Alicia Ault

DSM-5 Comments Close

The American Psychiatric Association reported that it received 6,400 comments on its draft of the DSM-5. About a quarter of the comments were general, another quarter were on neurodevelopmental disorders, 15% dealt with anxiety disorders, 11% were on psychoses, and 10% concerned sexual and gender-identity disorders. The remainder was split among nine other classes of mental disorders. The comments probably will result in revisions, according to the APA. In fact, the DSM-5 Work Group on Eating Disorders already has proposed revisions to criteria for anorexia nervosa and bulimia nervosa. Now that comments have closed, the APA will test the proposed diagnostic criteria in clinical settings and then refine them. Final publication is planned for May 2013.

New Tobacco-Science Chief

The Food and Drug Administration has named a director for the Office of Science within its new Center for Tobacco Products. Dr. David L. Ashley will assume the position in June. Currently, he is the chief of the Emergency Response and Air Toxicants Branch of the Centers for Disease Control and Prevention's National Center for Environmental Health. Dr. Ashley also is a member of the World Health Organization's study group on tobacco regulation. At the center, he will oversee science, product review, epidemiology and metrics, and social and behavioral sciences, according to the FDA.

$153 Billion Wasted on Medications

Americans are wasting $153 billion a year on medications, primarily because of lack of adherence to prescriptions, estimates the pharmacy-benefit management company Express Scripts. The company came up with this tally as part of its annual report on drug spending. In 2009, $106 billion in waste was caused by nonadherence, $51 billion by failure to use lower-cost alternatives, and $6 billion from people choosing retail over mail order delivery, said the Express Scripts. (It has a mail order subsidiary.) The biggest medical area of waste is in treating high cholesterol, followed by hypertension, ulcer disease, and depression, according to the company. It said that 35% of the annual spending on lipid medications could be saved if people behaved better. Overall, drug spending rose 6.4% in 2009, which reversed a downward trend over the past few years. Spending for specialty drugs–for conditions such as rheumatoid arthritis, cancer, and multiple sclerosis–rose by 11%, driven largely by price increases.

Sales of Generics Still on Rise

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken commented in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer Inc. has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other drug company has detailed trial payments. The data, which are posted at

www.pfizer.com/responsibility

Reform Was Lobbying Cash Cow

Lawyers, professional societies, and other organizations spent $1.2 billion lobbying Congress and the White House on health reform and other issues in 2009, according to a report by the Center for Public Integrity (CPI), a Washington-based watchdog group. How much went to health reform is not known, but if it was even 10%, that would be record lobbying for a single issue in 1 year, according to the CPI. The group estimates that 1,750 entities spread the money around. In addition to making use of its own lobbyists, Pharmaceutical Research and Manufacturers of America, for instance, hired 25 outside firms, CPI said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it isn't overshadowed by other parts of either type of ad. The FDA will accept comments on the proposed rule until June 28.

DSM-5 Comments Close

The American Psychiatric Association reported that it received 6,400 comments on its draft of the DSM-5. About a quarter of the comments were general, another quarter were on neurodevelopmental disorders, 15% dealt with anxiety disorders, 11% were on psychoses, and 10% concerned sexual and gender-identity disorders. The remainder was split among nine other classes of mental disorders. The comments probably will result in revisions, according to the APA. In fact, the DSM-5 Work Group on Eating Disorders already has proposed revisions to criteria for anorexia nervosa and bulimia nervosa. Now that comments have closed, the APA will test the proposed diagnostic criteria in clinical settings and then refine them. Final publication is planned for May 2013.

New Tobacco-Science Chief

The Food and Drug Administration has named a director for the Office of Science within its new Center for Tobacco Products. Dr. David L. Ashley will assume the position in June. Currently, he is the chief of the Emergency Response and Air Toxicants Branch of the Centers for Disease Control and Prevention's National Center for Environmental Health. Dr. Ashley also is a member of the World Health Organization's study group on tobacco regulation. At the center, he will oversee science, product review, epidemiology and metrics, and social and behavioral sciences, according to the FDA.

$153 Billion Wasted on Medications

Americans are wasting $153 billion a year on medications, primarily because of lack of adherence to prescriptions, estimates the pharmacy-benefit management company Express Scripts. The company came up with this tally as part of its annual report on drug spending. In 2009, $106 billion in waste was caused by nonadherence, $51 billion by failure to use lower-cost alternatives, and $6 billion from people choosing retail over mail order delivery, said the Express Scripts. (It has a mail order subsidiary.) The biggest medical area of waste is in treating high cholesterol, followed by hypertension, ulcer disease, and depression, according to the company. It said that 35% of the annual spending on lipid medications could be saved if people behaved better. Overall, drug spending rose 6.4% in 2009, which reversed a downward trend over the past few years. Spending for specialty drugs–for conditions such as rheumatoid arthritis, cancer, and multiple sclerosis–rose by 11%, driven largely by price increases.

