Alicia Ault

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal schemes, she said.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal schemes, she said.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal schemes, she said.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, according to government officials.

The Affordable Care Act–one of the health reform laws–gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, she said, adding that the law increases penalties for fraud and puts more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys' Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, according to government officials.

The Affordable Care Act–one of the health reform laws–gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, she said, adding that the law increases penalties for fraud and puts more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys' Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, according to government officials.

The Affordable Care Act–one of the health reform laws–gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, she said, adding that the law increases penalties for fraud and puts more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys' Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Pediatrics, American College of Cardiology, Accreditation Council for Continuing Medical Education, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, American College of Preventive Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Radiology, American Society for Radiation Oncology, and ASCO.

In an interview, Dr. Scully said that the APA had been working on its own transparency, disclosure, and ethical conflict code in parallel to the CMSS process and would address the CMSS code at its board meeting in September.

As with the CMSS code, the APA requires that its key leaders and guideline committee chairs not have links with the industry. However, Dr. Scully noted that that condition could be waived if a person's participation on a guidelines committee, for example, was deemed important. In such a case, the decision process and the finding would be transparent, and that person's reviews would be subject to peer review.

He said that the problem with the specialty's relationship with drug companies lies in “the overlap between marketing and education.” Ideally, pooled funding from drug companies should be used for services or research that the association would control independently. For example, the APA's study on Part D was funded by drug companies, as are two services it is associated with–the Typical or Troubled? school mental health program that trains high school teachers to identify the warning signs of mental illness in teens; and the Give an Hour volunteer program aimed at military personnel and their families.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

CMSS said the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Pediatrics, American College of Cardiology, Accreditation Council for Continuing Medical Education, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, American College of Preventive Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Radiology, American Society for Radiation Oncology, and ASCO.

In an interview, Dr. Scully said that the APA had been working on its own transparency, disclosure, and ethical conflict code in parallel to the CMSS process and would address the CMSS code at its board meeting in September.

As with the CMSS code, the APA requires that its key leaders and guideline committee chairs not have links with the industry. However, Dr. Scully noted that that condition could be waived if a person's participation on a guidelines committee, for example, was deemed important. In such a case, the decision process and the finding would be transparent, and that person's reviews would be subject to peer review.

He said that the problem with the specialty's relationship with drug companies lies in “the overlap between marketing and education.” Ideally, pooled funding from drug companies should be used for services or research that the association would control independently. For example, the APA's study on Part D was funded by drug companies, as are two services it is associated with–the Typical or Troubled? school mental health program that trains high school teachers to identify the warning signs of mental illness in teens; and the Give an Hour volunteer program aimed at military personnel and their families.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

CMSS said the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Pediatrics, American College of Cardiology, Accreditation Council for Continuing Medical Education, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, American College of Preventive Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Radiology, American Society for Radiation Oncology, and ASCO.

In an interview, Dr. Scully said that the APA had been working on its own transparency, disclosure, and ethical conflict code in parallel to the CMSS process and would address the CMSS code at its board meeting in September.

As with the CMSS code, the APA requires that its key leaders and guideline committee chairs not have links with the industry. However, Dr. Scully noted that that condition could be waived if a person's participation on a guidelines committee, for example, was deemed important. In such a case, the decision process and the finding would be transparent, and that person's reviews would be subject to peer review.

He said that the problem with the specialty's relationship with drug companies lies in “the overlap between marketing and education.” Ideally, pooled funding from drug companies should be used for services or research that the association would control independently. For example, the APA's study on Part D was funded by drug companies, as are two services it is associated with–the Typical or Troubled? school mental health program that trains high school teachers to identify the warning signs of mental illness in teens; and the Give an Hour volunteer program aimed at military personnel and their families.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

CMSS said the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

No Smoking in Michigan

As of May 1, smoking was banned in Michigan workplaces, including bars and restaurants. According to the American Cancer Society's Cancer Action Network, Michigan is the 20th state to adopt such restrictions, with Wisconsin and Kansas ready to soon implement similar laws. With smoke-free workplaces, “workers can make a living without risking their health, patrons and tourists can enjoy time out without the hazards of second hand smoke, and bar and restaurant owners can promote healthy environments,” said the cancer network's chief executive officer John Seffrin, Ph.D. A statement from the cancer network said that almost three-quarters of the United States population is now covered by state, local, or municipal laws that restrict smoking.

