Archive for August, 2013

US News and World Reports Ranks Diets

Tuesday, August 27, 2013 // Uncategorized

Best Diets

Best Plant-Based Diets

U.S. News Best Diets: How We Rated 29 Eating Plans

With help from a panel of diet and nutrition experts, U.S. News unveils new 2013 diet rankings

      By              U.S. News Staff

January 7, 2013         RSS Feed                Print            

Couple cooking dinner together and drinking wine

Diets come and go, teasing and tempting us with dreams of that  elusive hot body. Eat what you want! Pounds melt away overnight! The  reality, as frustrated dieters know well, is that dieting is hard, and  frankly, most diets don’t work. Some can even threaten your health. And  digging out the truth about dieting, let alone deciphering whether  particular plans live up to the hype, is laborious enough to burn off a  pound or two by itself.

Best Diets  2013 cuts through the clutter of claims and delivers the facts about 29  diets. Now in its third year, Best Diets is introducing four new diet  profiles and a new rankings category: Best Plant-Based Diets.

Many of the 29, such as Weight Watchers, are household names, while others, such as the DASH (Dietary Approaches to Stop Hypertension) diet, should be. To create the third annual rankings, U.S. News  editors and reporters spent months winnowing potential additions to our  diet roster and then mining medical journals, government reports, and  other resources to create in-depth profiles for those that made the cut.  This year we turned the spotlight on the Flexitarian Diet, Engine 2 Diet, Traditional Asian Diet, and Anti-Inflammatory Diet.

Each  profile explains how the diet works, determines whether its claims add  up or fall short, scrutinizes it for possible health risks—and reveals  what it’s like to live on the diet, not just read about it.

A panel of nationally recognized experts  in diet, nutrition, obesity, food psychology, diabetes, and heart  disease reviewed our profiles, added their own fact-finding, and rated  each diet in seven categories: how easy it is to follow, its ability to  produce short-term and long-term weight loss, its nutritional  completeness, its safety, and its potential for preventing and managing  diabetes and heart disease. We also asked the panelists to let us know  about aspects of each diet they particularly liked or disliked and to  weigh in with tidbits of advice that someone considering a particular  diet should know.

Every diet received robust  scrutiny, and we converted the experts’ ratings to scores and stars from  5 (highest) to 1 (lowest) to construct eight sets of Best Diets  rankings. One—Best Plant-Based Diets—is brand new for 2013; the other seven have been refreshed and include the four new diets:

Best Diets Overall  combines panelists’ ratings in all seven categories. All categories  were not equally weighted. Short-term and long-term weight loss were  combined, with long-term ratings getting twice the weight. Why? Quick  results are important after the holidays or when summer looms, but a  diet’s true test is whether it can be sustained for years. That’s  especially the case for those who are overweight or obese; losing as  little as 5 percent of body weight can dramatically reduce the risk of  chronic illnesses such as diabetes and heart disease. And this time  around, safety was double-counted, because no diet should be dangerous.

Best Commercial Diet Plans uses the same approach to rank 12 structured diet programs marketed to the public.

Best Weight-Loss Diets  was generated by combining short-term and long-term weight-loss  ratings, weighting both equally. Some dieters want to drop pounds fast;  others, looking years ahead, are aiming for slow and steady. Equal  weighting accepts both goals as worthy.

Best Diabetes Diets is based on averaged diabetes ratings.

Best Heart-Healthy Diets uses averaged heart-health ratings.

Best Diets for Healthy Eating  combines nutritional completeness and safety ratings, giving twice the  weight to safety. A healthy diet should provide sufficient calories and  not fall seriously short on important nutrients or entire food groups.

Easiest Diets to Follow  represents panelists’ averaged judgments about each diet’s taste  appeal, ease of initial adjustment, ability to keep dieters from feeling  hungry, and imposition of special requirements.

Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 11 plans that emphasize minimally processed foods from plants.

In all eight rankings, scores are rounded to one decimal place; diets with the same scores are ordered alphabetically.

In  addition to the rankings, ratings in all seven categories are displayed  for each diet as 1 to 5 stars on its individual profile page.

