Alicia Ault

President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS), bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, the President said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

White House spokesman Dan Pfeiffer wrote that the move was necessary because, “Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.”

Dr. Berwick, a pediatrician who is a nationally known leader in health care quality, is supported by many health care and consumer groups, Mr. Pfeiffer noted. Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

The American Hospital Association (AHA) and others leaped to support Dr. Berwick.

“Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care,” AHA President Rich Umbdenstock said in a statement. “A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice.”

President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS), bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, the President said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

White House spokesman Dan Pfeiffer wrote that the move was necessary because, “Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.”

Dr. Berwick, a pediatrician who is a nationally known leader in health care quality, is supported by many health care and consumer groups, Mr. Pfeiffer noted. Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

The American Hospital Association (AHA) and others leaped to support Dr. Berwick.

“Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care,” AHA President Rich Umbdenstock said in a statement. “A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice.”

President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS), bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, the President said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

White House spokesman Dan Pfeiffer wrote that the move was necessary because, “Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.”

Dr. Berwick, a pediatrician who is a nationally known leader in health care quality, is supported by many health care and consumer groups, Mr. Pfeiffer noted. Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

The American Hospital Association (AHA) and others leaped to support Dr. Berwick.

“Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care,” AHA President Rich Umbdenstock said in a statement. “A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice.”

In guidelines, the American Society for Gastrointestinal Endoscopy is suggesting that blacks begin colonoscopy screening at age 45.

It is a suggestion, not a recommendation, which would carry a greater weight, according to the ASGE's Standards of Practice Committee, which developed the guidelines (Gastrointest. Endosc. 2010;71:1108-11).

The recommendations are based on literature reviews; the word “recommendations” means that the quality of evidence was greater, while a “suggestion” indicates that the quality was weaker.

The authors noted that “African Americans with colon cancer have a 20% stage-adjusted increase in mortality risk, compared with European Americans,” are younger at presentation, have a higher proportion of cancers presenting before age 50, and generally, are of a more advanced stage at the time of diagnosis.

Many ethnic groups have low colon cancer screening rates; the guidelines recommend a new emphasis on screening for those groups.

Although there have been no studies that assess the impact of modifying specific endoscopic standards based on ethnicity, “it is logical to assume that increased awareness of differences in disease patterns and management among different ethnic groups could have beneficial impacts on the health-related quality of life of people in these groups,” said Dr. Jason A. Dominitz, chair of ASGE's Standards of Practice Committee, in a statement.

“At the same time, it is important to recognize that ethnic populations are not homogeneous and that additional factors, such as environment and behavior, also play important roles in disease,” he said.

The guidelines also suggest a screening esophagogastroduodenoscopy (EGD) for gastric cancer in new immigrants from high-risk regions, such as Korea, Japan, China, Russia, and South America, in particular if there is a family history in a first-degree relative.

However, screening EGD for adenocarcinoma or squamous cell carcinoma of the esophagus should be based on clinical considerations and not upon ethnicity, according to the guidelines.

The full guidelines can be found in the June issue of GIE at www.giejournal.org

In guidelines, the American Society for Gastrointestinal Endoscopy is suggesting that blacks begin colonoscopy screening at age 45.

It is a suggestion, not a recommendation, which would carry a greater weight, according to the ASGE's Standards of Practice Committee, which developed the guidelines (Gastrointest. Endosc. 2010;71:1108-11).

The recommendations are based on literature reviews; the word “recommendations” means that the quality of evidence was greater, while a “suggestion” indicates that the quality was weaker.

The authors noted that “African Americans with colon cancer have a 20% stage-adjusted increase in mortality risk, compared with European Americans,” are younger at presentation, have a higher proportion of cancers presenting before age 50, and generally, are of a more advanced stage at the time of diagnosis.

Many ethnic groups have low colon cancer screening rates; the guidelines recommend a new emphasis on screening for those groups.

Although there have been no studies that assess the impact of modifying specific endoscopic standards based on ethnicity, “it is logical to assume that increased awareness of differences in disease patterns and management among different ethnic groups could have beneficial impacts on the health-related quality of life of people in these groups,” said Dr. Jason A. Dominitz, chair of ASGE's Standards of Practice Committee, in a statement.

“At the same time, it is important to recognize that ethnic populations are not homogeneous and that additional factors, such as environment and behavior, also play important roles in disease,” he said.

The guidelines also suggest a screening esophagogastroduodenoscopy (EGD) for gastric cancer in new immigrants from high-risk regions, such as Korea, Japan, China, Russia, and South America, in particular if there is a family history in a first-degree relative.

However, screening EGD for adenocarcinoma or squamous cell carcinoma of the esophagus should be based on clinical considerations and not upon ethnicity, according to the guidelines.

The full guidelines can be found in the June issue of GIE at www.giejournal.org

In guidelines, the American Society for Gastrointestinal Endoscopy is suggesting that blacks begin colonoscopy screening at age 45.

It is a suggestion, not a recommendation, which would carry a greater weight, according to the ASGE's Standards of Practice Committee, which developed the guidelines (Gastrointest. Endosc. 2010;71:1108-11).

The recommendations are based on literature reviews; the word “recommendations” means that the quality of evidence was greater, while a “suggestion” indicates that the quality was weaker.

The authors noted that “African Americans with colon cancer have a 20% stage-adjusted increase in mortality risk, compared with European Americans,” are younger at presentation, have a higher proportion of cancers presenting before age 50, and generally, are of a more advanced stage at the time of diagnosis.

Many ethnic groups have low colon cancer screening rates; the guidelines recommend a new emphasis on screening for those groups.

Although there have been no studies that assess the impact of modifying specific endoscopic standards based on ethnicity, “it is logical to assume that increased awareness of differences in disease patterns and management among different ethnic groups could have beneficial impacts on the health-related quality of life of people in these groups,” said Dr. Jason A. Dominitz, chair of ASGE's Standards of Practice Committee, in a statement.

