Jane Anderson

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to "churn" beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems noted that the proposed regulations "go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program."

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements "will do little to address the fundamental problems with Medicare Advantage plans."

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report "has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans." He noted in a statement that the report "shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices."

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders. Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are "an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them."

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations "are inadequate to address the problems we see every day."

Specifically, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those who are eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, would more clearly establish and clarify delivery of care standards for SNPs, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

CMS is accepting comments on the proposal until July 15.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to "churn" beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems noted that the proposed regulations "go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program."

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements "will do little to address the fundamental problems with Medicare Advantage plans."

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report "has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans." He noted in a statement that the report "shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices."

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders. Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are "an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them."

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations "are inadequate to address the problems we see every day."

Specifically, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those who are eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, would more clearly establish and clarify delivery of care standards for SNPs, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

CMS is accepting comments on the proposal until July 15.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to "churn" beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems noted that the proposed regulations "go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program."

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements "will do little to address the fundamental problems with Medicare Advantage plans."

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report "has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans." He noted in a statement that the report "shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices."

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders. Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are "an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them."

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations "are inadequate to address the problems we see every day."

Specifically, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those who are eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, would more clearly establish and clarify delivery of care standards for SNPs, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

CMS is accepting comments on the proposal until July 15.

Each day in the United States, roughly one doctor dies by suicide. Studies over the past 4 decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

"Physicians have the means and the knowledge and access to ways to kill themselves," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention.

But the data on physicians dying by suicide are difficult to come by, and "we certainly don't have any data that [say] any particular specialty has any higher rates of suicide," Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide. Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

"It wasn't as if the institution and the department weren't aware that they had some problems," he said in an interview. "Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well."

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and "we certainly did everything we could in terms of their family in both cases." But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. "Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be."

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added.

"[Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it," said Dr. Austen.

"There's this proudness about their ability to cope," Dr. Clayton said. "They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem."

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. "I worked with a physician who took lithium," she said. "The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses." However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded three films on physician suicide as part of an ongoing campaign that seeks to educate physicians about depression. One of the films was designed specifically as an educational video for use at medical schools. Because many of the mood disorders that can lead to suicide might become evident during medical school, where professional and institutional barriers already exist, the goal is to encourage medical students to seek help for depression.

Each day in the United States, roughly one doctor dies by suicide. Studies over the past 4 decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

"Physicians have the means and the knowledge and access to ways to kill themselves," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention.

But the data on physicians dying by suicide are difficult to come by, and "we certainly don't have any data that [say] any particular specialty has any higher rates of suicide," Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide. Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

"It wasn't as if the institution and the department weren't aware that they had some problems," he said in an interview. "Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well."

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and "we certainly did everything we could in terms of their family in both cases." But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. "Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be."

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added.

"[Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it," said Dr. Austen.

"There's this proudness about their ability to cope," Dr. Clayton said. "They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem."

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. "I worked with a physician who took lithium," she said. "The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses." However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded three films on physician suicide as part of an ongoing campaign that seeks to educate physicians about depression. One of the films was designed specifically as an educational video for use at medical schools. Because many of the mood disorders that can lead to suicide might become evident during medical school, where professional and institutional barriers already exist, the goal is to encourage medical students to seek help for depression.

Each day in the United States, roughly one doctor dies by suicide. Studies over the past 4 decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

"Physicians have the means and the knowledge and access to ways to kill themselves," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention.

But the data on physicians dying by suicide are difficult to come by, and "we certainly don't have any data that [say] any particular specialty has any higher rates of suicide," Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide. Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

"It wasn't as if the institution and the department weren't aware that they had some problems," he said in an interview. "Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well."

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and "we certainly did everything we could in terms of their family in both cases." But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. "Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be."

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added.

"[Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it," said Dr. Austen.

"There's this proudness about their ability to cope," Dr. Clayton said. "They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem."

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. "I worked with a physician who took lithium," she said. "The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses." However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded three films on physician suicide as part of an ongoing campaign that seeks to educate physicians about depression. One of the films was designed specifically as an educational video for use at medical schools. Because many of the mood disorders that can lead to suicide might become evident during medical school, where professional and institutional barriers already exist, the goal is to encourage medical students to seek help for depression.

CBO Casts Doubt on Health IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a Congressional Budget Office. But the adoption of health IT alone will not produce significant savings, the report concludes. Institutions that have successfully used health IT to lower costs are generally integrated health care systems like Kaiser Permanente's. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. The CBO takes issue with those estimates, noting that the savings figures are derived by assuming changes to the health care system. But without changes to the current payment system, providers would not be incentivized to reduce costs to the system, according to the report (available at

www.cbo.gov

MD Cash Payments Cut Spending

Giving physicians cash payments for reduced hospital spending can help control costs without sacrificing quality or access to care, researchers reported in the policy journal Health Affairs. In a 5-year study of more than 220,000 patients who received coronary stents, Arizona State University researchers showed that “gainsharing” programs, in which physicians are paid for reducing hospital spending, cut costs by more than 7%, or $315 per patient. If these experiences are representative, the report said, then nationwide use of gainsharing would cut hospital costs for stent patients by about $195 million a year. The majority of savings from the gainsharing programs were attributed to lower prices for coronary stents, the study said. The researchers found that the gainsharing programs did not increase the risk of in-lab complications, and were associated with significant decreases in three specific types of complications.

Group Calls for Obesity Action

The advocacy group Campaign to End Obesity, in concert with the American College of Gastroenterology, the American Heart Association, the American Diabetes Association, and others, has issued a call to action outlining what it said Congress must do to address the obesity epidemic. “It is time for the government to take a more comprehensive policy approach to the problem—to look holistically at factors that influence obesity and to look for ways to support people in preventing, managing and treating the disease,” the report said. The call to action said that there is much more that lawmakers can do about improving school nutrition and physical activity standards, and that Congress also should consider reimbursement for providers who manage and treat obesity.

Family Spending Up 8%

The average annual medical cost for a typical American family of four increased by nearly 8% from 2007 to 2008, according to consulting firm Milliman Inc.'s fourth annual study of medical spending. Although the $1,109 increase is a big expense, the report said, the rate of increase was down for the second straight year and is the lowest rate of increase in the past 5 years. However, this was the second consecutive year of double-digit increase for the employee's share of spending on health care services, according to the report. The total medical cost in 2008 for a typical American family of four is $15,609, compared with $14,500 in 2007, the report found. Milliman also found wide variation in costs across the country: Among the 14 metropolitan areas studied, health care costs varied by more than 35%.

Few Americans Are Health Literate

Just 12% of America's 228 million adults have the skills to manage their own health care proficiently, according to the Agency for Healthcare Research and Quality. Those deemed proficient in health literacy skills can obtain and use health information to make appropriate health care decisions, can weigh the risks and benefits of different treatments, know how to calculate health insurance costs, and are able to fill out complex medical forms. AHRQ found that about 53% of U.S. adults have intermediate health literacy skills, such as being able to read instructions on a prescription label and determine the right time to take medication. Meanwhile, 22% had basic skills, such as being able to read a pamphlet and understand two reasons why a disease test might be appropriate despite a lack of symptoms, according to the report. And 14% had less than basic skills, meaning they could accomplish only simple tasks, such as understanding a set of short instructions, AHRQ said.

