIH extramural budget, as well, and the grants dispursed were in support of developing the medical faculty of the future. It has nothing to do with then organization of the practice of medicine, but it has contributed much to the widespread quality of american medical education.

flowchart_sm NIH 1949


 As the cost of healthcare was increasing, mainly after the Korean and Vietnam War periods, there was a medically initiated concept of a National not-for-profit health maintenance organization (HMO), which would be modeled after the likes of Mayo Clinic, Cleveland Clinic, the Kaiser Permanente Plan, and Geisinger. But the insurance industry was already mature, and the hospitals were closely tied to Aetna, CIGNA, and Blue Cross Blue Shields, which had the actuarial pieces needed. Then an HMO industry emerged with a for-profit motive. As the U.S. Became enmesshed in two military engagements in Iraq and Afganistan for a full decade, there was a fierce competition between the need to support military requirements and the need to support the welfare of the community, with brilliant accelerated achievements that brought the Human Genome Project to a successful conclusion in 2003, and from that emerged advances in both clinical laboratory diagnostics and imaging, and which portends to continuing significant advances in treatments in cardiology, surgery, endocrinology, and cancer. In order to succeed, there has been a redesign or rearrangement of how these services are delivered, with a business model intended to – in time – bring down costs, and to also improve quality. Ironically, there is an insufficiency of primary care physicians, even considering internal medicine, pediatrics, obstetrics, and general surgery, as well as osteopathic physicians.

Part I. The Establishment, Structure, and Nature of the Accountable Care Act (ACA)

Part II. The Implementation of the ACA, Impact on Physicians and Patients, and the Dis-Ease of the Accountable Care

Failure to Launch? The Independent Payment Advisory Board’s Uncertain Prospects

Jonathan Oberlander, Ph.D., and Marisa Morrison, B.A.
N Engl J Med 2013; 369:105-107July 11, 2013 http://dx.doi.org/10.1056/NEJMp1306051

The Affordable Care Act (ACA) established the IPAB as a 15-member, nonelected board. Among other duties, the IPAB is empowered to recommend changes to Medicare if projected per-beneficiary spending growth exceeds specified targets. If Congress does not enact legislation containing those proposals or alternative policies that achieve the same savings, the IPAB’s recommendations are to be implemented by the secretary of health and human services. President Obama has proposed strengthening the board’s role by lowering the Medicare spending targets that would trigger IPAB action.

Because the board is prohibited by law from making recommendations that raise revenues, increase cost sharing of Medicare beneficiaries, or restrict benefits and eligibility, it is expected to focus on savings from medical providers. In January 2013, the GOP adopted a House rule declaring that the IPAB “shall not apply” in the current Congress, thereby rejecting the special procedures that the ACA had established for congressional consideration of IPAB recommendations.

On April 30, the chief actuary of the Centers for Medicare and Medicaid Services released a report projecting Medicare spending growth during 2011–2015. According to the report, per-person Medicare spending will grow at an average rate of 1.15% during that period, far below the target growth rate set by the ACA — the average of the Consumer Price Index (CPI) and the Medical CPI (see graph).

8443-exhibit-2-3 increase in medicaid_CHIP all states expanding medicaid50-Graph-4-33_2012 Hospitalization Rates for Heart Failure, Ages 45–64 and 65 and Older, U.S., 1971–2010

8443-exhibit-2-7 nonelderly population uninsured52-Graph-4-35_2012 Total Economic Costs of the Leading Diagnostic Groups, U.S., 2009


Projected Growth in Medicare Per Capita Spending, the Consumer Price Index (CPI), and the Medical CPI, 2011–2015.

       healthprices time price of HC over 50 yearsjournal.pmed.0020133.g001 Global Mortality and Burden of Disease Attributable to Cardiovascular Diseases and Their Major Risk Factors for People 30 y of Age and Older

NHEbyDCforHS1 NHE annual growth rate of 4%      percentageincreasekff % increase in HI premiums

journal.pmed.0020133.t001 Risk and Socioeconomic Variables Used in the Analysis     T1.large uninsured by health and disability by region 2000-2005

T3.large uninsured by medicaid eligibility        T5 Characteristics Of Insurance, By Insurance Adequacy, Among Insured Adults Ages 19–64, 2007

The rate of increase in Medicare expenditures per enrollee has slowed since 2006, and because Medicare spending growth has moderated, the IPAB will be irrelevant to cost containment. 3 years after the ACA’s enactment, the IPAB still has no members. If no members are appointed, the power to recommend changes to Medicare when spending targets are exceeded does not disappear: it reverts to the secretary of health and human services.

The board’s appeal lies largely in its aspiration to remove politics from Medicare — to create a policymaking process that is informed by experts and insulated from pressures outside their professional overview. If Medicare spending growth accelerates, the IPAB’s role could expand. But that future is uncertain.