“At the same time, it is important to recognize that ethnic populations are not homogeneous and that additional factors, such as environment and behavior, also play important roles in disease,” he said.

The guidelines also suggest a screening esophagogastroduodenoscopy (EGD) for gastric cancer in new immigrants from high-risk regions, such as Korea, Japan, China, Russia, and South America, in particular if there is a family history in a first-degree relative.

However, screening EGD for adenocarcinoma or squamous cell carcinoma of the esophagus should be based on clinical considerations and not upon ethnicity, according to the guidelines.

The full guidelines can be found in the June issue of GIE at www.giejournal.org

NIMH Director Denies Conflict

Dr. Thomas R. Insel, director of the National Institute of Mental Health, is denying a report in the Chronicle of Higher Education that he assisted a former colleague in securing a new position after the person was removed as principal investigator on an NIMH-funded grant because of conflicts of interest. The story alleged that Dr. Insel helped Dr. Charles B. Nemeroff get a new position at the University of Miami after he left Emory University and that Dr. Insel helped Dr. Nemeroff avoid sanctioning by the National Institutes of Health. Dr. Nemeroff is under investigation for not disclosing payments from GlaxoSmithKline while he was leading studies of the company's drugs escitalopram and duloxetine at Emory. Dr. Insel has been leading the NIH's latest effort to weed out conflicts among employees. In a post on his “Director's Blog” in mid-June, he said that “Having been one of the most outspoken proponents for developing tougher conflict of interest policies at NIH, the allegations that I would help anyone avoid penalties struck me as surreal.” He added, “I realize that my tenure at Emory and a previous association with Dr Nemeroff will, for some, be 'guilt by association.' To avoid such allegations, I recused myself from all matters involving Dr. Nemeroff during the conflict of interest investigation at NIH… and from future applications or NIH matters involving Dr. Nemeroff.”

APA Beefs Up Conflict Policy

The American Psychiatric Association has approved a new code of conduct to govern its relationships with other organizations. The policy requires that any financial relationship with any entity that develops educational programs or subsidizes research should be clearly stated by APA staff and members working on behalf of the organization. It also requires all APA educational programs follow the American College of Continuing Medical Education standards for independent and unbiased presentations. A new conflict of interest committee will be charged with overseeing the organization's relationships with industry and other groups. The code is available at

www.psych.org/Resources/Governance/Disclosure-of-Interests-and-Affiliations/APA-Code-of-Conduct.aspx

Judge Hands Down Topamax Fine

Ortho-McNeil Pharmaceutical LLC, a subsidiary of Johnson & Johnson, recently pleaded guilty to one misdemeanor count of violating the Food, Drug & Cosmetic Act, for the illegal promotion of Topamax for psychiatric uses. Under a sentence delivered by a U.S. District Court judge in Boston last month, the company will pay a criminal fine of $6.14 million. The sentence is consistent with an agreement the company reached with the Justice Department in April. Prosecutors alleged that Ortho-McNeil used a program called “Doctor for a Day” to promote the epilepsy and migraine treatment Topamax among psychiatrists for off-label uses. The company paid physicians to accompany sales representatives meeting with psychiatrists. In its plea, the company acknowledged promoting the drug for certain unapproved uses between 2001 and 2003, but it said that it voluntarily discontinued the program before receiving the first subpoena in the government's investigation.

Tobacco Coverage to Be Broader

The Centers for Medicare and Medicaid Services is proposing to cover tobacco counseling services for all adults and pregnant women who are entitled to benefits under Part A or Part B of Medicare. Such counseling has been covered only for people with signs or symptoms of tobacco-related disease. Under the new plan, anyone who uses tobacco or desires the counseling would be entitled to two counseling “attempts” per year, which would include a maximum of eight intermediate (3-minute) or intensive (10-minute) sessions per year. A final coverage decision is pending, after comments on the proposal were taken through late June.

House Probes Home Gene Testing

Three key House lawmakers have launched an investigation into personal genetic testing kits that are being marketed directly to the public. The investigation, spearheaded by House Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) and supported by Rep. Joe Barton (R-Tex.), Rep. Bart Stupak (D-Mich.), and Rep. Michael C. Burgess (R-Tex.), has targeted the companies 23andMe Inc., Navigenics Inc., and Pathway Genomics Corp. The companies already offer their tests to consumers by phone or online, and San Diego-based Pathway announced that it is seeking to sell testing kits in retail locations, despite concerns from the scientific community about the accuracy of test results. In letters to the companies, the lawmakers said they want information on how the companies analyze test results and identify potential genetic risks. The three lawmakers also want to know how the companies collect, store, and process individual genetic samples collected from consumers.

NIMH Director Denies Conflict

Dr. Thomas R. Insel, director of the National Institute of Mental Health, is denying a report in the Chronicle of Higher Education that he assisted a former colleague in securing a new position after the person was removed as principal investigator on an NIMH-funded grant because of conflicts of interest. The story alleged that Dr. Insel helped Dr. Charles B. Nemeroff get a new position at the University of Miami after he left Emory University and that Dr. Insel helped Dr. Nemeroff avoid sanctioning by the National Institutes of Health. Dr. Nemeroff is under investigation for not disclosing payments from GlaxoSmithKline while he was leading studies of the company's drugs escitalopram and duloxetine at Emory. Dr. Insel has been leading the NIH's latest effort to weed out conflicts among employees. In a post on his “Director's Blog” in mid-June, he said that “Having been one of the most outspoken proponents for developing tougher conflict of interest policies at NIH, the allegations that I would help anyone avoid penalties struck me as surreal.” He added, “I realize that my tenure at Emory and a previous association with Dr Nemeroff will, for some, be 'guilt by association.' To avoid such allegations, I recused myself from all matters involving Dr. Nemeroff during the conflict of interest investigation at NIH… and from future applications or NIH matters involving Dr. Nemeroff.”

