Alicia Ault

Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.

The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.

In 2009, there was a "disturbing drop in commercially insured immunization rates," most likely resulting from the "suburban legend" that vaccinations are linked to autism, said NCQA President Margaret E. O'Kane during a briefing Oct. 13.

Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.

"The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation," said Ms. O'Kane.

Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O'Kane.

In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.

Those rates have been somewhat steady since 2007, but Ms. O'Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.

The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.

The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.

Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O'Kane said.

The full report can be found at www.ncqa.org.

Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.

The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.

In 2009, there was a "disturbing drop in commercially insured immunization rates," most likely resulting from the "suburban legend" that vaccinations are linked to autism, said NCQA President Margaret E. O'Kane during a briefing Oct. 13.

Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.

"The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation," said Ms. O'Kane.

Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O'Kane.

In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.

Those rates have been somewhat steady since 2007, but Ms. O'Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.

The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.

The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.

Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O'Kane said.

The full report can be found at www.ncqa.org.

Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.

The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.

In 2009, there was a "disturbing drop in commercially insured immunization rates," most likely resulting from the "suburban legend" that vaccinations are linked to autism, said NCQA President Margaret E. O'Kane during a briefing Oct. 13.

Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.

"The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation," said Ms. O'Kane.

Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O'Kane.

In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.

Those rates have been somewhat steady since 2007, but Ms. O'Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.

The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.

The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.

Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O'Kane said.

The full report can be found at www.ncqa.org.

Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.

The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.

In 2009, there was a “disturbing drop in commercially insured immunization rates,” most likely resulting from the “suburban legend” that vaccinations are linked to autism, said NCQA President Margaret E. O’Kane during a briefing Oct. 13.

Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.

“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said Ms. O’Kane.

Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O’Kane.

In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.

Those rates have been somewhat steady since 2007, but Ms. O’Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.

The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.

The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.

Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O’Kane said.

Areas for improvement included preventing falls and reducing inappropriate use of imaging for lower back pain, she said.

Physicians can have a huge impact on fall prevention, she said, noting, however, that the report found only about a third of Medicare patients discussed falls or gait problems with their physicians in the last year. That number has been unchanged the last several years. Evidence-based guidelines suggest that older people should be asked about falls once a year and should receive an assessment or advice on how to avoid falls.

“We’re not taking this seriously enough,” Ms. O’Kane said.

The full report can be found at www.ncqa.org.

Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.

The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.

In 2009, there was a “disturbing drop in commercially insured immunization rates,” most likely resulting from the “suburban legend” that vaccinations are linked to autism, said NCQA President Margaret E. O’Kane during a briefing Oct. 13.

Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.

“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said Ms. O’Kane.

Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O’Kane.

In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.

Those rates have been somewhat steady since 2007, but Ms. O’Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.

The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.

The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.

Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O’Kane said.

Areas for improvement included preventing falls and reducing inappropriate use of imaging for lower back pain, she said.

Physicians can have a huge impact on fall prevention, she said, noting, however, that the report found only about a third of Medicare patients discussed falls or gait problems with their physicians in the last year. That number has been unchanged the last several years. Evidence-based guidelines suggest that older people should be asked about falls once a year and should receive an assessment or advice on how to avoid falls.

“We’re not taking this seriously enough,” Ms. O’Kane said.

The full report can be found at www.ncqa.org.

Immunization rates for infants and toddlers in commercial health plans declined in 2009, as did patient satisfaction with health plan performance, while other quality measures rose markedly, according to a yearly accounting compiled by the National Committee for Quality Assurance.

The data for the NCQA State of Health Care Quality Report came from 1,000 HMOs and PPOs providing coverage for about 118 million U.S. residents insured by Medicare, Medicaid, or a private health plan. This is the 14th year that NCQA has compiled and analyzed data from its Healthcare Effectiveness Data and Information Set (HEDIS), which managed health plans use to measure their own performance.

In 2009, there was a “disturbing drop in commercially insured immunization rates,” most likely resulting from the “suburban legend” that vaccinations are linked to autism, said NCQA President Margaret E. O’Kane during a briefing Oct. 13.

Under Medicaid plans, childhood immunization rates improved by 1% from 2008 to 2009 to about 70% coverage; however, coverage in private plans declined 4% to about 72% coverage.

“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said Ms. O’Kane.

Patient satisfaction with private plans declined slightly, and was low compared with that of the public plans, according to Ms. O’Kane.

In 2009, about 60% of beneficiaries gave Medicare high marks, compared with 51% of Medicaid recipients and 39% of private health plan patients, according to data gleaned from the federally funded Consumer Assessment of Healthcare Providers and Systems survey.

Those rates have been somewhat steady since 2007, but Ms. O’Kane said she thought that attacks on health insurers during the health reform debates may have led to greater negative impressions of the private plans.

The report also covered a number of medical care measures. For example, beta-blocker use after myocardial infarction rose across all types of insurers, with 82% of those in Medicare plans receiving the treatment, compared with 76% of those on Medicaid and 74% of commercial patients. Colon cancer screening also rose, as did screening for chlamydia, with Medicaid plans screening 57% of patients for that sexually transmitted disease, compared with 43% of commercial plans.

The report tallied the lives and dollars saved from improvements on the five most costly conditions. By improving beta-blocker treatment, cholesterol management, blood pressure control, hemoglobin A1c management, approximately 272,000 to 1.7 million lives were saved, according to the report.

Adding in measures such as breast cancer screening, smoking cessation, and osteoporosis management led to some $2.4 billion to $6.5 billion in hospital savings, Ms. O’Kane said.

Areas for improvement included preventing falls and reducing inappropriate use of imaging for lower back pain, she said.

