"Absurd" Contract Dodge Rejected: Court Lets Cancer Center's Debt-Collection Suit Proceed

Appeals court denies "free speech" challenge to cancer center's debt-collection suit.

Progressive development and enhancement of palliative care services in Japan: nationwide surveys of designated cancer care hospitals for three consecutive years

CONTEXT

Policymaking plays an important role in national palliative care services. The Japanese Cancer Control Act was implemented in 2006.

OBJECTIVES

To evaluate changes in the structure and processes of palliative care services after implementation of the Cancer Control Act.

METHODS

We conducted annual nationwide surveys in designated cancer care hospitals (DCCHs, n = 349) between 2008 and 2010. The 65-item questionnaire was divided into seven domains: institutional framework, information to patient and family, practice of palliative care, activities of the palliative care teams (PCTs), members of PCTs, regional medical cooperation, and education. Increasing trends were tested using generalized estimating equation models.

RESULTS

The response rates were ≥ 99%. All domains showed an increasing trend (P < 0.001). There were significant increases in full-time PCT physicians (27.4%-45.7%, P(trend) < 0.001), full-time PCT nurses (38.9%-88.0%, P(trend) < 0.001), and the median number of annual referrals to PCTs (60-80 patients, P < 0.001). Essential drugs were available in most DCCHs from baseline. Although outpatient clinics increased significantly (27.0%-58.9%, P(trend) < 0.001), community outreach programs did not (9.0%-12.6%, P = 0.05). Basic education was actively introduced for in-hospital physicians and nurses (78.2% and 91.4% in 2010), but often unavailable for regional health care providers (basic education for regional physicians and nurses: 63.9% and 71.1% in 2010).

CONCLUSION

The Cancer Control Act promoted the development and enhancement of palliative care services in DCCHs. Regional medical cooperation and education are the future challenges of palliative care in Japan.

Accountability in the ontario cancer services system: a qualitative study of system leaders' perspectives

Cancer Care Ontario (CCO), the provincial cancer agency, operates under a model of accountable governance that has been hailed as exemplary. We explored cancer system leaders' views on the balance and perceived efficacy of approaches to accountability in this context. Semi-structured interviews were conducted with 19 participants (MOHLTC=5, CCO=14). Adopting a qualitative descriptive approach, we coded data for four policy instruments used in approaches to accountability. Financial incentives are a key lever used by both parties to effect change. Cancer-specific regulations were somewhat weak, but agency-wide directives were a necessary nuisance that had great force. The effect of public reporting on mobilizing consumer sovereignty was questioned; however, transparency for its own sake was highly valued. Professionalism and stewardship, with an emphasis on trust-based partnerships and clinical engagement, were critical to CCO's success. These approaches were seen to work together, but what made each have force was reliance on professionalism and stewardship.

[Nurse hygienist, a role in everyone's interest]

Pascale Auguste has been working as a nurse hygienist for four years. Her managerial and pedagogical skills, specialised and up-to-date knowledge and human qualities enable her to work efficiently with the nursing teams. The diversity of the missions which she carries out makes her practice in hospital hygiene, not only complex but also very interesting.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the administration of vaccines by nursing staff as well as the CoPs for critical access hospitals relating to the provision of acute care inpatient services. We are finalizing proposals issued in two separate proposed rules that included payment policies related to patient status: payment of Medicare Part B inpatient services; and admission and medical review criteria for payment of hospital inpatient services under Medicare Part A.

Transmission d'informations médicales aux ayants droit d'un malade décédé de cancer

INTRODUCTION

The transmission of medical information about patients who have died is regulated by statute, under strict conditions recently clarified by the Conseil d'Etat.

METHODS

Analysis of requests from heirs to our cancer center over a 4-year period.

RESULTS

Of 48 serious requests, 28 met the legal conditions and were answered by the transmission of the appropriate information. The remaining 20 were not covered by the law, but were rather personal questions by people in mourning; They received appropriate explanations.

DISCUSSION

These observations should help to manage similar requests in the future.