The Road Ahead for the Affordable Care Act

John E. McDonough, Dr.P.H.
N Engl J Med 2012; 367:199-201 http://dx.doi.org/10.1056/NEJMp1206845

The Affordable Care Act (ACA), the U.S. health care reform law enacted in 2010, was upheld as constitutional by the U.S. Supreme Court on June 28, 2012. As a result of the Court’s ruling –

  • the individual responsibility requirement (the individual mandate to obtain insurance coverage),
  • insurance reforms such as the elimination of coverage exclusions for preexisting conditions,
  • the establishment of state health insurance exchanges, and
  • the provision of private health insurance subsidies

stand unaltered despite the Court-ordered switch in the basis for constitutional legitimacy from the Commerce Clause to Congress’s taxing authority.

One consequential outcome of the ruling is the continuing benefit, and harm averted, for millions of Americans from ACA provisions that have already been implemented. Those benefiting include more than 6 million young adults enrolled in their parents’ insurance plans, 5.2 million Medicare enrollees who have saved on prescription-drug costs because of the shrinking Part D “doughnut hole,” 600,000 new adult Medicaid enrollees in seven states that have already expanded Medicaid eligibility, 12.8 million consumers who will receive more than $1 billion in insurance-premium rebates, and many others.

Also undisturbed are the ACA’s numerous system reforms, such as accountable care organizations, patient-centered medical homes, the Prevention and Public Health Fund, and the Patient-Centered Outcomes Research Institute. Since the ACA’s passage, health system innovation has surged — a dynamic that would have been undermined by a negative Court ruling.

The biggest change involves Medicaid. The ACA required that Medicaid serve nearly all legal residents with incomes below 138% of the federal poverty level. As a result, there is a new inequity in the health system: by 2014, all Americans will have guaranteed access to affordable health insurance except adults with incomes below the poverty level who were previously ineligible for Medicaid (those with incomes between 100 and 138% of the poverty level will be allowed to obtain coverage through insurance exchanges). States have strong economic incentives to expand Medicaid, since the federal government will pay 100% of expansion costs between 2014 and 2016. By 2020, the federal share will drop to no less than 90% — much more generous than the 50 to 83% that the federal government contributes for traditional Medicaid and the Children’s Health Insurance Plan.

The current implementation queue includes writing definitions and rules for private health insurance markets, clarifying rules for determining required “essential health benefits,” explaining how employer-responsibility provisions will be devised, and much more. The ACA is the first U.S. law to attempt comprehensive reform touching nearly every aspect of our health system. The law addresses far more than coverage, including health system quality and efficiency, prevention and wellness, the health care workforce, fraud and abuse, long-term care, biopharmaceuticals, elder abuse and neglect, the Indian Health Service, and other matters.

Encouraging competition among health plans, even if one of them is “public,” will also fail to solve the cost problem. With the exception of highly integrated organizations, such as Kaiser Permanente, health plans have only two tools to control costs: financial disincentives for patients and fee reductions for providers. Acceptable out-of-pocket maximums, however, vitiate economic incentives to restrain use, particularly for expensive care such as inpatient care. Unable to alter provider behavior, health plans primarily try to avoid enrolling people who are likely to need costly care.

Budget Sequestration and the U.S. Health Sector

McDonough J.E.N Engl J Med 2013; 368:1269-1271 http://dx.doi.org/10.1056/NEJMp1303266

In August 2011, in an agreement to raise the nation’s debt ceiling, bipartisan majorities in the House and Senate approved the Budget Control Act of 2011 (BCA) to reduce the deficit by $1.2 trillion between 2013 and 2021. The BCA established a threat of across-the-board cuts, or “sequestration,” if the Joint Select Committee on Deficit Reduction failed to approve, and Congress to enact, alternative reductions. Sequestration became operational on March 1. Of the $1.2 trillion in cuts, $216 billion will be reductions in debt-service payments, and the remaining $984 billion will be split evenly over 9 years at $109 billion per year, and further adjusted and split evenly between cuts to national defense and nondefense functions at $42.667 billion each.

T2.large Adults Ages 19–64 Who Were Uninsured And Underinsured, By Various Characteristics, 2003 And 2007   T3.large uninsured by medicaid eligibility

The $42.667 billion per year in nondefense cuts will not fall equally on all health-related government programs. Nonexempt and nondefense discretionary funding faces reductions of 7.6 to 8.2% in this fiscal year; certain programs such as Medicare and community health centers will have 2% reductions; and certain programs such as Medicaid and the Veterans Health Administration are exempt.

nejmp1303266_t1 Impact of Budget Sequestration on Key Federal Health and Safety Programs,

Impact of Budget Sequestration on Key Federal Health and Safety Programs, Fiscal Year 2013.