Half of America on Drugs

Medco Health Solutions Inc. has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: In all, 48% of women aged 20–44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, whereas the top therapies overall were antihypertensives and cholesterol cutters. Hormone therapy use by women aged 45–64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. But, “it does show that people are receiving treatment which can prevent more serious health problems down the road.”

CBO Casts Doubt on Health IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a Congressional Budget Office. But the adoption of health IT alone will not produce significant savings, the report concludes. Institutions that have successfully used health IT to lower costs are generally integrated health care systems like Kaiser Permanente's. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. The CBO takes issue with those estimates, noting that the savings figures are derived by assuming changes to the health care system. But without changes to the current payment system, providers would not be incentivized to reduce costs to the system, according to the report (available at

www.cbo.gov

MD Cash Payments Cut Spending

Giving physicians cash payments for reduced hospital spending can help control costs without sacrificing quality or access to care, researchers reported in the policy journal Health Affairs. In a 5-year study of more than 220,000 patients who received coronary stents, Arizona State University researchers showed that “gainsharing” programs, in which physicians are paid for reducing hospital spending, cut costs by more than 7%, or $315 per patient. If these experiences are representative, the report said, then nationwide use of gainsharing would cut hospital costs for stent patients by about $195 million a year. The majority of savings from the gainsharing programs were attributed to lower prices for coronary stents, the study said. The researchers found that the gainsharing programs did not increase the risk of in-lab complications, and were associated with significant decreases in three specific types of complications.

Group Calls for Obesity Action

The advocacy group Campaign to End Obesity, in concert with the American College of Gastroenterology, the American Heart Association, the American Diabetes Association, and others, has issued a call to action outlining what it said Congress must do to address the obesity epidemic. “It is time for the government to take a more comprehensive policy approach to the problem—to look holistically at factors that influence obesity and to look for ways to support people in preventing, managing and treating the disease,” the report said. The call to action said that there is much more that lawmakers can do about improving school nutrition and physical activity standards, and that Congress also should consider reimbursement for providers who manage and treat obesity.

Family Spending Up 8%

The average annual medical cost for a typical American family of four increased by nearly 8% from 2007 to 2008, according to consulting firm Milliman Inc.'s fourth annual study of medical spending. Although the $1,109 increase is a big expense, the report said, the rate of increase was down for the second straight year and is the lowest rate of increase in the past 5 years. However, this was the second consecutive year of double-digit increase for the employee's share of spending on health care services, according to the report. The total medical cost in 2008 for a typical American family of four is $15,609, compared with $14,500 in 2007, the report found. Milliman also found wide variation in costs across the country: Among the 14 metropolitan areas studied, health care costs varied by more than 35%.

Few Americans Are Health Literate

Just 12% of America's 228 million adults have the skills to manage their own health care proficiently, according to the Agency for Healthcare Research and Quality. Those deemed proficient in health literacy skills can obtain and use health information to make appropriate health care decisions, can weigh the risks and benefits of different treatments, know how to calculate health insurance costs, and are able to fill out complex medical forms. AHRQ found that about 53% of U.S. adults have intermediate health literacy skills, such as being able to read instructions on a prescription label and determine the right time to take medication. Meanwhile, 22% had basic skills, such as being able to read a pamphlet and understand two reasons why a disease test might be appropriate despite a lack of symptoms, according to the report. And 14% had less than basic skills, meaning they could accomplish only simple tasks, such as understanding a set of short instructions, AHRQ said.

Half of America on Drugs

Medco Health Solutions Inc. has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: In all, 48% of women aged 20–44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, whereas the top therapies overall were antihypertensives and cholesterol cutters. Hormone therapy use by women aged 45–64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. But, “it does show that people are receiving treatment which can prevent more serious health problems down the road.”

CBO Casts Doubt on Health IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a Congressional Budget Office. But the adoption of health IT alone will not produce significant savings, the report concludes. Institutions that have successfully used health IT to lower costs are generally integrated health care systems like Kaiser Permanente's. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. The CBO takes issue with those estimates, noting that the savings figures are derived by assuming changes to the health care system. But without changes to the current payment system, providers would not be incentivized to reduce costs to the system, according to the report (available at

www.cbo.gov

MD Cash Payments Cut Spending

Giving physicians cash payments for reduced hospital spending can help control costs without sacrificing quality or access to care, researchers reported in the policy journal Health Affairs. In a 5-year study of more than 220,000 patients who received coronary stents, Arizona State University researchers showed that “gainsharing” programs, in which physicians are paid for reducing hospital spending, cut costs by more than 7%, or $315 per patient. If these experiences are representative, the report said, then nationwide use of gainsharing would cut hospital costs for stent patients by about $195 million a year. The majority of savings from the gainsharing programs were attributed to lower prices for coronary stents, the study said. The researchers found that the gainsharing programs did not increase the risk of in-lab complications, and were associated with significant decreases in three specific types of complications.

Group Calls for Obesity Action

The advocacy group Campaign to End Obesity, in concert with the American College of Gastroenterology, the American Heart Association, the American Diabetes Association, and others, has issued a call to action outlining what it said Congress must do to address the obesity epidemic. “It is time for the government to take a more comprehensive policy approach to the problem—to look holistically at factors that influence obesity and to look for ways to support people in preventing, managing and treating the disease,” the report said. The call to action said that there is much more that lawmakers can do about improving school nutrition and physical activity standards, and that Congress also should consider reimbursement for providers who manage and treat obesity.

Family Spending Up 8%

The average annual medical cost for a typical American family of four increased by nearly 8% from 2007 to 2008, according to consulting firm Milliman Inc.'s fourth annual study of medical spending. Although the $1,109 increase is a big expense, the report said, the rate of increase was down for the second straight year and is the lowest rate of increase in the past 5 years. However, this was the second consecutive year of double-digit increase for the employee's share of spending on health care services, according to the report. The total medical cost in 2008 for a typical American family of four is $15,609, compared with $14,500 in 2007, the report found. Milliman also found wide variation in costs across the country: Among the 14 metropolitan areas studied, health care costs varied by more than 35%.

Few Americans Are Health Literate

Just 12% of America's 228 million adults have the skills to manage their own health care proficiently, according to the Agency for Healthcare Research and Quality. Those deemed proficient in health literacy skills can obtain and use health information to make appropriate health care decisions, can weigh the risks and benefits of different treatments, know how to calculate health insurance costs, and are able to fill out complex medical forms. AHRQ found that about 53% of U.S. adults have intermediate health literacy skills, such as being able to read instructions on a prescription label and determine the right time to take medication. Meanwhile, 22% had basic skills, such as being able to read a pamphlet and understand two reasons why a disease test might be appropriate despite a lack of symptoms, according to the report. And 14% had less than basic skills, meaning they could accomplish only simple tasks, such as understanding a set of short instructions, AHRQ said.