Physicians can have a huge impact on fall prevention, she said, noting, however, that the report found only about a third of Medicare patients discussed falls or gait problems with their physicians in the last year. That number has been unchanged the last several years. Evidence-based guidelines suggest that older people should be asked about falls once a year and should receive an assessment or advice on how to avoid falls.

“We’re not taking this seriously enough,” Ms. O’Kane said.

The full report can be found at www.ncqa.org.

WASHINGTON — More than a quarter (28%) of all U.S. acute care visits are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said at the briefing.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, according to the study, which appears in the journal's September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Those presenting to a primary care physician for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Disclosures: One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

WASHINGTON — More than a quarter (28%) of all U.S. acute care visits are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said at the briefing.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, according to the study, which appears in the journal's September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Those presenting to a primary care physician for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Disclosures: One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

WASHINGTON — More than a quarter (28%) of all U.S. acute care visits are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said at the briefing.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, according to the study, which appears in the journal's September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Those presenting to a primary care physician for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Disclosures: One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including, “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or nurse practitioner can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services.

There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it though the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes aren't being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. About 15 years ago, she was part of a group that attempted to get a bill passed to mandate the teaching of palliative care in medical schools, but it did not get anywhere.

She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The law will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

But it still will not make it easier for physicians who do not have experience in palliative care, Dr. Edwards said. “It's a very hard discussion to have; it's not something doctors are trained to do.”

A recent study in non–small cell lung cancer patients found that those who were given palliative care at the time of diagnosis had a better quality of life than did those in standard care (N. Engl. J. Med. 2010;363:733-42). This study may do more to advance the field than does the New York law, Dr. Edwards noted.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

Mandating that information be given on palliative care “may undermine the patient's belief and conviction in prevailing against their disease and undercut the confidence in their treating physician,” said Ms. Dears.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including, “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or nurse practitioner can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services.

There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it though the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes aren't being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. About 15 years ago, she was part of a group that attempted to get a bill passed to mandate the teaching of palliative care in medical schools, but it did not get anywhere.

She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The law will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

But it still will not make it easier for physicians who do not have experience in palliative care, Dr. Edwards said. “It's a very hard discussion to have; it's not something doctors are trained to do.”

A recent study in non–small cell lung cancer patients found that those who were given palliative care at the time of diagnosis had a better quality of life than did those in standard care (N. Engl. J. Med. 2010;363:733-42). This study may do more to advance the field than does the New York law, Dr. Edwards noted.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

Mandating that information be given on palliative care “may undermine the patient's belief and conviction in prevailing against their disease and undercut the confidence in their treating physician,” said Ms. Dears.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including, “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or nurse practitioner can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services.

There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it though the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes aren't being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. About 15 years ago, she was part of a group that attempted to get a bill passed to mandate the teaching of palliative care in medical schools, but it did not get anywhere.

She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The law will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

But it still will not make it easier for physicians who do not have experience in palliative care, Dr. Edwards said. “It's a very hard discussion to have; it's not something doctors are trained to do.”

A recent study in non–small cell lung cancer patients found that those who were given palliative care at the time of diagnosis had a better quality of life than did those in standard care (N. Engl. J. Med. 2010;363:733-42). This study may do more to advance the field than does the New York law, Dr. Edwards noted.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

Mandating that information be given on palliative care “may undermine the patient's belief and conviction in prevailing against their disease and undercut the confidence in their treating physician,” said Ms. Dears.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty, according to an article published online in the New England Journal of Medicine.

The 16-member ACGME task force that wrote the standards will review public comments and make modifications before July 2011, when the new standards will go into effect. The original 2003 standards have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a “shift mentality” among residents.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME task force considered ways to reconcile the IOM's suggestion for an across-the-board restriction on duty hours vs. the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]). For surgery, in particular, it would be difficult — and contrary to learning — to have a resident leave in the midst of a procedure because his or her duty hours had been reached. The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm, whereby first-year residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision. All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs — an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty,” said the authors.

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The ACGME is now undertaking annual site visits and analyzing whether institutions can comply. Eventually, the organization will give each institution a report on its compliance status and recommendations for resolving problems. The reports will be made available to the public, said the authors.

Wake Up Doctor, a coalition of public interest and patient safety groups, gave the ACGME “Fs” for failing to comply with the IOM recommendation that continuous duty be restricted to 16 hours for all residents and for failing to better monitor compliance with the standards. However, the recommendation for greater supervision of first-year residents got higher marks.

“I think the acid test will be in the details,” said Helen Haskell, founder of Mothers Against Medical Error and a coalition member, in a statement.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty, according to an article published online in the New England Journal of Medicine.

The 16-member ACGME task force that wrote the standards will review public comments and make modifications before July 2011, when the new standards will go into effect. The original 2003 standards have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a “shift mentality” among residents.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME task force considered ways to reconcile the IOM's suggestion for an across-the-board restriction on duty hours vs. the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]). For surgery, in particular, it would be difficult — and contrary to learning — to have a resident leave in the midst of a procedure because his or her duty hours had been reached. The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm, whereby first-year residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision. All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs — an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty,” said the authors.

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The ACGME is now undertaking annual site visits and analyzing whether institutions can comply. Eventually, the organization will give each institution a report on its compliance status and recommendations for resolving problems. The reports will be made available to the public, said the authors.

Wake Up Doctor, a coalition of public interest and patient safety groups, gave the ACGME “Fs” for failing to comply with the IOM recommendation that continuous duty be restricted to 16 hours for all residents and for failing to better monitor compliance with the standards. However, the recommendation for greater supervision of first-year residents got higher marks.

“I think the acid test will be in the details,” said Helen Haskell, founder of Mothers Against Medical Error and a coalition member, in a statement.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty, according to an article published online in the New England Journal of Medicine.