APA Beefs Up Conflict Policy

The American Psychiatric Association has approved a new code of conduct to govern its relationships with other organizations. The policy requires that any financial relationship with any entity that develops educational programs or subsidizes research should be clearly stated by APA staff and members working on behalf of the organization. It also requires all APA educational programs follow the American College of Continuing Medical Education standards for independent and unbiased presentations. A new conflict of interest committee will be charged with overseeing the organization's relationships with industry and other groups. The code is available at

www.psych.org/Resources/Governance/Disclosure-of-Interests-and-Affiliations/APA-Code-of-Conduct.aspx

Judge Hands Down Topamax Fine

Ortho-McNeil Pharmaceutical LLC, a subsidiary of Johnson & Johnson, recently pleaded guilty to one misdemeanor count of violating the Food, Drug & Cosmetic Act, for the illegal promotion of Topamax for psychiatric uses. Under a sentence delivered by a U.S. District Court judge in Boston last month, the company will pay a criminal fine of $6.14 million. The sentence is consistent with an agreement the company reached with the Justice Department in April. Prosecutors alleged that Ortho-McNeil used a program called “Doctor for a Day” to promote the epilepsy and migraine treatment Topamax among psychiatrists for off-label uses. The company paid physicians to accompany sales representatives meeting with psychiatrists. In its plea, the company acknowledged promoting the drug for certain unapproved uses between 2001 and 2003, but it said that it voluntarily discontinued the program before receiving the first subpoena in the government's investigation.

Tobacco Coverage to Be Broader

The Centers for Medicare and Medicaid Services is proposing to cover tobacco counseling services for all adults and pregnant women who are entitled to benefits under Part A or Part B of Medicare. Such counseling has been covered only for people with signs or symptoms of tobacco-related disease. Under the new plan, anyone who uses tobacco or desires the counseling would be entitled to two counseling “attempts” per year, which would include a maximum of eight intermediate (3-minute) or intensive (10-minute) sessions per year. A final coverage decision is pending, after comments on the proposal were taken through late June.

House Probes Home Gene Testing

Three key House lawmakers have launched an investigation into personal genetic testing kits that are being marketed directly to the public. The investigation, spearheaded by House Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) and supported by Rep. Joe Barton (R-Tex.), Rep. Bart Stupak (D-Mich.), and Rep. Michael C. Burgess (R-Tex.), has targeted the companies 23andMe Inc., Navigenics Inc., and Pathway Genomics Corp. The companies already offer their tests to consumers by phone or online, and San Diego-based Pathway announced that it is seeking to sell testing kits in retail locations, despite concerns from the scientific community about the accuracy of test results. In letters to the companies, the lawmakers said they want information on how the companies analyze test results and identify potential genetic risks. The three lawmakers also want to know how the companies collect, store, and process individual genetic samples collected from consumers.

NIMH Director Denies Conflict

Dr. Thomas R. Insel, director of the National Institute of Mental Health, is denying a report in the Chronicle of Higher Education that he assisted a former colleague in securing a new position after the person was removed as principal investigator on an NIMH-funded grant because of conflicts of interest. The story alleged that Dr. Insel helped Dr. Charles B. Nemeroff get a new position at the University of Miami after he left Emory University and that Dr. Insel helped Dr. Nemeroff avoid sanctioning by the National Institutes of Health. Dr. Nemeroff is under investigation for not disclosing payments from GlaxoSmithKline while he was leading studies of the company's drugs escitalopram and duloxetine at Emory. Dr. Insel has been leading the NIH's latest effort to weed out conflicts among employees. In a post on his “Director's Blog” in mid-June, he said that “Having been one of the most outspoken proponents for developing tougher conflict of interest policies at NIH, the allegations that I would help anyone avoid penalties struck me as surreal.” He added, “I realize that my tenure at Emory and a previous association with Dr Nemeroff will, for some, be 'guilt by association.' To avoid such allegations, I recused myself from all matters involving Dr. Nemeroff during the conflict of interest investigation at NIH… and from future applications or NIH matters involving Dr. Nemeroff.”

APA Beefs Up Conflict Policy

The American Psychiatric Association has approved a new code of conduct to govern its relationships with other organizations. The policy requires that any financial relationship with any entity that develops educational programs or subsidizes research should be clearly stated by APA staff and members working on behalf of the organization. It also requires all APA educational programs follow the American College of Continuing Medical Education standards for independent and unbiased presentations. A new conflict of interest committee will be charged with overseeing the organization's relationships with industry and other groups. The code is available at

www.psych.org/Resources/Governance/Disclosure-of-Interests-and-Affiliations/APA-Code-of-Conduct.aspx

Judge Hands Down Topamax Fine

Ortho-McNeil Pharmaceutical LLC, a subsidiary of Johnson & Johnson, recently pleaded guilty to one misdemeanor count of violating the Food, Drug & Cosmetic Act, for the illegal promotion of Topamax for psychiatric uses. Under a sentence delivered by a U.S. District Court judge in Boston last month, the company will pay a criminal fine of $6.14 million. The sentence is consistent with an agreement the company reached with the Justice Department in April. Prosecutors alleged that Ortho-McNeil used a program called “Doctor for a Day” to promote the epilepsy and migraine treatment Topamax among psychiatrists for off-label uses. The company paid physicians to accompany sales representatives meeting with psychiatrists. In its plea, the company acknowledged promoting the drug for certain unapproved uses between 2001 and 2003, but it said that it voluntarily discontinued the program before receiving the first subpoena in the government's investigation.