To  ward off possible bias, each panelist provided information indicating  clear or apparent conflicts of interest, such as a paid consulting  relationship with a company marketing a particular diet. In such cases,  panelists did not rate the diet. For commercial programs offering a  range of tracks that may target specific groups, such as pregnant women  or those with diabetes, U.S. News selected the most mainstream version.

A  vexing challenge faced us early on. To rate the diets, experts needed  more than just labels like “short-term weight loss” and “health risk,”  which can mean something different to different researchers. What should  the standard be for rating nutritional soundness? What constitutes a  health risk? Aided by the panelists and other experts, we settled on the  following definitions to use in rating the diets:

• Short-term weight loss.  Likelihood of losing significant weight during the first 12 months,  based on available evidence (5=extremely effective, 4=very effective,  3=moderately effective, 2=minimally effective, 1=ineffective).

• Long-term weight loss.  Likelihood of maintaining significant weight loss for two years or  more, based on available evidence (5=extremely effective, 4=very  effective, 3=moderately effective, 2=minimally effective,  1=ineffective).

• Diabetes. Effectiveness  for preventing diabetes or as a maintenance diet for diabetics  (5=extremely effective, 4=very effective, 3=moderately effective,  2=minimally effective, 1=ineffective).

• Heart.  Effectiveness for cardiovascular disease prevention and as  risk-reducing regimen for heart patients (5=extremely effective, 4=very  effective, 3=moderately effective, 2=minimally effective,  1=ineffective).

• Ease of compliance. Based  on initial adjustment, satiety (a feeling of fullness so that you’ll  stop eating), taste appeal, special requirements (5=extremely easy,  4=very easy, 3=moderately easy, 2=somewhat difficult, 1=extremely  difficult).

• Nutritional completeness. Based  on conformance with the federal government’s Dietary Guidelines for  Americans 2010, a widely accepted nutritional benchmark (5=extremely  complete, 4=very complete, 3=moderately complete, 2=somewhat complete,  1=extremely incomplete).

• Health risks. Including  malnourishment, specific nutrient concerns, overly rapid weight loss,  contraindications for certain populations or existing conditions, etc.  (5=extremely safe, 4=very safe, 3=moderately safe, 2=somewhat unsafe,  1=extremely unsafe).

We could not assign scores  to the cost of a plan, nor to exercise. Even dieters buying prepackaged  meals from commercial programs have to shop for at least some food, and  individual shopping habits and preferences, not to mention dining out,  will heavily determine any dieter’s total expense. Exercise gets serious  attention in some diets and lip service in others, but the primary  focus of a diet, after all, is food. Whether to exercise, how, and how  much is a lifestyle decision beyond the scope of a mere diet.

What’s  next for Best Diets? We plan to scrutinize more eating plans and give  dieters a way to plug in their personal preferences and requirements so  they can zero in on diets that have the best chance of working for them.  With diets, one size never fits all.

Experts Who Reviewed the Diets      

A panel of health experts, including nutritionists and specialists in diabetes, heart health, human behavior, and weight loss, reviewed detailed assessments prepared by U.S. News of 29 diets. The experts rated each diet in seven categories, including short- and long-term weight loss, ease of compliance, safety, and nutrition.

        Kathie Beals, Ph.D., R.D.

Associate professor, clinical, division of nutrition, University of Utah, Salt Lake City

Beals, a registered dietitian and associate professor of nutrition at the University of Utah, focuses her research on nutrition for athletes and athletic performance, weight management, and the glycemic index, a measure of how carbohydrates affect blood-sugar levels.


Amy Campbell, M.S., R.D., L.D.N. C.D.E.

Manager, clinical education programs, healthcare services, Joslin Diabetes Center, Boston

An expert in diabetes nutrition, Campbell leads educational initiatives aimed at healthcare providers, including physicians, nurses, pharmacists, and case managers, to better care for the growing number of people with diabetes. She also specializes in cardiovascular disease and weight management. Campbell coauthored 16 Myths of a Diabetic Diet, a book that debunks misconceptions about nutrition for people with diabetes.

          Read More »        


Lawrence Cheskin, M.D.

