one is, i'm pleased to say that cms now has an integrated data set, so medicare and medicaid. it's not 2011 unfortunately but we're getting there over time and it's really going to help drive i think our analysis as well as those of others in the room and other interested stakeholders. the second is, we'll soon be releasing state profiles, so it will be a state by state look at the demographics, utilization, the costs, again, for from an integrated data set perspective of the individual whose are duly eligible in the state. it's not meant to compare state-to-state, because we're not controlling for the differences in the medicaid program but again it will be a useful tool to get out there. another thing we're doing that i think is very relevant to this discussion is looking at the simplest way to call it is a pathway analysis. it's very different if you start on medicaid and age into medicare versus start medicare and have some financial decline that makes you medicaid eligible. types of care coordination models whether someone's care improved by care transitions. all of those

one is, i'm pleased to say that cms now has an integrated data set, so medicare and medicaid. it's not 2011 unfortunately but we're getting there over time and it's really going to help drive i think our analysis as well as those of others in the room and other interested stakeholders. the second is, we'll soon be releasing state profiles, so it will be a state by state look at the demographics, utilization, the costs, again, for from an integrated data set perspective of the individual whose are duly eligible in the state. it's not meant to compare state-to-state, because we're not controlling for the differences in the medicaid program but again it will be a useful tool to get out there. another thing we're doing that i think is very relevant to this discussion is looking at the simplest way to call it is a pathway analysis. it's very different if you start on medicaid and age into medicare versus start medicare and have some financial decline that makes you medicaid eligible. types of care coordination models whether someone's care improved by care transitions. all of those

get on cm. been on cm for three years. right now i haven't seen my fami family in four years.go to sleep at 10:00, 11:00. that's what i think about. that's all i really got. your families are the ones that are going to be there. >> it will now be up to administrators to determine he will have his visitation restored. in the meantime, officers will now update their photos of roca-morenos's tattoos and question him about his ties to the nielletas. >> what do they call you, roca? >> alfredo. >> come on now. what do the other guys call you around here? >> alfredo. >> what's your a.k., your nickname? going to be one of them? >> one of what? >> i ask questions you don't answer? >> yep. [ inaudible ] >> that's all we do, we do gang investigation. gang interviews. >>> the. >> you were on our list. >> i'm not in a gang. >> i see your tattoos. >> give me the other leg, all right. >> it is not the same thing. hold it right here. >> we're not in puerto rico. we ain't in santa rosa, california, either. >> that's what i'm saying. >> come over here and have a seat. if you are through with hi

i've got to calm down, get on cm.been on cm for three years, so right now, i ain't seen my family in four years. when i go to sleep at 10:00, 11:00, that's when i think about my family. that's the only thing i've really got, because in the end, no friends are going to do anything for you, but your family's the ones that are going to be there. >> it will now be up to administrators to determine if roca moreno will have his visitation restored. meantime, officers knight and demerey will update their photos with roca moreno's tattoos and question him about his ties to the nietas. >> pictures. >> what do they call you, roca? >> alfredo. >> alfredo? >> we're not going to call you by your first name. >> come on now. what do the other guys call you around here? >> alfredo. >> no, no, what's your ak, your nickname? it's going to be one of them? >> one of what? >> i ask questions, you don't answer? >> no, all depends on what kind of questions you ask me. >> where all this came from? >> we are the security threat group. that's

i know i definitely would never like to be in cm. >> cm is the close management unit where some of theoblematic inmates in the entire state of florida are housed. >> keep it quiet, you understand? no talking. >> among them is anthony cruzado, whose most recent problems have involved sending death threats to the president and cutting himself. now he has taken things to a new level. and we warn you, what you are about to hear is graphic and disturbing. >> we heard kicking on the door. i went ahead and i come up to the wing and i went to his door. and he was standing there and he had blood on him. and i look down, and he said, "look." and i look down and he had his testicle out of his scrotum. i ordered him to submit to i ordered him to submit to hand restraints, and he cuffed up. we took him to medical staff. >> staff believe that he peeled off the casing of a battery and used that to cut himself. he was treated at a local hospital. after returning to prison, cruzado underwent three days of psychological evaluation. >> you can imagine officers and nursing seeing that for the first time,