Sales of Generics Still on Rise

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken commented in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer Inc. has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other drug company has detailed trial payments. The data, which are posted at

www.pfizer.com/responsibility

Reform Was Lobbying Cash Cow

Lawyers, professional societies, and other organizations spent $1.2 billion lobbying Congress and the White House on health reform and other issues in 2009, according to a report by the Center for Public Integrity (CPI), a Washington-based watchdog group. How much went to health reform is not known, but if it was even 10%, that would be record lobbying for a single issue in 1 year, according to the CPI. The group estimates that 1,750 entities spread the money around. In addition to making use of its own lobbyists, Pharmaceutical Research and Manufacturers of America, for instance, hired 25 outside firms, CPI said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it isn't overshadowed by other parts of either type of ad. The FDA will accept comments on the proposed rule until June 28.

DSM-5 Comments Close

The American Psychiatric Association reported that it received 6,400 comments on its draft of the DSM-5. About a quarter of the comments were general, another quarter were on neurodevelopmental disorders, 15% dealt with anxiety disorders, 11% were on psychoses, and 10% concerned sexual and gender-identity disorders. The remainder was split among nine other classes of mental disorders. The comments probably will result in revisions, according to the APA. In fact, the DSM-5 Work Group on Eating Disorders already has proposed revisions to criteria for anorexia nervosa and bulimia nervosa. Now that comments have closed, the APA will test the proposed diagnostic criteria in clinical settings and then refine them. Final publication is planned for May 2013.

New Tobacco-Science Chief

The Food and Drug Administration has named a director for the Office of Science within its new Center for Tobacco Products. Dr. David L. Ashley will assume the position in June. Currently, he is the chief of the Emergency Response and Air Toxicants Branch of the Centers for Disease Control and Prevention's National Center for Environmental Health. Dr. Ashley also is a member of the World Health Organization's study group on tobacco regulation. At the center, he will oversee science, product review, epidemiology and metrics, and social and behavioral sciences, according to the FDA.

$153 Billion Wasted on Medications

Americans are wasting $153 billion a year on medications, primarily because of lack of adherence to prescriptions, estimates the pharmacy-benefit management company Express Scripts. The company came up with this tally as part of its annual report on drug spending. In 2009, $106 billion in waste was caused by nonadherence, $51 billion by failure to use lower-cost alternatives, and $6 billion from people choosing retail over mail order delivery, said the Express Scripts. (It has a mail order subsidiary.) The biggest medical area of waste is in treating high cholesterol, followed by hypertension, ulcer disease, and depression, according to the company. It said that 35% of the annual spending on lipid medications could be saved if people behaved better. Overall, drug spending rose 6.4% in 2009, which reversed a downward trend over the past few years. Spending for specialty drugs–for conditions such as rheumatoid arthritis, cancer, and multiple sclerosis–rose by 11%, driven largely by price increases.

Sales of Generics Still on Rise

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken commented in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer Inc. has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other drug company has detailed trial payments. The data, which are posted at

www.pfizer.com/responsibility

Reform Was Lobbying Cash Cow

Lawyers, professional societies, and other organizations spent $1.2 billion lobbying Congress and the White House on health reform and other issues in 2009, according to a report by the Center for Public Integrity (CPI), a Washington-based watchdog group. How much went to health reform is not known, but if it was even 10%, that would be record lobbying for a single issue in 1 year, according to the CPI. The group estimates that 1,750 entities spread the money around. In addition to making use of its own lobbyists, Pharmaceutical Research and Manufacturers of America, for instance, hired 25 outside firms, CPI said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it isn't overshadowed by other parts of either type of ad. The FDA will accept comments on the proposed rule until June 28.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

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 agreement comes after decades of effort to develop an appropriate way for emergency physicians to receive certification in critical care medicine. Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was no 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 took an examination through the European Society of Intensive Care Medicine. Some hospitals accept such overseas credentialing, because of 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 potential 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 communication between the ABEM and the two other medical specialty boards that currently certify physicians in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

The availability of a 2-year fellowship and subsequent U.S. certification also will help produce more U.S.-trained intensivists, Dr. Emlet said. Currently, about 20 emergency medicine residents enter a critical care fellowship program each year, he said, pointing out the natural affinity between emergency medicine and critical care medicine.

In a recent survey of emergency physicians who participated in a critical care medicine fellowship program, 49% of the physicians who had completed their fellowship (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 rose 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 that was discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current medical specialty 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 that they expect 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 agreement comes after decades of effort to develop an appropriate way for emergency physicians to receive certification in critical care medicine. Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was no 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 took an examination through the European Society of Intensive Care Medicine. Some hospitals accept such overseas credentialing, because of 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 potential 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 communication between the ABEM and the two other medical specialty boards that currently certify physicians in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

The availability of a 2-year fellowship and subsequent U.S. certification also will help produce more U.S.-trained intensivists, Dr. Emlet said. Currently, about 20 emergency medicine residents enter a critical care fellowship program each year, he said, pointing out the natural affinity between emergency medicine and critical care medicine.