The 16-member ACGME task force that wrote the standards will review public comments and make modifications before July 2011, when the new standards will go into effect. The original 2003 standards have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a “shift mentality” among residents.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME task force considered ways to reconcile the IOM's suggestion for an across-the-board restriction on duty hours vs. the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]). For surgery, in particular, it would be difficult — and contrary to learning — to have a resident leave in the midst of a procedure because his or her duty hours had been reached. The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm, whereby first-year residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision. All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs — an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty,” said the authors.

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The ACGME is now undertaking annual site visits and analyzing whether institutions can comply. Eventually, the organization will give each institution a report on its compliance status and recommendations for resolving problems. The reports will be made available to the public, said the authors.

Wake Up Doctor, a coalition of public interest and patient safety groups, gave the ACGME “Fs” for failing to comply with the IOM recommendation that continuous duty be restricted to 16 hours for all residents and for failing to better monitor compliance with the standards. However, the recommendation for greater supervision of first-year residents got higher marks.

“I think the acid test will be in the details,” said Helen Haskell, founder of Mothers Against Medical Error and a coalition member, in a statement.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the Centers for Medicare and Medicaid Services. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Now, any smoker covered by Medicare can have up to eight smoking cessation sessions per year from a physician or another Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil Wilson applauded the coverage expansion. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives,” he said in a statement.

Court Will Not Block Generic Lovenox

A U.S. District Court judge has refused to grant a motion for preliminary injunction against a generic version of Lovenox (enoxaparin sodium injection) that was filed by Lovenox maker Sanofi Aventis. In July, the Food and Drug Administration approved a generic version made by Sandoz Inc. Sanofi immediately sued the FDA and also sought an injunction to withdraw the approval. The Lovenox maker has not said yet whether it will appeal the judge's decision, but according to the Wall Street Journal, two other companies, Amphastar Pharmaceuticals Inc. and Teva Pharmaceutical Industries, have also applied for approval to market a generic version of Lovenox.

CMS Okays Pritikin, Ornish

The Centers for Medicare and Medicaid Services has said that it will now pay for Medicare enrollees who participate in the Ornish Program for Reversing Heart Disease and the Pritikin Program (also known as the Pritikin Longevity Program). Cardiac rehabilitation has been a covered benefit since 1982, but a new Part B benefit was more recently established for Intensive Cardiac Rehabilitation. The Pritikin and Ornish programs fall within that new benefit.

Consumers Wary of Drug Influence

Almost 70% of Americans who take prescription drugs believe that drug makers have too much influence over doctors when it comes to those prescriptions, and 50% believe that doctors prescribe drugs even when a person's condition could be managed without medication. The data are the result of a Consumer Reports magazine poll. On the basis of the survey of more than 1,150 adults, the magazine asserted that 51% of Americans don't think their doctors consider patients' ability to pay for prescribed drugs, 47% think gifts from pharmaceutical companies influence doctors' drug choices, 41% think their doctors tend to prescribe newer and more expensive drugs, and 20% have asked for a drug they've seen advertised. In those cases, 59% of the respondents said their doctors prescribed what they requested.

First EHR Certifying Bodies Named

A nonprofit organization dedicated to health information technology and a software-testing lab have been chosen as the first two bodies to officially test and certify electronic health record (EHR) systems for the federal government. The Certification Commission for Health Information Technology and the Drummond Group can immediately begin certifying EHR systems as HHS-compliant, the Department of Health and Human Services said in an announcement. Now that HHS has named the certifying organizations, vendors can start applying for certification of their EHR systems and physicians soon should be able to purchase certified products, the HHS said.

Outcomes Research Funded

HHS will provide grants totaling nearly $17 million for “patient-centered outcomes research” (PCOR), which focuses on treatments and strategies that might improve health outcomes from the patient's point of view. Most of the announced grants will support outcomes research in primary care, HHS said. As part of the grant program, five health organizations will attempt to show that providers and academic institutions can partner on PCOR. Each organization – in Illinois, California, New York, Massachusetts, and Oregon – will receive about $2 million over 3 years to create a national network for evaluating the patient-centered approach in patient populations that are not always adequately represented in other studies, according to HHS.

AMA Opposes Tax Change

The American Medical Association and 90 medical organizations, including the American Academy of Family Physicians and the American College of Physicians, have written to the Department of the Treasury urging it not to allow trial lawyers to deduct court costs and other expenses. Making such a change to tax law could encourage trial lawyers to file more claims, the organizations claimed. “Even though a substantial majority of claims are dropped or decided in favor of physicians, the cost of defending against meritless claims averages over $22,000,” their letter said. The organizations urged the treasury department to reconsider rumored plans to change current policy, which does not allow such tax deductions.

Prescription Drug Use Rises Again The percentage of Americans who

The percentage of Americans who said they took at least one prescription drug in the past month increased from 44% to 48% from 1999 to 2008, according to a report from the Centers for Disease Control and Prevention. At the same time, the number of people who said they had taken two or more drugs in previous month increased from 25% to 31%, and the number of people who took five or more drugs increased from 6% to 11%, the report found. One out of every five children used one or more prescription drugs, as did 90% of adults aged 60 or older. The data came from the National Health and Nutrition Examination Survey.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the Centers for Medicare and Medicaid Services. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Now, any smoker covered by Medicare can have up to eight smoking cessation sessions per year from a physician or another Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil Wilson applauded the coverage expansion. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives,” he said in a statement.