Founder and director, Johns Hopkins Weight Management Center, Baltimore

Trained in internal medicine and gastroenterology, Cheskin specializes in diet and weight management. He is associate professor of health, behavior, and society at the Johns Hopkins Bloomberg School of Public Health, with joint appointments in medicine and human nutrition. He has authored numerous studies on weight loss.

          Read More »        


Michael Davidson, M.D.

Director of preventive cardiology, University of Chicago Medical Center

Cutting the risk of heart disease with dietary changes and exercise is Davidson’s notable area of expertise. Also a clinical professor of medicine at the University of Chicago Medical Center, Davidson is an active nutrition researcher and is currently president of the National Lipid Association.

          Read More »        

Marion Franz, M.S., R.D.

Nutrition and health consultant, Nutrition Concepts by Franz, Inc., Minneapolis

Franz, a registered dietitian, author, lecturer, and diabetes educator, specializes in diabetes nutrition. She was director of nutrition and health-professional education at the International Diabetes Center in Minneapolis for over 20 years. She has also advised the American Diabetes Association and the American Dietetic Association on nutrition recommendations.

        Teresa Fung, Sc.D., R.D., L.D.N.

Professor of nutrition, Simmons College, Boston

A nutritional epidemiologist, Fung researches the relationship between diet and chronic disease, especially diabetes, heart disease, and cancer. In addition to Simmons College, she is adjunct professor of nutrition at the Harvard School of Public Health. She was previously a nutritionist at Yale-New Haven Hospital.


Andrea Giancoli, M.P.H., R.D.

Spokesperson, Academy of Nutrition and Dietetics, Los Angeles

A registered dietitian and an expert in nutrition policy and vegetarian and fad diets, Giancoli is nutrition policy consultant for the California Center for Public Health Advocacy, where she works with cities to adopt healthful food and beverage polices. Giancoli previously served as nutrition policy coordinator for the Los Angeles United School District, advocating for better nutrition in schools.

          Read More »        


Carole V. Harris, Ph.D.

Senior Fellow, Public Health Division, ICF International


A licensed clinical psychologist and behavioral researcher, Harris’ research has examined the impact of individual behavior change interventions on child and adult obesity, cardiovascular disease, and diabetes. She previously served as codirector of the West Virginia University School of Medicine Health Research Center, where she was responsible for evaluating the impact of the state’s school nutrition and childhood obesity prevention policies.

          Read More »        


David Katz, M.D., M.P.H.

Director, Yale-Griffin Prevention Research Center, Derby, Conn.

Katz is a recognized expert in nutrition, weight management, and chronic-disease prevention. He invented NuVal, a nutritional scoring system implemented in over 1,500 grocery stores nationwide. An active researcher and contributor to consumer health publications, he was recently appointed editor in chief of Childhood Obesity.

          Read More »        


Penny Kris-Etherton, Ph.D., R.D.

Distinguished Professor of Nutrition, the Pennsylvania State University, University Park, Pa.

Kris-Etherton has been studying the impact of diet on heart disease risk for more than 30 years. She has served on advisory committees to the federal government and the American Heart Association to help shape nutrition guidelines. She is president of the National Lipid Association and chair of the American Society for Nutrition’s Medical Nutrition Council.

          Read More »        


Robert Kushner, M.D.

Clinical director, Northwestern Comprehensive Center on Obesity, Chicago

Kushner is professor of medicine at Northwestern University’s Feinberg School of Medicine and an authority on weight management and obesity. In his post at the obesity center he helps patients lose and maintain their weight through diet, exercise, and behavioral change. Kushner serves on editorial boards for scientific journals, is past president of the Obesity Society, and is the author of Dr. Kushner’s Personality Type Diet.

          Read More »        


JoAnn Manson, M.D., Dr.P.H.

Michael and Lee Bell Professor of Women’s Health, Harvard Medical School, Boston, Mass.

Manson’s research focuses on how lifestyle factors and nutrition affect women’s risk for heart disease, diabetes, and cancer. She is chief of the division of preventive medicine and codirector of the Connors Center for Women’s Health and Gender Biology at Harvard-affiliated Brigham and Women’s Hospital. She directs the VITamin D and OmegA-3 TriaL (VITAL) and other studies.

          Read More »        


Lori Mosca, M.D., M.P.H, Ph.D.

Director of preventive cardiology, New York-Presbyterian Hospital, N.Y.