Medicare funding will be cut by 2% ($11.08 billion) through reductions in payments to hospitals, physicians, and other health care providers, as well as insurers participating in Medicare Advantage (Part C). The BCA prohibits cuts affecting premiums for Medicare Parts B and D, cost sharing, Part D subsidies, and Part A trust-fund revenues. The sequestration cuts arrive just as Medicare is beginning to fully implement the savings and cuts required by the Affordable Care Act (ACA), which the Congressional Budget Office estimates will slow Medicare’s rate of growth by $716 billion between 2013 and 2022. The National Institutes of Health (NIH) faces an 8.2% across-the-board reduction for the 7 months remaining in fiscal 2013, equaling cuts of $1.55 billion.

The Centers for Disease Control and Prevention (CDC), which is still recovering from major budget reductions in 2011, anticipates effective reductions of 8 to 10% for the remainder of the year. The American Public Health Association has projected that the reductions could result in 424,000 fewer HIV tests (the CDC funded 3.26 million in 2010) and 50,000 fewer immunizations for adults and children (from a baseline of about 300 million), elimination of tuberculosis programs in 11 states, and shutting down of the National Healthcare Safety Network.

Unaffected for all 9 years of the sequester are most expenses associated with the ACA. Medicaid is exempt, as is funding for its expansion, beginning next January, to all lower-income Americans in states that choose to participate. Also exempt are private insurance subsidies that will be available next January through new health insurance exchanges, because they were designed as refundable tax credits, another BCA-exempt category. Finally, the Children’s Health Insurance Plan, the Supplemental Nutrition Assistance Program, Temporary Assistance to Needy Families, and Supplemental Security Income are all exempt.

Threading the Needle ‹ Medicaid and the 113th Congress

fs310_graph3 leading causes of death by income class worldwideFUSA_INFOGRAPHIC_50-state-medicaid-expansion_rev_06-27-13_FACEBOOKCOVER

Rosenbaum S.N Engl J Med 2012; 367:2368-2369 http://dx.doi.org/10.1056/NEJMp1213901

Medicaid is a veteran of decades of warfare over its size and cost. Nevertheless, the program now plays a vital role in the U.S. health care system and a foundational role in health care reform. The central question, as we approach a major debate over U.S. spending and federal deficits, is how to preserve this role and shield Medicaid from crippling spending reductions. The Budget Control Act, which provides the initial framework for this debate, insulates Medicaid from sequestration. Budgetary protections for Medicaid date to the 1980s, but today’s politics are less tolerant of programs for poor and vulnerable populations. Medicaid is also at a deep political disadvantage. Medicaid is unequaled among federal grant programs: more than 60 million children and adults rely on the program, and it’s projected to grow to 80 million beneficiaries by 2020 if all states adopt the eligibility expansion in the Affordable Care Act (ACA). Medicaid’s cost is driven by high enrollment, not excessive per capita spending.2 As a result, there’s very little money to wring out of Medicaid without shaking its structure in ways that reduce basic coverage. Medicaid is part of the base on which health care reform rests; if it is not expanded per the ACA, the nation will lose its chance at near-universal health insurance coverage, which is essential to achieving systemwide savings and halting a $50 billion annual cost shift to insurers and patients. Deep federal spending reductions could lead states to abandon Medicaid expansion as a result of a confluence of factors —

  • the still-fragile nature of many state economies,
  • the continuing ideological opposition to Medicaid expansion, and
  • the Supreme Court decision to permit states to opt out of such expansion altogether.

Considerable evidence shows its effectiveness: most recently, a study by Sommers et al. documented its positive effects on health and health care. Experts in Medicaid spending also acknowledge the program’s operational efficiencies, achieved by states through the aggressive use of managed care and strict controls on spending for long-term care. Much of the health care that Medicaid beneficiaries receive is furnished through safety-net providers such as community health centers, which are highly efficient and accustomed to operating on tight budgets with only limited access to costly specialty care. Furthermore, Medicaid’s physician payments are substantially lower than those from commercial insurers and Medicare — a disparity that unfortunately limits provider participation even as it helps to keep per capita spending low. Indeed, the CBO has found that insuring the poor through Medicaid will cost 50% less per capita than doing so through tax-subsidized private insurance plans offered through state health insurance exchanges.

nejmp1306051_f1 Projected Growth in Medicare Per Capita Spending, the Consumer Price Index (CPI), and the Medical CPI, 2011–2015

The essential task is to thread the needle by accelerating efficiency reforms in health care payment and organization that, in turn, can generate savings over time while not damaging Medicaid’s role as a pillar of health care reform. Of particular importance is a heightened focus, begun under the ACA, on reforms that emphasize community care for millions of severely disabled children and adults, including patients who are dually enrolled in Medicare and Medicaid and who rely heavily on long-term institutional care.