Shift in Substance Abuse Patterns

From 1998 to 2008, the pattern of admissions for treatment of substance abuse changed markedly, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Admissions for alcohol abuse alone dropped from 27% of admissions to 23%, while admissions for drug abuse alone rose from 26% to 37%. Concurrent abuse of alcohol and drugs is still widespvread, but admissions for the combination declined from 44% of all admissions to 38% over the decade. Opiate-, stimulant-, and marijuana-related admissions rose, while cocaine-related admissions decreased from 15% to 11%. The majority of adolescent treatment admissions were for marijuana, and half of those admissions came through the criminal justice system. The data also revealed an economic change: In 2000 only 24% of people in treatment were unemployed, while that figure rose to 37% by in 2008. The Treatment Episode Data Set report is available at

wwwdasis.samhsa.gov/teds08/teds2k8natweb.pdf

Governor Signs Meth Law

Alabama Gov. Bob Riley (R) has signed a law intended to help law enforcement officials quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of methamphetamine. The law creates a new electronic database in an effort to modernize logs that already are kept on paper, making it possible to instantly track excessive purchases of pseudoephedrine. Every pharmacy or retailer selling ephedrine or pseudoephedrine products will be required to enter the purchaser's identifying information into an electronic database prior to any sale. The database then will notify the seller if the purchaser has exceeded the daily or monthly limit for such purchases.

Awards to Fight Kids' Trauma

SAMHSA will award $5.4 million over the next 3 years to three centers investigating treatments and services for children who experience traumatic events such as violence, natural disasters, and terrorism. Northwestern University Medical School, Evanston, Ill.; Children's Hospital, San Diego; and the Yale Child Study Center, New Haven, Conn., will receive the grants as part of the National Child Traumatic Stress Initiative. “By investing resources in improving the services offered, we can replace a lifetime of despair and disability with resiliency and hope,” Pamela S. Hyde, SAMHSA administrator, said in a statement.

Providers Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The 'Bad Ad' program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, agency officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

AARP Tallies Big Drug Price Rise

The AARP said that brand name prescription drug prices rose almost 10% in the year ended March 31, compared with a 0.3% rise in general inflation over the same period. The seniors' advocacy group said that the increase for the 25 brand-name drugs prescribed most often to Medicare beneficiaries for chronic conditions was the largest since the organization began tracking such data in 2002. The report said that prices for a sample of generic drugs declined by about 10% over the same period. Prices of specialty drugs–which include injectables and biologics used to treat cancer, rheumatoid arthritis, and other chronic diseases–rose by about 9%. That was less of an increase than in the previous 3 years. Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said in a statement that the report is “based on incomplete information” because prices don't take into account discounts and rebates.

No Smoking in Michigan

As of May 1, smoking was banned in Michigan workplaces, including bars and restaurants. According to the American Cancer Society's Cancer Action Network, Michigan is the 20th state to adopt such restrictions, with Wisconsin and Kansas ready to soon implement similar laws. With smoke-free workplaces, “workers can make a living without risking their health, patrons and tourists can enjoy time out without the hazards of second hand smoke, and bar and restaurant owners can promote healthy environments,” said the cancer network's chief executive officer John Seffrin, Ph.D. A statement from the cancer network said that almost three-quarters of the United States population is now covered by state, local, or municipal laws that restrict smoking.