Court Will Not Block Generic Lovenox

A U.S. District Court judge has refused to grant a motion for preliminary injunction against a generic version of Lovenox (enoxaparin sodium injection) that was filed by Lovenox maker Sanofi Aventis. In July, the Food and Drug Administration approved a generic version made by Sandoz Inc. Sanofi immediately sued the FDA and also sought an injunction to withdraw the approval. The Lovenox maker has not said yet whether it will appeal the judge's decision, but according to the Wall Street Journal, two other companies, Amphastar Pharmaceuticals Inc. and Teva Pharmaceutical Industries, have also applied for approval to market a generic version of Lovenox.

CMS Okays Pritikin, Ornish

The Centers for Medicare and Medicaid Services has said that it will now pay for Medicare enrollees who participate in the Ornish Program for Reversing Heart Disease and the Pritikin Program (also known as the Pritikin Longevity Program). Cardiac rehabilitation has been a covered benefit since 1982, but a new Part B benefit was more recently established for Intensive Cardiac Rehabilitation. The Pritikin and Ornish programs fall within that new benefit.

Consumers Wary of Drug Influence

Almost 70% of Americans who take prescription drugs believe that drug makers have too much influence over doctors when it comes to those prescriptions, and 50% believe that doctors prescribe drugs even when a person's condition could be managed without medication. The data are the result of a Consumer Reports magazine poll. On the basis of the survey of more than 1,150 adults, the magazine asserted that 51% of Americans don't think their doctors consider patients' ability to pay for prescribed drugs, 47% think gifts from pharmaceutical companies influence doctors' drug choices, 41% think their doctors tend to prescribe newer and more expensive drugs, and 20% have asked for a drug they've seen advertised. In those cases, 59% of the respondents said their doctors prescribed what they requested.

First EHR Certifying Bodies Named

A nonprofit organization dedicated to health information technology and a software-testing lab have been chosen as the first two bodies to officially test and certify electronic health record (EHR) systems for the federal government. The Certification Commission for Health Information Technology and the Drummond Group can immediately begin certifying EHR systems as HHS-compliant, the Department of Health and Human Services said in an announcement. Now that HHS has named the certifying organizations, vendors can start applying for certification of their EHR systems and physicians soon should be able to purchase certified products, the HHS said.

Outcomes Research Funded

HHS will provide grants totaling nearly $17 million for “patient-centered outcomes research” (PCOR), which focuses on treatments and strategies that might improve health outcomes from the patient's point of view. Most of the announced grants will support outcomes research in primary care, HHS said. As part of the grant program, five health organizations will attempt to show that providers and academic institutions can partner on PCOR. Each organization – in Illinois, California, New York, Massachusetts, and Oregon – will receive about $2 million over 3 years to create a national network for evaluating the patient-centered approach in patient populations that are not always adequately represented in other studies, according to HHS.

AMA Opposes Tax Change

The American Medical Association and 90 medical organizations, including the American Academy of Family Physicians and the American College of Physicians, have written to the Department of the Treasury urging it not to allow trial lawyers to deduct court costs and other expenses. Making such a change to tax law could encourage trial lawyers to file more claims, the organizations claimed. “Even though a substantial majority of claims are dropped or decided in favor of physicians, the cost of defending against meritless claims averages over $22,000,” their letter said. The organizations urged the treasury department to reconsider rumored plans to change current policy, which does not allow such tax deductions.

Prescription Drug Use Rises Again The percentage of Americans who

The percentage of Americans who said they took at least one prescription drug in the past month increased from 44% to 48% from 1999 to 2008, according to a report from the Centers for Disease Control and Prevention. At the same time, the number of people who said they had taken two or more drugs in previous month increased from 25% to 31%, and the number of people who took five or more drugs increased from 6% to 11%, the report found. One out of every five children used one or more prescription drugs, as did 90% of adults aged 60 or older. The data came from the National Health and Nutrition Examination Survey.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the Centers for Medicare and Medicaid Services. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Now, any smoker covered by Medicare can have up to eight smoking cessation sessions per year from a physician or another Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil Wilson applauded the coverage expansion. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives,” he said in a statement.

Court Will Not Block Generic Lovenox

A U.S. District Court judge has refused to grant a motion for preliminary injunction against a generic version of Lovenox (enoxaparin sodium injection) that was filed by Lovenox maker Sanofi Aventis. In July, the Food and Drug Administration approved a generic version made by Sandoz Inc. Sanofi immediately sued the FDA and also sought an injunction to withdraw the approval. The Lovenox maker has not said yet whether it will appeal the judge's decision, but according to the Wall Street Journal, two other companies, Amphastar Pharmaceuticals Inc. and Teva Pharmaceutical Industries, have also applied for approval to market a generic version of Lovenox.

CMS Okays Pritikin, Ornish

The Centers for Medicare and Medicaid Services has said that it will now pay for Medicare enrollees who participate in the Ornish Program for Reversing Heart Disease and the Pritikin Program (also known as the Pritikin Longevity Program). Cardiac rehabilitation has been a covered benefit since 1982, but a new Part B benefit was more recently established for Intensive Cardiac Rehabilitation. The Pritikin and Ornish programs fall within that new benefit.

Consumers Wary of Drug Influence

Almost 70% of Americans who take prescription drugs believe that drug makers have too much influence over doctors when it comes to those prescriptions, and 50% believe that doctors prescribe drugs even when a person's condition could be managed without medication. The data are the result of a Consumer Reports magazine poll. On the basis of the survey of more than 1,150 adults, the magazine asserted that 51% of Americans don't think their doctors consider patients' ability to pay for prescribed drugs, 47% think gifts from pharmaceutical companies influence doctors' drug choices, 41% think their doctors tend to prescribe newer and more expensive drugs, and 20% have asked for a drug they've seen advertised. In those cases, 59% of the respondents said their doctors prescribed what they requested.

