Health for life

The great Wayne Gretzky once famously observed that he achieved ice hockey prowess because he made a habit of skating to where the puck was going, not where it is.  That important lesson may have been lost on countless health care executives who, now that the Department of Health and Human Services has told us what an "Accountable Care Organization" (ACO) is, are furiously skating to fill out this application.

The Disease Management Care Blog suggests they also think about where this ACO puck could go.  Listen to the ACO zealots and its easy to believe that the triple aim will become manifest and providers will rolling in shared savings moolah in less than 18 months.

Regular DMCB readers know better.  They know that Medicares ACOs have no track record and that the ACO-like models have had a checkered experience.  As data on the Medicares ACOs come in, it is quite possible that we may discover a penalty box where a) shared risk translates to shared losses, b) the Feds are fickle partners, c) the correlation between cost inflation and quality is implacably positive and d) only a few hospital-physician alliances have the kind of non-generalizable culture necessary to make ACOs financially viable.

In other words, this is not going to be a preordained power play. By the time they get there, ACOs could find the puck went somewhere else. 

The DMCB humbly suggests that that somewhere else could be a post-ACO world.  That’s why the DMCB suggests that no organization’s long-term ACO strategic planning is complete without serious contemplation of why they should not follow the herd and plan on a 3rd quarter where:

The Bubble Bursts?  The hangover of lost millions in misallocated capital and human resource investments could preoccupy key partners and hobble lead competitors for years to come.  This has important implications for future business relationships, mergers and acquisitions and growing market share.

The Ascendancy of Physician Groups.  As hospital-physician arrangements unravel, the larger  independent physician-owned practices left behind could fill the vacuum with an array of contained, discreet and non-global commercial insurer payment arrangements that are based on 1) a level playing field and 2) what both sides value.  That is, of course, assuming these practices dont run afoul of any market dominance scrutiny by the FTC.

Federal Retrenchment:  Despite any prior deals on the SGR, a perfect storm of entitlement non-orm, rebounding cost inflation and the lack of any new innovative ideas forces CM to cut rates. The impact on physician participation in Medicare is anyone’s guess, but the new urgency to control costs means physicians will 1) have one more business reason to seek the efficiencies of larger groups and 2) be even less willing to take on additional practice costs that ranges from hiring to technology.

Should provider organizations skate toward this post-ACO world?  The DMCB suggests its not unreasonable.  Time will tell if they win this game.

With atypically little fanfare, the Disease Management Care Blog gazes into the crystal ball and offers ten health care predictions for 2012:

1.  After Mitt Romney secures the Republican nomination for President, he and Mr. Obama will mutually try to find ways to avoid debating the issue of health care orm.  Both will calculate that there’s little advantage to reminding voters of the messes they’ve made.

2.  As a result of 1 above, the election will not hinge on health care orm, which, thanks to an improving economy, will otherwise be very close and not be a erendum on Obamacare.

3. Yet, the U.S. Supreme Court will stir things up with a ruling that the Affordable Care Act mandate is unconstitutional because, among other reasons, Congress should have used its power to tax, not impose a penalty.

4.  There will be no generalizable and published peer reviewed studies on the Patient Centered Medical Home or the electronic health record that conclusively demonstrate that either reduces health care costs.

5.  Even though CMS will have trouble providing timely claims data feeds to its newly established ACOs, we’ll hear little about it in the public domain.  ACOs have every incentive to not cross CMS.

6. Speaking of ACOs, the least recognized Achilles heel as they start up will be a pervasive physician culture that trumps patient perence over shared savings.

7.  We will learn that, thanks to their complexity, the deadlines for implementation of health information exchanges will need to be pushed back.

8.  Congress will "kick the can" of the Sustainable Growth Rate conundrum down the road and past the 2012 election with another temporary patch.

9.  More academic medical center faculty will find that it’s far more professionally rewarding to post on line than to publish in paper-based journals.  Department Chairs will reluctantly find ways to use web statistics in promotion and tenure.