Patient perspectives: Tijuana cancer clinics in the post-NAFTA era

This article contains observations and historical considerations on cancer and complementary and alternative medicine (CAM) in the Tijuana, Mexico, area. There are approximately 2 dozen such clinics in Tijuana, some of which have been treating international cancer patients since 1963. Among the first clinics to be established were the Bio-Medical Center (Hoxsey therapy), Oasis of Hope (a Laetrile-oriented clinic), and a series of clinics affiliated with the Gerson diet therapy. These original clinics were established mainly by American citizens in response to increased regulation of nonstandard therapies in the United States, particularly after passage of the Kefauver-Harris Amendments to the Food, Drug and Cosmetics Act in 1962. In the 1970s, the Tijuana clinics proliferated with the upsurge of interest in Laetrile (amygdalin). By 1978, 70,000 US cancer patients had taken Laetrile for cancer treatment, and many of those had gone to Tijuana to receive it. The popularity of the Tijuana clinics peaked in the mid-1980s. Although many new clinics opened after then, a dozen have folded in the past 10 years alone. The turning point for the clinics came with passage of the North American Free Trade Agreement (NAFTA), which facilitated greater cooperation among the antifraud authorities of Canada, the United States, and Mexico. In 1994, the tripartite members of NAFTA formed the Mexico-United States-Canada Health Fraud Work Group, or MUCH, whose brief is to strengthen the 3 countries' ability to prevent cross-border health fraud. Under the auspices of MUCH and its members, regulatory crackdowns began in earnest early in 2001. The clinics were also badly affected by the general downturn in travel after 9/11. If these trends continue, many Tijuana clinics are unlikely to survive. Some suggestions are made for how the Tijuana clinics could be reorganized and reformed to minimize the likelihood of governmental actions and to maximize public support. Such reforms center on 5 main areas: (1) research, (2) physical plant, (3) finances, (4) ethics, and (5) education.

Cancer centers--origins and purpose. The James Ewing lecture

Cancer centers in the United States date back to the beginning of this century, although there were few until the late 1950s and 1960s. The National Cancer Act of 1971 introduced a new era in serving as a major stimulus to the development of comprehensive cancer centers. Research scientists and physicians in centers have contributed significantly to the new knowledge of normal and abnormal regulation of cell growth and differentiation and to the advances in the diagnosis and treatment of cancer. The future for cancer centers is very bright. They will continue to play a major role in the advancement of knowledge about cancer. However, centers must be reevaluated at intervals to correct any deficiencies and to stimulate new and innovative approaches. Surgical oncologists should become more involved in cancer center research. Comprehensive cancer centers should develop more effective regional cancer control and prevention programs. Reevaluation of centers by the National Cancer Institute, Bethesda, Md, and its advisory body, the National Cancer Advisory Board, along with cancer center leaders, should result in a consensus concerning changes to enhance their contribution to a solution to the cancer problem.

The NCI's Cancer Centers Program: past, present, and future

Since passage of the National Cancer Act in 1971, the NCI Centers Program has promoted the establishment and the development of cancer centers of many types throughout the nation. These now include 20 comprehensive cancer centers, as well as a number of clinical and basic science centers that are supported through NCI core grants. Scientific productivity at NCI-supported centers has been high. While cancer center core grants usually represent only a small proportion of the total extramural research support for a given institution, they are essential in providing shared resources and in pulling together the various component research programs of a center into a unified program. The future directions of the NCI centers program as a whole, as well as the role of cancer research centers within their communities and regions, are discussed.

FDA regulations as applied to research in cancer centers. Review of problems and possible solutions

The Food and Drug Administration is charged to insure that the general public is not exposed to drugs that are either harmful or ineffective; yet, the regulations issued by the Food and Drug Administration are perceived to be in conflict with therapeutic human research. This article briefly reviews some considerations relevant to the problem. The regulations create both tensions and conflicts, but in themselves are reasonable exercises of the authority under which the FDA acts. However, regulations cannot be made either so general or so detailed that they will apply to all eventualities. A major problem is the degeneration of accountability and evaluation, from a compliance with the spirit of the recommendation to a compliance with documentation. When the review of compliance of documentation is done by inexperienced individuals, adversary relationships develop and the scientific and ethical problems are not addressed. A regulation that is meeting determined and widespread opposition is not enforceable unless it is subjected to continuous official scrutiny and to continuous coercion. The regulating agency must acquaint the regulated with the regulations, but must also convince the regulated of the necessity of the regulations. The research center serves to accentuate the differences and the problems that exist between the FDA and the research community, but is not unique in and of itself.