Scientists identifies new genetic changes that increase risk of developing Hodgkin lymphoma

December 1, 2017

People who inherit genetic changes which alter the function of their immune system are at increased risk of developing Hodgkin lymphoma, a major new study reports.

Scientists at The Institute of Cancer Research, London, identified six new genetic changes that increase the risk of developing Hodgkin lymphoma – one of the most common cancers in young adults.

Many of the DNA changes seemed to affect the function of the immune system, and three had previously been associated with autoimmune diseases such as multiple sclerosis, rheumatoid arthritis or lupus.

The researchers stressed that the link did not mean people with autoimmune diseases are at increased risk of lymphoma, but did offer important genetic clues for understanding both lymphoma and autoimmune diseases better.

One of the genetic changes discovered increases the risk of Hodgkin lymphoma by more than a third and others by at least 15 percent each – information that could point to new targeted drugs for the disease.

The study was published today (Friday) in Nature Communications and was funded by a wide range of organizations including Bloodwise, Cancer Research UK and the Lymphoma Research Trust.

Scientists at The Institute of Cancer Research (ICR) analyzed genetic data from 5,314 cases of Hodgkin lymphoma and 16,749 controls, from four different European studies.

The study is the largest of its kind for Hodgkin lymphoma. For most people, Hodgkin lymphoma can be successfully treated with first-line therapies – but there is a need for new treatments for those for whom first line treatment has failed.

The researchers identified six new single-letter changes in DNA that were linked to the development of Hodgkin lymphoma – and five of these affect the way a type of white blood cell, called B cells, develop.

Hodgkin lymphoma is a cancer of the B cells – which are responsible for producing antibodies as a critical component of the immune system.

The study also picked out clear differences in genetic risk between two different subtypes of Hodgkin Lymphoma – nodular sclerosis Hodgkin Lymphoma (NSHL) and mixed cellularity Hodgkin Lymphoma (MCHL).

For example, a single-letter change located in DNA near the gene LPP increased the risk of NSHL by 37 per cent, but had little effect on the risk of developing MCHL.

Professor Richard Houlston, Professor of Molecular and Population Genetics at The Institute of Cancer Research, London, said:

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“Hodgkin lymphoma is a cancer of immune cells called B cells, and our study links the risk of the disease to changes in the genes that control how B cells develop.

“Interestingly, we found that some of the genetic changes we have linked to Hodgkin lymphoma have previously been associated with the risk of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis.

“It doesn’t mean that if you develop an autoimmune disease you are at increased risk of lymphoma, but it does offer fascinating genetic clues to these diseases. The new information could point towards new ways of diagnosing, treating, or even helping to prevent Hodgkin lymphoma.”

Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said:

“Understanding the genetic changes that underpin cancer’s development is crucial for all aspects of our quest to defeat cancer – to understand which patients are most at risk from different types of cancer, to improve diagnosis, and to develop treatments that are most likely to work for individual patients.

“This important new study sheds light on the DNA changes that can contribute to a person’s risk of developing Hodgkin lymphoma, and offers clues as to how they might increase that risk, including the interesting link to the immune system. These findings could lead to new ways of managing the disease.”

Dr Alasdair Rankin, Director of Research at Bloodwise said:

“Because of research, treatments for many people with Hodgkin lymphoma are now good, and around 80 per cent of all people affected survive in the long-term. Although this is good news, treatments can have long-term health effects, such as infertility and secondary cancers, so finding kinder treatments for Hodgkin lymphoma is important. We welcome this study, which sheds new light on how Hodgkin lymphoma develops.”


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With CHIP In Limbo, Here Are 5 Takeaways On The Congressional Impasse

Two months past its deadline, Congress has yet to fund the Children’s Health Insurance Program, leaving several states scrambling for cash.

Lawmakers grappling with the failed repeal of the Affordable Care Act allowed authorization of the program to lapse on Sept. 30. Although CHIP has always had broad bipartisan support, the House and Senate cannot agree on how to continue federal funding. And the Trump administration has been mostly silent on the issue.