10. Piqued by Mr. Obamas recent recess appointments, the Republicans will respond by holding the up the appointment of Ms. Tavenner as CMS Administrator.

The overall pattern of food that a person eats is more important to a healthy diet than focusing on single foods or individual nutrients, according to the Academy of Nutrition and Dietetics in its newly updated position paper "Total Diet Approach to Healthy Eating."

According to the position paper: "In contrast to the total diet approach, classification of specific foods as good or bad is overly simplistic and may foster unhealthy eating behaviors." The Academys position paper stresses that moderation, portion size and exercise are the key concepts for balancing food and beverage intakes.

The position paper has been published in the February Journal of the Academy of Nutrition and Dietetics and can be found on the Academys website. It states:

It is the position of the Academy of Nutrition and Dietetics that the total diet or overall pattern of food eaten is the most important focus of healthy eating. All foods can fit within this pattern, if consumed in moderation with appropriate portion size and combined with physical activity. The Academy strives to communicate healthy eating messages that emphasize a balance of food and beverages within energy needs, rather than any one food or meal.

The Academys position paper has been updated to lect the most current nutrition guidance, such as the 2010 Dietary Guidelines for Americans and the USDAs MyPlate food guidance system; the White Houses Lets Move! campaign to reduce childhood obesity and Healthy People 2020. Each of these public policies and dietary patterns supports the total diet approach.

According to the position paper, while studies including the Academys "Nutrition and You" national consumer survey show Americans are "conscious of the importance of healthy diets and physical activity," most people do not meet the recommendations of the Dietary Guidelines. For example, large majorities do not eat fruit (68 percent) or vegetables (74 percent) more than twice a day, and a substantial number (36 percent) engage in no leisure-time physical activity.

In that environment, according to the Academy: "Labeling specific foods in an overly simplistic manner as good foods and bad foods is not only inconsistent with the total diet approach, but it may cause many people to abandon efforts to make dietary improvements."

The position paper adds: "In 2011, 82 percent of U.S. adults cited not wanting to give up foods they like as a reason for not eating healthier. For these reasons, the concepts of moderation and proportionality are necessary components of a practical, action-oriented understanding of the total diet approach."

The Academys position paper notes that the most recent Dietary Reference Intakes use a total diet approach because it allows for a broad range of foods to meet a persons nutrition needs over time. Theore, a person can make diet choices based on individual perences, genetic background, personal health status and food availability.

The position paper was written by registered dietitians Jeanne Freeland-Graves, Bess Heflin Centennial Professor in the department of nutritional sciences at the University of Texas -- Austin; and Susan Nitzke, professor emerita and extension specialist in nutritional sciences at the University of Wisconsin -- Madison.

The Academys position paper contains advice and recommendations for health professionals as well as consumers. It explains how food and nutrition practitioners can use behavioral theories and models to develop effective nutrition communications; and how food and beverage choices are affected by multiple factors that influence peoples ability to make use of expert advice on healthy eating.

Updated sections of the position paper look at new indicators of nutrient quality, such as the Nutrient Rich Food Index, the European Union Nutrient Profiling System and the Overall Nutrient Quality Index. In addition, the Social Ecological model, used in the Dietary Guidelines, is incorporated into the Academys position as "a guide for understanding why we eat what we do."

According to the Academys position paper: "Food and nutrition practitioners have a responsibility to communicate unbiased food and nutrition information that is culturally sensitive, scientifically accurate, medically appropriate and tailored to the needs and perences of the target audience. Some health and nutrition professionals and many pseudo-experts promote specific types of foods to choose or avoid. A more responsible and effective approach is to help consumers understand and apply the principles of healthy diet and lifestyle choices. Unless there are extenuating circumstances (severe cognitive or physical limitations), the total diet approach is perred because it is more consistent with research on effective communication and inclusive of cultural/personal differences."

While the population health management service industry has a successful track record when it comes to chronic heart failure, diabetes and asthma, the Disease Management Care Blog thinks, after a quick scan of the literature, that there are fewer studies of its impact on hypertension.