The Shortfalls of ‘Obamacare’

Wilensky G.R. N Engl J Med 2012; 367:1479-1481 http://dx.doi.org/10.1056/NEJMp1210763

U.S. health care suffers from three major problems: millions of people go without insurance, health care costs are rising at unaffordable rates, and the quality of care is not what it should be. The Affordable Care Act (ACA) primarily addresses the first — and easiest — of these problems by expanding coverage to a substantial number of the uninsured. Solutions to the other two remain aspirations. The ACA’s primary accomplishment is that approximately 30 million previously uninsured people may end up with coverage — about half with subsidized private coverage purchased in the mostly yet-to-be-formed state insurance exchanges and the other half through Medicaid expansions. The law’s most controversial provision remains the individual mandate, which requires people either to have insurance coverage or to pay a penalty. The penalty for not having insurance is very small, particularly for younger people with modest incomes. It would have been smarter to mimic Medicare’s policies: seniors who don’t purchase the voluntary parts of Medicare covering physician services and outpatient prescription drugs during the first year in which they lack comparable coverage must pay a penalty for every month they have gone without coverage whenever they finally do purchase it.

Despite widespread recognition that fee-for-service reimbursement rewards providers for the quantity and complexity of services and encourages fragmentation in care delivery, the ACA retains all the predominantly fee-for-service reimbursement strategies currently used in Medicare. Much of the coverage expansion is financed through Medicare budget savings, which are produced by reducing the fees paid by Medicare to institutional providers such as hospitals, home care agencies, and nursing homes — but using the same perverse reimbursement system currently in place. Reducing payments to institutional providers should not be confused with lowering the cost of providing care.

The ACA also provides Medicare “productivity adjustments,” which assume that inflation adjustments can be reduced over time because institutions will become more productive, whether or not hospitals and other providers actually find ways to increase their productivity. Unless these institutions find ways to reduce costs, lower Medicare reimbursements will force providers to bargain for higher payments from private insurers. And eventually, seniors’ access to services will be threatened. The Medicare actuary expects that 15% of institutional providers will lose money on their Medicare business by 2019, and the proportion will increase to 25% by 2030 — a situation that he calls unsustainable

Most troubling, the ACA contains no reform of the way physicians are paid, which is the most dysfunctional part of the Medicare program. Through the Resource-Based Relative Value Scale, physicians are reimbursed on the basis of service codes, and payment for each physician service is reduced whenever aggregate spending on physician services exceeds a prespecified limit. This system disregards whether clinicians are providing low-cost, high-value care for patients. Given physicians’ key role in providing patient care, it’s impossible to imagine a reformed delivery system without one that rewards them for providing clinically appropriate care efficiently.

What is needed are reforms that create clear financial incentives that promote value over volume, with active engagement by both consumers and the health care sector. Market-friendly reforms require empowering individuals, armed with good information and nondistorting subsidies, to choose the type of Medicare delivery system they want. Being market-friendly means allowing seniors to buy more expensive plans if they wish, by paying the extra cost out of pocket, or to buy coverage in health plans with more tightly structured delivery systems at lower prices if that’s what suits them. 

Financing Graduate Medical Education — Mounting Pressure for Reform

John K. Iglehart N Engl J Med 2012; 366:1562-1563 http:dx.doi.org/10.1056/NEJMp1114236

Disparate voices from the White House, a national fiscal commission, Congress, a Medicare advisory body, private foundations, and academic medical leaders are advocating changes to Medicare’s investment in graduate medical education (GME), which currently totals $9.5 billion annually. They offer various prescriptions, including reducing federal support, developing new achievement measures for which GME programs should be held accountable, and seeking independent assessment of the governance and financing of training programs.

The influential GME community has withstood most past efforts to change Medicare’s GME policies. But recognizing today’s more challenging political environment, the Association of American Medical Colleges (AAMC) has begun discussing alternative methods of financing GME that could better align training with the future health care delivery system and address U.S. workforce needs. The association is also examining the influence of student debt on the enrollment of a diverse student body.

When Congress enacted Medicare in 1965, it assigned to the program functions that reached well beyond its mission of financing health care for the elderly. One function was supporting GME, at least until the society at large undertook “to bear such education costs in some other way.” Almost 50 years later, Medicare remains the largest supporter of GME, providing both direct payments to hospitals that cover medical education expenses related to the care of Medicare patients (about $3 billion per year) and an indirect medical education (IME) adjustment to teaching hospitals for the added patient-care costs associated with training (about $6.5 billion).

In its 2013 budget, unveiled on February 13, 2012, the Obama administration proposed reducing Medicare’s IME adjustment by $9.7 billion over 10 years, beginning in 2014, citing a report from the Medicare Payment Advisory Commission (MedPAC) indicating that Medicare’s IME adjustments “significantly exceed the actual added patient care costs these hospitals incur.” The administration also proposed that the secretary of health and human services be granted the authority to assess GME programs’ performance in instilling in residents the necessary skills to promote high-quality health care. Similarly, MedPAC had recommended redirecting about half the IME adjustments ($3.5 billion) into “incentive payments” that GME programs could earn by meeting performance standards. The Obama budget would also eliminate coverage of the IME expenses of free-standing children’s hospitals with pediatric residency programs — which do not treat Medicare patients — reducing their federal support by 66% (to $88 million). Moreover, Congress has revealed its uncertainty over how to change federal workforce policy. In the Affordable Care Act (ACA), Congress emphasized the importance of expanding the primary care workforce. But legislators rejected the AAMC’s call to expand the number of Medicare-funded GME positions by 15% in response to reported physician shortages in some specialties.