First EHR Certifying Bodies Named

A nonprofit organization dedicated to health information technology and a software-testing lab have been chosen as the first two bodies to officially test and certify electronic health record (EHR) systems for the federal government. The Certification Commission for Health Information Technology and the Drummond Group can immediately begin certifying EHR systems as HHS-compliant, the Department of Health and Human Services said in an announcement. Now that HHS has named the certifying organizations, vendors can start applying for certification of their EHR systems and physicians soon should be able to purchase certified products, the HHS said.

Outcomes Research Funded

HHS will provide grants totaling nearly $17 million for “patient-centered outcomes research” (PCOR), which focuses on treatments and strategies that might improve health outcomes from the patient's point of view. Most of the announced grants will support outcomes research in primary care, HHS said. As part of the grant program, five health organizations will attempt to show that providers and academic institutions can partner on PCOR. Each organization – in Illinois, California, New York, Massachusetts, and Oregon – will receive about $2 million over 3 years to create a national network for evaluating the patient-centered approach in patient populations that are not always adequately represented in other studies, according to HHS.

AMA Opposes Tax Change

The American Medical Association and 90 medical organizations, including the American Academy of Family Physicians and the American College of Physicians, have written to the Department of the Treasury urging it not to allow trial lawyers to deduct court costs and other expenses. Making such a change to tax law could encourage trial lawyers to file more claims, the organizations claimed. “Even though a substantial majority of claims are dropped or decided in favor of physicians, the cost of defending against meritless claims averages over $22,000,” their letter said. The organizations urged the treasury department to reconsider rumored plans to change current policy, which does not allow such tax deductions.

Prescription Drug Use Rises Again The percentage of Americans who

The percentage of Americans who said they took at least one prescription drug in the past month increased from 44% to 48% from 1999 to 2008, according to a report from the Centers for Disease Control and Prevention. At the same time, the number of people who said they had taken two or more drugs in previous month increased from 25% to 31%, and the number of people who took five or more drugs increased from 6% to 11%, the report found. One out of every five children used one or more prescription drugs, as did 90% of adults aged 60 or older. The data came from the National Health and Nutrition Examination Survey.

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or NP can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services. There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it though the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes are not being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The wal will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

Offer the care sooner, and to more patients, says Dr. Bradley Flansbaum.

Source Courtesy Lenox Hill Hospital

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or NP can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services. There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it though the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes are not being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The wal will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

Offer the care sooner, and to more patients, says Dr. Bradley Flansbaum.

Source Courtesy Lenox Hill Hospital

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or NP can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services. There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it though the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes are not being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The wal will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

Offer the care sooner, and to more patients, says Dr. Bradley Flansbaum.

Source Courtesy Lenox Hill Hospital

WASHINGTON — More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices, according to a study released Sept. 7.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said at the briefing.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, Dr. Pitts and his colleagues found.

Uninsured patients received more than half their acute care in EDs, according to the study, which appears in the journal's September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints such as stomach and abdominal pain, chest pain, and fever, dominated the list of what brought patients to the ED. Conversely, patients who presented to the primary care physician's office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Seventy-five percent of patients with acute respiratory problems received care in a primary care practice or hospital outpatient department, the authors found.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Previous studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O'Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

In a separate study, Dr. Ateev Mehrotra and his colleagues reported that 14%-27% of ED visits could have been handled at either a retail clinic or an urgent care center. Switching to these alternate sites could save the system $4.4 billion a year, said Dr. Mehrotra of the University of Pittsburgh and a policy analyst at Rand.

The authors determined that most visits for nine common conditions treated at EDs could be switched easily to those alternate sites. Those conditions include upper-respiratory infections; musculoskeletal conditions such as strains, fractures, and back pain; dermatologic conditions; abdominal pain, headache, and other symptoms without a specific diagnosis; urinary tract infections, some chronic illnesses, and psychiatric conditions; lower-respiratory conditions; such minor problems as insect bites and conjunctivitis; and preventive care.

Disclosures: Dr. Mehrotra and his coauthors received funding from the California HealthCare Foundation for their study. One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

WASHINGTON — More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices, according to a study released Sept. 7.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said at the briefing.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, Dr. Pitts and his colleagues found.

Uninsured patients received more than half their acute care in EDs, according to the study, which appears in the journal's September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints such as stomach and abdominal pain, chest pain, and fever, dominated the list of what brought patients to the ED. Conversely, patients who presented to the primary care physician's office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Seventy-five percent of patients with acute respiratory problems received care in a primary care practice or hospital outpatient department, the authors found.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Previous studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O'Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

In a separate study, Dr. Ateev Mehrotra and his colleagues reported that 14%-27% of ED visits could have been handled at either a retail clinic or an urgent care center. Switching to these alternate sites could save the system $4.4 billion a year, said Dr. Mehrotra of the University of Pittsburgh and a policy analyst at Rand.

The authors determined that most visits for nine common conditions treated at EDs could be switched easily to those alternate sites. Those conditions include upper-respiratory infections; musculoskeletal conditions such as strains, fractures, and back pain; dermatologic conditions; abdominal pain, headache, and other symptoms without a specific diagnosis; urinary tract infections, some chronic illnesses, and psychiatric conditions; lower-respiratory conditions; such minor problems as insect bites and conjunctivitis; and preventive care.

Disclosures: Dr. Mehrotra and his coauthors received funding from the California HealthCare Foundation for their study. One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

WASHINGTON — More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices, according to a study released Sept. 7.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said at the briefing.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, Dr. Pitts and his colleagues found.