Half of America on Drugs

Medco Health Solutions Inc. has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: In all, 48% of women aged 20–44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, whereas the top therapies overall were antihypertensives and cholesterol cutters. Hormone therapy use by women aged 45–64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. But, “it does show that people are receiving treatment which can prevent more serious health problems down the road.”

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choice, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season. CMS is accepting public comments on the proposal until July 15.

Kerry Weems, CMS acting administrator, noted that the proposed regulations “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program,” adding that he wanted “to emphasize that this is a large and comprehensive rule.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The proposal received mixed reviews from Medicare Advantage stakeholders.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.” In March, AHIP advocated for stronger federal regulation and oversight of Medicare Advantage and Part D plan marketing activities.

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day. These regulations do nothing to prevent insurance companies from using high commissions and volume-based bonuses to encourage agents to enroll people with Medicare in substandard plans that provide inadequate financial protection, abysmal customer service, and poor access to providers.”

The proposed marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.

Medicare Advantage organizations that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choice, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season. CMS is accepting public comments on the proposal until July 15.

Kerry Weems, CMS acting administrator, noted that the proposed regulations “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program,” adding that he wanted “to emphasize that this is a large and comprehensive rule.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The proposal received mixed reviews from Medicare Advantage stakeholders.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.” In March, AHIP advocated for stronger federal regulation and oversight of Medicare Advantage and Part D plan marketing activities.

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day. These regulations do nothing to prevent insurance companies from using high commissions and volume-based bonuses to encourage agents to enroll people with Medicare in substandard plans that provide inadequate financial protection, abysmal customer service, and poor access to providers.”

The proposed marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.

Medicare Advantage organizations that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choice, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season. CMS is accepting public comments on the proposal until July 15.

Kerry Weems, CMS acting administrator, noted that the proposed regulations “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program,” adding that he wanted “to emphasize that this is a large and comprehensive rule.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The proposal received mixed reviews from Medicare Advantage stakeholders.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.” In March, AHIP advocated for stronger federal regulation and oversight of Medicare Advantage and Part D plan marketing activities.

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day. These regulations do nothing to prevent insurance companies from using high commissions and volume-based bonuses to encourage agents to enroll people with Medicare in substandard plans that provide inadequate financial protection, abysmal customer service, and poor access to providers.”

The proposed marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance.

Medicare Advantage organizations that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.

WASHINGTON — Although e-health activities are becoming commonplace, a variety of legal, financial, and logistical issues still must be addressed for the technology to realize its potential for physicians and patients, the American College of Physicians said in a position paper.

The challenges for effectively implementing e-health activities lie not only in the adoption of universal technical standards for the exchange of electronic health information, but also in the more fundamental concern of economic support for health information technology, the ACP said in a new position paper, which was released at the group's annual meeting and posted at www.acponline.org

“ACP believes that patient portals and personal health records may provide the biggest benefits to patients when they are used collaboratively with physicians,” said ACP President David Dale at a press briefing at the meeting. But Dr. Dale added that “the biggest single concern of physicians is the substantial cost in acquiring and maintaining the necessary technology, which averages $50,000 per physician.”

The paper, “E-Health and Its Impact on Medical Practice,” analyzes the benefits, technical and financial challenges, and legal issues related to adopting and implementing e-health activities for physicians and patients.

These issues include the privacy of medical records, financing and payment for physicians adopting electronic records and communication systems, computer literacy among patients, and telemedicine development and funding. The ACP also recommends the creation of national standards for e-health Web site content.

Dr. Joel Levine, chairman of the ACP Board of Regents, said at the briefing that e-health initiatives have great potential to transform health care in the United States, especially as part of the development of the patient-centered medical home. “ACP recommends ongoing investment in demonstration projects … within the context of the patient-centered medical home,” Dr. Levine said.

However, Dr. Dale and Dr. Levine both said that payment policy reforms are needed to compensate physicians appropriately for their investment in and implementation of e-health services. The new fee structures likely would include some sort of flat fee that would cover all communications with a patient, they said.

“This is the management of chronic health we're talking about—you can't do that by giving me 25 cents every time I click on my Blackberry,” Dr. Levine said.

In addition, confidentiality, privacy, and standardization are needed to create a trusted nationwide health information network, according to the ACP, as health care providers and individuals are likely to be reluctant to adopt e-health activities unless they are confident that the systems are secure and accurate.

In the paper, the ACP calls on technology developers and policy makers to support standards that address interoperability, functionality, security, privacy, content, and legal liability. In addition, it recommends the use of secure Web messaging infrastructure rather than standard e-mail to ensure the highest levels of confidentiality for electronic communications between physicians and patients. Records of communication fall within the parameters of the Health Insurance Portability and Accountability Act and therefore must be protected according to HIPAA standards, the ACP said.

WASHINGTON — Although e-health activities are becoming commonplace, a variety of legal, financial, and logistical issues still must be addressed for the technology to realize its potential for physicians and patients, the American College of Physicians said in a position paper.

The challenges for effectively implementing e-health activities lie not only in the adoption of universal technical standards for the exchange of electronic health information, but also in the more fundamental concern of economic support for health information technology, the ACP said in a new position paper, which was released at the group's annual meeting and posted at www.acponline.org

“ACP believes that patient portals and personal health records may provide the biggest benefits to patients when they are used collaboratively with physicians,” said ACP President David Dale at a press briefing at the meeting. But Dr. Dale added that “the biggest single concern of physicians is the substantial cost in acquiring and maintaining the necessary technology, which averages $50,000 per physician.”

The paper, “E-Health and Its Impact on Medical Practice,” analyzes the benefits, technical and financial challenges, and legal issues related to adopting and implementing e-health activities for physicians and patients.

These issues include the privacy of medical records, financing and payment for physicians adopting electronic records and communication systems, computer literacy among patients, and telemedicine development and funding. The ACP also recommends the creation of national standards for e-health Web site content.

Dr. Joel Levine, chairman of the ACP Board of Regents, said at the briefing that e-health initiatives have great potential to transform health care in the United States, especially as part of the development of the patient-centered medical home. “ACP recommends ongoing investment in demonstration projects … within the context of the patient-centered medical home,” Dr. Levine said.

However, Dr. Dale and Dr. Levine both said that payment policy reforms are needed to compensate physicians appropriately for their investment in and implementation of e-health services. The new fee structures likely would include some sort of flat fee that would cover all communications with a patient, they said.

“This is the management of chronic health we're talking about—you can't do that by giving me 25 cents every time I click on my Blackberry,” Dr. Levine said.

In addition, confidentiality, privacy, and standardization are needed to create a trusted nationwide health information network, according to the ACP, as health care providers and individuals are likely to be reluctant to adopt e-health activities unless they are confident that the systems are secure and accurate.

In the paper, the ACP calls on technology developers and policy makers to support standards that address interoperability, functionality, security, privacy, content, and legal liability. In addition, it recommends the use of secure Web messaging infrastructure rather than standard e-mail to ensure the highest levels of confidentiality for electronic communications between physicians and patients. Records of communication fall within the parameters of the Health Insurance Portability and Accountability Act and therefore must be protected according to HIPAA standards, the ACP said.