On December 21, seven senators — Democrats Michael Bennet (CO), Jeff Bingaman (NM), Mark Udall (CO), and Tom Udall (NM) and Republicans Mike Crapo (ID), Chuck Grassley (IA), and Jon Kyl (AZ) — sent a letter to the Institute of Medicine (IOM) encouraging it to “conduct an independent review of the governance and financing of our system of [GME].” They urged the IOM to explore subjects including accreditation; reimbursement policy; the use of GME to better predict and ensure adequate workforce supply in terms of type of provider, specialty, and demographic mix; GME’s role in care of the underserved; and use of GME to ensure the creation of a workforce with the skills necessary for addressing future health care needs. The senators emphasized their interest “in IOM’s observations about the uneven distribution of GME funding across states based on need and capacity, and how to address this inequity.” In an interview, Bingaman said he initiated the letter for the same reasons he had championed creation of a National Health Care Workforce Commission as part of the ACA: to strengthen the government’s resolve to do “a more credible job of assessing workforce shortages” and because he believes Medicare’s GME policies are “outmoded.”

The priorities cited in the IOM letter parallel some of the recommendations of a group of academic medical leaders who gathered at two conferences underwritten by the Josiah Macy Jr. Foundation. At the first conference, in October 2010, the top recommendation was that “an independent external review of the goals, governance, and financing of the GME system should be undertaken by the Institute of Medicine, or a similar body.”3 George Thibault, president of the Macy Foundation, says the group concluded that “because GME is a public good and is significantly financed with public dollars, the GME system must be accountable to the needs of the public.” Acknowledging that some people in academic medicine “favor a behind-the-scenes discussion of GME reform alternatives,” Thibault noted, “I believe we should be upfront, providing examples of change that could influence the thinking of policymakers.” The foundation awarded the IOM $750,000 — about half the support it needs for the GME study.

Among subjects under discussion are the collection of more data highlighting the importance of the safety-net functions and unique services of academic medical centers and the creation of a long-term vision for GME financing that is more closely aligned with emerging care delivery models, such as accountable care organizations. The association is also revisiting a potential financial model under which all health care payers would explicitly cover GME expenses. Private insurers maintain that they accomplish this implicitly by paying teaching hospitals more for clinical services than they pay most other hospitals. GME leaders think one possibility would be to include the costs of residency training when calculating premium amounts for products sold through health insurance exchanges. Similarly, a recent Carnegie Foundation report asserted that “GME redesign demands . . . a more broad-based, less politicized flow of funds.”

Dr. Darrell Kirch noted, CEO of AAMC, “A significant step forward is the announcement by the ACGME [Accreditation Council for Graduate Medical Education] describing major changes in how the nation’s residency programs will be accredited in the future, putting in place an outcomes-based evaluation system by which new physicians will be measured for their competency in performing the essential tasks necessary for clinical practice in the 21st century.”

Achieving Health Care Reform — How Physicians Can Help

Elliott S. Fisher, M.D., M.P.H., Donald M. Berwick, M.D., M.P.P., and Karen Davis, Ph.D.
N Engl J Med 2009; 360:2495-2497 http://dx.doi.org/10.1056/NEJMp0903923

The recent commitment by several major stakeholders — including the American Medical Association — to slowing the growth of health care spending is a promising development. But the controversy about whether the organizations actually agreed to a 1.5-percentage-point reduction in annual spending growth is just one indication that success is still far from assured.

Two threats in particular put reform at risk: conflicting doctrines (regarding the creation of a new public insurance option and government support for comparative-effectiveness studies) and opposition to change among some current stakeholders. In the face of this uncertainty, physicians have a choice: to wait and see what happens or to lead the change our country needs. We’d prefer the latter.

The first level is aims. For health care reform, we propose that physicians, through their advocacy, help lead the country to embrace the so-called triple aim: better experience of care (safe, effective, patient-centered, timely, efficient, and equitable), better health for the population, and lower total per capita costs.

The second level is the design of the care processes that affect the patient — clinical “microsystems.” Health care microsystems are famously unreliable, variable in costs, and often unsafe. Physicians, through their participation in quality-improvement initiatives in their practices and hospitals, can and should lead the needed changes in the systems of care in which they work, to make them safer, more reliable, more patient-centered, and more affordable.

However, neither physicians nor anyone else on the front lines can improve care much on their own. Their most important source of support for improvement is the third level described by the IOM — the health care organizations that house almost all clinical microsystems and can ensure coordination among them. We need organizations large enough to be accountable for the full continuum of patients’ care as well as for achieving the triple aim. We will create a high-performing health care system only if integrated delivery systems become the mainstay of organizational design. Organizations could be virtually integrated, such as networks of independent physicians sharing electronic health records and administrative and clinical support for care management and quality improvement, or structurally integrated, such as multispecialty group practices or staff-model health maintenance organizations. Fostering the development of such accountable care organizations need not be disruptive to patients or providers: almost all physicians already work within natural referral networks that provide the vast majority of care to patients seen by the primary care physicians within the network.