CHIP benefits 9 million children nationwide and 370,000 pregnant women a year. It helps lower- and middle-income families that otherwise earn too much to be eligible for Medicaid. Like Medicaid, CHIP is paid for with state and federal funds, but the federal government covers close to 90 percent of the cost.

To keep the program going, states with unspent federal CHIP money have seen their excess sent to a handful of states running low on funds. But that is a bureaucratic band-aid; some large states are warning families they may not be able to rely on CHIP for much longer.

All told, CMS has given out $1.2 billion in redistribution dollars since October. To keep the program going would cost the federal government $8.5 billion over five years, the Congressional Budget Office estimates.

Saturday marks the 25th anniversary of Pennsylvania approving the original CHIP program, which served as a model for the national law, established in 1997. Since then, CHIP has been left in the fiscal lurch only once before. In 2007, CHIP went several weeks without funding authorization from Congress.

Here’s a quick look at what the shortfall may mean to daily life.

1. Are any kids hurting because Congress has failed to fund CHIP?

No. But states such as California will run out of money within weeks. That state alone accounts for nearly 15 percent of all children benefiting from CHIP. Without federal money, state programs could freeze enrollment or suspend operation.

2. What are states doing since Congress missed the deadline?

Most states are doing little except looking for other unspent federal funds or asking the federal government to send some unspent funds from other states. But some, such as Colorado, are sending warning letters to beneficiaries to tell them that the program could soon end and to look for alternatives. This could mean exploring the ACA marketplace for coverage or researching if a child qualifies for Medicaid.

Colorado said it has only enough CHIP funding to last through January and then the program, without federal dollars, will end.

Arizona officials announced Thursday that it will use Medicaid funding to fill in the shortage of CHIP dollars to extend the life of its CHIP program.

Virginia officials plan to send out a similar notice to parents of CHIP members by early this month.

Minnesota is keeping CHIP alive by paying the federal share with state funds.

In Oregon, Democratic Gov. Kate Brown recently said that she is ready to spend $35 million in state funds to keep CHIP running through December.

Nevada this week announced it had been approved for extra funding from the Centers for Medicare & Medicaid Services — nearly $5.7 million — which could keep CHIP alive through December and possibly January.

California, which leads the nation in CHIP enrollment, has received the lion’s share of CMS redistribution funds since October: nearly $692 million.

“Approximately 98 percent of the 1.3 million population now covered using CHIP funding would continue to receive coverage under the Medicaid program because of a legal obligation to cover them through September 2019,” said California Medicaid/CHIP spokesman Tony Cava.  “If CHIP is not reauthorized, the governor and Legislature would need to deliberate on how best to address the population no longer eligible for federal CHIP funding.”

3. When is Congress likely to act?

Not sure. CHIP reauthorization could be included in an appropriations bill that Congress must pass to fund the government into 2018. (Congress now has funded the government through next Friday.) A “continuing resolution” bill would have to be approved by then to avert a government shutdown.

But we’re journalists, not prognosticators — and we have been wrong before. Most Capitol Hill observers expected a deal by the end of September.

4. If CHIP is so popular among Republicans and Democrats, what’s the problem?

There is little debate about its worth and value, but the momentum on CHIP was lost amid disagreements over the Affordable Care Act. The House did extend authorization with a vote —mostly along party lines — on Nov. 3. The Senate itself has yet to vote. The Senate Finance Committee on Oct. 3 approved a bipartisan bill to extend the program for five years.

The sticking point is not whether to keep CHIP running but how to raise the cash needed.The House agreed to charge higher premiums to wealthier Medicare beneficiaries, cut money from the ACA’s preventive health fund and shorten the grace period for ACA enrollees who fail to make monthly premium payments.

Like the House bill, the Senate committee bill eliminated an ACA provision to increase CHIP matching funds — to states — by 23 percent. The increased funding would continue through fiscal year 2019 and fall to 11.5 percent in fiscal year 2020. It would be cut entirely in the following fiscal year.