WASHINGTON — Although e-health activities are becoming commonplace, a variety of legal, financial, and logistical issues still must be addressed for the technology to realize its potential for physicians and patients, the American College of Physicians said in a position paper.

The challenges for effectively implementing e-health activities lie not only in the adoption of universal technical standards for the exchange of electronic health information, but also in the more fundamental concern of economic support for health information technology, the ACP said in a new position paper, which was released at the group's annual meeting and posted at www.acponline.org

“ACP believes that patient portals and personal health records may provide the biggest benefits to patients when they are used collaboratively with physicians,” said ACP President David Dale at a press briefing at the meeting. But Dr. Dale added that “the biggest single concern of physicians is the substantial cost in acquiring and maintaining the necessary technology, which averages $50,000 per physician.”

The paper, “E-Health and Its Impact on Medical Practice,” analyzes the benefits, technical and financial challenges, and legal issues related to adopting and implementing e-health activities for physicians and patients.

These issues include the privacy of medical records, financing and payment for physicians adopting electronic records and communication systems, computer literacy among patients, and telemedicine development and funding. The ACP also recommends the creation of national standards for e-health Web site content.

Dr. Joel Levine, chairman of the ACP Board of Regents, said at the briefing that e-health initiatives have great potential to transform health care in the United States, especially as part of the development of the patient-centered medical home. “ACP recommends ongoing investment in demonstration projects … within the context of the patient-centered medical home,” Dr. Levine said.

However, Dr. Dale and Dr. Levine both said that payment policy reforms are needed to compensate physicians appropriately for their investment in and implementation of e-health services. The new fee structures likely would include some sort of flat fee that would cover all communications with a patient, they said.

“This is the management of chronic health we're talking about—you can't do that by giving me 25 cents every time I click on my Blackberry,” Dr. Levine said.

In addition, confidentiality, privacy, and standardization are needed to create a trusted nationwide health information network, according to the ACP, as health care providers and individuals are likely to be reluctant to adopt e-health activities unless they are confident that the systems are secure and accurate.

In the paper, the ACP calls on technology developers and policy makers to support standards that address interoperability, functionality, security, privacy, content, and legal liability. In addition, it recommends the use of secure Web messaging infrastructure rather than standard e-mail to ensure the highest levels of confidentiality for electronic communications between physicians and patients. Records of communication fall within the parameters of the Health Insurance Portability and Accountability Act and therefore must be protected according to HIPAA standards, the ACP said.

CBO Casts Doubt on Health IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a Congressional Budget Office report. But the adoption of health IT alone will not produce significant savings, the report concludes. Institutions that have successfully used health IT to lower costs are generally integrated health care systems like Kaiser Permanente's. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. The CBO takes issue those estimates, noting that the savings figures are derived by assuming changes to the health care system. But without changes to the current payment system, providers would not be incentivized to reduce costs to the system, according to the report (available at

www.cbo.gov

MD Cash Payments Cut Spending

Giving physicians cash payments for reduced hospital spending can help control costs without sacrificing quality or access to care, researchers reported in the policy journal Health Affairs. In a 5-year study of more than 220,000 patients who received coronary stents, Arizona State University researchers showed that “gainsharing” programs, in which physicians are paid for reducing hospital spending, cut costs by more than 7%, or $315 per patient. If these experiences are representative, the report said, nationwide use of gainsharing would cut hospital costs for stent patients by about $195 million a year. Most savings from the gainsharing programs were attributed to lower prices for coronary stents, the study said. The researchers found that the programs did not increase the risk of in-lab complications, and were associated with significant decreases in three specific types of complications.

Group Calls for Obesity Action

The advocacy group Campaign to End Obesity, in concert with the American College of Gastroenterology, the American Heart Association, the American Diabetes Association, and others, has issued a call to action outlining what it said Congress must do to address the obesity epidemic. “It is time for the government to take a more comprehensive policy approach to the problem—to look holistically at factors that influence obesity and to look for ways to support people in preventing, managing and treating the disease,” the report said. The call to action said that there is much more that lawmakers can do about improving school nutrition and physical activity standards, and that Congress also should consider reimbursement for providers who manage and treat obesity.

Family Spending Up 8%

The average annual medical cost for a typical American family of four increased by nearly 8% from 2007 to 2008, according to consulting firm Milliman Inc.'s fourth annual study of medical spending. Although the $1,109 increase is a lot, the rate of increase was down for the second straight year and is the lowest rate of increase in the past 5 years. This was the second consecutive year of double-digit increase for the employee's share of spending on health care, the report said. Medical costs in 2008 for a typical American family of four will be $15,609, compared with $14,500 in 2007, the report found. Milliman also found wide variation across the country: Among the 14 metropolitan areas studied, health care costs varied by more than 35%.

Few Americans Are Health Literate

Just 12% of America's 228 million adults have the skills to manage their own health care proficiently, according to the Agency for Healthcare Research and Quality. Those deemed proficient in health literacy skills can obtain and use health information to make appropriate health care decisions, can weigh the risks and benefits of different treatments, know how to calculate health insurance costs, and are able to fill out complex medical forms. AHRQ found that about 53% of U.S. adults have intermediate health literacy skills, such as being able to read instructions on a prescription label and determine the right time to take medication. Meanwhile, 22% had basic skills, such as being able to read a pamphlet and understand two reasons why a disease test might be appropriate despite a lack of symptoms, according to the report. And 14% had less than basic skills, meaning they could accomplish only simple tasks, such as understanding a set of short instructions or identifying what is permissible to drink before a medical test, AHRQ said.

Half of America on Drugs

Medco Health Solutions Inc. has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: In all, 48% of women aged 20–44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, whereas the top therapies overall were antihypertensives and cholesterol cutters. Hormone therapy use by women aged 45–64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. “But there is a silver lining: It does show that people are receiving treatment which can prevent more serious health problems down the road.”

CBO Casts Doubt on Health IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a Congressional Budget Office report. But the adoption of health IT alone will not produce significant savings, the report concludes. Institutions that have successfully used health IT to lower costs are generally integrated health care systems like Kaiser Permanente's. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. The CBO takes issue those estimates, noting that the savings figures are derived by assuming changes to the health care system. But without changes to the current payment system, providers would not be incentivized to reduce costs to the system, according to the report (available at

www.cbo.gov

MD Cash Payments Cut Spending

Giving physicians cash payments for reduced hospital spending can help control costs without sacrificing quality or access to care, researchers reported in the policy journal Health Affairs. In a 5-year study of more than 220,000 patients who received coronary stents, Arizona State University researchers showed that “gainsharing” programs, in which physicians are paid for reducing hospital spending, cut costs by more than 7%, or $315 per patient. If these experiences are representative, the report said, nationwide use of gainsharing would cut hospital costs for stent patients by about $195 million a year. Most savings from the gainsharing programs were attributed to lower prices for coronary stents, the study said. The researchers found that the programs did not increase the risk of in-lab complications, and were associated with significant decreases in three specific types of complications.

