The Morning Report provides a quick look at today’s medical news, research and features.
|Walking For Health Is Great, But Not Too Slow
Walking, fast or slow, is wonderful exercise. But now a first-of-its-kind study shows that to get the most health benefits from walking, many of us need to pick up the pace. Walking is the most popular physical activity in America. But people who walk for exercise do so at wildly varying speeds and intensities. Exercise guidelines generally suggest that for health purposes, people should engage in 30 minutes of moderate-intensity activity most days of the week. For walkers, a moderately intense pace would probably be about 15 or 16 minutes per mile.
It has generally been assumed that if people walk more slowly but expend the same total energy as brisk walkers – meaning that they spend more time walking – they should gain the same health benefits. But few large-scale studies have directly compared the impact of moderate- and light-intensity walking, especially in terms of longevity.
Researchers placed walkers in four numerically equal categories, based on their normal pace. Those in Category 1, the fleetest, averaged less than 13.5 minutes per mile, putting them on the cusp of jogging, while those in Category 4, the slowest, strolled at a relatively dilatory 17 minutes or more per mile. The majority of the walkers in this group in fact required at least 20 minutes to complete a mile, and many had a pace of 25 minutes or more per mile. Then they cross-referenced the data against that in the essential if somewhat ghoulish National Death Index to determine which of the almost 39,000 walkers had died in the decade of the study.
It turned out that nearly 2,000 of the walkers had died. More telling, these deaths disproportionately were clustered among the slowest walkers. Those in Category 4 were about 18 percent more likely to have died from any cause than those in the other three categories and were particularly vulnerable to deaths from heart disease and dementia. This effect was most pronounced among the slowest of the slow walkers, whose pace was 24 minutes per mile or higher. They were 44 percent more likely to have died than walkers who moved faster, even if they met the exercise guidelines. One important inference of these statistics is that intensity matters. (NY Times)
|P4P Will Affect More Docs in 2014|
Next year will bring a number of changes to one of Medicare’s pay-for-performance programs, the physician value-based payment modifier (VPM) — changes that will show up in physicians’ paychecks a few years hence. In 2014, the VPM will be expanded to practices with 10 or more eligible professionals. The program, which was mandated by the Affordable Care Act, assesses a provider’s quality of care and costs, and increases Medicare payments for good performers and decreases them for bad ones.
As finalized in the 2014 Medicare physician fee schedule released last week, physicians’ 2014 performance will be reflected in adjustments to 2016 payments. As much as 2% of Medicare payments will be at risk in 2016 based on physician performance in 2014. It was only 1% for 2015, which was based on doctors’ 2013 performance.
This year, groups of 100 or more were measured for payment adjustments in 2015. In 2014, the program will begin affecting groups of 10 or more, and, in 2015, the VPM program will kick in for all Medicare practices — regardless of size — with the adjustments from that year’s performance starting in 2017. However, only groups of 100 or more professionals could potentially receive downward adjustments over the next few years. Practices with between 10 and 99 professionals will only see their payments go up if they perform well — at least for 2016.
Also starting in 2014, physician practices will have additional ways to report quality measures, and patient experience measures — as reflected in patient satisfaction surveys — will be added for groups of 25 or more professionals. (MedPage Today)
|Cities Take On E-Cigarette Health Battle|
Calling it a potential health risk and a gateway to tobacco use, the Los Angeles City Council on Wednesday voted unanimously to regulate the sales of e-cigarettes and other “vaping” devices. The new law puts electronic smoking devices in the same category as tobacco products, subjecting their sales to the same restrictions. It bans sales from street kiosks, ice cream trucks and self-service displays, and requires retailers to obtain a license before selling the products. Parallel legislation under city consideration would ban the use of e-cigarettes in the same places that tobacco is prohibited, including restaurants and parks. (LA Times)
LA is not alone. New York City is debating similar legislation. In a city where the technocratic mayor prides himself on making decisions based on the evidence, the proposed ban produced one of the most scientifically vague and emotionally charged health committee hearings in recent memory. Anyone who used the word “smoke” or “smoking” to refer to electronic cigarettes, which typically contain nicotine, was instantly corrected by audience members hissing “Vapor!” and “Vaping!”
The health commissioner, Dr. Thomas A. Farley, said electronic cigarettes were such a recent invention that he could not say whether they were hazardous to the health of those smoking them or those who might breathe in secondhand vapor. He said that they do put out fine particles and chemicals, and “I certainly can’t guarantee that that is safe.” (NY Times)