5. How does CHIP differ based on where you live?

CHIP income eligibility levels vary by state. About 90 percent of children who qualify are from families earning 200 percent of poverty or less ($40,840 for a family of three). CHIP covers children up to age 19. But states have the option to cover pregnant women, and 18 states plus the District of Columbia do so.

And some states call CHIP by different names. For example, it is known as Hoosier Healthwise in Indiana, PeachCare for Kids in Georgia and KidsCare in Arizona.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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Texans With HIV Cope With Homes And Medicines Ruined By Hurricane Harvey

People With HIV Went Weeks Without Meds After Hurricane Harvey

This story by KHN senior national correspondent Sarah Varney aired Nov. 24, 2017, on Here & Now.

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Angelia Soloman watched out the window of her ranch house in northeastern Houston as the floodwaters rose up to the windowsills.

She huddled inside with her three adopted children (ages 12 to 15), a nephew and her 68-year-old mother. “They were looking and crying, like, ‘We’re gonna lose everything,’” said Soloman. “And I’m like, ‘No, it’ll be OK.’”

When the water began rushing under the front door, filling up the house like a bathtub, Soloman led her family outside, and plunged into a river of water up to her chest.

The hurricane couldn’t have come at a worse time for the 47-year-old single mother, who was diagnosed with HIV in 2011. Just before the storm, in a troubling sign, the count of her T cells — the cells that HIV kills — had plummeted from the stress of losing her job. She had used her last unemployment check to buy school clothes and supplies that now faced certain ruin in the floodwaters.

“It was like 5 feet of water. We just lost everything. Cars, everything,” said Soloman.

The destruction included her HIV medication. When I met Soloman in Houston, it had been a month since she had taken her last HIV pill. There were just too many crises to contend with — dealing with the Federal Emergency Management Agency to rebuild her house, finding a car and enrolling her kids in another school district.

Many Houstonians with HIV faced similar problems. The hurricane closed pharmacies and clinics for a week — or longer. Floodwaters ruined drugs. People who fled to other states couldn’t get their prescriptions filled for HIV medicine.

As the days ticked on, many worried the amount of HIV in their blood would increase and become resistant to treatment.

Donnall Walker waited out the storm with his 12 brothers and sisters outside Houston. The 52-year-old former fashion designer left his HIV medication behind. His family’s house hadn’t flooded once in his lifetime, and he assumed he would be back home the next day.

A week later, when he finally returned, everything inside was ruined.

“My biggest emotion was racing in the house to check for my medication because I hadn’t had it and it was underwater,” said Walker. “It was in my nightstand and my nightstand was floating.”

Walker went to his pharmacy the day it reopened, but he had gone nearly two weeks without his HIV drugs.

“On top of all this disaster, I could possibly die and have that burden on top of my family,” he said.

He said he feared for his life — not only from the missed doses but because HIV had weakened his immune system. “I had been in a lot of floodwaters. I didn’t know if I got hepatitis,” Walker said. “I didn’t know what my condition was.”

There are some 25,000 people with HIV and AIDS living in Houston and Harris County. Dr. Thomas Giordano, medical director at Thomas Street Health Center, a public clinic that offers HIV services, said it will take months to determine — through a series of blood tests — whether his patients’ viral loads were affected by the storm.

Giordano said he worries most about his patients who haven’t made it back to the clinic. Hurricane Harvey upended so many lives, scattering people to live with friends or family who may not know their status.

“A lot of people don’t want their friends or extended family to know they have HIV, and so they can’t get the assistance they might need to get to the pharmacy to get a refill or take their medicines with their meals,” said Giordano. “And so a lot of them stay undercover until things are stabilized again.”

Soloman, the single mother who waded through the waters with her family, finally found a ride to the county clinic to refill her HIV prescription.

I asked her where she is headed next. Back to her sister’s house, she said, where she and her kids are living with 16 other relatives until her house is fixed up.

She doesn’t feel relief or even hope, she said. There is still too much to do.