 A recent Morbidity and Mortality Weekly Report (MMWR) reminds us that thats a problem.

The National Health and Nutrition Examination Survey(NHANES) performs interviews and physical examinations of a representative sample of U.S. households.  This particular report on the prevalence and treatment of high blood pressure was based on a sample of 20,811 individuals from four 2-year survey cycles that were performed from 2003 to 2010.

Extrapolating from the sample, 66.9 million persons or 30.4% of the U.S. populationn have high blood pressure. Of this population, just over half (54% or 35.8 million) have uncontrolled hypertension.  Of these persons, 31 million (or 88%) had been seen by a health care provider in the preceding year. The prevalence of uncontrolled hypertension among those hypertensives with Medicare was 52%. Not having health insurance or having seen a health care provider in the past year increased the risk of untreated and uncontrolled high blood pressure.

Whats more, the DMCB discovered control of hypertension doesnt appear to be getting better over time.

The good news is that the treatment of high blood pressure is not all that complicated and that team-based non-physicians can play an important role.  Patients should be engaged on weight control, a DASH diet, restricting salt, exercise and moderating alcohol intake. Medication therapy can be individualized and tailored to meet mutually agreed-upon goals and to minimize any barriers.  Check out this MMWR table and youll see erences to "lifestyle counseling," "self monitoring," "self-management education."

Given the looming shortage of primary care care settings and the coming influx of newly insured persons, the DMCB believes population health management will need to be part of the solution.  In addition to the established science, the industry 1) understands the importance of risk stratification, 2) can be bolted onto accountable care arrangements and 3) understands that optimal outcomes are somewhere between 46% and 100% control.

Hopefully, given the relative dearth of high quality studies, this opportunity will be accompanied by ongoing studies of outcomes.

People with heart disease have special needs when it comes to dental care. Here are some tips to consider before going to the dentist if you suffer from one of the following heart conditions.
Dental Care After Heart Attack

Wait a minimum of six months after a heart attack before undergoing any dental treatments. Tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures. Ask your dentist if oxygen and nitroglycerin are available in case a medical emergency should arise during your office visit.
High Blood Pressure (Hypertension)

Some high blood pressure drugs can cause dry mouth or alter your sense of taste. Calcium channel blockers in particular can cause the gum tissue to swell and overgrow, resulting in chewing difficulties. If you do experience gum overgrowth, your dentist will give you detailed oral hygiene instructions and may ask you to make more frequent dental visits for cleanings. In some cases, gum surgery may be required. (A gingivectomy is the name of the surgical procedure performed to remove excess gum tissue).

If your dental procedure requires the use of anesthesia, ask your dentist if the anesthesia contains epinephrine. Epinephrine is a common additive in local anesthesia products. Use of epinephrine in some patients with high blood pressure may result in cardiovascular changes - including the rapid development of dangerously high blood pressure, angina, heart attack, and arrhythmias - and theore should be used with caution.
Chest Pain (Angina)

Patients with angina treated with calcium cannel blockers may experience gum overgrowth. In some cases, gum surgery may be required.

Like patients with a previous heart attack, patients with angina may want to ask their dentist if oxygen and nitroglycerin are available in case a medical emergency should arise.

While patients with stable angina (chest pain that occurs in a predictable pattern) can undergo any dental procedure, patients with unstable angina (new chest pain or unpredictable chest pain) should not undergo elective (nonessential) dental procedures, and emergency dental care should be performed in a hospital or office equipped with cardiac monitoring capability.
Stroke

If you’ve had a stroke in the past, tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medications could result in excessive bleeding during some oral surgery procedures.

If your stroke has impaired your ability to produce an adequate amount of saliva, your dentist may recommend the use of artificial saliva. If your stroke has affected your face, tongue, or dominant hand and arm, your dentist may also recommend use of fluoride gels, modified brushing or flossing techniques, and strategies others can use to assist you in maintaining good oral hygiene.
Oral Health and Heart Failure

Some medications used to treat heart failure (such as diuretics, or water pills) can also cause dry mouth. Ask your dentist about dry mouth treatments, including the use of artificial saliva.