Tobacco Coverage to Be Broader

The Centers for Medicare and Medicaid Services is proposing to cover tobacco counseling services for all adults and pregnant women who are entitled to benefits under Part A or Part B of Medicare. Such counseling has been covered only for people with signs or symptoms of tobacco-related disease. Under the new plan, anyone who uses tobacco or desires the counseling would be entitled to two counseling “attempts” per year, which would include a maximum of eight intermediate (3-minute) or intensive (10-minute) sessions per year. A final coverage decision is pending, after comments on the proposal were taken through late June.

House Probes Home Gene Testing

Three key House lawmakers have launched an investigation into personal genetic testing kits that are being marketed directly to the public. The investigation, spearheaded by House Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) and supported by Rep. Joe Barton (R-Tex.), Rep. Bart Stupak (D-Mich.), and Rep. Michael C. Burgess (R-Tex.), has targeted the companies 23andMe Inc., Navigenics Inc., and Pathway Genomics Corp. The companies already offer their tests to consumers by phone or online, and San Diego-based Pathway announced that it is seeking to sell testing kits in retail locations, despite concerns from the scientific community about the accuracy of test results. In letters to the companies, the lawmakers said they want information on how the companies analyze test results and identify potential genetic risks. The three lawmakers also want to know how the companies collect, store, and process individual genetic samples collected from consumers.

Saying that there is too much confusion between the requirements of the new health reform law and the not-yet-final mental health parity law regulations, a group of mental health behavioral care organizations has sued the federal government to delay the implementation of the rules.

Meanwhile, the American Psychiatric Association is pressing the government to move forward, saying that some health plans are imposing cost control techniques that subvert the parity law's intent and are restricting patient access to care.

The litigation was filed by Magellan Health Services, Beacon Health Strategies, and ValueOptions. The companies supported the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, but are not satisfied with the interim final rules issued in February by the Department of Health and Human Services, the Department of the Treasury, and the Department of Labor, saamela Greenberg, president and CEO of the Association for Behavioral Health and Wellness, said in an interview.

The association is not involved in the suit, she said, but would prefer a 1-year delay in the issuance of the final rules to give mental health managers time to comply.

The law went into effect Jan. 1. Most insurers and employer-based plans began complying with the intent of the law at that time, but awaited the exact details that would be spelled out in the regulations. With the issuance of the interim final rules, all plans must comply for plan years that start July 1.

Insurers and managed behavioral companies object to the “nonquantitative treatment limits” spelled out in the interim final rules, Kris Haltmeyer, executive director of policy for the BlueCross BlueShield Association, said in an interview. The Blues did not join the suit, but is also seeking a delay until July 2011, Mr. Haltmeyer said.

According to the rules, viewable at www.regulations.gov

The Blues would argue that the parity legislation never explicitly discussed whether plans could use traditional behavioral benefit management techniques, such as prior authorization or formulary tiers, so the rules go beyond the intent of the legislation, Mr. Haltmeyer said. Without those tools, plans might have to clamp down further on all health care services to achieve true parity in benefits and cost control, he said.

Psychiatrists, however, say they increasingly are being burdened with bureaucratic requests from insurers that seem designed “to drive physicians out of the network and to block patient access,” Jennifer Tassler, deputy director of regulatory affairs for the APA, said in an interview.

Plan administrators have the legal right to manage the benefit, but it's being overzealously and unfairly applied, she said. The APA has received reports that physicians are being asked in some cases to get prior authorization before every patient visit or to submit treatment plans after every few visits.

In comments to the government, the APA expressed its support for the restrictions on nonquantitative limitations and a single deductible. The organization is concerned, however, that the rules did not appear to apply to Medicaid-managed care plans and urged the government to issue regulations to cover those plans.

Overall, though, the interim final rules “went a long way to clear up what the law intended and covered,” Ms. Tassler said.

No one knows when final rules might be issued. The government also issues interim final rules that stand, she said. The insurers are aware of that possibility, which is why they are seeking a delay in implementation, Mr. Haltmeyer said.

Mental Health Parity's Evolution

September 1996 The Mental Health Parity Act establishes parity for lifetime and annual dollar limits.

October 2008 The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) is enacted, guaranteeing full parity with medical and surgical benefits and out-of-pocket costs.

April 2009 The federal government seeks comments on how to implement MHPAEA.

October 2009 MHPAEA goes into effect for the plan year starting January 2010.

February 2010 Interim final rules are published.

May 2010 The comment period closes for the interim final rules.

July 2010 The rules apply to all plans.

Saying that there is too much confusion between the requirements of the new health reform law and the not-yet-final mental health parity law regulations, a group of mental health behavioral care organizations has sued the federal government to delay the implementation of the rules.

Meanwhile, the American Psychiatric Association is pressing the government to move forward, saying that some health plans are imposing cost control techniques that subvert the parity law's intent and are restricting patient access to care.

The litigation was filed by Magellan Health Services, Beacon Health Strategies, and ValueOptions. The companies supported the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, but are not satisfied with the interim final rules issued in February by the Department of Health and Human Services, the Department of the Treasury, and the Department of Labor, saamela Greenberg, president and CEO of the Association for Behavioral Health and Wellness, said in an interview.

The association is not involved in the suit, she said, but would prefer a 1-year delay in the issuance of the final rules to give mental health managers time to comply.

The law went into effect Jan. 1. Most insurers and employer-based plans began complying with the intent of the law at that time, but awaited the exact details that would be spelled out in the regulations. With the issuance of the interim final rules, all plans must comply for plan years that start July 1.

Insurers and managed behavioral companies object to the “nonquantitative treatment limits” spelled out in the interim final rules, Kris Haltmeyer, executive director of policy for the BlueCross BlueShield Association, said in an interview. The Blues did not join the suit, but is also seeking a delay until July 2011, Mr. Haltmeyer said.