Shift in Substance Abuse Patterns

From 1998 to 2008, the pattern of admissions for treatment of substance abuse changed markedly, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Admissions for alcohol abuse alone dropped from 27% of admissions to 23%, while admissions for drug abuse alone rose from 26% to 37%. Concurrent abuse of alcohol and drugs is still widespvread, but admissions for the combination declined from 44% of all admissions to 38% over the decade. Opiate-, stimulant-, and marijuana-related admissions rose, while cocaine-related admissions decreased from 15% to 11%. The majority of adolescent treatment admissions were for marijuana, and half of those admissions came through the criminal justice system. The data also revealed an economic change: In 2000 only 24% of people in treatment were unemployed, while that figure rose to 37% by in 2008. The Treatment Episode Data Set report is available at

wwwdasis.samhsa.gov/teds08/teds2k8natweb.pdf

Governor Signs Meth Law

Alabama Gov. Bob Riley (R) has signed a law intended to help law enforcement officials quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of methamphetamine. The law creates a new electronic database in an effort to modernize logs that already are kept on paper, making it possible to instantly track excessive purchases of pseudoephedrine. Every pharmacy or retailer selling ephedrine or pseudoephedrine products will be required to enter the purchaser's identifying information into an electronic database prior to any sale. The database then will notify the seller if the purchaser has exceeded the daily or monthly limit for such purchases.

Awards to Fight Kids' Trauma

SAMHSA will award $5.4 million over the next 3 years to three centers investigating treatments and services for children who experience traumatic events such as violence, natural disasters, and terrorism. Northwestern University Medical School, Evanston, Ill.; Children's Hospital, San Diego; and the Yale Child Study Center, New Haven, Conn., will receive the grants as part of the National Child Traumatic Stress Initiative. “By investing resources in improving the services offered, we can replace a lifetime of despair and disability with resiliency and hope,” Pamela S. Hyde, SAMHSA administrator, said in a statement.

Providers Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The 'Bad Ad' program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, agency officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

AARP Tallies Big Drug Price Rise

The AARP said that brand name prescription drug prices rose almost 10% in the year ended March 31, compared with a 0.3% rise in general inflation over the same period. The seniors' advocacy group said that the increase for the 25 brand-name drugs prescribed most often to Medicare beneficiaries for chronic conditions was the largest since the organization began tracking such data in 2002. The report said that prices for a sample of generic drugs declined by about 10% over the same period. Prices of specialty drugs–which include injectables and biologics used to treat cancer, rheumatoid arthritis, and other chronic diseases–rose by about 9%. That was less of an increase than in the previous 3 years. Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said in a statement that the report is “based on incomplete information” because prices don't take into account discounts and rebates.

No Smoking in Michigan

As of May 1, smoking was banned in Michigan workplaces, including bars and restaurants. According to the American Cancer Society's Cancer Action Network, Michigan is the 20th state to adopt such restrictions, with Wisconsin and Kansas ready to soon implement similar laws. With smoke-free workplaces, “workers can make a living without risking their health, patrons and tourists can enjoy time out without the hazards of second hand smoke, and bar and restaurant owners can promote healthy environments,” said the cancer network's chief executive officer John Seffrin, Ph.D. A statement from the cancer network said that almost three-quarters of the United States population is now covered by state, local, or municipal laws that restrict smoking.

Shift in Substance Abuse Patterns

From 1998 to 2008, the pattern of admissions for treatment of substance abuse changed markedly, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Admissions for alcohol abuse alone dropped from 27% of admissions to 23%, while admissions for drug abuse alone rose from 26% to 37%. Concurrent abuse of alcohol and drugs is still widespvread, but admissions for the combination declined from 44% of all admissions to 38% over the decade. Opiate-, stimulant-, and marijuana-related admissions rose, while cocaine-related admissions decreased from 15% to 11%. The majority of adolescent treatment admissions were for marijuana, and half of those admissions came through the criminal justice system. The data also revealed an economic change: In 2000 only 24% of people in treatment were unemployed, while that figure rose to 37% by in 2008. The Treatment Episode Data Set report is available at

