Dialysis at a crossroads--Part II: A call for action.

A previous commentary pointed out that the renal community has led American healthcare in the development and continuous improvement of quality outcomes. However, survival, hospitalization, and quality of life for US dialysis patients is still not optimal. This follow-up commentary examines the obstacles, gaps, and metrics that characterize this unfortunate state of affairs.

Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission.

Background: In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures.

Methods And Results: We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008.

Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.

Context: During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates.

Objective: To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI.

Commentary. The imperatives for change in the US health care payment and delivery systems are clear.

Americans' spending on health care is the highest in the world, yet it does not equate with the value expected. There are disparities in access to care and a wide variation in quality. It is imperative that the US health care payment and delivery system change.

Using population segmentation to provide better health care for all: the "Bridges to Health" model.

The model discussed in this article divides the population into eight groups: people in good health, in maternal/infant situations, with an acute illness, with stable chronic conditions, with a serious but stable disability, with failing health near death, with advanced organ system failure, and with long-term frailty. Each group has its own definitions of optimal health and its own priorities among services. Interpreting these population-focused priorities in the context of the Institute of Medicine's six goals for quality yields a framework that could shape planning for resources, care arrangements, and service delivery, thus ensuring that each person's health needs can be met effectively and efficiently.

How changes in the Medicare coverage process have facilitated the spread of new technologies.

The Medicare coverage decision process can affect the availability and use of new technologies. The Centers for Medicare and Medicaid Services (CMS) has recently made advances in making its coverage decision process speedier, predictable, and more transparent. The CMS recently issued draft Coverage with Evidence Development (CED) guidance to assure that Medicare beneficiaries have access to new technologies through expanded coverage criteria, while gathering information that can be helpful to the doctors who care for them.