According to the rules, viewable at www.regulations.gov

The Blues would argue that the parity legislation never explicitly discussed whether plans could use traditional behavioral benefit management techniques, such as prior authorization or formulary tiers, so the rules go beyond the intent of the legislation, Mr. Haltmeyer said. Without those tools, plans might have to clamp down further on all health care services to achieve true parity in benefits and cost control, he said.

Psychiatrists, however, say they increasingly are being burdened with bureaucratic requests from insurers that seem designed “to drive physicians out of the network and to block patient access,” Jennifer Tassler, deputy director of regulatory affairs for the APA, said in an interview.

Plan administrators have the legal right to manage the benefit, but it's being overzealously and unfairly applied, she said. The APA has received reports that physicians are being asked in some cases to get prior authorization before every patient visit or to submit treatment plans after every few visits.

In comments to the government, the APA expressed its support for the restrictions on nonquantitative limitations and a single deductible. The organization is concerned, however, that the rules did not appear to apply to Medicaid-managed care plans and urged the government to issue regulations to cover those plans.

Overall, though, the interim final rules “went a long way to clear up what the law intended and covered,” Ms. Tassler said.

No one knows when final rules might be issued. The government also issues interim final rules that stand, she said. The insurers are aware of that possibility, which is why they are seeking a delay in implementation, Mr. Haltmeyer said.

Mental Health Parity's Evolution

September 1996 The Mental Health Parity Act establishes parity for lifetime and annual dollar limits.

October 2008 The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) is enacted, guaranteeing full parity with medical and surgical benefits and out-of-pocket costs.

April 2009 The federal government seeks comments on how to implement MHPAEA.

October 2009 MHPAEA goes into effect for the plan year starting January 2010.

February 2010 Interim final rules are published.

May 2010 The comment period closes for the interim final rules.

July 2010 The rules apply to all plans.

Saying that there is too much confusion between the requirements of the new health reform law and the not-yet-final mental health parity law regulations, a group of mental health behavioral care organizations has sued the federal government to delay the implementation of the rules.

Meanwhile, the American Psychiatric Association is pressing the government to move forward, saying that some health plans are imposing cost control techniques that subvert the parity law's intent and are restricting patient access to care.

The litigation was filed by Magellan Health Services, Beacon Health Strategies, and ValueOptions. The companies supported the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, but are not satisfied with the interim final rules issued in February by the Department of Health and Human Services, the Department of the Treasury, and the Department of Labor, saamela Greenberg, president and CEO of the Association for Behavioral Health and Wellness, said in an interview.

The association is not involved in the suit, she said, but would prefer a 1-year delay in the issuance of the final rules to give mental health managers time to comply.

The law went into effect Jan. 1. Most insurers and employer-based plans began complying with the intent of the law at that time, but awaited the exact details that would be spelled out in the regulations. With the issuance of the interim final rules, all plans must comply for plan years that start July 1.

Insurers and managed behavioral companies object to the “nonquantitative treatment limits” spelled out in the interim final rules, Kris Haltmeyer, executive director of policy for the BlueCross BlueShield Association, said in an interview. The Blues did not join the suit, but is also seeking a delay until July 2011, Mr. Haltmeyer said.

According to the rules, viewable at www.regulations.gov

The Blues would argue that the parity legislation never explicitly discussed whether plans could use traditional behavioral benefit management techniques, such as prior authorization or formulary tiers, so the rules go beyond the intent of the legislation, Mr. Haltmeyer said. Without those tools, plans might have to clamp down further on all health care services to achieve true parity in benefits and cost control, he said.

Psychiatrists, however, say they increasingly are being burdened with bureaucratic requests from insurers that seem designed “to drive physicians out of the network and to block patient access,” Jennifer Tassler, deputy director of regulatory affairs for the APA, said in an interview.

Plan administrators have the legal right to manage the benefit, but it's being overzealously and unfairly applied, she said. The APA has received reports that physicians are being asked in some cases to get prior authorization before every patient visit or to submit treatment plans after every few visits.

In comments to the government, the APA expressed its support for the restrictions on nonquantitative limitations and a single deductible. The organization is concerned, however, that the rules did not appear to apply to Medicaid-managed care plans and urged the government to issue regulations to cover those plans.

Overall, though, the interim final rules “went a long way to clear up what the law intended and covered,” Ms. Tassler said.

No one knows when final rules might be issued. The government also issues interim final rules that stand, she said. The insurers are aware of that possibility, which is why they are seeking a delay in implementation, Mr. Haltmeyer said.

Mental Health Parity's Evolution

September 1996 The Mental Health Parity Act establishes parity for lifetime and annual dollar limits.

October 2008 The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) is enacted, guaranteeing full parity with medical and surgical benefits and out-of-pocket costs.

April 2009 The federal government seeks comments on how to implement MHPAEA.

October 2009 MHPAEA goes into effect for the plan year starting January 2010.

February 2010 Interim final rules are published.

May 2010 The comment period closes for the interim final rules.

July 2010 The rules apply to all plans.

President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS), bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, the President said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

White House spokesman Dan Pfeiffer wrote that the move was necessary because, “Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.”

Dr. Berwick, a pediatrician who is a nationally known leader in health care quality, is supported by many health care and consumer groups, Mr. Pfeiffer noted. Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

In a statement, the American College of Physicians wrote that “Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care. He is well respected in the health-care community and known for his desire to bring constructive change to health care delivery. We share these objectives and believe Dr. Berwick will be an able Administrator and partner for change.”

American Medical Association President Rich Umbdenstock wrote: “Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care.… A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice.”

Sen. John Kerry (D-Mass.) also issued a statement, chiding Republicans for their “lockstep stalling” of Dr. Berwick's nomination, and praising him for his assistance in overhauling the Massachusetts health care system.

“He's first rate all the way, and throughout Massachusetts' landmark health reform, Don was there, helping lead our state to the highest rate of health care coverage in the nation,” according to Sen. Kerry.