Points to Remember About Dental Care and Heart Disease

    Give your dentist a complete list of the names and dosages of all the drugs you are taking for your heart condition (as well as any other prescription or nonprescription drugs that you may be taking). This will help your dentist decide on the best treatment course for you including medication selection for dental procedures.
    Give your dentist the name and phone number of your doctor(s) in case your dentist needs to speak to him or her about your care.
    If you are particularly nervous about undergoing a dental procedure as a result of your heart condition, talk with your dentist and heart doctor. Your doctors can provide you with information and work with you on strategies for controlling dental pain and easing your fears.


Is There a Link Between Periodontal Disease and Heart Disease?

Various researchers and government agencies continue to investigate the possible relationship between gum (periodontal) disease and heart disease. Some researchers speculate that bacteria in the mouth that are involved in the development of gum disease move into the bloodstream and cause inflammation in the blood vessels - changes that in turn contribute to heart disease and stroke.

Numerous studies are being conducted that both support and ute the possible link between these two diseases. One study, published in Stroke: Journal of the American Heart Association, found that people who had fewer than 25 teeth at the start of the 12-year trial (teeth loss is the ultimate end result of untreated gum disease) had a 57% greater risk of stroke compared with patients who had 25 or more teeth.

Another study involving over 4,000 patients and 17 years of follow up showed no evidence of a decreased risk of coronary heart disease if chronic gum disease was eliminated. Based on these results, these researchers speculate that the relationship between gum disease and an increase in cardiovascular risk is coincidental and not causal (that is to say that gum disease does not cause coronary heart disease).

The true role, if there is one, between gum disease and heart disease remains to be determined.

And shes blogging about it:
Oprahs 21-Day Cleanse

A vegan diet excludes meat, fish, eggs, and dairy food. For her cleanse, Oprah is also shunning caffeine, sugar, alcohol, and products made with gluten. I believe shes also cutting the fat.

Why go vegan? In an earlier post (Vegan Diet Outshines ADA Diet), I wrote about a study which found:

" ... that people with diabetes who followed a low-fat, vegan diet saw improvements in HbA1c, body weight, BMI, waist circumference, total cholesterol, and LDL cholesterol that were significantly greater than improvements in a group following an ADA diet (which adhered to American Diabetes Association guidelines)."

________

Now that 2011 is gone, this is a good time for the Disease Management Care Blog pause and take stock. How is it doing?

It likes to think of itself as a unique ongoing journal club on the organization, delivery and financing of health care.  If the DMCB was soup, thered be three ingredients:

1) reliance, whenever possible, on peer-reviewed and published evidence,

2) a physicians "real world" experience and

3) a ready dash of skeptical humor.

The DMCB must be doing something right.  Despite a narrow mix of medical science, economics, effectiveness and policy, the DMCB has attracted a relatively large and elite readership.  If youre reading this, that means you. 

Sophistication

When it looks at the ISPs of its many return visitors, the DMCB sees dozens of academic institutions, big and small name news media outlets, publishing houses, trade associations, information technology businesses, Congress, CMS, the White House, state government, foundations, commercial insurers, hospitals, health care consulting organizations and population management service providers. Many are household names.

It doesnt stop there. The DMCB has been contacted by and gotten to know folks from all levels in the health care industry.  Based on those conversations, it knows this a smart group.  The author of this blog is a better person for it.

The DMCB knows each regular visitor, twitter follower and Google subscriber has been earned one person at a time. It knows its elite readers are knowledgeable, active or interested in health policy, population health management, the patient centered medical home or primary care. These are not casual readers.

