By August 1, employers, employees, and individuals from across the United States will receive refunds from health insurance companies that failed to meet minimum standards set forth in the Patient Protection and Affordable Care Act (ACA).

An ACA provision, lauded by the Obama administration for looking out for consumers’ interests, set required medical loss ratios (MLRs) for insurers. Insurers covering employers or groups with ≥50 people must spend ≥85% of the premiums they collect on medical care, while those covering ≤50 people have a minimum of 80%.

Much of the racial gap in mortality rates between whites and African Americans can be attributed to the disproportionate number of African Americans with poorly controlled hypertension. Lack of adherence to medication regimens may explain the poor blood pressure (BP) control among African Americans. The adverse effect of inadequate adherence on cardiovascular mortality and morbidity has been well established, creating a need for interventions designed to improve adherence and narrow the racial gap in outcomes related to hypertension.

A new meta-analysis comparing stent implantation and medical therapy versus medical therapy alone for patients with stable coronary artery disease (CAD) found that initial stent implantation did not appear to offer a benefit in terms of preventing death, nonfatal myocardial infarction (MI), unplanned revascularization, or angina when compared with medical therapy alone. These findings were published in Archives of Internal Medicine [2012;172(4):312-319].

Urinary tract infections represent a large portion of all hospital-acquired infections, with catheter-associated urinary tract infection (CAUTI) accounting for the majority of cases. Results of a retrospective analysis from 163 inpatient units in 71 participating Michigan hospitals found that reducing inappropriate urinary catheter use was associated with a considerable reduction in catheter use and improved compliance with appropriate use. The effect of the statewide intervention was sustained for almost 2 years [Arch Intern Med. 2012;172(3):255-260].

A new report with extended follow-up from the European Randomized Study of Screening for Prostate Cancer (ERSPC) strengthened the study’s previous findings by finding once again that prostate-specific antigen (PSA) screening for men significantly reduced mortality from prostate cancer, but did not have an affect on all-cause mortality. These latest findings, which include a median of 11 years of follow-up data, were reported in the New England Journal of Medicine [2012;366(11):981-90].

Worldwide epilepsy accounts for 1% of the burden of disease, a proportion equal to that of lung cancer in men and breast cancer in women. Nearly 80% of the cost of managing and treating epilepsy is associated with the 20% to 40% of patients who have medically intractable disease, according to researchers.

In a special communication posted online in the Journal of the American Medical Association, Daniel M. Berwick, MD, MPP, and Andrew D. Hackbarth, MPhil, offered a strategy aimed at Eliminating Waste in US Healthcare [JAMA. 2102;307(14):doi:10.1001/jama.2012.363]. Dr. Berwick is the former president and CEO of the Institute for Healthcare Improvement and the former administrator of the Centers for Medicare & Medicaid Services (CMS). Mr. Hackbarth is affiliated with the Rand Corporation in Santa Monica, California.

Orlando—For years, the federal government and states have attempted to rein in costs associated with Medicare and Medicaid. Still, the expenses associated with these programs continue to grow, as the population gets older and more people are unemployed and need assistance to pay for their healthcare.

Orlando—In nearly 5 decades as a doctor, Sam JW Romeo has seen numerous industry innovations that did not improve care or cut costs. He is now the medical director at Tower Health & Wellness Center in Turlock, California, which he and other partners opened in 2005.

Of Dr. Romeo’s 6 children, 5 are physicians. The sixth is a licensed clinical social worker. Due to his childrens’ occupations, Dr. Romeo is familiar with all of the recent proposals, particularly those included in the Patient Protection and Affordable Care Act (ACA).

Orlando—Healthcare spending in the United States has reached $2.25 trillion, accounting for 16% of the country’s gross domestic product (GDP). Most experts expect it to keep rising and predict that by 2025, healthcare spending will account for as much as 20% of the US GDP.

New Orleans—Chronic migraine (CM) patients treated with onabotulinumtoxinA reported a significant decline in emergency department (ED) visits. The results were presented at the AAN meeting during a poster session. The poster was titled Real-World Economic Impact of OnabotulinumtoxinA in Patients with Chronic Migraine.

Most of the substantial increase in Clostridium difficile infections (CDIs) over the past decade in the United States is related to healthcare exposures that may be prevented by reducing unnecessary antibiotic use and interrupting transmission of C. difficile between patients, report investigators in the March 6 Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) [MMWR Weekly. 2012;61:1-6].