and we heard about a number of the pilots that cms has under way now to look for ways to improve the care of those individuals, decrease the churn back and forth between hospitals and nursing homes, et cetera, and reduce rate of costs there. we heard from joe newhouse that the problem of rising growth in health spending, those growth rates is really a problem that is ubiquitous across the world. and not withstanding the fact that the u.s. has a higher level, the real issue that these other countries, the real issue is this rate of growth of cost. however as he mentioned nothing grows to the sky. i was reminded of herb stein's comment that things that cannot go on forever will stop. and you mentioned that we are broadly going to halt the dramatic rates of growth in health spending. you just don't know exactly how. we'd love to hear you perhaps address maybe whether we are in the midst of that stopping now with consumer directed health plans and high deductible health plans and people not being able to afford care and all of the other things that we know are a factor currently. we hear

the two colleagues, my two colleagues at cms and i published the piece that is in your book on mechanisms, and we talked about income changes over time, which are certainly common across the developed countries, and this goes partly to joe antos talk. we thought that accounted for 29-43% of the change in growth, and we thought that interacted with technology, again goes to joe's point come at an auction passionate interaction was another 29-49%. the insurance changes mattered less. i do think there's some, and our data, we are looking out across the oecd and the demographic changes mattered just a little bit. so chronic diseases, to go to ken sport, are also increasing i think throughout the developed, certainly diabetes is increasing throughout. so that i think going forward, that's also going to be driving cost, as he said. but again, i think all of these things are different aspects of the same reality. but i do think there is a mechanism that is driving the growth rates. >> i think dallas had a hand up. >> just a quick follow on on that set of points is, in work that paul has been doi

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am concerned for the patient safety or any concerns for the malignancy, any polyps' greater than 1 cm> is it safe? >> is quite safe >> this dr. heads the program and says the nurses do a great job >> the complications we have experienced are exceedingly rare and they are comparable to physicians performing them >> adding on physicians to the mix has dramatically increased the number of patients they're able to see >> is a great service to the minority community where i am from and i like to give back to where i grew up from >> and nurses are cheaper to train and when they do a procedure is that a lower cost. your health care dollars are spent. philip had a nurse to his and a precancerous polyps was removed >> i'm very lucky and i think everyone ought to take this test even if you are of little afraid like i was. i would never worry about it again >> by having nurses involved, the gastroenterologist is available for more complicated procedures and has more time to see patients with complex problems. the main challenges educating the public that they're still getting very very good care

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thank you for cms and hearing aid. i'm here with my husband -- thank you for seeing less and hearing us. i'm here with my husband. we are not directly impacted in that we are a little farther up the street. in that sense, you can think of us as being a little bit neutral. but we have been kept abreast of what has been going on and we were invited to the first meeting that was described. i am encouraging you all to give this a second look was the strong recommendation that all parties go back and reach a better compromise because we have a nice community. certainly think it's come up, people want to extend or go up in height, but we all talk and we are careful about each other's feelings and each others' sensibilities and lifestyles. we are all nice to each other as neighbors. when i see that e-mail's going back and forth at the meeting, just sitting here having mr. teed laugh during this whole process is a little disconcerting and it makes me feel like there's not a lot of respect for the neighbors or the whole process

> you could get transparency for all the contract actions if you had a good dedication to using the cms system and you would be able to find out much more about the progress and what the contract was and the terms and be able to do reviews much quicker and better. >> is there a defined training level with the competency requirement for the people that do these reviews that includes something like that? are you aware of that? >> yes, there are. the kotares which is a technical rep, there is training for that. it takes them through a process where they are delegated the responsibilities. the contracting officers will lay out the responsibilities to review such things as the invoices. because normally they come into play much more after the award of a contract. so they are looking at that contract administration piece. >> so since your investigation has anyone changed the way they are doing business here? or is this going on the way it is. is anyone being reprimanded for not following the rules? >> at this point i would have to say it is too early for us to assess that. the department has