The IOM’s fourth level is the environment, which includes the payment, regulatory, legal, and educational systems. On this front, too, we need physician advocacy. The United States cannot achieve the triple aim without health insurance for everyone. Integrated delivery systems that are accountable for populations won’t thrive unless payment systems encourage their development and unless we change the laws and regulations — including proscriptions of gainsharing and anti-kickback rules — that prevent cooperation among health care professionals and organizations.

If stakeholders can agree on such a vision of health care reform, perhaps we could shift our focus from the conflict over whether a new public plan should be created to a more constructive insistence that all health plans, whether public or private, focus on the development of professionally led, integrated systems.

If health care providers and suppliers could actually achieve this reduction in growth rates, the federal government would harvest about $1.1 trillion in savings over the 11-year period — enough, perhaps, to close the deal on affordable health insurance for all. Others would also see savings: $497 billion for employers, $529 billion for state and local governments, and $671 billion for households. One simple way for physicians to start contributing to this goal is by reassessing and scaling back, where appropriate, their use of clinical practices now listed as “overused” by the National Quality Forum’s National Priorities Partnership.

Editor-in-Chief Eric J. Topol, MD, interviews Secretary of Health and Human Services (HHS) Kathleen Sebelius


Editor’s Note: On the eve of the first anniversary of the Supreme Court’s ruling to uphold most provisions of the Affordable Care Act (ACA), Medscape Editor-in-Chief Eric J. Topol, MD, questioned Secretary of Health and Human Services (HHS) Kathleen Sebelius about the act’s effect on medical technology, clinical trial participation, genetic testing, primary care, and patient safety.


Dr. Topol: We are experiencing a digital revolution in which technological advances are putting healthcare where it should be: in the hands of patients. How is the ACA helping to foster medical innovation?
Secretary Sebelius: A recent New York Times column, “Obamacare’s Other Surprise,”[1] by Thomas L. Friedman, echoes what we’ve been hearing from healthcare providers and innovators: Data that support medical decision-making and collaboration, dovetailing with new tools in the Affordable Care Act, are spurring the innovation necessary to deliver improved healthcare for more people at affordable prices.
Today we are focused on driving a smarter healthcare system with an emphasis on the quality — not quantity — of care. The healthcare law includes many tools to increase transparency, avoid costly mistakes and hospital readmissions, keep patients healthy, and test new payment and care delivery models, like Accountable Care Organizations (ACOs). Health information technology is a critical underpinning to this larger strategy.
In May we reached an important milestone in the adoption of health information technology. More than half of all doctors and other eligible providers, and nearly 80% of hospitals, are using electronic health records (EHRs) to improve care, an increase of at least 200% since 2008. Also in May, we announced a $1 billion challenge to help jump-start innovative projects that test creative ways to deliver high-quality medical care and lower costs to people enrolled in Medicare and Medicaid, following 81 Health Care Innovation Awards that HHS awarded last year.
Dr. Topol: Physicians have long lamented the lack of participation by patients in clinical trials, but the ACA is opening the door for greater participation by allowing patients to keep their health insurance while participating in clinical research. Are patients even aware that this provision now exists? How do you see it affecting clinical trial participation in the future?
Secretary Sebelius: In 2014, thanks to the ACA, insurance companies will no longer be able to deny patients from participating in an approved clinical trial for treatment of cancer or another life-threatening disease or condition, nor can they deny or limit the coverage of routine patient costs for items or services in connection with trial participation. For many patients, access to cutting-edge medicine available through clinical trials can increase their likelihood of survival. This is an important protection for patients that not only could have a life-altering impact, but it’s also one that serves to facilitate participation in research that is critical to expanding our knowledge base and finding cures and treatments for those illnesses that threaten the lives of Americans each day.
Dr. Topol: One of the intentions of the ACA is to increase the primary care workforce. This is critical as we approach 2014, when more Americans than ever will have either private insurance or Medicaid. Have you seen any movement in the primary care workforce? Are there concerns that there aren’t enough clinicians available to meet the forthcoming patient load?
Secretary Sebelius: Primary care providers are critical to ensuring better coordinated care and better health outcomes for all Americans. To meet the health needs of Americans, the Obama Administration has made the recruitment, training, and retention of primary care professionals a top priority.
Together, the ACA, the American Recovery and Reinvestment Act of 2009, and ongoing federal investments in the healthcare workforce have led to significant progress in training new primary care providers — such as physicians, nurse practitioners, and physician assistants — and encouraging primary care providers to practice in underserved areas, including:
Nearly tripling the National Health Service Corps;
Increasing the number of medical residents, nurse practitioners, and physician assistants trained in primary care, including placing over 1500 new primary care providers in underserved areas;
Creating primary care payment incentives for providers; and Redistributing unused residency positions and directing those slots for the training of primary care physicians.
Additionally, the ACA is modernizing the primary care training infrastructure, creating new primary care clinical training opportunities, supporting primary care practice, and improving payment and financial incentives for coordinated care.
Improving Hospital Safety
Dr. Topol: George Orwell once said that the hospital is the antechamber to the tomb. That was written decades ago, and unfortunately there’s still truth to that today. One in 4 hospital patients in America have a problem with medical mistakes, contract hospital-acquired infections, and experience medication errors. The ACA last year began linking Medicare payments to quality of patient care, offering financial incentives to hospitals that improve patient care. How is this working? Have there been any meaningful care improvements over the past year?
Secretary Sebelius: The ACA includes steps to improve the quality of healthcare and, in so doing, lowers costs for taxpayers and patients. This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and creating the health information technology infrastructure that enables new payment and delivery models to work. These reforms and investments will build a healthcare system that will ensure quality care for generations to come.
Already we have made significant progress:
Healthcare Spending Is Slowing
Secretary Sebelius: Medicare spending per beneficiary grew just 0.4% per capita in fiscal year 2012, continuing the pattern of very low growth in 2010 and 2011. Medicaid spending per beneficiary also decreased 0.9% in 2011, compared with 0.6% growth in 2010. Average annual increases in family premiums for employer-sponsored insurance were 6.2% from 2004 to 2008, 5.6% from 2009 to 2012, and 4.5% in 2012 alone.
Health Outcomes Are Improving and Adverse Events Are Decreasing
Secretary Sebelius: Several programs tie Medicare reimbursement for hospitals to their readmission rates, when patients have to come back into the hospital within 30 days of being discharged. Additionally, as part of a new ACA initiative, clinicians at some hospitals have reduced their early elective deliveries to close to zero, meaning fewer at-risk newborns and fewer admissions to the NICU.
Providers Are Engaged
Secretary Sebelius: In 2012, we debuted the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model. These programs encourage providers to invest in redesigning care for higher-quality and more efficient service delivery, without restricting patients’ freedom to go to the Medicare provider of their choice.
Over 250 organizations are participating in Medicare ACOs, serving approximately 4 million, or 8%, of Medicare beneficiaries. As existing ACOs choose to add providers and as more organizations join the program, participation in ACOs is expected to grow. ACOs are estimated to save up to $940 million in the first 4 years.
Bundle with Care ‹ Rethinking Medicare Incentives for Post­Acute Care Services