Senate Minority Leader Mitch McConnell (R-Ky.), however, was scathing in his reaction to the appointment, calling Dr. Berwick “one of the most prominent advocates of rationed health care.”

“Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny,” Sen. McConnell said in a statement.

Under the Constitution, the President nominates individuals to serve in high-level government positions; those individuals must then be confirmed by the Senate. However, the Constitution also allows the President to make such appointments without Senate confirmation if Congress is in recess, as it currently is for the Independence Day holiday.

Dr. Donald Berwick is a pediatrician and a leader in health care quality.

Source Courtesy Institute for Healthcare Improvement

President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS), bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, the President said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

White House spokesman Dan Pfeiffer wrote that the move was necessary because, “Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.”

Dr. Berwick, a pediatrician who is a nationally known leader in health care quality, is supported by many health care and consumer groups, Mr. Pfeiffer noted. Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

In a statement, the American College of Physicians wrote that “Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care. He is well respected in the health-care community and known for his desire to bring constructive change to health care delivery. We share these objectives and believe Dr. Berwick will be an able Administrator and partner for change.”

American Medical Association President Rich Umbdenstock wrote: “Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care.… A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice.”

Sen. John Kerry (D-Mass.) also issued a statement, chiding Republicans for their “lockstep stalling” of Dr. Berwick's nomination, and praising him for his assistance in overhauling the Massachusetts health care system.

“He's first rate all the way, and throughout Massachusetts' landmark health reform, Don was there, helping lead our state to the highest rate of health care coverage in the nation,” according to Sen. Kerry.

Senate Minority Leader Mitch McConnell (R-Ky.), however, was scathing in his reaction to the appointment, calling Dr. Berwick “one of the most prominent advocates of rationed health care.”

“Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny,” Sen. McConnell said in a statement.

Under the Constitution, the President nominates individuals to serve in high-level government positions; those individuals must then be confirmed by the Senate. However, the Constitution also allows the President to make such appointments without Senate confirmation if Congress is in recess, as it currently is for the Independence Day holiday.

Dr. Donald Berwick is a pediatrician and a leader in health care quality.

Source Courtesy Institute for Healthcare Improvement

President Obama announced the recess appointment of Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services (CMS), bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, the President said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

White House spokesman Dan Pfeiffer wrote that the move was necessary because, “Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.”

Dr. Berwick, a pediatrician who is a nationally known leader in health care quality, is supported by many health care and consumer groups, Mr. Pfeiffer noted. Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

In a statement, the American College of Physicians wrote that “Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care. He is well respected in the health-care community and known for his desire to bring constructive change to health care delivery. We share these objectives and believe Dr. Berwick will be an able Administrator and partner for change.”

American Medical Association President Rich Umbdenstock wrote: “Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care.… A physician and innovator in health care quality, his knowledge of the health care system makes him the right choice.”

Sen. John Kerry (D-Mass.) also issued a statement, chiding Republicans for their “lockstep stalling” of Dr. Berwick's nomination, and praising him for his assistance in overhauling the Massachusetts health care system.

“He's first rate all the way, and throughout Massachusetts' landmark health reform, Don was there, helping lead our state to the highest rate of health care coverage in the nation,” according to Sen. Kerry.

Senate Minority Leader Mitch McConnell (R-Ky.), however, was scathing in his reaction to the appointment, calling Dr. Berwick “one of the most prominent advocates of rationed health care.”

“Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny,” Sen. McConnell said in a statement.

Under the Constitution, the President nominates individuals to serve in high-level government positions; those individuals must then be confirmed by the Senate. However, the Constitution also allows the President to make such appointments without Senate confirmation if Congress is in recess, as it currently is for the Independence Day holiday.

Dr. Donald Berwick is a pediatrician and a leader in health care quality.

Source Courtesy Institute for Healthcare Improvement

The federal government published regulations June 18 that will allow for temporary certification of electronic health records - the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule "establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology."

"We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs," said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the "meaningful use" standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act.

"By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system," Dr. Blumenthal said.

The current rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

The federal government published regulations June 18 that will allow for temporary certification of electronic health records - the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule "establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology."

"We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs," said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the "meaningful use" standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act.

"By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system," Dr. Blumenthal said.

The current rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

The federal government published regulations June 18 that will allow for temporary certification of electronic health records - the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule "establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology."

"We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs," said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the "meaningful use" standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act.

"By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system," Dr. Blumenthal said.

The current rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

WASHINGTON – The federal government is seeking to track acute and long-term health effects in individuals working to clean up the BP oil spill in the Gulf of Mexico and is enlisting health care providers to assist, the director of the National Institute for Occupational Safety and Health (NIOSH) testified at a hearing June 16.

Dr. John Howard said that the agency he leads had begun enrolling workers in what could end up becoming a formal registry. NIOSH is anxious to have a full list of anyone involved in the clean-up, he said, noting that no such list was compiled for volunteers and others who helped at Ground Zero in the wake of Sept. 11, 2001. The lack of such a list made it difficult to go back and correlate either acute or long-term health complaints with exposure, he said.

NIOSH is “trying to keep all health care professionals alerted to our rostering effort,” so that all workers who are potentially exposed to any hazards are included in the database, Dr. Howard said. He called on Gulf region physicians to refer to NIOSH any patients they might see who have worked on the clean-up effort.

NIOSH employees have gone into the field and to BP-operated training centers to ask workers to complete a simple one-page questionnaire. The questionnaire seeks demographic data, whether the worker is a contractor, BP employee, or volunteer. It includes specific questions relating to the type of work being done, duration of the work, and whether the person smokes or has been vaccinated for tetanus. Federal officials hope to post the questionnaire online shortly, and are asking physicians who encounter workers to direct them to NIOSH to complete the survey.

