if you look at the cms data there's been a 10% reduction from last year -- or actually, the year before to last year. for both cabbages and stenting and actually reduction in imaging. i think that's actually speaks towards the addressing of the risk factors. i'm glad everyone's looking at obesity and mary ellen knows that i worked on obesity when i was in practice in arkansas. it gets to be quite hard. we were on the commission that set up measuring the bmi on the kids at the school and you could imagine when you had to do it so no one else knew the bmi and sending it home, but we had a 33% prevalence of obesity in the school-aged kids. by doing the measurement, taking the vending machines out of school, et cetera, we at least levelled that. now, we didn't impact the 48% smoking prevalence or i guess tobacco use. it was as much dipping as smoking. one program i'll mention is the durable balloon. when a patient with acute mi, until they're blowing up the vessel we know that if you do than 90 minutes you save heart muscle and you don't have as much congestive heart failure. we -- now, we

and by the way, by looking at this cms data, we in fact can assure you that by reducing utilization and being a little more thoughtful about a your use of angioography, you in fact could put yourself in a position where you could responsibly assume risk, financial risk without compromising the care of your population. so i think for a lot of these issues, we need to think about companion solutions and actually collect and combine some of the issues that we've been talking about. >> don't underestimate the power of peer pressure. if we can profile these practices and create the data and make that data available to people, we had two large cardiology groups in adjacent counties. and the utilization practices in one of those counties was egregious. we went to those cardiologists and we showed them their data compared to the next county. and if we had just sent that out to them and not engaged them, they would have thought, well, i guess that means we're diagnose a better job. so instead we were able to engage them, hold their feet to the fire. and now two years later their utilization prac

are issues so you received a global rate for your community and by the way by looking at the cms data we assure you by looking at utilization and the more thoughtful about your use of and geography and 25 other tests you in fact put yourself in a position where you could responsibly assume risk, financial risk without compromising the care of your population. for a lot of these issues you have to think about companion solutions that combine the issues we are talking about. >> don't underestimate the power of peer pressure. if we can profile this practices and make the data available to people we have two large cardiology groups in adjacent counties and the utilization practices of one of those counties was agreed does. we went to those cardiologists and showed them their data compared to the next county and if we had sent that out and not engaged them they would have thought we are doing a better job. instead we were able to engage them, hold their feet to the fire and two years later their utilization practices are what the other counties are. driving toward the means. >> is it worki

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 medicaid and medicare at the person level, it's not 2011 unfortunately. but we're getting there. over time. it's really going to help drive 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, the utilization, the costs again for -- from an integrated data set perspective of the individuals who are duly eligible in the state. 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. so it's very different if you start on medicaid and age into medicare versus if you start on medicare if you have a functional decline that makes you medicaid eligible. and the models are whether should be would be -- whose care is improved by care transition

so we think cms needs to develop alternative data bases. for example, on the specific issue of time. >> i'd like to stop you there. i put a bill in saying you should have your own analytic people doing this rather than the ruk. what is it that prevents you from doing that? >> if the question is what prevents cms from doing that -- >> yes. >> we think they need to be less dependent on the ruk and have more alternative sources of information to guide their decisions. it sounds like we're together on that issue. one last point on primary care. we do think that this revaluation could help primary care, but the problems we face in primary care are so urgent that we need to do something in addition to improving the relative values. part of that is incorporated in the patient protection and affordable care act for primary care, as you well know. we think that's a constructive step. but it may be that we need to do some additional stopgap measures. for example, payments for care coordination in addition to looking at the relative value. >> may i ma

cm wear or emc. >> i prefer emc. a little less wild, a little less crazy. big data is something that a lot of oracle calls.nnsylvania. >> caller: how are you? >> all right, lee. how about you? >> caller: go phillies. the stock that next week the supreme court will give information about the health care law, and i want to know about quest diagnostics. >> i have a feel for quest. i think the stock is moving up. it was stalled for a long time. it is a fine company, but i'm not sure how it dove tails what may happen with the supremes. shelley in new york. shelley. >> caller: so nice to have you on tv. thanks for helping this small investor. >> that's what i'm trying to do. >> caller: a great big boo-yah from shelley in brooklyn. >> love brooklyn, be there later this evening. what's up? >> caller: jim, maybe you could help me, please. over a year ago i bought citi corp incorporated, symbol c. it was only $4.40 a share. i bought a couple of shares. then it split, which i thought would be a good thing, but they gave me very few shares and posted a higher value and i have lost about half the money. >> it's too low