Group Calls for Obesity Action

The advocacy group Campaign to End Obesity, in concert with the American College of Gastroenterology, the American Heart Association, the American Diabetes Association, and others, has issued a call to action outlining what it said Congress must do to address the obesity epidemic. “It is time for the government to take a more comprehensive policy approach to the problem—to look holistically at factors that influence obesity and to look for ways to support people in preventing, managing and treating the disease,” the report said. The call to action said that there is much more that lawmakers can do about improving school nutrition and physical activity standards, and that Congress also should consider reimbursement for providers who manage and treat obesity.

Family Spending Up 8%

The average annual medical cost for a typical American family of four increased by nearly 8% from 2007 to 2008, according to consulting firm Milliman Inc.'s fourth annual study of medical spending. Although the $1,109 increase is a lot, the rate of increase was down for the second straight year and is the lowest rate of increase in the past 5 years. This was the second consecutive year of double-digit increase for the employee's share of spending on health care, the report said. Medical costs in 2008 for a typical American family of four will be $15,609, compared with $14,500 in 2007, the report found. Milliman also found wide variation across the country: Among the 14 metropolitan areas studied, health care costs varied by more than 35%.

Few Americans Are Health Literate

Just 12% of America's 228 million adults have the skills to manage their own health care proficiently, according to the Agency for Healthcare Research and Quality. Those deemed proficient in health literacy skills can obtain and use health information to make appropriate health care decisions, can weigh the risks and benefits of different treatments, know how to calculate health insurance costs, and are able to fill out complex medical forms. AHRQ found that about 53% of U.S. adults have intermediate health literacy skills, such as being able to read instructions on a prescription label and determine the right time to take medication. Meanwhile, 22% had basic skills, such as being able to read a pamphlet and understand two reasons why a disease test might be appropriate despite a lack of symptoms, according to the report. And 14% had less than basic skills, meaning they could accomplish only simple tasks, such as understanding a set of short instructions or identifying what is permissible to drink before a medical test, AHRQ said.

Half of America on Drugs

Medco Health Solutions Inc. has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: In all, 48% of women aged 20–44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, whereas the top therapies overall were antihypertensives and cholesterol cutters. Hormone therapy use by women aged 45–64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. “But there is a silver lining: It does show that people are receiving treatment which can prevent more serious health problems down the road.”

CBO Casts Doubt on Health IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a Congressional Budget Office report. But the adoption of health IT alone will not produce significant savings, the report concludes. Institutions that have successfully used health IT to lower costs are generally integrated health care systems like Kaiser Permanente's. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. The CBO takes issue those estimates, noting that the savings figures are derived by assuming changes to the health care system. But without changes to the current payment system, providers would not be incentivized to reduce costs to the system, according to the report (available at

www.cbo.gov

MD Cash Payments Cut Spending

Giving physicians cash payments for reduced hospital spending can help control costs without sacrificing quality or access to care, researchers reported in the policy journal Health Affairs. In a 5-year study of more than 220,000 patients who received coronary stents, Arizona State University researchers showed that “gainsharing” programs, in which physicians are paid for reducing hospital spending, cut costs by more than 7%, or $315 per patient. If these experiences are representative, the report said, nationwide use of gainsharing would cut hospital costs for stent patients by about $195 million a year. Most savings from the gainsharing programs were attributed to lower prices for coronary stents, the study said. The researchers found that the programs did not increase the risk of in-lab complications, and were associated with significant decreases in three specific types of complications.

Group Calls for Obesity Action

The advocacy group Campaign to End Obesity, in concert with the American College of Gastroenterology, the American Heart Association, the American Diabetes Association, and others, has issued a call to action outlining what it said Congress must do to address the obesity epidemic. “It is time for the government to take a more comprehensive policy approach to the problem—to look holistically at factors that influence obesity and to look for ways to support people in preventing, managing and treating the disease,” the report said. The call to action said that there is much more that lawmakers can do about improving school nutrition and physical activity standards, and that Congress also should consider reimbursement for providers who manage and treat obesity.

Family Spending Up 8%

The average annual medical cost for a typical American family of four increased by nearly 8% from 2007 to 2008, according to consulting firm Milliman Inc.'s fourth annual study of medical spending. Although the $1,109 increase is a lot, the rate of increase was down for the second straight year and is the lowest rate of increase in the past 5 years. This was the second consecutive year of double-digit increase for the employee's share of spending on health care, the report said. Medical costs in 2008 for a typical American family of four will be $15,609, compared with $14,500 in 2007, the report found. Milliman also found wide variation across the country: Among the 14 metropolitan areas studied, health care costs varied by more than 35%.

Few Americans Are Health Literate

Just 12% of America's 228 million adults have the skills to manage their own health care proficiently, according to the Agency for Healthcare Research and Quality. Those deemed proficient in health literacy skills can obtain and use health information to make appropriate health care decisions, can weigh the risks and benefits of different treatments, know how to calculate health insurance costs, and are able to fill out complex medical forms. AHRQ found that about 53% of U.S. adults have intermediate health literacy skills, such as being able to read instructions on a prescription label and determine the right time to take medication. Meanwhile, 22% had basic skills, such as being able to read a pamphlet and understand two reasons why a disease test might be appropriate despite a lack of symptoms, according to the report. And 14% had less than basic skills, meaning they could accomplish only simple tasks, such as understanding a set of short instructions or identifying what is permissible to drink before a medical test, AHRQ said.

Half of America on Drugs

Medco Health Solutions Inc. has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: In all, 48% of women aged 20–44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, whereas the top therapies overall were antihypertensives and cholesterol cutters. Hormone therapy use by women aged 45–64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. “But there is a silver lining: It does show that people are receiving treatment which can prevent more serious health problems down the road.”

IAN Registers Nearly 24,000

The Kennedy Krieger Institute has announced that its Interactive Autism Network (IAN), the first U.S. autism registry, has registered nearly 24,000 individuals in its first year and is helping to facilitate approximately 75 research projects across the United States. As part of that total, 299 sets of twins have enrolled in the IAN research protocol, providing the largest collection of twins in published autism research. Twin studies provide an opportunity for researchers to investigate both genetic and environmental factors in autism, but studies historically have found it difficult to recruit twin sets, the institute said. Initial data from the registry indicated that living in a more rural state may delay the diagnosis of autism and limit access to private schools. In addition, another analysis of initial registry data showed that families of children with autism spectrum disorders (ASD) are using a number of autism interventions, ranging from therapy to medication to diet. The average number of simultaneous treatments was five, although half of those with an ASD receive four or fewer.

CMS Softens SCHIP Policy

The Centers for Medicare and Medicaid Services will make it a little easier for states to expand coverage under the State Children's Health Insurance Program. States had expressed concern that they would not be able to achieve the required coverage for 95% of children in families with incomes at or below 200% of the poverty level before expanding SCHIP to children in families with incomes above 250% of the poverty level. In a letter to state health officials, CMS told states that they now may use “a variety of approaches,” including state surveys, to prove they have reached the 95% threshold set by CMS for using federal money to expand SCHIP to families making more money. The agency also told state officials that children already enrolled in SCHIP, children in families with incomes at or below 250% of the poverty level, children whose enrollment costs are paid exclusively with state dollars, and unborn children are not subject to the threshold limits.