Uninsured patients received more than half their acute care in EDs, according to the study, which appears in the journal's September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints such as stomach and abdominal pain, chest pain, and fever, dominated the list of what brought patients to the ED. Conversely, patients who presented to the primary care physician's office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Seventy-five percent of patients with acute respiratory problems received care in a primary care practice or hospital outpatient department, the authors found.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Previous studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O'Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

In a separate study, Dr. Ateev Mehrotra and his colleagues reported that 14%-27% of ED visits could have been handled at either a retail clinic or an urgent care center. Switching to these alternate sites could save the system $4.4 billion a year, said Dr. Mehrotra of the University of Pittsburgh and a policy analyst at Rand.

The authors determined that most visits for nine common conditions treated at EDs could be switched easily to those alternate sites. Those conditions include upper-respiratory infections; musculoskeletal conditions such as strains, fractures, and back pain; dermatologic conditions; abdominal pain, headache, and other symptoms without a specific diagnosis; urinary tract infections, some chronic illnesses, and psychiatric conditions; lower-respiratory conditions; such minor problems as insect bites and conjunctivitis; and preventive care.

Disclosures: Dr. Mehrotra and his coauthors received funding from the California HealthCare Foundation for their study. One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including, “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or nurse practitioner can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services.

There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it through the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes are not being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. About 15 years ago, she was part of a group that attempted to get a bill passed to mandate the teaching of palliative care in medical schools, but it did not get anywhere.

She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The law will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

But it still will not make it easier for physicians who do not have experience in palliative care, Dr. Edwards said. “It's a very hard discussion to have; it's not something doctors are trained to do.”

A recent study in non–small cell lung cancer patients found that those who were given palliative care at the time of diagnosis had a better quality of life than did those in standard care (N. Engl. J. Med. 2010;363:733–42). This study may do more to advance the field than does the New York law, Dr. Edwards noted.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

Mandating that information be given on palliative care “may undermine the patient's belief and conviction in prevailing against their disease and undercut the confidence in their treating physician,” said Ms. Dears.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

“I don't know how they're going to put it into effect,” said Dr. Bradley Flansbaum.

Source Courtesy Lenox Hill Hospital

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including, “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or nurse practitioner can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services.

There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it through the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes are not being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. About 15 years ago, she was part of a group that attempted to get a bill passed to mandate the teaching of palliative care in medical schools, but it did not get anywhere.

She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The law will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

But it still will not make it easier for physicians who do not have experience in palliative care, Dr. Edwards said. “It's a very hard discussion to have; it's not something doctors are trained to do.”

A recent study in non–small cell lung cancer patients found that those who were given palliative care at the time of diagnosis had a better quality of life than did those in standard care (N. Engl. J. Med. 2010;363:733–42). This study may do more to advance the field than does the New York law, Dr. Edwards noted.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

Mandating that information be given on palliative care “may undermine the patient's belief and conviction in prevailing against their disease and undercut the confidence in their treating physician,” said Ms. Dears.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

“I don't know how they're going to put it into effect,” said Dr. Bradley Flansbaum.

Source Courtesy Lenox Hill Hospital

A new law requiring New York physicians to discuss palliative care and end-of-life options with terminally ill patients is well intentioned, but may not do much to change clinical practice or institutional culture, according to some observers in the state.

The New York Palliative Care Information Act was signed into law by Gov. David Paterson (D) in August. Perhaps as a sign that palliative care is being embraced more readily and becoming better understood, it took just 14 months from the bill's introduction in the state Senate (S. 4498 and A. 7617) to its signing.

Even so, “whether or not it will change behavior is a bit of a black box,” said Dr. Bradley Flansbaum, director of hospitalist services at Lenox Hill Hospital in New York. “It's a nice thought, but I don't know how they're going to put it into effect.”

Under the law, physicians and nurse practitioners are required to provide a patient who has less than 6 months to live with information and counseling on palliative care and end-of-life options, including, “the range of options appropriate to the patient, the prognosis, risks and benefits of the various options, and the patient's legal rights to comprehensive pain and symptom management at the end of life.”

The physician or nurse practitioner can refer the patient to another provider who is willing to meet the legal statute or who is “professionally qualified” to offer the services.

There is no reimbursement offered for the required services.

Because it is an amendment to the state's public health law, violations of the new law could result in penalties or fines. It's not clear how it will be enforced or what might trigger the penalties; the health department has until the law's effective date (February 2011) to devise regulations, said David Leven, executive director of Compassion and Choices of New York.

That advocacy group helped devise the proposal and then shepherded it through the legislature, said Mr. Leven. California has a similar statute, but is not as strong because it does not put the onus on physicians, he said.

The organization sought the legislation because even with increased training on end-of-life issues, too few physicians are having conversations with their dying patients, Mr. Leven said. That means patients' wishes are not being respected, to the detriment of both patients and the practice of medicine.

The organization also hoped that the law would be a catalyst to improving end-of-life education in medical school and at the professional level, he said.

Dr. Wendy Edwards, director of the palliative medicine program at Lenox Hill, said that education would be a key component, but there appeared to be no such formal requirements in the law. About 15 years ago, she was part of a group that attempted to get a bill passed to mandate the teaching of palliative care in medical schools, but it did not get anywhere.

She said she wasn't sure that the new law was the way to increase attention to palliative care, but that it had likely come about as a result of frustration and impatience on the part of palliative specialists.

The law will be positive, however, she said. Palliative care won't just be the standard of care, but will be the law, which gives some backing to hospitals that seek to implement and strengthen their quality of care, and end-of-life care in particular.

But it still will not make it easier for physicians who do not have experience in palliative care, Dr. Edwards said. “It's a very hard discussion to have; it's not something doctors are trained to do.”

A recent study in non–small cell lung cancer patients found that those who were given palliative care at the time of diagnosis had a better quality of life than did those in standard care (N. Engl. J. Med. 2010;363:733–42). This study may do more to advance the field than does the New York law, Dr. Edwards noted.