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Exclusive: CVS eyes major expansion of health clinics with Aetna deal – sources

NEW YORK (Reuters) – CVS Health Corp (CVS.N) is planning to significantly expand health services at its retail pharmacies if it completes a more than $66 billion deal for insurer Aetna Inc (AET.N), a move that could save more than $1 billion annually, people familiar with the matter said.

FILE PHOTO: The CVS logo is seen at one of their stores in Manhattan, New York, U.S., August 1, 2016. REUTERS/Andrew Kelly/File Photo

A key rationale is to use many of the U.S. pharmacy chain’s 9,700 brick-and-mortar outlets to improve access to preventative care and cut back on some emergency room visits for Aetna’s roughly 23 million members with medical coverage, these people said.

The full benefits of the strategy will take several years to realize, requiring billions of dollars in investment to increase the number of CVS clinics and provide the staff and equipment for a wider variety of treatments, the people said.

Those funds would be diverted from planned investments in CVS retail facilities, and not amount to additional expenses, they said.

Deal talks between the companies are still underway, and an agreement could be announced as early as Sunday or Monday, sources familiar with the matter told Reuters. It is also possible that a deal is delayed or does not materialize, they said.

Health insurers have redoubled their efforts to cut costs in a time of steep prescription drug price rises and requirements to care for even the sickest patients under the Affordable Care Act.

Aetna last year tried to buy rival Humana Inc (HUM.N) to gain more leverage over costs, but that transaction, as well as a proposed merger between Anthem Inc (ANTM.N) and Cigna Corp (CI.N), was shot down by antitrust regulators.

Many insurers have already been encouraging patients to use urgent care centers, which can provide some of the same services as emergency rooms for as little as a tenth of the cost, said Laurel Stoimenoff, chief executive of the Urgent Care Association of America.


FILE PHOTO: Marissa Farris is examined by nurse practitioner Tamara Hauserman-Aggacid in a Minute Clinic in a CVS pharmacy in Chicago, Illinois, U.S. August 1, 2013. REUTERS/Jim Young/File Photo

The industry has grown to about 8,000 urgent care centers nationwide, as more hospitals, insurers and private operators open such walk-in facilities, Stoimenoff said, with 400 to 500 centers added each year. They may be staffed by doctors and provide relatively advanced care including X-rays.

CVS operates more than 1,000 MinuteClinics, which offer more basic services ranging from flu shots to physicals and are mainly staffed by nurse practitioners.

Combined with Aetna, the company would be able to seamlessly access medical records, offer certain preventive services to covered members for free and make drugs promptly available in adjacent CVS pharmacies, said Dan Mendelson, president of consultancy Avalere Health.

FILE PHOTO: People walk by a CVS Pharmacy store in the Manhattan borough of New York City, New York, U.S., November 30, 2017. REUTERS/Shannon Stapleton/File Photo

The in-store clinics could provide immunizations, check if a patient needs antibiotics, help manage chronic illnesses like diabetes or even administer medications by infusion, but are unlikely to offer acute treatment of serious injuries, healthcare experts said.

“It would probably be unsettling to people coming in to buy socks to have someone with a bleeding head come in for stitches,” said Greg Burke of the United Hospital Fund, a non-profit focused on improving healthcare in New York.

Expanding the clinics could eventually save the combined company more than $1 billion annually by substituting low-cost treatments in CVS stores for more expensive hospital visits, two people familiar with the matter said. The combined net income of Aetna and CVS is forecast to be about $9.25 billion in 2017, according to Thomson Reuters data.

Aetna competitor UnitedHealth Group Inc (UNH.N) operates 230 MedExpress urgent care centers in 17 states in one of its fastest-growing divisions, with nearly 20 percent compounded revenue growth per year.

For CVS, which has seen non-pharmacy sales decline at its stores, the clinics could have the added benefit of bringing in new customers and providing alternatives for less productive retail space.

“It’s a tough retail environment. I think they’re going to devote less space to it and more to different healthcare services and clinics,” said Jeff Jonas, a portfolio manager at Gabelli Funds which owns shares in Aetna and CVS.