In a recent survey of emergency physicians who participated in a critical care medicine fellowship program, 49% of the physicians who had completed their fellowship (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 rose 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 that was discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current medical specialty 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 that they expect 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 agreement comes after decades of effort to develop an appropriate way for emergency physicians to receive certification in critical care medicine. Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was no 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 took an examination through the European Society of Intensive Care Medicine. Some hospitals accept such overseas credentialing, because of 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 potential 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 communication between the ABEM and the two other medical specialty boards that currently certify physicians in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

The availability of a 2-year fellowship and subsequent U.S. certification also will help produce more U.S.-trained intensivists, Dr. Emlet said. Currently, about 20 emergency medicine residents enter a critical care fellowship program each year, he said, pointing out the natural affinity between emergency medicine and critical care medicine.

In a recent survey of emergency physicians who participated in a critical care medicine fellowship program, 49% of the physicians who had completed their fellowship (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 rose 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 that was discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current medical specialty 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 that they expect the first certification exam to be offered in 2012.

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. The competencies also are a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Negotiations with the ABP are ongoing, said coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego. The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been defined, because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

“This groundbreaking event now gives a context by which all pediatric hospitalists can judge their expertise and training. As this new subspecialty emerges, it will give training programs and examiners a body of knowledge and skill to aspire to,” commented Dr. Michelle Marks, director of pediatric hospitalist medicine and director of medical operations at the the Cleveland Clinic Children's Hospital.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said. They may even be difficult to achieve during a fellowship, Dr. Stucky added.

The competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Next steps include developing assessment strategies, including examinations, simulations, and practice reviews. The competencies themselves also will be continually assessed and revised, Dr. Ottolini said.

Disclosures: Dr. Ottolini, Dr. Stucky, and Dr. Marks reported no financial conflicts.

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The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location. However, the competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Mary C. Ottolini said.

Source Courtesy Children's National Medical Center

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. The competencies also are a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Negotiations with the ABP are ongoing, said coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego. The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been defined, because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

“This groundbreaking event now gives a context by which all pediatric hospitalists can judge their expertise and training. As this new subspecialty emerges, it will give training programs and examiners a body of knowledge and skill to aspire to,” commented Dr. Michelle Marks, director of pediatric hospitalist medicine and director of medical operations at the the Cleveland Clinic Children's Hospital.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said. They may even be difficult to achieve during a fellowship, Dr. Stucky added.

The competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Next steps include developing assessment strategies, including examinations, simulations, and practice reviews. The competencies themselves also will be continually assessed and revised, Dr. Ottolini said.

Disclosures: Dr. Ottolini, Dr. Stucky, and Dr. Marks reported no financial conflicts.

Document

70104_fx1.sml

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location. However, the competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Mary C. Ottolini said.

Source Courtesy Children's National Medical Center

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. The competencies also are a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Negotiations with the ABP are ongoing, said coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego. The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been defined, because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

“This groundbreaking event now gives a context by which all pediatric hospitalists can judge their expertise and training. As this new subspecialty emerges, it will give training programs and examiners a body of knowledge and skill to aspire to,” commented Dr. Michelle Marks, director of pediatric hospitalist medicine and director of medical operations at the the Cleveland Clinic Children's Hospital.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said. They may even be difficult to achieve during a fellowship, Dr. Stucky added.

The competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Next steps include developing assessment strategies, including examinations, simulations, and practice reviews. The competencies themselves also will be continually assessed and revised, Dr. Ottolini said.

Disclosures: Dr. Ottolini, Dr. Stucky, and Dr. Marks reported no financial conflicts.

Document

70104_fx1.sml

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location. However, the competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Mary C. Ottolini said.

Source Courtesy Children's National Medical Center

The federal government has granted states and territories $119 million to reduce tobacco use, increase physical activity, and fight obesity, the Health and Human Services department said.

The grants are funded by the American Recovery and Reinvestment Act, also known as the stimulus package.

The money will go to programs aimed at prevention and wellness, HHS Secretary Kathleen Sebelius said at a press briefing.

“Prevention is a 'best buy' for health,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said during the press conference. His agency will help states implement the grants.

The awards were made in three major categories: policy and environmental changes, innovative programs, and tobacco cessation/telephone “quit-lines.”

All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quit-lines. Dr. Frieden called the lines “highly cost effective.” He noted that tobacco-related disease is the No. 1 cause of preventable death.

Innovative programs in 13 states will be receiving money for 15 projects. Among those: Mississippi will receive $3 million to fund a smoke-free air policy, and Rhode Island will get $3 million to fund a program to help elderly residents age at home. These programs will likely serve as models for other states, Ms. Sebelius said.

Other awards will go to help support healthy food choices and physical activity, Dr. Frieden said.

Details on the awards are available at www.cdc.gov/chronicdisease/recovery

The federal government has granted states and territories $119 million to reduce tobacco use, increase physical activity, and fight obesity, the Health and Human Services department said.

The grants are funded by the American Recovery and Reinvestment Act, also known as the stimulus package.

The money will go to programs aimed at prevention and wellness, HHS Secretary Kathleen Sebelius said at a press briefing.

“Prevention is a 'best buy' for health,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said during the press conference. His agency will help states implement the grants.