And you have a lot of company:

According to Google Analytics mix of ISP addresses and cookies, DMCB Ver. 2011 had 29,000 unique visitors with 42,000 visits. A third were repeat (defined as more than one) visits.  While there is no definition of a "regular" reader, the number of visitors with more than 50 DMCB "hits" in 2011 numbered 5153. There were 786 visitors with more than 200 hits. 

The DMCB also has 416 Twitter followers.  According to TweetReach, the DMCB regularly reaches almost 1500 persons with its tweets.  Depending on re-Tweets, that number can exceed 7000. 

There are also 466 Google RSS subscribers. 

These 2011 numbers suggest there are thousands of persons that regularly read the DMCB.  Every individual visitor, follower and subscriber returned or opted-in based on the DMCB content and only the DMCB content. There is no marketing, emailing or use of any services to promote the DMCB. It doesnt have the advantage of a sponsoring institution or explicit link to a big-name business. And its readership continues to slowly grow.

The DMCB Web Juggernaut

The DMCB is regularly lected and linked in many prestigious web outlets, include HealthHombre, Health Affairs, KevinMD, Forbes, and many sister blogs. Its also appeared in the web sites of USAToday, Wall Street Journal, the Washington Post, Dartmouth Atlas, Business Week and the National Review. Its also been linked in the intranet web sites of many insurers, provider organizations, and health information tech companies.

And, by the way, according to YouTube, the DMCBs videos to date have had 33,486 views.

As testimony to its growing web presence, the DMCB is on the first page when the term "disease management" is Googled.  The DMCBs growing web traffic has ironically made its "Comments" section a target by spammers with links to its dubious medical web sites.  With only one unobtrusive Google "Ad" that generates pennies per click, it still got a check for $100 (prompting the derision of the DMCB spouse, but thats another post).  The DMCB has also been offered - and used - cash to provide link backs.  It also had one complaint lodged over copyright infringement over an image (the post has since been removed, with apologies).  Simply put, folks are paying attention.

Last but not least, the DMCB is proud of its four 2011 peer reviewed publications in Population Health Management, Self Care and the Journal of Comparative Effectiveness Research.

And a thank you....

... to the readers who have commented or emailed with feedback, comments and insights.  To the readers who use their precious time and keep coming back.

A healthy cook’s kitchen is much like any other. There are probably some pots, a few pans, a spatula, and, mysteriously, 48,000 whisks. There might be a chef’s knife among the cutlery, and a splotch of tomato sauce on the floor. Somewhere, maybe behind the spice rack or in a rarely used thermos, lies a king-sized bag of guilty pleasure M&Ms.

However, upon deeper inspection, there are differences between the two galleys. Foremost among the cookware lies a large nonstick skillet. Claiming places of prominence in the utensil drawer are a zester and pack of wooden skewers. Bizarrely, there’s a food scale in the liquor cabinet. (Because seriously, where else do you put that thing?)

Lighter cooking doesn’t have to involve a lot of pricey additional gear, but there are a few pieces of inexpensive, multi-purpose equipment that can undoubtedly make the venture a bit easier. These are my ten picks, garnered from eons and epochs and ages (Note: a coupla years) of healthy-type meal prep. Some would appear in any well-stocked kitchen. Others are specific to us nutritionally-minded folks.

Readers, what would you add? What would you leave off? Aren’t microplane graters the best? Seriously, I could run away to Tahiti with one.

1) Large nonstick skillet with lid
I love Calphalon pans, but they require a good amount of oil and butter to prevent food from sticking. On the other hand, my 13-year-old, 12-inch nonstick barely needs any at all. A little dab of olive oil is enough for most veggies and meats. Not to mention, its sheer size is perfect for a plethora of healthy one-dish meals.

2) Pepper grinder
An important part of healthy cooking is creating maximum flavor without adding too much extra fat or too many calories. For this, salt and pepper are absolutely vital. And while there isn’t a huge difference between mass-produced salts, the same isn’t true for their black-n-gray partners. Freshly ground peppercorns are far superior to dusty, pre-ground supermarket pepper, in both taste and intensity. Find a durable, inexpensive, hand-operated grinder online (Amazon is a good place to start) and get cranking.