Reporting by Carl O’Donnell, Bill Berkrot and Caroline Humer; Editing by Michele Gershberg and Meredith Mazzilli

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Exclusive: U.S. health regulator Verma eyes new methods for drug pricing

NEW YORK (Reuters) – The U.S. government is considering setting new payment methods aimed at curbing costs for Medicare and Medicaid coverage of breakthrough medical treatments with very high prices, particularly novel gene-based therapies for cancer and other diseases, a top health official said on Thursday.

FILE PHOTO – U.S. Administrator of the Centers for Medicare and Medicaid Services (CMS) Seema Verma (C) is joined by Concerned Women for America CEO Penny Nance (L) as she talks to reporters about President Trump’s signing of House Resolution 43, which allows states to withhold federal funds from facilities that provide abortion services, at the White House in Washington, U.S., April 13, 2017. REUTERS/Jonathan Ernst

Seema Verma, head of the Centers for Medicare and Medicaid Services (CMS), made the comments in an interview with Reuters on the sidelines of the Forbes Healthcare Summit in New York.

CMS, part of the U.S. Department of Health and Human Services (HHS), spends hundreds of billions of dollars annually on medicines for seniors, disabled people and low-income households through the huge Medicare and Medicaid programs. CMS does not negotiate prices or purchase drugs, but sets ground rules for the managed care companies and state Medicaid agencies that do.

“We are trying to do whatever we can to increase competition and give the (health insurance) plans more tools so that they can be better negotiators on our behalf,” Verma said.

Roughly 125 million Americans are covered by Medicare and Medicaid.

The United States is the world’s most expensive market for prescription drugs. Government agencies and private sector companies are struggling to cover the costs of new medicines that have made the most progress to date in treating cancer and rare genetic disorders, some with annual price tags of nearly $500,000.

Verma said one model under consideration was paying different prices for a single drug based on its success treating a particular condition, such as paying more for a therapy that works better for breast cancer than it does for lung cancer or liver cancer.

A second method would be to extend the payment of an extremely expensive medicine over a longer time-frame, rather than immediately after it is given to a patient, Verma added, saying both are being tested by private sector pharmacy benefit managers.

That approach could be particularly useful for gene-based therapies aimed at small patient populations, she said. One such treatment expected to be approved by early next year is Spark Therapeutics’ (ONCE.O) therapy for a genetic mutation that causes blindness in around 1,000 to 2,000 patients. Some industry experts expect it to carry a list price of as much as $1 million.

Earlier this year, drugmaker Novartis (NOVN.S) said it reached an agreement with CMS over its revolutionary new blood cancer drug Kymriah, which has a list price of $475,000. Novartis is paid based on the outcomes achieved among pediatric and young adult leukemia patients by the end of the first month.

A similar treatment that harnesses the immune system’s CAR-T cells from Gilead Sciences Inc’s (GILD.O) Kite Pharma unit was approved last month and costs $373,000. Other companies including Juno Therapeutics (JUNO.O) and BlueBird Bio (BLUE.O) have similar treatments in advanced clinical trials, all of which aim to cure the disease with a one-time treatment.

President Donald Trump has promised to curb drug costs, but little concrete action has been taken so far. CMS has begun seeking information from insurance plans and drug companies as it considers possible changes, Verma said.

Alex Azar, Trump’s nominee for HHS secretary, on Wednesday promised to address drug prices if confirmed to the job, where he would be Verma’s boss.

Some Democratic and Republican lawmakers, as well as healthcare experts, have urged Congress to enact new laws allowing the government to negotiate drug prices directly with manufacturers. In the meantime, Verma is focusing on what she is already authorized to do.

“We are trying to do whatever we can within the regulatory structure,” she said.

Reporting by Caroline Humer; Editing by Michele Gershberg and Will Dunham

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Does Marriage Help Preserve Your Brain?