The awards were made in three major categories: policy and environmental changes, innovative programs, and tobacco cessation/telephone “quit-lines.”

All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quit-lines. Dr. Frieden called the lines “highly cost effective.” He noted that tobacco-related disease is the No. 1 cause of preventable death.

Innovative programs in 13 states will be receiving money for 15 projects. Among those: Mississippi will receive $3 million to fund a smoke-free air policy, and Rhode Island will get $3 million to fund a program to help elderly residents age at home. These programs will likely serve as models for other states, Ms. Sebelius said.

Other awards will go to help support healthy food choices and physical activity, Dr. Frieden said.

Details on the awards are available at www.cdc.gov/chronicdisease/recovery

The federal government has granted states and territories $119 million to reduce tobacco use, increase physical activity, and fight obesity, the Health and Human Services department said.

The grants are funded by the American Recovery and Reinvestment Act, also known as the stimulus package.

The money will go to programs aimed at prevention and wellness, HHS Secretary Kathleen Sebelius said at a press briefing.

“Prevention is a 'best buy' for health,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said during the press conference. His agency will help states implement the grants.

The awards were made in three major categories: policy and environmental changes, innovative programs, and tobacco cessation/telephone “quit-lines.”

All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quit-lines. Dr. Frieden called the lines “highly cost effective.” He noted that tobacco-related disease is the No. 1 cause of preventable death.

Innovative programs in 13 states will be receiving money for 15 projects. Among those: Mississippi will receive $3 million to fund a smoke-free air policy, and Rhode Island will get $3 million to fund a program to help elderly residents age at home. These programs will likely serve as models for other states, Ms. Sebelius said.

Other awards will go to help support healthy food choices and physical activity, Dr. Frieden said.

Details on the awards are available at www.cdc.gov/chronicdisease/recovery

WASHINGTON — New federal data show that 12-year-olds abuse inhalants more than marijuana, cocaine, and hallucinogens combined.

From 2006 to 2008, almost 7% of 12-year-olds said they had used an inhalant to get high, according to the National Survey on Drug Use and Health, a survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

In comparison, the lifetime use rate is 5% for prescription drugs and 1.4% for marijuana. Alcohol remains the most abused substance overall among 12-year-olds.

Officials from SAMHSA, the National Institute on Drug Abuse, the National Inhalant Prevention Coalition, and the White House Office of National Drug Control Policy gathered in Washington to discuss the inhalant use data, and to urge parents and physicians to educate children and adolescents about the dangers of “huffing.”

Although federal statistics show a decline over the last decade in the numbers of people first using inhalants, the numbers are still large: 729,000 Americans tried inhalants in 2008, with 489,000 of them in the 12- to-17-year-old age group.

That's down from 821,000 total in 1998, and but up slightly from 455,000 in 1998 in the younger age group. Officials also said they are concerned that from 2007 to 2008, fewer eighth graders perceived inhalant use as harmful, according to the Monitoring the Future Survey conducted for NIDA.

Usually, a decline in risk perception is followed by an uptick in usage, officials said at the briefing.

Inhalant use is largely a phenomenon among whites, but large numbers of Hispanic and African Americans also abuse the chemicals.

The mean age for first-time inhalant use is 16—a year younger than for any other illicit substance, according to SAMHSA.

SAMHSA Administrator Pamela Hyde said inhalant use often precedes a move to other drugs. And, according to Ashley Upchurch, a 17-year-old recovering inhalant addict who spoke at the briefing, inhalants often are used to enhance the high from other drugs or alcohol.

Inhalants are easy to obtain and can often be abused without detection.

The chemicals can be found in household cleaners, paint thinner, fabric protector, magic markers, glue, hairspray, nail polish remover, and dessert topping sprays, among a multitude of other products.

Teens also inhale freon, butane, and nitrites, which are sold under names such as “Rush” or “Locker Room.”

For Ms. Upchurch, the inhalant of choice was a pressurized can used to force dust out of computer keyboards and other electronics.

The chemicals can lead to short-term memory loss, emotional instability, problems with gait and speech, and over the long term, more permanent neurologic and cardiac symptoms.

“As risky as inhalants are, many kids don't see the drugs that way,” said Dr. Timothy Condon, deputy director of NIDA. Dr. Condon said warnings about huffing dangers weren't “hype.” He added, “inhalants can be deadly.”

Dr. Jennifer N. Caudle, director of the family medicine section at Sinai Hospital, Baltimore, said there was a phenomenon called sudden sniffing death, in which the inhaler dies from cardiac arrest.

Dr. Caudle and her colleagues at the American Osteopathic Association are collaborating with the Inhalant Prevention Coalition to publicize the dangers in inhalants.

They are working together to educate physicians about the signs and symptoms of huffing, and about the need to educate adolescents regarding the dangers.

WASHINGTON — New federal data show that 12-year-olds abuse inhalants more than marijuana, cocaine, and hallucinogens combined.

From 2006 to 2008, almost 7% of 12-year-olds said they had used an inhalant to get high, according to the National Survey on Drug Use and Health, a survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

In comparison, the lifetime use rate is 5% for prescription drugs and 1.4% for marijuana. Alcohol remains the most abused substance overall among 12-year-olds.