An expert in preventive cardiology and women’s health, Mosca’s research examines the role family and lifestyle play in preventing heart disease. She also is professor of medicine at Columbia University Medical Center in New York. Mosca authored Heart to Heart: A Personal Plan for Creating a Heart-Healthy Family. Mosca participated in the first two editions of Best Diets. Mosca participated in the first and second iterations of Best Diets.

          Read More »        


Yasmin Mossavar-Rahmani, Ph.D., R.D.

Associate professor of clinical epidemiology and population health, Albert Einstein College of Medicine, New York

Mossavar-Rahmani studies the link between nutrition and chronic disease and does cutting-edge research on dietary assessment using biomarkers. She is the principal investigator of the NIH-funded Study of Latinos: Nutrition & Physical Activity Assessment Study, and is a co-investigator of the Women’s Health Initiative.

          Read More »        


Elisabetta Politi, M.P.H., R.D., C.D.E., L.D.N.

Nutrition director, Duke Diet and Fitness Center, Durham, N.C.

Politi, a dietitian and certified diabetes educator, focuses on preventing chronic diseases through diet and weight management. At the center, she teaches patients how to make better food choices and plan healthy meals. She also oversees the preparation of well-balanced meals that are low in calories and high in taste.

          Read More »        


Rebecca Reeves, M.P.H., Dr.P.H., R.D.

Adjunct assistant professor, University of Texas School of Public Health, Austin

Reeves, a registered dietitian, has helped lead clinical trials in the fields of nutrition and behavioral medicine, including studies on the prevention of heart disease and the behavioral treatment of obesity. She was project director of the landmark Look AHEAD (Action for Health in Diabetes) study, and former managing director of the Behavioral Medicine Research Center at Baylor College of Medicine, Houston.

          Read More »        

Michael Rosenbaum, M.D.

Professor of clinical pediatrics and clinical medicine and associate director of the Clinical Research Resource at Columbia University Medical Center, N.Y.

Rosenbaum is a pediatrician and pediatric endocrinologist. He has authored more than 70 peer-reviewed manuscripts focusing on the regulation of body weight in adults and the prevention of obesity and its complications in children. He has received numerous awards as a clinician and as a scientist.


Lisa Sasson, R.D.

Clinical associate professor of nutrition, food studies and public health, New York University

Sasson’s expertise includes weight maintenance through behavior modification, sports nutrition, and the development of food attitudes and beliefs. She teaches both graduate and undergraduate nutrition courses and has a private practice specializing in weight management and other weight issues.

          Read More »        

Joanne Slavin, Ph.D., R.D.

Professor, department of food science and nutrition, University of Minnesota, Twin Cities

Noted for her research on dietary fiber and whole grains, Slavin served on the 13-member advisory committee that helped shape the 2010 Dietary Guidelines for Americans. She also studies the effect of diet on the development of chronic diseases.


Laurence Sperling, M.D.

Director of preventive cardiology, Emory Clinic, Atlanta

Sperling is a cardiologist, professor of medicine, and director of the Center for Heart Disease Prevention at the Emory University School of Medicine. He has authored more than 100 manuscripts, abstracts, and book chapters, and has been an investigator in landmark clinical heart trials.

          Read More »        


Sachiko St. Jeor, Ph.D., R.D.

Professor Emeritus of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada

A behavioral scientist, St. Jeor is known for her innovative work in nutrition and weight management. She served on the 1995 U.S. Dietary Guidelines Advisory Committee and coauthored the Institute of Medicine’s Weighing the Options: Criteria for Evaluating Weight-Management Programs.

          Read More »        


Brian Wansink, Ph.D.

Director, Food and Brand Lab, Cornell University, Ithaca, N.Y.

An authority on food psychology, Wansink is best known for his work on consumer behavior and for popularizing terms such as “mindless eating” and “health halos.” He authored the best-selling book Mindless Eating: Why We Eat More Than We Think (Bantam, 2006). Wansink participated in the first two editions of Best Diets.


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Antibiotics Do’s and Don’t

Monday, August 26, 2013 // Uncategorized

Here is a good article from the Wall Street Journal that I read last week that gives some practical advice of when antibiotics are indicated and the perils of overuse.