3) Microplane zester/grater
Along the same lines, a handheld microplane zester is fantastic for upping your flavor factor. Mulched garlic, grated nutmeg, finely shredded parmesan, and rasped citrus all have a place on its resumé, and it’s really fun to hold. Having one makes me feel like Mario Batali. (Note: Minus the hair.)

4) Food scale
Owning a food scale may not seem useful outside a regimented diet, but hear me now and believe me later: they’re spectacular for gauging portion sizes, no matter how you eat. Four ounces of meat can be difficult to eyeball, but stick that baby on a food scale and *poof*, you’re good to go. Plus, scales are great for measuring exact weights for more accurate recipe reproduction. Grab a cheap-o mechanical version, and you’ll never puzzle over half a pound of penne again.

5) Stick blender
Let’s talk about blender explosions. You know the drill: you ladle a few cups of hot soup in for a puree, you hit the “chop” button, and BLAMMO, there’s butternut squash all over your counter, your walls, and *ouch* your now-blistering hand. Don’t worry, sweet reader. A stick blender will make all that badness go away. Spectacular for healthy soups and purees, it does all the work of a regular blender, without the hospital bills. Cleanup is way easier, as well, and bargain buys tend to perform as well as pricier pieces in reviews.

6) Steamer basket
Soggy vegetables are the bane of humanity. Boiling or over-nuking them can have this unfortunate effect. BUT. Imagine chowing down on crisp, tender, colorful vegetables less than five minutes after turning on your stove’s burner. A $10 metal steamer basket will perform this miracle, and cure your cat of lockjaw. (Note: Only one of those last two statements are true.)

7) Food processor
When you think “food processor,” what’s the first image that comes to mind? Is it a 20-cup monster used for commercial baking? Is it an impossible-to-clean leviathan that takes up 70% of your counter space? Is it an airplane propeller? (Er … weirdo.) Never fear, my friends. Essential for light sauces, dips, salsas, pestos, and other flavorful mixtures, these champions of chop can be found small, cheap, and well-made online. A few minutes (seriously, that’s it) of searching will give your knife calluses a much-needed rest.

8) Bulk storage
Whole foods (as opposed to processed ones) are the cornerstone of healthy eating. Frequently, this means cooking and baking with grains, dried beans, lentils, whole-wheat flour, and a multitude of other items that can be purchased cheaper en masse. Subsequently, having convenient, airtight, bug-resistant storage at hand is highly suggested. You don’t have to buy 20-gallon bins or anything, but a few good OXO or Snapware jars can be just the ticket.

9) Skewers
Fast, high-heat methods of cooking like broiling and grilling don’t generally require a boatload of extra cooking oil, which is nice. Usually, you need just enough to keep food from sticking to a grate. Beyond that, skewers are nice to have. Because:

• They make smaller cuts of meat look gigantic.
• They promote even cooking.
• They’re cheap as heck.
• It is proven scientific fact (by me) that everything tastes 200% to 300% better when stuck on a stick. Give a kid a tomato, he’ll throw it at the dog. Put a tomato on a stick, and he’ll ask for seventh helpings.

Note: I use metal skewers, but mah friend Rachel pers wooden. If you buy the latter, be aware they tend to burn at the ends unless you soak ‘em first.

10) Tongs, kitchen shears, and a slow cooker (TIE).
These three items are common to most kitchens, but I’m listing them anyway. Why? Well, I use the first two almost everyday, for everything. The latter is helpful when I’m in a rush and need big portions of light food with little effort. I suspect families might use it pretty frequently, too.

And with that, sweet readers, I leave it to you. Is there anything about this list you’d change? I dare you to comment on it. (MUHAHAHAHA!)