Feder J. N Engl J Med 2013; 369:400-401

A Medicare payment approach in which savings and risk are shared may achieve a better balance of cost, quality, and access than a system of single bundled payments, at least until our capacity to measure patients’ care needs and outcomes is sufficiently robust.

Healthcare Reform 2014: Mandated Coverage, Insurance Exchanges, and Employer Requirements

3 of 5 in Series: The Essentials of Healthcare Reform

The Affordable Care Act federal and state officials are working with leaders in the health and insurance industries to restructure our nation’s healthcare system. That restructuring means most Americans will be required to have health insurance and most businesses will be required to offer it to their employees. It also means the creation of another kind of insurance plan called a health insurance exchange.

The government will require most Americans to have health insurance by 2014. The government has enacted this provision as a way to get healthy people who don’t feel the need to pay for coverage to buy insurance. That way, the healthy people can help fund the cost of people who require more medical care.

Several states filed, and lost, a suit against the federal government saying that it is unconstitutional to make individual citizens to buy health insurance.

If you don’t have coverage and you’re not in one of the groups that is an exception to the rule, you’ll pay a penalty. You may not be required to purchase health insurance if you

  • Face financial hardships.
  • Have been uninsured for less than three months.
  • Have religious objections.
  • Are American Indian.
  • Are a prison inmate.
  • Are an undocumented immigrant.

If you’re penalized, the amount you’ll be fined will go up each year for the first three years. In 2014, you’ll pay $95 or 1 percent of your taxable income, whichever is greater. In 2015, the fine will be $325 or 2 percent of taxable income, and in 2016 the penalty will be $695 or 2.5 percent of income. Each year after 2016, the government will refigure the fine based on a cost-of-living adjustment.

To help you meet the cost of mandated insurance, the government will offer premium credits and cost sharing subsidies if you and your family meet certain income guidelines and if you enroll in one of the new state-run insurance exchanges.

If your income falls between 133 and 400 percent of the federal poverty level (FPL), you could receive premium credits that will lower the maximum amount of premium you have to pay for your coverage.

  • There will be a catastrophic plan for people under 30 and for those who are exempt from mandated coverage.

States don’t have to set up the exchanges. If a state chooses not to, the federal government can come in and create them. States that do opt for exchanges will decide whether they’ll be run by a government or not-for-profit entity.

Health Care Reform — Why So Much Talk and So Little Action?