The Wall Street Journal

  • August 19, 2013, 7:12 p.m. ET

Antibiotics Do’s and Don’ts

Doctors Too Often Prescribe ‘Big Guns’; Impatient Patients Demand a Quick Fix

    Columnist's name


    [image]                                                                                                                 Getty ImagesOveruse of antibiotics, and prescribing broad-spectrum drugs when they aren’t needed, can cause a range of problems.

    Doctors aren’t only handing out too many antibiotics, they also are frequently prescribing the wrong ones, researchers and public-health officials say.

    Recent studies have shown that doctors are overprescribing broad-spectrum antibiotics, sometimes called the big guns, that kill a wide swath of both good and bad bacteria in the body. Instead, narrow-spectrum antibiotics, like penicillin, amoxicillin and cephalexin, can usually clear up many infections, while targeting a smaller number of bacteria.

    Professional organizations, including the American Academy of Pediatrics, and public-health groups such as the Centers for Disease Control and Prevention are pushing doctors to limit the use of broad-spectrum antibiotics. Among the most common broad-spectrum antibiotics are ciprofloxacin and levofloxacin—a class of drugs known as fluoroquinolones—and azithromycin, which is sold by one drug maker under the brand name Zithromax, or Z-Pak.

    Overuse of antibiotics, and prescribing broad-spectrum drugs when they aren’t needed, can cause a range of problems. It can make the drugs less effective against the bacteria they are intended to treat by fostering the growth of antibiotic-resistant infections. And it can wipe out the body’s good bacteria, which help digest food, produce vitamins and protect from infections, among other functions.

    In a July study published in the Journal of Antimicrobial Chemotherapy, researchers from the University of Utah and the CDC found that 60% of the time physicians prescribe antibiotics, they choose broad-spectrum ones. “There is overuse of broad-spectrum antibiotics both in situations where a narrower alternative would be appropriate and in situations where no therapy is indicated at all,” said Adam Hersh, assistant professor of pediatrics at University of Utah and a study author.

    The study, which relied on a public database with information on nearly 240,000 visits to doctor’s offices and emergency departments, said illnesses for which doctors choose the stronger antibiotics include skin infections, urinary-tract infections and respiratory problems.

    A similar study of children, published in the journal Pediatrics in 2011, found that when antibiotics were prescribed they were broad-spectrum 50% of the time, mainly for respiratory conditions.

    Both studies also found that about 25% of the time antibiotics were being prescribed for conditions in which they have no use, such as viral infections.

    “This is upward of 30, 40 million prescriptions a year. And on top of it, these are conditions where antibiotics aren’t justified—coughs, colds, bronchitis—and the majority of the antibiotics prescribed are the broad-spectrum antibiotics,” says Dr. Hersh, also a co-author of the Pediatrics study.

    When doctors don’t know exactly what type of bacteria is causing an infection they may prescribe a broad-spectrum antibiotic. Ordering up a test to isolate the source of the bacteria can take a day or two to get results. Waiting can risk the infection spreading. Patients also may be in discomfort and not willing to wait.

    Experts say broad-spectrum antibiotics are best used for more severe conditions, such as when a child or adult is in the hospital or has already had multiple courses of antibiotics that didn’t work. Someone at risk for infection with resistant bacteria because of repetitive or prolonged antibiotic exposure, such as recurrent ear infections, might also fare better with a broad-spectrum drug.

    Charles Cutler, an internist near Philadelphia, says women with recurring urinary-tract infections frequently request broad-spectrum drugs like ciprofloxacin because it is what they know. But the overprescription of such drugs has created a lot of resistant infections, he says. It can take 48 hours for a test to determine what is causing a urinary-tract infection and “doctors and patients don’t want to wait 48 hours,” says Dr. Cutler, who is chairman of the American College of Physicians’ Board of Regents.

    Bronchitis is another illness for which antibiotics are often overused, says Lauri Hicks, medical director for the CDC’s “Get Smart: Know When Antibiotics Work” program. Eighty percent of the time patients come into a doctor’s office with acute bronchitis they will be prescribed an antibiotic, and usually a broad-spectrum one, she says. “Bronchitis in someone who’s otherwise healthy typically gets better on its own,” she says.