Although the Hospice and Palliative Care Association of New York State supported the law, the Medical Society of the State of New York did not. The medical society, which represents 25,000 physicians, opposed the law because of concerns that it would interfere with the way each and every doctor navigates through end-of-life situations with each individual patient, said Elizabeth C. Dears, the society's senior vice president for legislative and regulatory affairs.

Mandating that information be given on palliative care “may undermine the patient's belief and conviction in prevailing against their disease and undercut the confidence in their treating physician,” said Ms. Dears.

The medical society also said that physicians are not licensed to provide legal advice in areas such as pain or symptom management, and that they may not know what they are supposed to be communicating to patients under certain provisions, while still being subject to penalties.

Although the medical society might object to requiring any such talk, both Dr. Flansbaum and Dr. Edwards said that, realistically, the law should be requiring palliative care to be offered sooner in the disease process and to a broader group of patients, such as those who have chronic life-limiting conditions such as heart failure.

“By the time you're invoking palliative care in terminal patients, you're behind the curve,” said Dr. Flansbaum.

“I don't know how they're going to put it into effect,” said Dr. Bradley Flansbaum.

Source Courtesy Lenox Hill Hospital

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the Centers for Medicare and Medicaid Services. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Under the new guidelines, any smoker covered by Medicare can have up to eight smoking-cessation sessions per year from a physician or other Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil B. Wilson applauded the agency's coverage expansion. “More than 400,000 Americans die needlessly every year as a direct result of tobacco use,” Dr. Wilson said in a statement. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives.”

BP Will Pay for Health Studies

Oil company BP is contributing $10 million to the National Institutes of Health to jump-start the company's $500 million research project aimed at determining the health effects from the Deepwater Horizon spill in the Gulf of Mexico. The NIH, with local advice from people in the Gulf region, thus takes over distribution of the first funds from the company's 10-year Gulf of Mexico Research Initiative. The effort will focus on the potential health consequences of workers' exposure to oil and dispersants, such as respiratory, neurobehavioral, carcinogenic, and immunologic conditions. It also will evaluate “mental health concerns and other oil spill–related stressors such as job loss, family disruption, and financial uncertainties,” according to the NIH. Distribution of the remaining funds for the project will be determined in consultation with Gulf state governors, BP said.

Prescription Drug Use Rises Again

The percentage of Americans who said they took at least one prescription drug in the past month increased from 44% to 48% from 1999 to 2008, according to a report from the Centers for Disease Control and Prevention. At the same time, the number of people who said they had taken two or more drugs in the previous month increased from 25% to 31%, and the number of people who took five or more drugs increased from 6% to 11%, the report found. One out of every five children used one or more prescription drugs, as did 90% of adults aged 60 years and older. Women were more likely to have taken a prescription drug, while those who did not have health insurance, prescription drug coverage, or a regular place to receive health care tended to take fewer prescriptions. The data came from the National Health and Nutrition Examination Survey.

Patients See Pharma's Influence

Almost 70% of Americans who take prescription drugs believe that drug makers have too much influence over doctors when it comes to those prescriptions, and 50% believe that doctors prescribe drugs even when a person's condition could be managed without medication. The data are the result of a Consumer Reports magazine poll. On the basis of the survey of more than 1,150 adults, the magazine asserted that 51% of Americans don't think that their doctors consider patients' ability to pay for prescribed drugs and 47% think gifts from pharmaceutical companies influence doctors' drug choices.

Drug Information Found Lacking

The printed consumer information that is provided with prescription drugs often fails to provide easy-to-understand information about the product's use and risks, a study by the National Association of Boards of Pharmacy found. Secret shoppers visited pharmacies and filled prescriptions for lisinopril and metformin. Only about three-fourths of the consumer information, which pharmacies routinely staple to the outside of prescription bags, met the Food and Drug Administration's minimum criteria for usefulness. The FDA does not regulate the consumer information that accompanies prescriptions. Pharmacies usually purchase it from contractors. The study was published in the Archives of Internal Medicine.

First EHR Certifying Bodies Named

A nonprofit organization that is dedicated to health information technology and a software-testing lab have been chosen as the first two bodies to officially test and certify electronic health record (EHR) systems for the federal government. The Certification Commission for Health Information Technology and the Drummond Group can immediately begin certifying EHR systems as HHS compliant, the Department of Health and Human Services announced. Now that HHS has named the certifying organizations, vendors can apply for certification of their EHR systems and physicians soon should be able to purchase certified products, the HHS said.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the Centers for Medicare and Medicaid Services. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Under the new guidelines, any smoker covered by Medicare can have up to eight smoking-cessation sessions per year from a physician or other Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil B. Wilson applauded the agency's coverage expansion. “More than 400,000 Americans die needlessly every year as a direct result of tobacco use,” Dr. Wilson said in a statement. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives.”

BP Will Pay for Health Studies

Oil company BP is contributing $10 million to the National Institutes of Health to jump-start the company's $500 million research project aimed at determining the health effects from the Deepwater Horizon spill in the Gulf of Mexico. The NIH, with local advice from people in the Gulf region, thus takes over distribution of the first funds from the company's 10-year Gulf of Mexico Research Initiative. The effort will focus on the potential health consequences of workers' exposure to oil and dispersants, such as respiratory, neurobehavioral, carcinogenic, and immunologic conditions. It also will evaluate “mental health concerns and other oil spill–related stressors such as job loss, family disruption, and financial uncertainties,” according to the NIH. Distribution of the remaining funds for the project will be determined in consultation with Gulf state governors, BP said.