wwwdasis.samhsa.gov/teds08/teds2k8natweb.pdf

Governor Signs Meth Law

Alabama Gov. Bob Riley (R) has signed a law intended to help law enforcement officials quickly track excessive purchases of pseudoephedrine, the chief ingredient used in the manufacture of methamphetamine. The law creates a new electronic database in an effort to modernize logs that already are kept on paper, making it possible to instantly track excessive purchases of pseudoephedrine. Every pharmacy or retailer selling ephedrine or pseudoephedrine products will be required to enter the purchaser's identifying information into an electronic database prior to any sale. The database then will notify the seller if the purchaser has exceeded the daily or monthly limit for such purchases.

Awards to Fight Kids' Trauma

SAMHSA will award $5.4 million over the next 3 years to three centers investigating treatments and services for children who experience traumatic events such as violence, natural disasters, and terrorism. Northwestern University Medical School, Evanston, Ill.; Children's Hospital, San Diego; and the Yale Child Study Center, New Haven, Conn., will receive the grants as part of the National Child Traumatic Stress Initiative. “By investing resources in improving the services offered, we can replace a lifetime of despair and disability with resiliency and hope,” Pamela S. Hyde, SAMHSA administrator, said in a statement.

Providers Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The 'Bad Ad' program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, agency officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

AARP Tallies Big Drug Price Rise

The AARP said that brand name prescription drug prices rose almost 10% in the year ended March 31, compared with a 0.3% rise in general inflation over the same period. The seniors' advocacy group said that the increase for the 25 brand-name drugs prescribed most often to Medicare beneficiaries for chronic conditions was the largest since the organization began tracking such data in 2002. The report said that prices for a sample of generic drugs declined by about 10% over the same period. Prices of specialty drugs–which include injectables and biologics used to treat cancer, rheumatoid arthritis, and other chronic diseases–rose by about 9%. That was less of an increase than in the previous 3 years. Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said in a statement that the report is “based on incomplete information” because prices don't take into account discounts and rebates.

NATIONAL HARBOR, MD. — Hospitalists within a practice most likely know which of their colleagues want time off on nights and weekends, but they probably haven't given a lot of thought to how to efficiently assign new patients, Dr. John Nelson said.

Managing patient assignments successfully improves physician and patient satisfaction, said Dr. Nelson of Nelson Flores Hospital Medicine Consultants, La Quinta, Calif., and Dr. Troy W. Ahlstrom, chief financial officer of Hospitalists of Northern Michigan, Traverse City.

A successful assignment system feels fair to the hospitalist, supports continuity of care, and allows other physicians in the hospital to always know which hospitalist is caring for a patient, said Dr. Nelson, who also is the medical director for the hospitalist practice at Overlake Hospital, Bellevue, Wash.

One commonly used method involves distributing patients sequentially and assigning based on location—for instance, one physician takes floors 1 and 3, and another floors 2 and 4. Load leveling also is common, but can be time consuming to manage, Dr. Nelson said. With that method, the next patient is assigned to the physician with the lightest patient load at that time.

Less common is uneven assignment, when one physician might take all the admissions on one day and none the next. Another method is for a hospitalist to be paired with a primary care physician, taking all of his or her patients. With this approach, the primary care physician will always know who is covering his or her patients, and patients who are admitted repeatedly will always have the same hospitalist. A variation is for repeat patients to always be admitted by the same physician.

Even with an assignment scheme in place, hospitalists have to be prepared to cope with special cases, such as “bounce backs”—patients readmitted shortly after discharge. Dr. Nelson suggested establishing a formal policy on how to handle such situations. Formal policies should also be in place for assignment exceptions when one hospitalist is at the cap for new admissions and the others in the practice are not, or when other physicians request a consultation with a specific hospitalist. Finally, practices should anticipate what to do when a patient “fires” a particular hospitalist, and they should have a policy for that, he said.

Using a “triage” or “hot” pager, in which all patients are routed first through the pager operator, usually a hospitalist, can also help with assignments, Dr. Nelson said.

