Excerpts from the Globe's blog on the Boston-area medical community.

Massachusetts General Hospital and Brigham and Women's Hospital held onto their honor roll positions in the annual rankings by U.S. News & World Report, called "America's Best Hospitals."

Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth, and the Cleveland Clinic slipped to fourth from third.

The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties, based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.

Cancer death rates fall slightly

The number of people dying of cancer has fallen slightly in Massachusetts, while the number of newly diagnosed cases has stayed about the same. But racial and ethnic disparities remain, in both the risk of developing cancer and of dying from it, a new report says.

The change in mortality rates was small but significant, according to the state Department of Public Health's latest study, which covers 2000 through 2004. In 2000, the mortality rate from 24 types of cancer was 205.8 deaths per 100,000 people. In 2004 it declined to 187.9 deaths per 100,000 people.

27,000 are newly insured

More than 155,000 Massachusetts residents have obtained health insurance prior to the July 1 deadline to obtain coverage, the state agency implementing the healthcare law said last week.

About 2,500 people bought private insurance through the state's Commonwealth Choice program since it went on sale in May, a figure that is 50 percent higher than anticipated, according to the Commonwealth Health Insurance Connector Authority , which implements the law. The others purchased plans through work or from insurance companies. Another 200,000 to 270,000 uninsured people still face the requirement to buy private insurance.

By the end of the year, adults who are uninsured and who do not qualify for an exemption, will lose their $219 state personal income tax exemption, a penalty that will rise in subsequent years.

Pre-65 coverage cuts costs

Providing health care to uninsured adults before they qualify for Medicare coverage may not only improve their health but also reduce costs after they turn 65, a Harvard Medical School study says.

People who haven't had insurance coverage are significantly more likely to report poor health before the age of 65, the authors report in tomorrow's New England Journal of Medicine.

They looked at data from the national Health and Retirement Study to compare health care expenditures between insured and uninsured adults at age 59 and 60 and then again after 65. They concluded that expanding health insurance coverage for uninsured people before 65 might be offset by savings in healthcare costs later, particularly for people who have cardiovascular disease or diabetes.

"It may be less costly than people thought," Dr. J. Michael McWilliams, a research associate at Harvard Medical, said in an interview.

Down side of surgeon rankings

Dr. Thomas H. Lee, network president of Partners Health Care and associate editor of the New England Journal of Medicine, is concerned that public reporting of mortality rates for individual cardiac surgeons carries unintended, perverse consequences. Writing with two colleagues in last week's New England Journal, he said he fears that surgeons might hesitate to operate on high-risk patients if they are seeking a perfect performance record.

"When so few patients can swing things for you being ranked, we're worried about that effect on the decision-making process," Lee said.

Instead, it makes more sense to report by institution, said Lee and his coauthors, Dr. David F. Torchiana of Massachusetts General Hospital and Dr. James E. Lock of Children's Hospital Boston. Massachusetts recently joined New York, New Jersey, and Pennsylvania in publicly reporting death rates for individual cardiac surgeons.

Empathy may guide testing

Men who are too young or too old for prostate cancer screening tests are still getting them from clinicians whose "prostatempathy" may be guiding their decisions, Harvard researchers suggest in a study of seven New England veterans' hospitals.

Health specialists agree that men without symptoms who are under 40, older than 75, or expected to have less than 10 years to live do not benefit from the prostate- specific antigen test and can suffer unnecessary psychological and financial costs, according to the article in last week's Archives of Internal Medicine.

"It it possible that, as they age, male healthcare providers increasingly empathize with their older male patients over prostate cancer concerns. Their 'prostatempathy' may then lead to more aggressive screening in these older male patients," wrote Dr. B. Price Kerfoot and his colleagues at Harvard Medical and the Veterans Affairs Boston Healthcare System.

Source:www.boston.com