Few Meet Activity Guidelines

Children who do not meet American Academy of Pediatrics guidelines for activity and screen time were much more likely to be overweight than children complying with both AAP recommendations, a study in The Journal of Pediatrics showed. The AAP recommends that boys take at least 13,000 steps a day, girls at least 11,000 steps a day, and all children limit their total screen time to 2 hours a day. Researchers from Iowa State University and the National Institute on Media and the Family studied 709 children aged 7–12 years. The children were asked to wear pedometers and track their screen time. Almost 20% of the children were overweight and fewer than half met both AAP recommendations. Those children who did not meet both recommendations were three to four times more likely to be overweight than children who complied with both recommendations.

Poorer Children in ED More

Lower-income children made almost twice as many visits to hospital emergency departments as higher-income children in 2005, according to the Agency for Healthcare Research and Quality. AHRQ's analysis found that the rate of emergency department visits by children from low-income communities, where the average household income was under $37,000, was 414 visits for every 1,000 children. For children living in a household where the average income was more than $61,000, the rate was 223 visits for every 1,000 children. AHRQ also found that in 96% of all visits, children were treated—for problems such as respiratory conditions, superficial injuries, middle-ear infections, open wounds, and muscle sprains and strains—and released. The top reasons to admit children from the ED included pneumonia, asthma, acute bronchitis, appendicitis, dehydration, depression, and epileptic convulsions.

Nearly One-Third on Drugs

Thirty percent of children under age 19 years were taking a prescription medication to treat at least one chronic health condition in 2007, according to Medco Health Solutions. Prescriptions for children most often involved asthma or allergy drugs, followed by drugs for attention-deficit/hyperactivity disorder. The number of girls taking ADHD medications rose 72% from 2001 to 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. Overall, it determined that 51% of insured Americans—both children and adults—were taking at least one prescription medication in 2007. “These data do paint a pretty unhealthy picture of America,” said Medco chief medical officer Robert Epstein, in a statement. “But there is a silver lining; they do show that people are receiving treatment which can prevent more serious health problems down the road.”

FDA Pushes for Event Reports

The Food and Drug Administration is working with a medical software firm to get more physicians to submit adverse event reports. Doctors who use Epocrates products have received a message on their personal digital assistant explaining how adverse event reporting works. “Physicians are on the front line when it comes to patient care, and working with Epocrates helps us remind them of safety and error reporting directly at the point of patient contact,” said Dr. Norman Marks, medical director of the FDA's MedWatch program. “We want physicians to understand that by taking a few minutes to submit a report, that action may be the necessary first step that triggers an evaluation and action by the FDA and ultimately reduces the risk of patient harm.”

IAN Registers Nearly 24,000

The Kennedy Krieger Institute has announced that its Interactive Autism Network (IAN), the first U.S. autism registry, has registered nearly 24,000 individuals in its first year and is helping to facilitate approximately 75 research projects across the United States. As part of that total, 299 sets of twins have enrolled in the IAN research protocol, providing the largest collection of twins in published autism research. Twin studies provide an opportunity for researchers to investigate both genetic and environmental factors in autism, but studies historically have found it difficult to recruit twin sets, the institute said. Initial data from the registry indicated that living in a more rural state may delay the diagnosis of autism and limit access to private schools. In addition, another analysis of initial registry data showed that families of children with autism spectrum disorders (ASD) are using a number of autism interventions, ranging from therapy to medication to diet. The average number of simultaneous treatments was five, although half of those with an ASD receive four or fewer.

CMS Softens SCHIP Policy

The Centers for Medicare and Medicaid Services will make it a little easier for states to expand coverage under the State Children's Health Insurance Program. States had expressed concern that they would not be able to achieve the required coverage for 95% of children in families with incomes at or below 200% of the poverty level before expanding SCHIP to children in families with incomes above 250% of the poverty level. In a letter to state health officials, CMS told states that they now may use “a variety of approaches,” including state surveys, to prove they have reached the 95% threshold set by CMS for using federal money to expand SCHIP to families making more money. The agency also told state officials that children already enrolled in SCHIP, children in families with incomes at or below 250% of the poverty level, children whose enrollment costs are paid exclusively with state dollars, and unborn children are not subject to the threshold limits.

Few Meet Activity Guidelines

Children who do not meet American Academy of Pediatrics guidelines for activity and screen time were much more likely to be overweight than children complying with both AAP recommendations, a study in The Journal of Pediatrics showed. The AAP recommends that boys take at least 13,000 steps a day, girls at least 11,000 steps a day, and all children limit their total screen time to 2 hours a day. Researchers from Iowa State University and the National Institute on Media and the Family studied 709 children aged 7–12 years. The children were asked to wear pedometers and track their screen time. Almost 20% of the children were overweight and fewer than half met both AAP recommendations. Those children who did not meet both recommendations were three to four times more likely to be overweight than children who complied with both recommendations.

Poorer Children in ED More

Lower-income children made almost twice as many visits to hospital emergency departments as higher-income children in 2005, according to the Agency for Healthcare Research and Quality. AHRQ's analysis found that the rate of emergency department visits by children from low-income communities, where the average household income was under $37,000, was 414 visits for every 1,000 children. For children living in a household where the average income was more than $61,000, the rate was 223 visits for every 1,000 children. AHRQ also found that in 96% of all visits, children were treated—for problems such as respiratory conditions, superficial injuries, middle-ear infections, open wounds, and muscle sprains and strains—and released. The top reasons to admit children from the ED included pneumonia, asthma, acute bronchitis, appendicitis, dehydration, depression, and epileptic convulsions.

Nearly One-Third on Drugs

Thirty percent of children under age 19 years were taking a prescription medication to treat at least one chronic health condition in 2007, according to Medco Health Solutions. Prescriptions for children most often involved asthma or allergy drugs, followed by drugs for attention-deficit/hyperactivity disorder. The number of girls taking ADHD medications rose 72% from 2001 to 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. Overall, it determined that 51% of insured Americans—both children and adults—were taking at least one prescription medication in 2007. “These data do paint a pretty unhealthy picture of America,” said Medco chief medical officer Robert Epstein, in a statement. “But there is a silver lining; they do show that people are receiving treatment which can prevent more serious health problems down the road.”

FDA Pushes for Event Reports

The Food and Drug Administration is working with a medical software firm to get more physicians to submit adverse event reports. Doctors who use Epocrates products have received a message on their personal digital assistant explaining how adverse event reporting works. “Physicians are on the front line when it comes to patient care, and working with Epocrates helps us remind them of safety and error reporting directly at the point of patient contact,” said Dr. Norman Marks, medical director of the FDA's MedWatch program. “We want physicians to understand that by taking a few minutes to submit a report, that action may be the necessary first step that triggers an evaluation and action by the FDA and ultimately reduces the risk of patient harm.”