    Doctors say it can be difficult to tell a bacterial infection from a viral one. A general rule of thumb with sinus infections is to hold off on the early use of antibiotics but consider using them if symptoms persist. Infections like bronchitis, which is mostly caused by a virus, and pneumonia are usually diagnosed by listening to lungs with a stethoscope. If there is doubt, X-rays can often tell the difference.

    Experts say patients should question their doctors about the use of antibiotics—both whether they are warranted and why a particular type is chosen.

    The American Academy of Pediatrics has emphasized the importance of judicious use of antibiotics. The group this year updated guidelines for treating sinusitis and ear infections to help physicians determine which illnesses will respond to antibiotics and which type of antibiotic to prescribe. Both updates recommended the narrow-spectrum amoxicillin as a first-line treatment when antibiotics are warranted.

    Resistant bacteria are often present in the body in small numbers to begin with but are crowded out by other bacteria that are more susceptible to antibiotics. When a person takes an antibiotic, it kills off the susceptible bacteria, allowing the resistant bacteria to grow more easily, says Dr. Hersh.

    Jeffrey Gerber, a pediatric infectious-disease specialist at the Children’s Hospital of Philadelphia, recently led a research team exploring whether doctors’ prescribing habits could change. The researchers looked at 18 primary-care pediatric offices. In half of the offices, doctors received on-site education about prescribing guidelines for some common infections: pneumonia, strep throat and sinus infections. Narrow-spectrum antibiotics were recommended for all three conditions. The other offices didn’t receive any guidance.

    “After 12 months we saw overall a nearly 50% reduction in broad spectrum or off-guideline prescribing for these conditions” in the intervention group of offices compared with the control group, Dr. Gerber said. The study appeared in the June issue of the Journal of the American Medical Association. He said the researchers are currently examining what effect the change in prescribing habits had on illness control, cost and other outcomes.

    Write to                 Sumathi Reddy at [email protected]

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    Patient’s Costs Rise When Practices Are Sold

    Thursday, August 15, 2013 // Uncategorized

    Primary care physicians are selling their practices as they get squeezed between higher costs and reimbursements that are declining.  As this article from CNBC   indicates, there are financial repercussions for patients.

    Patients see higher bills after doctors sell practices

       Text Size  

    Published: Thursday, 25 Jul 2013 |  1:12  PM ET

        By: | Health Care Reporter

    Martin Barraud | OJO+ | Getty Images

      The doctor might be the same, but her bill’s going to be higher.

    A strong trend of hospitals buying up physicians practices as well as hospital mergers is threatening to also drive up costs to patients—at least in the short term.

    A key factor in that consolidation trend is doctors now are willing to work for someone else to get rid of the hassle of paperwork, fighting with insurance companies, increased overhead costs and other duties that keep them away from patients.

    “What you hear over and over again is: ‘I just want to practice medicine,’ ” said Shane Jackson, president of physicians staffing service

    Jackson and others said the trend toward doctors working for hospitals is being fueled by middle-age and older doctors who like the idea of spending less time on non-medicine-related work, and younger doctors who “place a lot of value on work-life balance.”

    (Read more: Long-term care feared more than death)

    And all age groups are increasingly inclined to opt for a guaranteed salary from a hospital instead of fluctuating year-to-year profits from a private practice.

    Delays in Obamacare
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      Research by LocumTenens’ parent Jackson Healthcare found that the number of solo practitioners among doctors fell from 21 percent to 15 percent from 2012 until this year, while the number of hospital-employed doctors jumped from 20 percent to 26 percent.

    “Doctors are asking us, ‘Come run my practice, because we can’t do it anymore,’ ” said Alan Miller, CEO of giant hospital chain operator Universal Health Services. “And now we’ve been investing in doctor’s practices. We didn’t do much of that before. This is not a great moneymaking business, but it could be.”

    (Read more: Doctors skeptical, clueless about Obamacare: Survey)

    Sean Benson, vice president of innovation at Wolters Kluwer Health, said his company is “seeing that as a major trend … physicians either selling out their practices, or looking into the possibility of being acquired by a provider organization.”