Officials from SAMHSA, the National Institute on Drug Abuse, the National Inhalant Prevention Coalition, and the White House Office of National Drug Control Policy gathered in Washington to discuss the inhalant use data, and to urge parents and physicians to educate children and adolescents about the dangers of “huffing.”

Although federal statistics show a decline over the last decade in the numbers of people first using inhalants, the numbers are still large: 729,000 Americans tried inhalants in 2008, with 489,000 of them in the 12- to-17-year-old age group.

That's down from 821,000 total in 1998, and but up slightly from 455,000 in 1998 in the younger age group. Officials also said they are concerned that from 2007 to 2008, fewer eighth graders perceived inhalant use as harmful, according to the Monitoring the Future Survey conducted for NIDA.

Usually, a decline in risk perception is followed by an uptick in usage, officials said at the briefing.

Inhalant use is largely a phenomenon among whites, but large numbers of Hispanic and African Americans also abuse the chemicals.

The mean age for first-time inhalant use is 16—a year younger than for any other illicit substance, according to SAMHSA.

SAMHSA Administrator Pamela Hyde said inhalant use often precedes a move to other drugs. And, according to Ashley Upchurch, a 17-year-old recovering inhalant addict who spoke at the briefing, inhalants often are used to enhance the high from other drugs or alcohol.

Inhalants are easy to obtain and can often be abused without detection.

The chemicals can be found in household cleaners, paint thinner, fabric protector, magic markers, glue, hairspray, nail polish remover, and dessert topping sprays, among a multitude of other products.

Teens also inhale freon, butane, and nitrites, which are sold under names such as “Rush” or “Locker Room.”

For Ms. Upchurch, the inhalant of choice was a pressurized can used to force dust out of computer keyboards and other electronics.

The chemicals can lead to short-term memory loss, emotional instability, problems with gait and speech, and over the long term, more permanent neurologic and cardiac symptoms.

“As risky as inhalants are, many kids don't see the drugs that way,” said Dr. Timothy Condon, deputy director of NIDA. Dr. Condon said warnings about huffing dangers weren't “hype.” He added, “inhalants can be deadly.”

Dr. Jennifer N. Caudle, director of the family medicine section at Sinai Hospital, Baltimore, said there was a phenomenon called sudden sniffing death, in which the inhaler dies from cardiac arrest.

Dr. Caudle and her colleagues at the American Osteopathic Association are collaborating with the Inhalant Prevention Coalition to publicize the dangers in inhalants.

They are working together to educate physicians about the signs and symptoms of huffing, and about the need to educate adolescents regarding the dangers.

WASHINGTON — New federal data show that 12-year-olds abuse inhalants more than marijuana, cocaine, and hallucinogens combined.

From 2006 to 2008, almost 7% of 12-year-olds said they had used an inhalant to get high, according to the National Survey on Drug Use and Health, a survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

In comparison, the lifetime use rate is 5% for prescription drugs and 1.4% for marijuana. Alcohol remains the most abused substance overall among 12-year-olds.

Officials from SAMHSA, the National Institute on Drug Abuse, the National Inhalant Prevention Coalition, and the White House Office of National Drug Control Policy gathered in Washington to discuss the inhalant use data, and to urge parents and physicians to educate children and adolescents about the dangers of “huffing.”

Although federal statistics show a decline over the last decade in the numbers of people first using inhalants, the numbers are still large: 729,000 Americans tried inhalants in 2008, with 489,000 of them in the 12- to-17-year-old age group.

That's down from 821,000 total in 1998, and but up slightly from 455,000 in 1998 in the younger age group. Officials also said they are concerned that from 2007 to 2008, fewer eighth graders perceived inhalant use as harmful, according to the Monitoring the Future Survey conducted for NIDA.

Usually, a decline in risk perception is followed by an uptick in usage, officials said at the briefing.

Inhalant use is largely a phenomenon among whites, but large numbers of Hispanic and African Americans also abuse the chemicals.

The mean age for first-time inhalant use is 16—a year younger than for any other illicit substance, according to SAMHSA.

SAMHSA Administrator Pamela Hyde said inhalant use often precedes a move to other drugs. And, according to Ashley Upchurch, a 17-year-old recovering inhalant addict who spoke at the briefing, inhalants often are used to enhance the high from other drugs or alcohol.

Inhalants are easy to obtain and can often be abused without detection.

The chemicals can be found in household cleaners, paint thinner, fabric protector, magic markers, glue, hairspray, nail polish remover, and dessert topping sprays, among a multitude of other products.

Teens also inhale freon, butane, and nitrites, which are sold under names such as “Rush” or “Locker Room.”

For Ms. Upchurch, the inhalant of choice was a pressurized can used to force dust out of computer keyboards and other electronics.

The chemicals can lead to short-term memory loss, emotional instability, problems with gait and speech, and over the long term, more permanent neurologic and cardiac symptoms.