Another option is exempting hospitalists from taking any new admissions the day before they rotate off shift. Assuming that the average length of stay is 4 days and that hospitalists work 7 consecutive days, this method of assignment means that 71% of patients will see the same physician throughout their stay, Dr. Nelson said. If, instead, the physician gets the same patient load every day, including the day before going off shift, only 57% of patients will see the same hospitalist for the duration of their stay.

The advantages of the exemption scheme include better continuity of care, fewer handoffs, and more time for the physician to “tee up” patients for the incoming hospitalist, Dr. Nelson said. However, it also means that the other physicians in the practice will need to take more patients on some days.

Dr. Ahlstrom said the traditional model of 7 days on/7 days off did not work well at his practice at the Alpena (Mich.) Regional Medical Center. So the Alpena practice instituted a flexible full-time equivalent (FTE)–based work schedule that allows each hospitalist to tailor his or her patient load each day.

It's a somewhat complicated approach, however. The FTE is defined by the number of patients seen per day—for instance, if the FTE is defined as 16 patients a day, and the practice admits about 160 patients daily, 10 FTE physicians are needed to cover each day. Physicians are queried about how many patients they want to take on each day. They are assigned FTE numbers based on patient load and then scheduled accordingly so that the entire practice has coverage for all of the anticipated admissions.

The flexible schedule lets the physician work in a pattern that is optimal for his or her lifestyle and compensation needs, Dr. Ahlstrom said. Finally, although it's a great retention tool because it allows physicians to maintain a work-life balance, it can make recruitment more difficult because there can be some initial resistance to nontraditional scheduling, he added.

Compensation is based solely on productivity, which may give some hospitalists pause. Because it is so complicated, the Alpena practice has a dedicated employee who works 20–40 hours a week solely on scheduling at the three hospitals it serves. Start-up costs are about $20,000, primarily for the software and hardware needed, he said.

Disclosures: Dr. Ahlstrom disclosed that he is a consultant with Hospital Solutions of Michigan. Dr. Nelson reported that in addition to his consultancy, he is a stockholder in Ingenious Med.

NATIONAL HARBOR, MD. — Hospitalists within a practice most likely know which of their colleagues want time off on nights and weekends, but they probably haven't given a lot of thought to how to efficiently assign new patients, Dr. John Nelson said.

Managing patient assignments successfully improves physician and patient satisfaction, said Dr. Nelson of Nelson Flores Hospital Medicine Consultants, La Quinta, Calif., and Dr. Troy W. Ahlstrom, chief financial officer of Hospitalists of Northern Michigan, Traverse City.

A successful assignment system feels fair to the hospitalist, supports continuity of care, and allows other physicians in the hospital to always know which hospitalist is caring for a patient, said Dr. Nelson, who also is the medical director for the hospitalist practice at Overlake Hospital, Bellevue, Wash.

One commonly used method involves distributing patients sequentially and assigning based on location—for instance, one physician takes floors 1 and 3, and another floors 2 and 4. Load leveling also is common, but can be time consuming to manage, Dr. Nelson said. With that method, the next patient is assigned to the physician with the lightest patient load at that time.

Less common is uneven assignment, when one physician might take all the admissions on one day and none the next. Another method is for a hospitalist to be paired with a primary care physician, taking all of his or her patients. With this approach, the primary care physician will always know who is covering his or her patients, and patients who are admitted repeatedly will always have the same hospitalist. A variation is for repeat patients to always be admitted by the same physician.

Even with an assignment scheme in place, hospitalists have to be prepared to cope with special cases, such as “bounce backs”—patients readmitted shortly after discharge. Dr. Nelson suggested establishing a formal policy on how to handle such situations. Formal policies should also be in place for assignment exceptions when one hospitalist is at the cap for new admissions and the others in the practice are not, or when other physicians request a consultation with a specific hospitalist. Finally, practices should anticipate what to do when a patient “fires” a particular hospitalist, and they should have a policy for that, he said.