aspirin, blood pressure control, cholesterol screening, and smoking cessation is a joint program with cms. the degree of collaboration around tobacco control between the cdc and are fda is a fantastic effort. and collaboration over food safety, and, you know, it's hard to know why that progress didn't exist sooner, because these issues have moved forward so substantially in the last couple of years. >> do we have questions out in the audience that -- while crisis chris is getting it, i will ask one more for bill and then i have one for kevin. as you look at this space, how do we achieve broader social change? what is it going to take? >> as i -- as i think i indicated, the changes in the food and physical activity environments really need to be transformative in order to reverse this epidemic. analogous to a social movement. and there is certainly a lot of movement, but i'm not yet sure u.s. a movement, and one of the problems the constituencies around these issues are different. so that the same group that promote s increased rates of breast feeding may be very different than those who w

. >> i would argue cms can have as big an impact as anybody in directly addressing obesity. >> thank you very much for joining us. have a wonderful weekend. we'll talk again soon. >>> coming up, president obama makes news, he makes history by saying same-sex marriage should be legal. we look at the political and personal repercussions. >>> facebook goes public this week. we'll tell you if you should buy it and how to, next. if you are one of the millions of men who have used androgel 1%, there's big news. presenting androgel 1.62%. both are used to treat men with low testosterone. androgel 1.62% is from the makers of the number one prescribed testosterone replacement therapy. it raises your testosterone levels, and... is concentrated, so you could use less gel. and with androgel 1.62%, you can save on your monthly prescription. [ male announcer ] dosing and application sites between these products differ. women and children should avoid contact with application sites. discontinue androgel and call your doctor if you see unexpected signs of early puberty in a child, or, signs in a wom

we would also look with cms to promote home and community-based services and support. last but not least, i will be remiss if i forget to mention that may is also the time of the year when communities across nations come together to celebrate the older americans month. the proud tradition that shows our nation's commitment to recognize is the -- recognizing the contributions and achievements of our seniors. the theme for this year is "never too old to play." we want to encourage older americans to be engaged, active, and involved in your own lives and in your own communities. in closing, thank you so much for inviting me to speak at your summit. we wish everyone the very best, and we want to commend san francisco for again launching this important event today, and that is connecting seniors and people with disabilities to a world of possibilities. thank you very much, everyone. [applause] >> i think this program certainly is set up in the right order. learn something about your topic, and when you go to play, you'll understand the importance of what you have learned an

that's exactly what cms wants to do and there's got to be a way to pay for quality on the way. so, yes, you get paid for now, but you can't game the system. you have to make outcomes in order to get reimbursed. so -- that's going to take a lot talking, but a concrete way to accomplish it. >> carmella, give you the last word. >> so my comment actually goes back to the proposal that ken put on the, the plea ken put on the table about, you know, prevention and diabetic care and unfortunately i have to agree with joann. medicare is just this 800-pound gorilla that isn't flexible and didn't move like that and they try to create programs, one size fits all. this is not about one size fits all. as we've looked at what goes on in the private sector, we have a lot of physicians in this country that are in one and two doctor offices. they're going to have very different needs and have different infrahm structure tst need pop build than those in ins grated infrap sturs. every time we have the debate we kind of forget about them. i'm very worry and them because they need certain support if

it was hours before they realize it was this, a 1.5 cm bristle.use to clean the grill prayed >>> it took the doctor for iras to remove the bristle from his esophagus. more than a dozen people have reported similar incidents over the past three years. it was nearly 12 years ago that the brizola almost killed this firefighter. he doesn't remember any warnings on the brussels back then but now many bristles come with warnings come with the growth brush. we couldn't find one morning at this store. >>> and the say, this happened to me before i know what to do. >>> it sounds obvious, but check your wire brush bristles to see of any are loose. if you have a consumer question or complaint had to our website and click consumer watched help. >>> speaking of grilling and pat getting out expect patchy fog. pet expected to clear out. >>> it is 54 degrees at s f o. 56 degrees in santa rosa. big question is how will skies people, will have more on that. >>> happy anniversary to all the bay bridge. the project came on time and under budget. the project came a.m.