So far, 13,000 workers have completed forms, said Dr. Howard, but he estimates that at least another 15,000-20,000 people are working on the clean-up. NIOSH asked for but has yet to receive a full list of BP workers involved, Dr. Howard said. “It’s a simple request,” he said to reporters after the hearing. Dr. Howard expressed consternation that the oil company had yet to respond.

Clean-up workers will receive the most significant exposure to toxic substances, he said, adding that they would be the best group to study to determine long-term risks. Currently, there are little data on long-term health effects of exposures to oil and to the chemicals, such as dispersants, being used in the clean-up, Dr. Howard said.

The federal government also is attempting to track exposures in the general population. The American Association of Poison Control Centers has directed its 60 local centers in all 50 states to code any calls related to the oil spill so that the Centers for Disease Control and Prevention (CDC) can track them, said Dr. Howard. As of May 27, there were 93 calls, mostly from Louisiana and Mississippi. Thirty-four callers had been exposed to oil and reported symptoms including cough, nausea, headache, eye irritation, chest pain, and dizziness, according to data on the CDC’s Web site.

Health issues are also being tracked through BioSense, an existing network of health facilities that track health changes in real time and report back to the CDC. There are 86 participating facilities in the five Gulf states. So far, there have been some spikes in skin irritation and asthma in two states; investigations are continuing.

State health departments in Alabama, Florida, Louisiana, and Mississippi are also soliciting reports and tracking illnesses. At press time, the Louisiana Department of Health and Hospitals reported 109 spill-related illnesses – 74 from workers and 35 from the public. Thirty-three cases were reported through poison control centers; 43 through emergency departments; and others from urgent care centers, clinics, physician offices and a hotline. Most of the complaints were of odors or inhalation issues. There were nine hospitalizations, all in workers.

Many lawmakers at the hearing said they were concerned that both workers and residents of the Gulf states were being given confusing messages about health and safety and where to report exposures or problems. In addition to the state health departments, the CDC, NIOSH, and BP are also taking exposure reports.

Dr. Howard said that was one reason he was pushing BP to correlate its list with NIOSH. He also said that he supports a centralized Web site for all the spill-related data.

The Environmental Protection Agency is also monitoring the air, water, and soil and issuing reports on its Web site; the Food and Drug Administration is tracking seafood safety.

WASHINGTON – The federal government is seeking to track acute and long-term health effects in individuals working to clean up the BP oil spill in the Gulf of Mexico and is enlisting health care providers to assist, the director of the National Institute for Occupational Safety and Health (NIOSH) testified at a hearing June 16.

Dr. John Howard said that the agency he leads had begun enrolling workers in what could end up becoming a formal registry. NIOSH is anxious to have a full list of anyone involved in the clean-up, he said, noting that no such list was compiled for volunteers and others who helped at Ground Zero in the wake of Sept. 11, 2001. The lack of such a list made it difficult to go back and correlate either acute or long-term health complaints with exposure, he said.

NIOSH is “trying to keep all health care professionals alerted to our rostering effort,” so that all workers who are potentially exposed to any hazards are included in the database, Dr. Howard said. He called on Gulf region physicians to refer to NIOSH any patients they might see who have worked on the clean-up effort.

NIOSH employees have gone into the field and to BP-operated training centers to ask workers to complete a simple one-page questionnaire. The questionnaire seeks demographic data, whether the worker is a contractor, BP employee, or volunteer. It includes specific questions relating to the type of work being done, duration of the work, and whether the person smokes or has been vaccinated for tetanus. Federal officials hope to post the questionnaire online shortly, and are asking physicians who encounter workers to direct them to NIOSH to complete the survey.

So far, 13,000 workers have completed forms, said Dr. Howard, but he estimates that at least another 15,000-20,000 people are working on the clean-up. NIOSH asked for but has yet to receive a full list of BP workers involved, Dr. Howard said. “It’s a simple request,” he said to reporters after the hearing. Dr. Howard expressed consternation that the oil company had yet to respond.

Clean-up workers will receive the most significant exposure to toxic substances, he said, adding that they would be the best group to study to determine long-term risks. Currently, there are little data on long-term health effects of exposures to oil and to the chemicals, such as dispersants, being used in the clean-up, Dr. Howard said.

The federal government also is attempting to track exposures in the general population. The American Association of Poison Control Centers has directed its 60 local centers in all 50 states to code any calls related to the oil spill so that the Centers for Disease Control and Prevention (CDC) can track them, said Dr. Howard. As of May 27, there were 93 calls, mostly from Louisiana and Mississippi. Thirty-four callers had been exposed to oil and reported symptoms including cough, nausea, headache, eye irritation, chest pain, and dizziness, according to data on the CDC’s Web site.

Health issues are also being tracked through BioSense, an existing network of health facilities that track health changes in real time and report back to the CDC. There are 86 participating facilities in the five Gulf states. So far, there have been some spikes in skin irritation and asthma in two states; investigations are continuing.

State health departments in Alabama, Florida, Louisiana, and Mississippi are also soliciting reports and tracking illnesses. At press time, the Louisiana Department of Health and Hospitals reported 109 spill-related illnesses – 74 from workers and 35 from the public. Thirty-three cases were reported through poison control centers; 43 through emergency departments; and others from urgent care centers, clinics, physician offices and a hotline. Most of the complaints were of odors or inhalation issues. There were nine hospitalizations, all in workers.

Many lawmakers at the hearing said they were concerned that both workers and residents of the Gulf states were being given confusing messages about health and safety and where to report exposures or problems. In addition to the state health departments, the CDC, NIOSH, and BP are also taking exposure reports.

Dr. Howard said that was one reason he was pushing BP to correlate its list with NIOSH. He also said that he supports a centralized Web site for all the spill-related data.

The Environmental Protection Agency is also monitoring the air, water, and soil and issuing reports on its Web site; the Food and Drug Administration is tracking seafood safety.