Using a “triage” or “hot” pager, in which all patients are routed first through the pager operator, usually a hospitalist, can also help with assignments, Dr. Nelson said.

Another option is exempting hospitalists from taking any new admissions the day before they rotate off shift. Assuming that the average length of stay is 4 days and that hospitalists work 7 consecutive days, this method of assignment means that 71% of patients will see the same physician throughout their stay, Dr. Nelson said. If, instead, the physician gets the same patient load every day, including the day before going off shift, only 57% of patients will see the same hospitalist for the duration of their stay.

The advantages of the exemption scheme include better continuity of care, fewer handoffs, and more time for the physician to “tee up” patients for the incoming hospitalist, Dr. Nelson said. However, it also means that the other physicians in the practice will need to take more patients on some days.

Dr. Ahlstrom said the traditional model of 7 days on/7 days off did not work well at his practice at the Alpena (Mich.) Regional Medical Center. So the Alpena practice instituted a flexible full-time equivalent (FTE)–based work schedule that allows each hospitalist to tailor his or her patient load each day.

It's a somewhat complicated approach, however. The FTE is defined by the number of patients seen per day—for instance, if the FTE is defined as 16 patients a day, and the practice admits about 160 patients daily, 10 FTE physicians are needed to cover each day. Physicians are queried about how many patients they want to take on each day. They are assigned FTE numbers based on patient load and then scheduled accordingly so that the entire practice has coverage for all of the anticipated admissions.

The flexible schedule lets the physician work in a pattern that is optimal for his or her lifestyle and compensation needs, Dr. Ahlstrom said. Finally, although it's a great retention tool because it allows physicians to maintain a work-life balance, it can make recruitment more difficult because there can be some initial resistance to nontraditional scheduling, he added.

Compensation is based solely on productivity, which may give some hospitalists pause. Because it is so complicated, the Alpena practice has a dedicated employee who works 20–40 hours a week solely on scheduling at the three hospitals it serves. Start-up costs are about $20,000, primarily for the software and hardware needed, he said.

Disclosures: Dr. Ahlstrom disclosed that he is a consultant with Hospital Solutions of Michigan. Dr. Nelson reported that in addition to his consultancy, he is a stockholder in Ingenious Med.

NATIONAL HARBOR, MD. — Hospitalists within a practice most likely know which of their colleagues want time off on nights and weekends, but they probably haven't given a lot of thought to how to efficiently assign new patients, Dr. John Nelson said.

Managing patient assignments successfully improves physician and patient satisfaction, said Dr. Nelson of Nelson Flores Hospital Medicine Consultants, La Quinta, Calif., and Dr. Troy W. Ahlstrom, chief financial officer of Hospitalists of Northern Michigan, Traverse City.

A successful assignment system feels fair to the hospitalist, supports continuity of care, and allows other physicians in the hospital to always know which hospitalist is caring for a patient, said Dr. Nelson, who also is the medical director for the hospitalist practice at Overlake Hospital, Bellevue, Wash.

One commonly used method involves distributing patients sequentially and assigning based on location—for instance, one physician takes floors 1 and 3, and another floors 2 and 4. Load leveling also is common, but can be time consuming to manage, Dr. Nelson said. With that method, the next patient is assigned to the physician with the lightest patient load at that time.

Less common is uneven assignment, when one physician might take all the admissions on one day and none the next. Another method is for a hospitalist to be paired with a primary care physician, taking all of his or her patients. With this approach, the primary care physician will always know who is covering his or her patients, and patients who are admitted repeatedly will always have the same hospitalist. A variation is for repeat patients to always be admitted by the same physician.

Even with an assignment scheme in place, hospitalists have to be prepared to cope with special cases, such as “bounce backs”—patients readmitted shortly after discharge. Dr. Nelson suggested establishing a formal policy on how to handle such situations. Formal policies should also be in place for assignment exceptions when one hospitalist is at the cap for new admissions and the others in the practice are not, or when other physicians request a consultation with a specific hospitalist. Finally, practices should anticipate what to do when a patient “fires” a particular hospitalist, and they should have a policy for that, he said.