IAN Registers Nearly 24,000

The Kennedy Krieger Institute has announced that its Interactive Autism Network (IAN), the first U.S. autism registry, has registered nearly 24,000 individuals in its first year and is helping to facilitate approximately 75 research projects across the United States. As part of that total, 299 sets of twins have enrolled in the IAN research protocol, providing the largest collection of twins in published autism research. Twin studies provide an opportunity for researchers to investigate both genetic and environmental factors in autism, but studies historically have found it difficult to recruit twin sets, the institute said. Initial data from the registry indicated that living in a more rural state may delay the diagnosis of autism and limit access to private schools. In addition, another analysis of initial registry data showed that families of children with autism spectrum disorders (ASD) are using a number of autism interventions, ranging from therapy to medication to diet. The average number of simultaneous treatments was five, although half of those with an ASD receive four or fewer.

CMS Softens SCHIP Policy

The Centers for Medicare and Medicaid Services will make it a little easier for states to expand coverage under the State Children's Health Insurance Program. States had expressed concern that they would not be able to achieve the required coverage for 95% of children in families with incomes at or below 200% of the poverty level before expanding SCHIP to children in families with incomes above 250% of the poverty level. In a letter to state health officials, CMS told states that they now may use “a variety of approaches,” including state surveys, to prove they have reached the 95% threshold set by CMS for using federal money to expand SCHIP to families making more money. The agency also told state officials that children already enrolled in SCHIP, children in families with incomes at or below 250% of the poverty level, children whose enrollment costs are paid exclusively with state dollars, and unborn children are not subject to the threshold limits.

Few Meet Activity Guidelines

Children who do not meet American Academy of Pediatrics guidelines for activity and screen time were much more likely to be overweight than children complying with both AAP recommendations, a study in The Journal of Pediatrics showed. The AAP recommends that boys take at least 13,000 steps a day, girls at least 11,000 steps a day, and all children limit their total screen time to 2 hours a day. Researchers from Iowa State University and the National Institute on Media and the Family studied 709 children aged 7–12 years. The children were asked to wear pedometers and track their screen time. Almost 20% of the children were overweight and fewer than half met both AAP recommendations. Those children who did not meet both recommendations were three to four times more likely to be overweight than children who complied with both recommendations.

Poorer Children in ED More

Lower-income children made almost twice as many visits to hospital emergency departments as higher-income children in 2005, according to the Agency for Healthcare Research and Quality. AHRQ's analysis found that the rate of emergency department visits by children from low-income communities, where the average household income was under $37,000, was 414 visits for every 1,000 children. For children living in a household where the average income was more than $61,000, the rate was 223 visits for every 1,000 children. AHRQ also found that in 96% of all visits, children were treated—for problems such as respiratory conditions, superficial injuries, middle-ear infections, open wounds, and muscle sprains and strains—and released. The top reasons to admit children from the ED included pneumonia, asthma, acute bronchitis, appendicitis, dehydration, depression, and epileptic convulsions.

Nearly One-Third on Drugs

Thirty percent of children under age 19 years were taking a prescription medication to treat at least one chronic health condition in 2007, according to Medco Health Solutions. Prescriptions for children most often involved asthma or allergy drugs, followed by drugs for attention-deficit/hyperactivity disorder. The number of girls taking ADHD medications rose 72% from 2001 to 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. Overall, it determined that 51% of insured Americans—both children and adults—were taking at least one prescription medication in 2007. “These data do paint a pretty unhealthy picture of America,” said Medco chief medical officer Robert Epstein, in a statement. “But there is a silver lining; they do show that people are receiving treatment which can prevent more serious health problems down the road.”

FDA Pushes for Event Reports

The Food and Drug Administration is working with a medical software firm to get more physicians to submit adverse event reports. Doctors who use Epocrates products have received a message on their personal digital assistant explaining how adverse event reporting works. “Physicians are on the front line when it comes to patient care, and working with Epocrates helps us remind them of safety and error reporting directly at the point of patient contact,” said Dr. Norman Marks, medical director of the FDA's MedWatch program. “We want physicians to understand that by taking a few minutes to submit a report, that action may be the necessary first step that triggers an evaluation and action by the FDA and ultimately reduces the risk of patient harm.”

FDA Hiring Experts

The Food and Drug Administration has begun a multiyear hiring initiative and plans to fill more than 1,300 positions within the next several months—nearly triple the number hired from 2005 to 2007, the FDA said. The agency said it is hiring hundreds of individuals with science and medical backgrounds, including biologists, chemists, medical officers, mathematical statisticians, and investigators, in part to implement the FDA's Food Protection Plan and the Import Safety Action Plan. Because of the critical need for scientific personnel, the federal Office of Personnel Management has granted authority to the FDA to expedite hiring of qualified candidates by eliminating certain rating and ranking preferences, making it possible for qualified candidates to start work in as little as 3 weeks.

RUC Recommendations Submitted

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the new Medicare medical home demonstration project to the Centers for Medicare and Medicaid Services. The RUC recommendations are specific to the development of the reporting mechanism and underlying data that CMS will use to determine payments in the medical home demonstration project. These data include physician work relative value and practice expense input recommendations, such as electronic medical record costs and nurse care coordination. The 3-year medical home demonstration project, mandated by Congress in 2006, will begin on Jan. 1, 2009.

Report: Food Safety in Crisis

Approximately 76 million people in the United States—one in four—are sickened by foodborne illnesses each year, and of these, an estimated 325,000 are hospitalized and 5,000 die, according to a report from the advocacy group Trust for America's Health. Medical costs and lost productivity resulting from foodborne illnesses in the United States are estimated to cost $44 billion annually, according to the report. The report blamed obsolete laws, misallocation of resources, and inconsistencies among major food safety agencies for leaving Americans vulnerable to foodborne illnesses. “We will not be able to adequately protect people from contaminated foods if we continue to use 100-year-old practices,” said Dr. Jeff Levi, executive director of the group. “We need to bring food safety into the 21st century. We have the technology. We are way past due for a smart and strategic upgrade.” The report noted that inadequate resources are spent on fighting modern bacteria threats. It also said that federal food safety efforts are fragmented and that no single agency has the ultimate authority or responsibility for food safety.

GAO: Prioritize Infection Control

The federal government is not doing enough to prevent hospital-acquired infections, and the Department of Health and Human Services needs to identify priorities and establish greater consistency in reporting rates, the U.S. Government Accountability Office found in a report. The report, titled “Health-Care-Associated Infections in Hospitals,” notes that the Centers for Disease Control and Prevention has 13 guidelines for hospitals on infection control and prevention, but HHS has not prioritized these practices. In addition, although the CDC's guidelines describe specific clinical practices recommended to reduce infections, the infection control standards that the CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation.

Insurance Costs Rise Fast

Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their incomes in recent years, according to an analysis of government data. The study, which was supported by the Robert Wood Johnson Foundation and conducted by researchers at the University of Minnesota, showed that the proportion of insurance premiums that workers pay for family coverage has remained constant over the years, but the dollar amount that workers contribute has increased substantially. The amount that workers pay for family coverage nationwide increased by 30% (from $8,281 in 2001 to $10,728 in 2005), whereas employee income rose by only 3% during the same time period. Meanwhile, the average cost employers pay for their share of family coverage increased by 28% (from $6,360 to $8,143) during the same time period.