“As risky as inhalants are, many kids don't see the drugs that way,” said Dr. Timothy Condon, deputy director of NIDA. Dr. Condon said warnings about huffing dangers weren't “hype.” He added, “inhalants can be deadly.”

Dr. Jennifer N. Caudle, director of the family medicine section at Sinai Hospital, Baltimore, said there was a phenomenon called sudden sniffing death, in which the inhaler dies from cardiac arrest.

Dr. Caudle and her colleagues at the American Osteopathic Association are collaborating with the Inhalant Prevention Coalition to publicize the dangers in inhalants.

They are working together to educate physicians about the signs and symptoms of huffing, and about the need to educate adolescents regarding the dangers.

President Obama signed legislation on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th.

The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare sustainable growth rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the SGR cuts retroactively.

But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

“If the formula is not repealed, the problem will continue to grow,” he added.

President Obama signed legislation on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th.

The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare sustainable growth rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the SGR cuts retroactively.

But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

“If the formula is not repealed, the problem will continue to grow,” he added.

President Obama signed legislation on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th.

The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare sustainable growth rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the SGR cuts retroactively.

But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said.

“If the formula is not repealed, the problem will continue to grow,” he added.

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine (ABIM).

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, she said in an interview.

Physicians have been eligible to receive bonuses for participating in the Medicare PQRI, but they have criticized it as a redundant, burdensome, and confusing process, and have complained about botched or missing payments.

Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, Dr. Cassel said.

The ABIM and other specialty boards want to help CMS officials write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway [that] would include all the same conditions and measures as PQRI, but be even more comprehensive.”

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, said Dr. Michael Hagen, the ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. They could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus. Last year, all participants were required to report during the full year, and about 720 family physicians participated, Dr. Hagen said in an interview.

Dr. Hagen said he doesn't expect the ABFM process to change soon, but he envisions a future in which physicians can submit data for PQRI, MOC, and meaningful electronic health records in one fell swoop.

As the three programs are currently structured, he added, “nobody wants the same information in the same way, and it's just driving people nuts.”

Document

70402_fx1.sml

The process “would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Christine K. Cassel, shown here at a 2009 Senate hearing.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine (ABIM).

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, she said in an interview.

Physicians have been eligible to receive bonuses for participating in the Medicare PQRI, but they have criticized it as a redundant, burdensome, and confusing process, and have complained about botched or missing payments.

Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, Dr. Cassel said.

The ABIM and other specialty boards want to help CMS officials write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway [that] would include all the same conditions and measures as PQRI, but be even more comprehensive.”

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, said Dr. Michael Hagen, the ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. They could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus. Last year, all participants were required to report during the full year, and about 720 family physicians participated, Dr. Hagen said in an interview.

Dr. Hagen said he doesn't expect the ABFM process to change soon, but he envisions a future in which physicians can submit data for PQRI, MOC, and meaningful electronic health records in one fell swoop.

As the three programs are currently structured, he added, “nobody wants the same information in the same way, and it's just driving people nuts.”

Document

70402_fx1.sml

The process “would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Christine K. Cassel, shown here at a 2009 Senate hearing.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.

The details have yet to be worked out, but physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine (ABIM).

The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, she said in an interview.

Physicians have been eligible to receive bonuses for participating in the Medicare PQRI, but they have criticized it as a redundant, burdensome, and confusing process, and have complained about botched or missing payments.

Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.

In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality.”

Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, Dr. Cassel said.

The ABIM and other specialty boards want to help CMS officials write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway [that] would include all the same conditions and measures as PQRI, but be even more comprehensive.”

Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, said Dr. Michael Hagen, the ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.

In 2008 (the first year of the registry), 260 family physicians participated. They could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus. Last year, all participants were required to report during the full year, and about 720 family physicians participated, Dr. Hagen said in an interview.

Dr. Hagen said he doesn't expect the ABFM process to change soon, but he envisions a future in which physicians can submit data for PQRI, MOC, and meaningful electronic health records in one fell swoop.

As the three programs are currently structured, he added, “nobody wants the same information in the same way, and it's just driving people nuts.”

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The process “would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Christine K. Cassel, shown here at a 2009 Senate hearing.

This Month's Talk Back Question

How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?

After more than a year of debate on the merits of health care reform, policymakers and physicians are switching gears, assessing the impact of the new law and considering how to improve it.

For dermatology, the law presents both positives and negatives. The expansion of coverage--through additions to the Medicaid rolls and children being allowed to stay on parents' policies until age 26, for instance--means that more people will have access to care. That jibes with core principles advocated by the American Academy of Dermatology throughout the health reform debate, said Dr. William James, AAD president.

A strong focus on prevention and wellness is also positive, especially the new 10% tax on tanning salon owners.

"This is certainly a victory for dermatology," Dr. James told Skin & Allergy News.

The hope is that the tax will draw attention to the evidence that tanning promotes skin cancer. Perhaps it also will lead to higher costs for tanning, and thus, to discouraging individuals, especially teenagers, from indoor tanning, he said.

There are some concerns about the health reform law, however. For instance, many areas currently are experiencing a shortage of dermatologists to provide care. More patients in the system could lengthen wait times for appointments even further, Dr. James said.