WASHINGTON – The federal government is seeking to track acute and long-term health effects in individuals working to clean up the BP oil spill in the Gulf of Mexico and is enlisting health care providers to assist, the director of the National Institute for Occupational Safety and Health (NIOSH) testified at a hearing June 16.

Dr. John Howard said that the agency he leads had begun enrolling workers in what could end up becoming a formal registry. NIOSH is anxious to have a full list of anyone involved in the clean-up, he said, noting that no such list was compiled for volunteers and others who helped at Ground Zero in the wake of Sept. 11, 2001. The lack of such a list made it difficult to go back and correlate either acute or long-term health complaints with exposure, he said.

NIOSH is “trying to keep all health care professionals alerted to our rostering effort,” so that all workers who are potentially exposed to any hazards are included in the database, Dr. Howard said. He called on Gulf region physicians to refer to NIOSH any patients they might see who have worked on the clean-up effort.

NIOSH employees have gone into the field and to BP-operated training centers to ask workers to complete a simple one-page questionnaire. The questionnaire seeks demographic data, whether the worker is a contractor, BP employee, or volunteer. It includes specific questions relating to the type of work being done, duration of the work, and whether the person smokes or has been vaccinated for tetanus. Federal officials hope to post the questionnaire online shortly, and are asking physicians who encounter workers to direct them to NIOSH to complete the survey.

So far, 13,000 workers have completed forms, said Dr. Howard, but he estimates that at least another 15,000-20,000 people are working on the clean-up. NIOSH asked for but has yet to receive a full list of BP workers involved, Dr. Howard said. “It’s a simple request,” he said to reporters after the hearing. Dr. Howard expressed consternation that the oil company had yet to respond.

Clean-up workers will receive the most significant exposure to toxic substances, he said, adding that they would be the best group to study to determine long-term risks. Currently, there are little data on long-term health effects of exposures to oil and to the chemicals, such as dispersants, being used in the clean-up, Dr. Howard said.

The federal government also is attempting to track exposures in the general population. The American Association of Poison Control Centers has directed its 60 local centers in all 50 states to code any calls related to the oil spill so that the Centers for Disease Control and Prevention (CDC) can track them, said Dr. Howard. As of May 27, there were 93 calls, mostly from Louisiana and Mississippi. Thirty-four callers had been exposed to oil and reported symptoms including cough, nausea, headache, eye irritation, chest pain, and dizziness, according to data on the CDC’s Web site.

Health issues are also being tracked through BioSense, an existing network of health facilities that track health changes in real time and report back to the CDC. There are 86 participating facilities in the five Gulf states. So far, there have been some spikes in skin irritation and asthma in two states; investigations are continuing.

State health departments in Alabama, Florida, Louisiana, and Mississippi are also soliciting reports and tracking illnesses. At press time, the Louisiana Department of Health and Hospitals reported 109 spill-related illnesses – 74 from workers and 35 from the public. Thirty-three cases were reported through poison control centers; 43 through emergency departments; and others from urgent care centers, clinics, physician offices and a hotline. Most of the complaints were of odors or inhalation issues. There were nine hospitalizations, all in workers.

Many lawmakers at the hearing said they were concerned that both workers and residents of the Gulf states were being given confusing messages about health and safety and where to report exposures or problems. In addition to the state health departments, the CDC, NIOSH, and BP are also taking exposure reports.

Dr. Howard said that was one reason he was pushing BP to correlate its list with NIOSH. He also said that he supports a centralized Web site for all the spill-related data.

The Environmental Protection Agency is also monitoring the air, water, and soil and issuing reports on its Web site; the Food and Drug Administration is tracking seafood safety.

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That’s up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC’s Morbidity and Mortality Weekly Report.

Overall, 46.3 million people–or 15.4% of the population–were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview–some 58.5 million–but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children’s higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children’s Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18- 64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That’s up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC’s Morbidity and Mortality Weekly Report.

Overall, 46.3 million people–or 15.4% of the population–were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview–some 58.5 million–but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children’s higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children’s Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18- 64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That’s up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC’s Morbidity and Mortality Weekly Report.

Overall, 46.3 million people–or 15.4% of the population–were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview–some 58.5 million–but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children’s higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children’s Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18- 64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up the transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” Dr. Wolter said.

To view a video interview with Dr. Wolter, go to www.youtube.com/familypracticenews

Members of the Premier ACO

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C., and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-Long Island Jewish Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up the transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” Dr. Wolter said.

To view a video interview with Dr. Wolter, go to www.youtube.com/familypracticenews

Members of the Premier ACO

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C., and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-Long Island Jewish Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up the transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” Dr. Wolter said.

To view a video interview with Dr. Wolter, go to www.youtube.com/familypracticenews

Members of the Premier ACO

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C., and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-Long Island Jewish Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

The American Medical Association has called on health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates in 2008. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesperson Robert Zirkelbach said that many of the principles are covered under the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancelations and recissions; open access to care; fairness in contract negotiations with physicians; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings, which are used to select doctors for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, go to www.ama-assn.org

'It's time for insurers to recommit to patients' best interests.'

Source DR. ROHACK

The American Medical Association has called on health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates in 2008. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesperson Robert Zirkelbach said that many of the principles are covered under the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancelations and recissions; open access to care; fairness in contract negotiations with physicians; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings, which are used to select doctors for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, go to www.ama-assn.org

'It's time for insurers to recommit to patients' best interests.'

Source DR. ROHACK

The American Medical Association has called on health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates in 2008. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesperson Robert Zirkelbach said that many of the principles are covered under the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancelations and recissions; open access to care; fairness in contract negotiations with physicians; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings, which are used to select doctors for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, go to www.ama-assn.org

'It's time for insurers to recommit to patients' best interests.'

Source DR. ROHACK