Using a “triage” or “hot” pager, in which all patients are routed first through the pager operator, usually a hospitalist, can also help with assignments, Dr. Nelson said.

Another option is exempting hospitalists from taking any new admissions the day before they rotate off shift. Assuming that the average length of stay is 4 days and that hospitalists work 7 consecutive days, this method of assignment means that 71% of patients will see the same physician throughout their stay, Dr. Nelson said. If, instead, the physician gets the same patient load every day, including the day before going off shift, only 57% of patients will see the same hospitalist for the duration of their stay.

The advantages of the exemption scheme include better continuity of care, fewer handoffs, and more time for the physician to “tee up” patients for the incoming hospitalist, Dr. Nelson said. However, it also means that the other physicians in the practice will need to take more patients on some days.

Dr. Ahlstrom said the traditional model of 7 days on/7 days off did not work well at his practice at the Alpena (Mich.) Regional Medical Center. So the Alpena practice instituted a flexible full-time equivalent (FTE)–based work schedule that allows each hospitalist to tailor his or her patient load each day.

It's a somewhat complicated approach, however. The FTE is defined by the number of patients seen per day—for instance, if the FTE is defined as 16 patients a day, and the practice admits about 160 patients daily, 10 FTE physicians are needed to cover each day. Physicians are queried about how many patients they want to take on each day. They are assigned FTE numbers based on patient load and then scheduled accordingly so that the entire practice has coverage for all of the anticipated admissions.

The flexible schedule lets the physician work in a pattern that is optimal for his or her lifestyle and compensation needs, Dr. Ahlstrom said. Finally, although it's a great retention tool because it allows physicians to maintain a work-life balance, it can make recruitment more difficult because there can be some initial resistance to nontraditional scheduling, he added.

Compensation is based solely on productivity, which may give some hospitalists pause. Because it is so complicated, the Alpena practice has a dedicated employee who works 20–40 hours a week solely on scheduling at the three hospitals it serves. Start-up costs are about $20,000, primarily for the software and hardware needed, he said.

Disclosures: Dr. Ahlstrom disclosed that he is a consultant with Hospital Solutions of Michigan. Dr. Nelson reported that in addition to his consultancy, he is a stockholder in Ingenious Med.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a May 13 briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal and inappropriate schemes, Ms. Sebelius added.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a May 13 briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal and inappropriate schemes, Ms. Sebelius added.

Physicians may find themselves under increased scrutiny as a result of provisions in the Affordable Care Act—one of the health reform laws—giving government agencies new funding and enforcement powers to go after fraud and abuse.

The Affordable Care Act will require providers and suppliers to meet new compliance criteria, said Daniel Levinson, inspector general for the Department of Health and Human Services. After the criteria are issued, his office will provide training to health care providers, he added at a May 13 briefing.

HHS Secretary Kathleen Sebelius said that the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. In 2009, the federal government recovered $2.5 billion in fraudulent Medicare payments, officials said at the briefing.

Potential Medicare or Medicaid providers will be categorized as at high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, Ms. Sebelius said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse, she noted, as opposed to the current “pay and chase” model.

The HHS and the Department of Justice also will be adopting strategies used by credit card companies to flag aberrant charges and stop fraud in its tracks. “As we try to bring down skyrocketing costs across our health care system, we can't afford to ignore the billions of dollars we lose to fraud and theft,” she said.

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, health care providers, drug and device makers, and non–health providers found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was formed in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. Los Angeles, Detroit, and Houston were added in 2009. The strike force now also operates in Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

New types of scams are emerging as criminals try to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” Ms. Sebelius said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the so-called doughnut hole that limits coverage, she said.

The HHS is working with advocacy organizations to educate laypeople who can train their peers how to recognize illegal and inappropriate schemes, Ms. Sebelius added.