Dementia Quiz

News Picture: Does Marriage Help Preserve Your Brain?By Randy Dotinga
HealthDay Reporter

WEDNESDAY, Nov. 29, 2017 (HealthDay News) — Tie the knot, save the brain?

Latest Alzheimers News

A new research review suggests there’s something about marriage — or people who get and stay married — that significantly lowers the risk of mental decline in old age.

“We were surprised by the strength of our findings,” said review lead author Dr. Andrew Sommerlad, a psychiatrist in England.

The new analysis found that lifelong single people have a 42 percent higher likelihood of developing dementia than married people. Widowed people also have a higher rate of dementia, but divorced people don’t.

The findings don’t prove a direct link between marriage and lower risk of dementia, however.

Still, “the higher risk for unmarried people remains even when physical health is taken into account, suggesting that the benefit of marriage is due to more than just improving physical health,” said Sommerlad, a research fellow at University College London.

Research has previously linked marriage to health benefits such as fewer strokes and heart attacks, and higher survival after coronary bypass surgery. But it’s difficult to tease out the reasons why.

“We conducted this research because it is well known that being married is associated with a range of health benefits including living a longer life, and we thought that these benefits may extend to lower dementia risk,” Sommerlad said.

“As there is currently no cure for dementia, it is important to establish whether there are steps which we can take in our lives to reduce our dementia risk,” he added.

For the new review, Sommerlad and his colleagues analyzed 15 studies looking into marriage and dementia. The research involved more than 812,000 people in all, and took place in numerous countries including the United States, China, Japan, France, Germany and Sweden.

The vast majority of study participants were married or widowed. Few were divorced (between 4 and 6 percent in most of the studies), and few were lifelong singles (less than 10 percent in most studies).

Compared to wedded people, lifelong singles had an overall 42 percent higher risk of dementia, the findings showed.

“Around seven in 100 people aged over 65 have dementia,” Sommerlad said, adding that may be closer to 10 in 100 in never-marrieds.

The researchers also found that widows and widowers had a 20 percent higher risk of dementia compared with people who were still with their spouse.

“We do not think that it is marriage itself which causes reduced dementia risk,” Sommerlad said.

“Our research suggests that the possible protective effect is linked to various lifestyle factors which are known to accompany marriage, such as living a generally healthier lifestyle and having more social stimulation as a result of living with a spouse or partner,” he explained.

The study is strong, said Dr. Christopher Chen, director of the National University Health System’s Memory Aging & Cognition Center in Singapore.

“It is interesting that divorce does not increase the risk. It may be that those who divorce do not share the same risk profile as those who are single or widowed,” said Chen, co-author of a commentary accompanying the study.

Is there a message here for people as they age?

According to Sommerlad, “We can take steps in our lives to reduce or delay dementia. A healthy diet, exercise and prompt treatment of medical problems, as well as keeping an active mind through social and mental activities, may make a difference.”

These steps are “particularly important for those at higher risk of dementia, such as unmarried people,” Sommerlad said.

And doctors should be especially attentive when assessing unmarried adults, he added.

“Diagnosis is often difficult in people who attend clinics alone, rather than accompanied by their spouse, as it is harder to get information about symptoms of the condition,” Sommerlad noted.

The review was published online Nov. 28 in the Journal of Neurology, Neurosurgery & Psychiatry.

Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Andrew Sommerlad, MBBS, MRCPsych, psychiatrist and research fellow, University College London, England; Christopher Chen, BMBCh, director, Memory Aging and Cognition Center, National University Health System, Singapore; Nov. 28, 2017, Journal of Neurology, Neurosurgery & Psychiatry, online

Next Article: Could New ‘Brain Training’ Help Prevent Dementia?