Victor R. Fuchs, Ph.D
N Engl J Med 2009; 360:208-209 http://dx.doi.org/10.1056/NEJMp0809733

First, many organizations and individuals prefer the status quo. This category includes health insurance companies; manufacturers of drugs, medical devices, and medical equipment; companies that employ mostly young, healthy workers and therefore have lower health care costs than they would if required to help subsidize care for the poor and the sick; high-income employees, whose health insurance is heavily subsidized through a tax exemption for the portion of their compensation spent on health insurance; business leaders and others who are ideologically opposed to a larger role of government; highly paid physicians in some surgical and medical specialties; and workers who mistakenly believe that their employment-based insurance is a gift from their employer rather than an offset to their potential take-home pay.

Second, as Niccoló Machiavelli presciently wrote in 1513, “There is nothing more difficult to manage, more dubious to accomplish, nor more doubtful of success . . . than to initiate a new order of things. The reformer has enemies in all those who profit from the old order and only lukewarm defenders in all those who would profit from the new order.”

Third, our country’s political system renders Machiavelli’s Law of Reform particularly relevant in the United States, where many potential “choke points” offer opportunities to stifle change. The problem starts in the primary elections in so-called safe congressional districts, where special-interest money can exert a great deal of influence because of low voter turnout. The fact that Congress has two houses increases the difficulty of passing complex legislation, especially when several committees may claim jurisdiction over portions of a bill. Also, a supermajority of 60% may be needed to force a vote in the filibuster-prone Senate.

Fourth, reformers have failed to unite behind a single approach. Disagreement among reformers has been a major obstacle to substantial reform since early in the last century. According to historian Daniel Hirshfield, “Some saw health insurance primarily as an educational and public health measure, while others argued that it was an economic device to precipitate a needed reorganization of medical practice. . . . Some saw it as a device to save money for all concerned, while others felt sure that it would increase expenditures significantly.” These differences in objectives persist to this day.

Health insurers are opening stores alongside department stores, other typical mall tenants.

Jayne O’Donnell , USA TODAY

,The new health law known as the Affordable Care Act means most uninsured Americans are required to have insurance beginning March 31 or pay a penalty at tax time in 2015.

Insurers need to sign up as many healthy, younger people as they can to pay for all of the older, sick customers they will be taking on. The law prohibits insurers from denying people insurance because of pre-existing health problems and limits how much more they can charge older than younger people.

So, for the first time, insurers are fiercely competing to attract individual consumers and turning to traditional retail marketing techniques to do so, luring them into stores with special events and using splashy advertising. As any retailer knows, they have the greatest chance of converting shoppers to customers once they have them in their retail locations or on their sites.

The Medical Breakthrough Nobody’s Talking About

Toby CosgroveCEO and President at Cleveland Clinic


The latest medical breakthrough hasn’t gotten much press, but it’s changing medicine even as we speak. It’s the dawning realization that healthcare is not about how many patients you can see, how many tests and procedures you can order, or how much you can charge for these things. The breakthrough is the understanding that healthcare is a value proposition, which means getting patients the right care, at the right time, in the right place. It’s a matter of focusing on outcomes and cost, so that more Americans will start getting what they pay for in healthcare dollars.

Value-based care focuses on two targets: outcomes and cost. Until recently, providers pursued these goals separately, with doctors concentrating on outcomes and the administrators trying to control costs. Value-based care does something different. It works to bring these targets into alignment. The caregivers in a value-based provider work with cost-experts as a team to simultaneously improve outcomes and lower expenses.

Doctors, hospitals and payers are partners in the move to value-based care. The Affordable Care Act includes incentives for providers to improve outcomes and lower costs. But this is one breakthrough that will take time for implementation nationwide. Providers who make the transition early will be rewarded with more satisfied patients, lower expenses and pride in a job well done.

Six-Month Enforcement Delay After Guidance

According to AAMC, the language in the final rule requires that the order to admit a patient be written by a practitioner “who has admitting privileges at the hospital,” something that few residents have as they are not considered members of the hospital’s medical staff.

AAMC said it brought the issue to CMS’s attention during an Open Door Forum call Aug. 15. The agency acknowledged it did not intend to prohibit residents from admitting patients, and said it would be issuing a Q&A. However, AAMC said until the issue can be resolved “to the satisfaction of the teaching hospital community,” CMS should make clear to all contractors that no inpatient admission should be denied because it was ordered by a resident while under the supervision of an attending physician.

AAMC said CMS should delay enforcing the new requirements for at least six months following the release of the guidance so hospitals will have sufficient time to understand the rules, educate physicians and others, and ensure that they have put in place the mechanisms that are needed to comply with the new requirements.

“As short inpatient stays have been a focus of audits by [Recovery Audit Contractors], hospitals feel especially at risk for failure to properly implement CMS requirements,” AAMC said.

The letter is available at http://op.bna.com/hl.nsf/r?Open=nwel-9auqls.

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