The American Medical Association on May 25 called on U.S. 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 at its 2008 Interim Meeting. 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 re-commit to patients’ best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, 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 cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; 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 in those systems, according to the principles.

The systems are used to select physicians for preferential networks.

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

The American Medical Association on May 25 called on U.S. 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 at its 2008 Interim Meeting. 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 re-commit to patients’ best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, 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 cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; 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 in those systems, according to the principles.

The systems are used to select physicians for preferential networks.

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

The American Medical Association on May 25 called on U.S. 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 at its 2008 Interim Meeting. 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 re-commit to patients’ best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, 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 cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; 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 in those systems, according to the principles.

The systems are used to select physicians for preferential networks.

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

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing May 13.

The Affordable Care Act – one of the health reform laws – gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider’s legitimacy, she said, adding that the law increases penalties for fraud, and put more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we’ve tolerated health care fraud,” she said. “We’ve accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system we can’t afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys’ Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing May 13.

The Affordable Care Act – one of the health reform laws – gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider’s legitimacy, she said, adding that the law increases penalties for fraud, and put more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we’ve tolerated health care fraud,” she said. “We’ve accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system we can’t afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys’ Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing May 13.

The Affordable Care Act – one of the health reform laws – gives government agencies new enforcement powers and new funding to go after fraud and abuse and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse.

The law will make it more difficult to become enrolled as a Medicare or Medicaid provider as potential providers will be categorized as high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider’s legitimacy, she said, adding that the law increases penalties for fraud, and put more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model used now.

HHS and the Department of Justice also will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges to stop fraud in its tracks, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, Ms. Sebelius said.

“For years, we’ve tolerated health care fraud,” she said. “We’ve accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end. As we try to bring down skyrocketing costs across our health care system we can’t afford to ignore the billions of dollars we lose to fraud and theft.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians and other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

A total of 583 individuals were convicted of health care fraud in 2009, by U.S. Attorneys’ Offices and federal prosecutors. On the civil side, the Department of Justice opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes, including a California physician who paid $2.2 million to settle allegations that between 2002 and 2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida.

The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston, were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said.

The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The landmark agreement comes after decades of effort to find an appropriate mechanism for emergency physicians to receive certification in the subspecialty of critical care medicine.

Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was never a pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows have gone on to take an examination through the European Society of Intensive Care Medicine. In general, some hospitals accept that overseas exam certification as a surrogate due to the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate additional communication between the ABEM and the two other boards that currently certify in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

But the availability of a 2-year fellowship and subsequent U.S. certification will also help produce more U.S.-trained intensivists, Dr. Emlet said.

Currently, about 20 emergency medicine residents enter a critical care fellowship each year, Dr. Emlet said, adding that there's a natural affinity between emergency medicine and critical care medicine. A recently published survey of emergency physicians in a critical care medicine fellowship found that of those who had completed their fellowship, 49% (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9).

The number of emergency physicians who have completed critical care fellowships has risen from 12 over the 1974-1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said they expected the first certification exam to be offered in 2012.

The White House announced on April 19 that it has nominated Dr. Donald M. Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the recent passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

'I would welcome the opportunity … to help extend the effort to improve America's health care system.'

Source DR. BERWICK

The White House announced on April 19 that it has nominated Dr. Donald M. Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the recent passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

'I would welcome the opportunity … to help extend the effort to improve America's health care system.'

Source DR. BERWICK

The White House announced on April 19 that it has nominated Dr. Donald M. Berwick to lead the Centers for Medicare and Medicaid Services.

The nomination of Dr. Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, had been rumored for weeks.

In a statement released by the White House, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the recent passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

Physicians, hospitals, insurers, consumers, and pharmaceutical and medical device manufacturers all are hoping to influence how the law is implemented.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

For his part, Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

'I would welcome the opportunity … to help extend the effort to improve America's health care system.'

Source DR. BERWICK