Prescription Drug Use Rises Again

The percentage of Americans who said they took at least one prescription drug in the past month increased from 44% to 48% from 1999 to 2008, according to a report from the Centers for Disease Control and Prevention. At the same time, the number of people who said they had taken two or more drugs in the previous month increased from 25% to 31%, and the number of people who took five or more drugs increased from 6% to 11%, the report found. One out of every five children used one or more prescription drugs, as did 90% of adults aged 60 years and older. Women were more likely to have taken a prescription drug, while those who did not have health insurance, prescription drug coverage, or a regular place to receive health care tended to take fewer prescriptions. The data came from the National Health and Nutrition Examination Survey.

Patients See Pharma's Influence

Almost 70% of Americans who take prescription drugs believe that drug makers have too much influence over doctors when it comes to those prescriptions, and 50% believe that doctors prescribe drugs even when a person's condition could be managed without medication. The data are the result of a Consumer Reports magazine poll. On the basis of the survey of more than 1,150 adults, the magazine asserted that 51% of Americans don't think that their doctors consider patients' ability to pay for prescribed drugs and 47% think gifts from pharmaceutical companies influence doctors' drug choices.

Drug Information Found Lacking

The printed consumer information that is provided with prescription drugs often fails to provide easy-to-understand information about the product's use and risks, a study by the National Association of Boards of Pharmacy found. Secret shoppers visited pharmacies and filled prescriptions for lisinopril and metformin. Only about three-fourths of the consumer information, which pharmacies routinely staple to the outside of prescription bags, met the Food and Drug Administration's minimum criteria for usefulness. The FDA does not regulate the consumer information that accompanies prescriptions. Pharmacies usually purchase it from contractors. The study was published in the Archives of Internal Medicine.

First EHR Certifying Bodies Named

A nonprofit organization that is dedicated to health information technology and a software-testing lab have been chosen as the first two bodies to officially test and certify electronic health record (EHR) systems for the federal government. The Certification Commission for Health Information Technology and the Drummond Group can immediately begin certifying EHR systems as HHS compliant, the Department of Health and Human Services announced. Now that HHS has named the certifying organizations, vendors can apply for certification of their EHR systems and physicians soon should be able to purchase certified products, the HHS said.

Stop-Smoking Coverage Expanded

Physicians will be reimbursed for counseling any Medicare patient about smoking cessation, not just those with tobacco-related illness, under new guidelines approved by the Centers for Medicare and Medicaid Services. Previously, a patient needed to at least show signs of illness related to smoking before Medicare would pay. Under the new guidelines, any smoker covered by Medicare can have up to eight smoking-cessation sessions per year from a physician or other Medicare-recognized health practitioner, CMS said. American Medical Association President Cecil B. Wilson applauded the agency's coverage expansion. “More than 400,000 Americans die needlessly every year as a direct result of tobacco use,” Dr. Wilson said in a statement. “This expansion of coverage takes an important step toward helping Medicare patients lead healthier, tobacco-free lives.”

BP Will Pay for Health Studies

Oil company BP is contributing $10 million to the National Institutes of Health to jump-start the company's $500 million research project aimed at determining the health effects from the Deepwater Horizon spill in the Gulf of Mexico. The NIH, with local advice from people in the Gulf region, thus takes over distribution of the first funds from the company's 10-year Gulf of Mexico Research Initiative. The effort will focus on the potential health consequences of workers' exposure to oil and dispersants, such as respiratory, neurobehavioral, carcinogenic, and immunologic conditions. It also will evaluate “mental health concerns and other oil spill–related stressors such as job loss, family disruption, and financial uncertainties,” according to the NIH. Distribution of the remaining funds for the project will be determined in consultation with Gulf state governors, BP said.

Prescription Drug Use Rises Again

The percentage of Americans who said they took at least one prescription drug in the past month increased from 44% to 48% from 1999 to 2008, according to a report from the Centers for Disease Control and Prevention. At the same time, the number of people who said they had taken two or more drugs in the previous month increased from 25% to 31%, and the number of people who took five or more drugs increased from 6% to 11%, the report found. One out of every five children used one or more prescription drugs, as did 90% of adults aged 60 years and older. Women were more likely to have taken a prescription drug, while those who did not have health insurance, prescription drug coverage, or a regular place to receive health care tended to take fewer prescriptions. The data came from the National Health and Nutrition Examination Survey.

Patients See Pharma's Influence

Almost 70% of Americans who take prescription drugs believe that drug makers have too much influence over doctors when it comes to those prescriptions, and 50% believe that doctors prescribe drugs even when a person's condition could be managed without medication. The data are the result of a Consumer Reports magazine poll. On the basis of the survey of more than 1,150 adults, the magazine asserted that 51% of Americans don't think that their doctors consider patients' ability to pay for prescribed drugs and 47% think gifts from pharmaceutical companies influence doctors' drug choices.

Drug Information Found Lacking

The printed consumer information that is provided with prescription drugs often fails to provide easy-to-understand information about the product's use and risks, a study by the National Association of Boards of Pharmacy found. Secret shoppers visited pharmacies and filled prescriptions for lisinopril and metformin. Only about three-fourths of the consumer information, which pharmacies routinely staple to the outside of prescription bags, met the Food and Drug Administration's minimum criteria for usefulness. The FDA does not regulate the consumer information that accompanies prescriptions. Pharmacies usually purchase it from contractors. The study was published in the Archives of Internal Medicine.

First EHR Certifying Bodies Named

A nonprofit organization that is dedicated to health information technology and a software-testing lab have been chosen as the first two bodies to officially test and certify electronic health record (EHR) systems for the federal government. The Certification Commission for Health Information Technology and the Drummond Group can immediately begin certifying EHR systems as HHS compliant, the Department of Health and Human Services announced. Now that HHS has named the certifying organizations, vendors can apply for certification of their EHR systems and physicians soon should be able to purchase certified products, the HHS said.