(Photos from Sur La Table [zester], Skillet Cookware [skillet], Amazon [food scale and canister].)

~~~

If you enjoy this piece, you might also quite like:

• Dessert Island Gadgets
• Finding Quality Kitchen Equipment on the Cheap
• Ultimate Guide to Kitchen Equipment

Sweet readers! Today’s question is pretty self-centered, but what are blogs, if not digital representations of our desperate need for validation on a mass scale? Also, the winner gets a cookbook! Whee!

Q: A long, long time ago (37 days) in a galaxy far, far away (Lawn Guyland, Noo Yawk), I married a man of unparalleled awesomeness and beard-growing ability. Until that fateful evening, he was erred to on this blog as Husband-Elect. Now he has been … uh … sworn in (?) as my spouse, we need a new moniker.

What should we call The Artist Formerly Known as Husband-Elect?

A: Our favorite name will receive a copy of Giada De Laurentiis’ newest cookbook, Giada at Home: Family Recipes from Italy and California. (We went to Italy for our honeymoon, and I hear California is very nice, so its kind of fitting.)

As always with these kinds of things, there are a few rules:

• Entries must be in by this Thursday, October 14th, at 6pm. 
• One entry per person.
• Entries must include your idea and a name with which we can identify you. No anonymous comments, please.
• Winner will be announced in this Friday’s Top Ten Links post.
• In the case of a repeated idea, the commenter who mentioned it first will receive the cookbook.
• No family or friends of CHG bloggers can enter. Sorry, Ma.

Hope that makes sense, sweet readers. Can’t wait to see your ideas, and don’t forget to log on later for Jaime’s newest Green Kitchen column!

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

While the Disease Management Care Blog is pretty good at spotting current health policy silliness, its track record at predicting the future has been rather spotty.  Regular readers have undoubtedly forgotten this brazen attempt at 2012 health care augury, but the transparent DMCB uses to bury its mistakes.

So how did it do with its Ten 2012 Predictions?

1. Mitt Romney will win the Republican nomination and avoid discussing health care.  The DMCB got some of this right, but who would have predicted that the President would cleverly upend his opponents by embracing the term "Obamacare?"

2. A close election will hinge on an improving economy, not on Obamacare. In the end it wasnt really that close, but the DMCB was correct in foreseeing that Mr. Romneys candidacy would be undermined by dropping unemployment levels and the bottoming out of the comatose housing market.

3. The Supreme Court will rule Obamacare unconstitutional: Boy, the DMCB got that wrong.  But in its defense, few foresaw that SCOTUS would ignore the Affordable Care Acts statutory language and rule that a penalty was really a tax all along.

4. There will be no generalizable and published peer-review studies on the electronic record of the medical home that conclusively show that either saves reduces health care costs.  "Bingo!" says the DMCB.  It hopes 2013 is different and that a p value is < 0.05.

5. ACOs will not criticize CMS about the tardy delivery of claims data necessary to manage its assigned populations. The DMCB says the silence over this issue is deafening, which means either a) CMS has overcome its dismal track record on providing timely information or b) the ACOs are reluctant to go public with any concerns.  The DMCB has heard rumors that the latter is true.

6. Speaking of ACOs, their physicians will trump patient perences over savings.  The DMCB says the jury is still out on this, but time will tell if its call about this ACO Achilles heel is as important as it thinks it is.

7.  Health exchange deadlines will be pushed back. To the DMCBs knowledge, CMS is holding firm on the fall 2013 implementation date.  The DMCB takes some credit, however, for being among the first to spot this issue and bring it to its readers attention.

8. CMS will kick the Sustainable Growth Rate (SGR) down the road. "Bingo again!" says the DMCB.  It got his one right and looks forward to how Congress will deal with this in 2013.

9. Medical academics will increasingly turn to social media instead of print to make their mark on the scientific world. The DMCB believes this trend is continuing but has yet to reach a tipping point.

10. CMS Interim Administrator Tavenners status will remain in recess limbo.  OK, it wasnt all that hard to bank on continued partisan bickering, but the DMCB got this one right too.

Will the DMCB offer up predictions for 2013?  Stay tuned!