The AAD, like most other physician organizations, also has concerns about the Independent Payment Advisory Board (IPAB), which in its first few years, has been charged with determining ways to reduce physician costs. Hospitals and other providers and pharmaceutical and medical device makers are exempt from IPAB scrutiny until 2018.

Both the IPAB and the lack of a permanent fix to the Sustainable Growth Rate formula "are concerning because physicians really need a secure payment system," said Dr. James. He noted that physicians are being asked to make new investments in information technology and hire new employees to ensure that the newly insured can get access to care.

"At the same time, they're undermining our ability to do so by having a very unstable payment system," he said.

Going forward, the AAD "hopes to remain a positive influence in the regulatory framework that's going to come out of this," he said. "How these laws are going to be interpreted and how they're going to be implemented is the next big question."

Indeed, the details of the law are far from clear. The reform package was accomplished in several steps.

President Obama signed most of the health reform provisions into law March 23. Later in the week Congress passed a smaller bill--known as the reconciliation bill--that included corrections to the original package, including additional subsidies for purchasing insurance, and removed some of the more controversial political deals from the law. The President signed that companion legislation March 30.

The new law clears the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years. The law creates health insurance exchanges where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions.

The reconciliation bill removes some of the controversial elements of the Senate-passed bill. For example, it strips out the so-called "Cornhusker kickback,"a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.

The reconciliation bill also includes increased federal subsidies for Americans who can't afford to buy health insurance, and it also lowers financial penalties for individuals who choose not to purchase insurance.

Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians, up to the level of Medicare payments in 2013 and 2014. It also increases funding for community health centers.
The law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals.

Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologicals, and devices must report any payments or transfers of value they make to physicians and hospitals, unless it is under $100 a year, starting in 2013. Manufacturers will also have to report physician ownership stakes. The Health and Human Services department will be required to make this information available to the public.

Finally, starting in 2012, manufacturers will also have to report to HHS all the drug samples they give to physicians, if the drugs are covered by Medicare or Medicaid.

The law also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs paid for while the patient is in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.

 

On the insurance side, the federal government will require health plans within 6 months to provide coverage for nondependent children up to age 26 years. The law also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans will be barred from pre-existing conditions exclusions 6 months after enactment.

During the course of final debate, no Republican member of Congress voted in favor of passing the bills. Republicans railed against the package as bloated and unaffordable at the Congressional Budget Office estimated price tag of $940 billion over 10 years, despite CBO assurance that the legislation also would reduce the deficit by $143 billion over the same period.

Republican opponents also said the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.

After more than a year of debate on the merits of health care reform, policymakers and physicians are switching gears, assessing the impact of the new law and considering how to improve it.

For dermatology, the law presents both positives and negatives. The expansion of coverage--through additions to the Medicaid rolls and children being allowed to stay on parents' policies until age 26, for instance--means that more people will have access to care. That jibes with core principles advocated by the American Academy of Dermatology throughout the health reform debate, said Dr. William James, AAD president.

A strong focus on prevention and wellness is also positive, especially the new 10% tax on tanning salon owners.

"This is certainly a victory for dermatology," Dr. James told Skin & Allergy News.

The hope is that the tax will draw attention to the evidence that tanning promotes skin cancer. Perhaps it also will lead to higher costs for tanning, and thus, to discouraging individuals, especially teenagers, from indoor tanning, he said.

There are some concerns about the health reform law, however. For instance, many areas currently are experiencing a shortage of dermatologists to provide care. More patients in the system could lengthen wait times for appointments even further, Dr. James said.

The AAD, like most other physician organizations, also has concerns about the Independent Payment Advisory Board (IPAB), which in its first few years, has been charged with determining ways to reduce physician costs. Hospitals and other providers and pharmaceutical and medical device makers are exempt from IPAB scrutiny until 2018.

Both the IPAB and the lack of a permanent fix to the Sustainable Growth Rate formula "are concerning because physicians really need a secure payment system," said Dr. James. He noted that physicians are being asked to make new investments in information technology and hire new employees to ensure that the newly insured can get access to care.

"At the same time, they're undermining our ability to do so by having a very unstable payment system," he said.

Going forward, the AAD "hopes to remain a positive influence in the regulatory framework that's going to come out of this," he said. "How these laws are going to be interpreted and how they're going to be implemented is the next big question."

Indeed, the details of the law are far from clear. The reform package was accomplished in several steps.

President Obama signed most of the health reform provisions into law March 23. Later in the week Congress passed a smaller bill--known as the reconciliation bill--that included corrections to the original package, including additional subsidies for purchasing insurance, and removed some of the more controversial political deals from the law. The President signed that companion legislation March 30.

The new law clears the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years. The law creates health insurance exchanges where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions.

The reconciliation bill removes some of the controversial elements of the Senate-passed bill. For example, it strips out the so-called "Cornhusker kickback,"a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.

The reconciliation bill also includes increased federal subsidies for Americans who can't afford to buy health insurance, and it also lowers financial penalties for individuals who choose not to purchase insurance.

Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians, up to the level of Medicare payments in 2013 and 2014. It also increases funding for community health centers.
The law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals.

Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologicals, and devices must report any payments or transfers of value they make to physicians and hospitals, unless it is under $100 a year, starting in 2013. Manufacturers will also have to report physician ownership stakes. The Health and Human Services department will be required to make this information available to the public.

Finally, starting in 2012, manufacturers will also have to report to HHS all the drug samples they give to physicians, if the drugs are covered by Medicare or Medicaid.

The law also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs paid for while the patient is in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.

 

On the insurance side, the federal government will require health plans within 6 months to provide coverage for nondependent children up to age 26 years. The law also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans will be barred from pre-existing conditions exclusions 6 months after enactment.

During the course of final debate, no Republican member of Congress voted in favor of passing the bills. Republicans railed against the package as bloated and unaffordable at the Congressional Budget Office estimated price tag of $940 billion over 10 years, despite CBO assurance that the legislation also would reduce the deficit by $143 billion over the same period.

Republican opponents also said the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.

After more than a year of debate on the merits of health care reform, policymakers and physicians are switching gears, assessing the impact of the new law and considering how to improve it.

For dermatology, the law presents both positives and negatives. The expansion of coverage--through additions to the Medicaid rolls and children being allowed to stay on parents' policies until age 26, for instance--means that more people will have access to care. That jibes with core principles advocated by the American Academy of Dermatology throughout the health reform debate, said Dr. William James, AAD president.

A strong focus on prevention and wellness is also positive, especially the new 10% tax on tanning salon owners.

"This is certainly a victory for dermatology," Dr. James told Skin & Allergy News.

The hope is that the tax will draw attention to the evidence that tanning promotes skin cancer. Perhaps it also will lead to higher costs for tanning, and thus, to discouraging individuals, especially teenagers, from indoor tanning, he said.

There are some concerns about the health reform law, however. For instance, many areas currently are experiencing a shortage of dermatologists to provide care. More patients in the system could lengthen wait times for appointments even further, Dr. James said.

The AAD, like most other physician organizations, also has concerns about the Independent Payment Advisory Board (IPAB), which in its first few years, has been charged with determining ways to reduce physician costs. Hospitals and other providers and pharmaceutical and medical device makers are exempt from IPAB scrutiny until 2018.

Both the IPAB and the lack of a permanent fix to the Sustainable Growth Rate formula "are concerning because physicians really need a secure payment system," said Dr. James. He noted that physicians are being asked to make new investments in information technology and hire new employees to ensure that the newly insured can get access to care.

"At the same time, they're undermining our ability to do so by having a very unstable payment system," he said.

Going forward, the AAD "hopes to remain a positive influence in the regulatory framework that's going to come out of this," he said. "How these laws are going to be interpreted and how they're going to be implemented is the next big question."

Indeed, the details of the law are far from clear. The reform package was accomplished in several steps.

President Obama signed most of the health reform provisions into law March 23. Later in the week Congress passed a smaller bill--known as the reconciliation bill--that included corrections to the original package, including additional subsidies for purchasing insurance, and removed some of the more controversial political deals from the law. The President signed that companion legislation March 30.

The new law clears the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years. The law creates health insurance exchanges where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions.

The reconciliation bill removes some of the controversial elements of the Senate-passed bill. For example, it strips out the so-called "Cornhusker kickback,"a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.

The reconciliation bill also includes increased federal subsidies for Americans who can't afford to buy health insurance, and it also lowers financial penalties for individuals who choose not to purchase insurance.

Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians, up to the level of Medicare payments in 2013 and 2014. It also increases funding for community health centers.
The law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals.

Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologicals, and devices must report any payments or transfers of value they make to physicians and hospitals, unless it is under $100 a year, starting in 2013. Manufacturers will also have to report physician ownership stakes. The Health and Human Services department will be required to make this information available to the public.

Finally, starting in 2012, manufacturers will also have to report to HHS all the drug samples they give to physicians, if the drugs are covered by Medicare or Medicaid.

The law also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs paid for while the patient is in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.

 

On the insurance side, the federal government will require health plans within 6 months to provide coverage for nondependent children up to age 26 years. The law also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans will be barred from pre-existing conditions exclusions 6 months after enactment.

During the course of final debate, no Republican member of Congress voted in favor of passing the bills. Republicans railed against the package as bloated and unaffordable at the Congressional Budget Office estimated price tag of $940 billion over 10 years, despite CBO assurance that the legislation also would reduce the deficit by $143 billion over the same period.

Republican opponents also said the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.

The White House announced on April 19 that it has nominated Dr. Donald 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."

Physicians' organizations began to express their enthusiasm for Dr. Berwick's nomination even before it was made official.

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 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.

The White House announced on April 19 that it has nominated Dr. Donald 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."

Physicians' organizations began to express their enthusiasm for Dr. Berwick's nomination even before it was made official.

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 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.

The White House announced on April 19 that it has nominated Dr. Donald 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."

Physicians' organizations began to express their enthusiasm for Dr. Berwick's nomination even before it was made official.

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 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.