today also represents an unprecedented degree of cooperation among cms, the inspector general and thedepartment of justice and the fbi which made it possible to tie our civil administrative actions together with the criminal ones. today's historic takedown is just the beginning. in the near future we'll see results which will demonstrate that we're able to prevent fraud from ever escalating to the massive level we have seen and brought down today. now i'm pleased to turn things back over to the secretary and the attorney general. >> [inaudible]. >> you said that somebody stole documents from the u.s. attorney's office? is that -- >> right. well, well, we allege that in connection with a civil-related action here that some of the defendants in baton rouge were in the united states attorney's office during civil discovery and in the course of it, took and or destroyed documents. >> was anyone watching them at the time? >> i can't go any further than that at this point. >> payment blocks on any of the $452 or do you have any indication how much you're going to be able to recover? >> i'm

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>>ity's getting a lot easier, thanks so the affordable care act and reorganization of cms before i got. but i took it over, the fraud unit. integrity unit is much stronger than ever before. remarkable dr. peter badetti runs it. we are working with the local law enforcement. there the affordable care act there is predictive analytics. that's what your credit card uses. if you try to use your card in turkey, they might call you and say what is going on. and data is disturbing. quite a bit of fraud. very few people carrying it out but it is large when they do. >> imagen? >> first of all, i have to say, i'm your biggest fan. thank you for what you said on the free healthcare service in the uk. you said you loved it, you have romantic notions. it was very much appreciatated in the uk. is there anything that u.s. healthcare system can learn from the uk healthcare system. maybe the nice, which n which republicans compare as to death pen panels. do you think that has to be looked at in america? >> that's a lot of questions. >> sorry. >> we can deliver everything our patient and families want a

luscious focus on one of the most tangible and our cms cost and you're suggesting even giving a pain for the public good now. so i was wondering what your thought is i'm not. >> well, i think to govern is to choose and you can't do everything. you can't afford to do everything. i think the public peace is definitely a public good. it's a collective public good. it is something the united states should aspire not to unilaterally deliver to people whether they asked for it or not, but to operate in the international arena as a sort of imperfectly did to mobilize international forces for collect it -- it is their tradition after all. we slipped into saying in the beginning of afghanistan, rumsfeld was very explicit. there is nato offering to help. we don't watch you. we want our forces. we trust our forces. you go in the quiet areas. i have an article coming out in the world policy journal and a few weeks, which takes on this very question, which is to say i'm not an isolationist. i think that they unfortunately named the vote nationalism is not the only kind of internationalism and ord

we refer providers to cms for pimmit suspension. -- payments suspension. the indictments announced today demonstrate we are fighting back, leveraging data, technology, and investigative expertise to achieve record- setting results in broad enforcement. we recovered more than $7 for every dollar spent fighting health-care fraud. oig and our partners have announced record-setting results before. because of this partnership, i know it will not be the last time. thank you. i would like to introduce our next speaker. >> thank you, deputy inspector. one of my close inspectors -- partners in fighting health-care fraud. today the centers have proposed payment suspensions and other actions against 52 providers to ensure that for the program dollars do not go out the door. these providers including home health agencies pain management clinic and ambulance services and will stop receiving payment until the investigations are resolved and claims to terminations have been made. these actions are being taken under one of the powerful anti- fraud provisions in the afford

a study in the journal "cmaj" looked at 30 cms patients who had not improved with conventional medicationsers found those who smoked real marijuana showed substantial improvement in their spasticity. patients in the cannabis group also reported less pain. the study found that the thought process in the cannabis group was slower. but in a normal range for their age group. nonetheless, the authors call for more research on treating ms with marijuana. i'm dr. timothy johnson. >> wow. i mean, and this is no small change. get this. california tax authorities estimate that the state currently collects $58 million to 105 -- [ coughing ] willis -- >> i'm staying out of this conversation. >> willis! cheetos, man. >> feed me! >> that glaucoma has never been better on you. we'll be back. >>> there's been a major boom in the pawn shop business. and some stores have lost that low-rent stigma. >> many high-end luxury items can be found by those looking to cash in. abby boudreau looks into the trend. >> reporter: gold, diamonds, jewels and art. the classic pawn shop where you sell or get a loan for your