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CMS releases its Measures Under Consideration List for 2018 pre-rulemaking

November 30
by Centers for Medicare & Medicaid Services

By: Kate Goodrich, M.D., M.H.S., Director, Center for Clinical Standards & Quality, CMS Chief Medical Officer

Medicare and other payers are rapidly moving toward a healthcare system that rewards high quality care while spending more wisely. Foundational to the success of these efforts is having quality measures that are meaningful to patients, consumers, and providers alike.  CMS recently announced the “Meaningful Measures” initiative to identify the most impactful areas for quality measurement and improvement and reflect core issues that are most vital to high quality care and better individual outcomes. Each year, CMS publishes a list of quality and cost measures that are under consideration for Medicare quality reporting and value-based purchasing programs, and collaborates with the National Quality Forum (NQF) to get critical input from multiple stakeholders, including patients, families, caregivers, clinicians, commercial payers and purchasers, on the measures that are best suited for these programs. Ultimately, these measures may help patients choose the nursing home, hospital, or clinician that is best for them, and can help providers to provide the highest quality of care across care settings.

I am happy to announce that CMS posted the Measures under Consideration (MUC) List for 2018 pre-rulemaking on the CMS website and has sent it to NQF in preparation for multi-stakeholder input.

This year’s MUC List contains 32 measures that have the potential to drive improvement in quality across numerous settings of care, including clinician practices, hospitals, and dialysis facilities. CMS is considering new measures to help quantify healthcare outcomes and track the effectiveness, safety and patient-centeredness of the care provided.  At the same time, CMS is taking a new approach to coordinated implementation of meaningful quality measures focused on the most critical, highly impactful areas for improvement while reducing the burden of quality reporting on all providers so they can spend more time with their patients.  In addition to other factors, CMS evaluated the measures on the MUC list to ensure that measures considered for adoption in a CMS program through rulemaking as necessary, focus on clearly defined, meaningful measure priority areas that safeguard public health and improve patient outcomes.  For example, to generate this year’s MUC list, CMS considered 184 measures submitted by stakeholders during an open call for measures.  Considering the meaningful measurement areas, CMS narrowed the list to 32 measures (17% of the original submissions) which focus CMS efforts to achieve goals of high quality healthcare and meaningful outcomes for patients, while minimizing burden. CMS will continue to use the Meaningful Measures approach to strategically assess the development and implementation of quality measure sets that are the most parsimonious and least burdensome, that are well understood by external stakeholders, and are most likely to drive improvement in health outcomes.

This year, approximately 40% of measures on the MUC list are outcome measures, including patient-reported outcome measures, which will help empower patients to make decisions about their own healthcare and help clinicians to make continuous improvements in the care provided. In addition, this year there are eight episode-based cost measures proposed that were developed by incorporating the insight and expertise of clinicians and specialty societies.  CMS is committed to working with clinicians, consumers, and other stakeholders on the development and use of measures that are most meaningful to patients and clinicians and our programs.

We invite you to review the MUC List in detail and to participate in the public process. We believe it is critical to hear a wide range of voices in the selection of quality and efficiency measures that are used for accountability and transparency purposes and look forward to another successful pre-rulemaking season. For more information regarding the NQF Measure Applications Partnership public stakeholder review meeting purpose, meetings, 2017 MUC List deliberations and voting, visit the NQF website at

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Wear your red ribbon – Support World AIDS Day

Did you know that 40,000 people are diagnosed with HIV in the U.S. each year? Of the 1.1 million people currently living with HIV in the U.S., 1 in 7 don’t even know they have it. Medicare covers HIV screenings for people with Medicare 15-65 years old who ask for the test, people younger than 15 or older than 65 who are at increased risk, and pregnant women.

HIV is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS. Early testing and diagnosis play key roles in reducing the spread of the disease, extending life expectancy, and cutting costs of care. Thanks to better treatments, many people with HIV and AIDS in the U.S. are living longer. Testing is an important first step in getting HIV-infected people the medical care and support they need to improve their health and help them maintain safer behaviors. To learn more about how you can reduce your risk of HIV, check out the CDC’s HIV Risk Reduction Tool.

Visit to learn more about their Act Against AIDS campaign. To find an HIV test site, visit, or text your zip code to “KNOWIT” (566948).

December 1st is World AIDS Day, so wear your red ribbon and together we can raise awareness and fight HIV.

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