    In a new report, Wolters Kluwer Health found that 34 percent of doctors said that over the next three to five years they would be “exploring different business models,” which could include “mergers [or] becoming part of a hospital system.”

    The report was based on a survey by Ipsos in April of 300 physicians practicing in primary care, family medicine and internal medicine.

    Threat to falling costs?

    Benson said that doctors’ growing inclination to consider selling their practices or merging with hospitals has gotten stronger at the same time that hospitals have become more aggressive at seeking such deals to expand business.

    “It’s cheaper to build that way,” said Benson. But it’s not necessarily cheaper for patients.

    In June, PwC’s Health Research Institute projected a “historic slowdown” in the growth of health-care spending in 2014, saying medical inflation was likely to rise just 6.5 percent over 2013’s costs.

      However, PwC cited two inflationary trends swimming against that current: the increasing costs of specialty drugs, and what was termed “industry consolidation.”

    “Over half of hospitals plan to acquire physicians practices in 2014,” PwC noted. “Studies suggest that consolidation in concentrated markets can drive prices up as much as 20 percent.”

    (Read more: Health-cost inflation on track to slow in 2014: Report)

      The New York Times, in its July 16 headline announcing the merger of Mount Sinai Medical Center and Continuum Health Partners, warned that the creation of New York’s largest private hospital system was “raising the specter of costlier care.”

    In Massachusetts—where its ongoing seven-year-old experiment with health-insurance reform foreshadowed Obamacare—regulatory changes have lead to almost one-third of acute care hospitals being involved in mergers, acquisitions or partnerships since 2007, and another 20 percent being currently involved in discussions to do so, according to PwC.

    Massachusetts’ experience with consolidation—which leaves just 9 percent of its hospitals entirely independent—raised “doubt about the long-term viability of stand-alone community hospitals in the U.S.,” PwC said.

    Dr. Napoleon Knight, a medical director at the Carle Foundation Hospital in Urbana, Ill., said his hospital’s 2010 merger with the large Carle Physician Group was driven by the knowledge that the Affordable Care Act was coming, as were other regulatory changes that could affect health-care reimbursement rates and encourage “economies of scale.”

    “We saw the landscape of health care changing,” said Knight, whose hospital last fall also merged with another health-care system in Hoopeston, Ill.

    Ceci Connolly, managing director of PwC Health Research Institute, said, “We do expect there to be some efficiencies that come out of consolidation” that could ultimately result in lower costs to patients.

    “It’s less clear how long it will take to deliver those efficiencies,” Connolly said. “It certainly doesn’t happen overnight.”

    And it might not happen soon enough for many patients as merger and acquisition activity continues apace.

    (Read more: Surgery patients may not get what they pay for)

    “This trend is here, it’s here to stay,” said Dr. Peter Angood, CEO of the American College of Physician Executives.

    “It’s going to take another, I would say, three to five years, before we’re really seeing the return on investments,” said Angood, referring to both the hospital’s outlays and ability to achieve cost savings.

    “As health-care systems continue to look for ways to integrate physicians into their delivery models, there will be upfront costs incurred, and it should not be expected that the return on investment will be immediate.”

    ACPE in a recent poll of doctors found that 32 percent of them said that health-care costs “go up” when “a group or practice is bought by a hospital or health-care system.” Just 5 percent said costs go down.

    Besides upfront costs and the lag time in realizing cost savings from a deal, there are other factors at play, namely traditional reimbursement practices. Hospitals are able to charge Medicare a higher rate for some services that take place in a hospital setting compared with the rates doctors are able to charge in their independent practices.

    That means the same procedure performed in an independent doctor’s office on Wednesday might be charged to Medicare at a lower rate than for the same procedure in the same office after a hospital buys that doctors’ practice Thursday.

    The Medicare Payment Advisory Commission, when it released a report to Congress on the government health insurance program in June, noted that, “Medicare pays 141 percent more for one type of echocardiogram when done in a hospital outpatient department than when it is done in a freestanding physician’s office.”

    “If Medicare pays a higher rate for a service in one setting over another, program spending increases and beneficiaries pay more in cost sharing without a corresponding increase in quality of care.”

    By CNBC’s Dan Mangan. Follow him on Twitter @_DanMangan.

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