Part D Helps Adherence

The Medicare Part D drug benefit has made it less likely that elderly beneficiaries will forego basic needs such as food or housing in order to pay for medications, a study published in JAMA found. In addition, the study found a small but significant decrease in cost-related medication nonadherence (that is, beneficiaries who fail to adhere to their medication regimens because of cost) among patients with good to excellent health. However, there was no net decrease in cost-related medication nonadherence among the sickest beneficiaries, the study found. Overall, 14% of beneficiaries reported skipping medication doses in 2005, but that figure dropped to less than 12% in 2006 after Part D was introduced.

FDA Hiring Experts

The Food and Drug Administration has begun a multiyear hiring initiative and plans to fill more than 1,300 positions within the next several months—nearly triple the number hired from 2005 to 2007, the FDA said. The agency said it is hiring hundreds of individuals with science and medical backgrounds, including biologists, chemists, medical officers, mathematical statisticians, and investigators, in part to implement the FDA's Food Protection Plan and the Import Safety Action Plan. Because of the critical need for scientific personnel, the federal Office of Personnel Management has granted authority to the FDA to expedite hiring of qualified candidates by eliminating certain rating and ranking preferences, making it possible for qualified candidates to start work in as little as 3 weeks.

RUC Recommendations Submitted

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the new Medicare medical home demonstration project to the Centers for Medicare and Medicaid Services. The RUC recommendations are specific to the development of the reporting mechanism and underlying data that CMS will use to determine payments in the medical home demonstration project. These data include physician work relative value and practice expense input recommendations, such as electronic medical record costs and nurse care coordination. The 3-year medical home demonstration project, mandated by Congress in 2006, will begin on Jan. 1, 2009.

Report: Food Safety in Crisis

Approximately 76 million people in the United States—one in four—are sickened by foodborne illnesses each year, and of these, an estimated 325,000 are hospitalized and 5,000 die, according to a report from the advocacy group Trust for America's Health. Medical costs and lost productivity resulting from foodborne illnesses in the United States are estimated to cost $44 billion annually, according to the report. The report blamed obsolete laws, misallocation of resources, and inconsistencies among major food safety agencies for leaving Americans vulnerable to foodborne illnesses. “We will not be able to adequately protect people from contaminated foods if we continue to use 100-year-old practices,” said Dr. Jeff Levi, executive director of the group. “We need to bring food safety into the 21st century. We have the technology. We are way past due for a smart and strategic upgrade.” The report noted that inadequate resources are spent on fighting modern bacteria threats. It also said that federal food safety efforts are fragmented and that no single agency has the ultimate authority or responsibility for food safety.

GAO: Prioritize Infection Control

The federal government is not doing enough to prevent hospital-acquired infections, and the Department of Health and Human Services needs to identify priorities and establish greater consistency in reporting rates, the U.S. Government Accountability Office found in a report. The report, titled “Health-Care-Associated Infections in Hospitals,” notes that the Centers for Disease Control and Prevention has 13 guidelines for hospitals on infection control and prevention, but HHS has not prioritized these practices. In addition, although the CDC's guidelines describe specific clinical practices recommended to reduce infections, the infection control standards that the CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation.

Insurance Costs Rise Fast

Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their incomes in recent years, according to an analysis of government data. The study, which was supported by the Robert Wood Johnson Foundation and conducted by researchers at the University of Minnesota, showed that the proportion of insurance premiums that workers pay for family coverage has remained constant over the years, but the dollar amount that workers contribute has increased substantially. The amount that workers pay for family coverage nationwide increased by 30% (from $8,281 in 2001 to $10,728 in 2005), whereas employee income rose by only 3% during the same time period. Meanwhile, the average cost employers pay for their share of family coverage increased by 28% (from $6,360 to $8,143) during the same time period.

Part D Helps Adherence

The Medicare Part D drug benefit has made it less likely that elderly beneficiaries will forego basic needs such as food or housing in order to pay for medications, a study published in JAMA found. In addition, the study found a small but significant decrease in cost-related medication nonadherence (that is, beneficiaries who fail to adhere to their medication regimens because of cost) among patients with good to excellent health. However, there was no net decrease in cost-related medication nonadherence among the sickest beneficiaries, the study found. Overall, 14% of beneficiaries reported skipping medication doses in 2005, but that figure dropped to less than 12% in 2006 after Part D was introduced.

FDA Hiring Experts

The Food and Drug Administration has begun a multiyear hiring initiative and plans to fill more than 1,300 positions within the next several months—nearly triple the number hired from 2005 to 2007, the FDA said. The agency said it is hiring hundreds of individuals with science and medical backgrounds, including biologists, chemists, medical officers, mathematical statisticians, and investigators, in part to implement the FDA's Food Protection Plan and the Import Safety Action Plan. Because of the critical need for scientific personnel, the federal Office of Personnel Management has granted authority to the FDA to expedite hiring of qualified candidates by eliminating certain rating and ranking preferences, making it possible for qualified candidates to start work in as little as 3 weeks.

RUC Recommendations Submitted

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the new Medicare medical home demonstration project to the Centers for Medicare and Medicaid Services. The RUC recommendations are specific to the development of the reporting mechanism and underlying data that CMS will use to determine payments in the medical home demonstration project. These data include physician work relative value and practice expense input recommendations, such as electronic medical record costs and nurse care coordination. The 3-year medical home demonstration project, mandated by Congress in 2006, will begin on Jan. 1, 2009.

Report: Food Safety in Crisis

Approximately 76 million people in the United States—one in four—are sickened by foodborne illnesses each year, and of these, an estimated 325,000 are hospitalized and 5,000 die, according to a report from the advocacy group Trust for America's Health. Medical costs and lost productivity resulting from foodborne illnesses in the United States are estimated to cost $44 billion annually, according to the report. The report blamed obsolete laws, misallocation of resources, and inconsistencies among major food safety agencies for leaving Americans vulnerable to foodborne illnesses. “We will not be able to adequately protect people from contaminated foods if we continue to use 100-year-old practices,” said Dr. Jeff Levi, executive director of the group. “We need to bring food safety into the 21st century. We have the technology. We are way past due for a smart and strategic upgrade.” The report noted that inadequate resources are spent on fighting modern bacteria threats. It also said that federal food safety efforts are fragmented and that no single agency has the ultimate authority or responsibility for food safety.

GAO: Prioritize Infection Control

The federal government is not doing enough to prevent hospital-acquired infections, and the Department of Health and Human Services needs to identify priorities and establish greater consistency in reporting rates, the U.S. Government Accountability Office found in a report. The report, titled “Health-Care-Associated Infections in Hospitals,” notes that the Centers for Disease Control and Prevention has 13 guidelines for hospitals on infection control and prevention, but HHS has not prioritized these practices. In addition, although the CDC's guidelines describe specific clinical practices recommended to reduce infections, the infection control standards that the CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation.

Insurance Costs Rise Fast

Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their incomes in recent years, according to an analysis of government data. The study, which was supported by the Robert Wood Johnson Foundation and conducted by researchers at the University of Minnesota, showed that the proportion of insurance premiums that workers pay for family coverage has remained constant over the years, but the dollar amount that workers contribute has increased substantially. The amount that workers pay for family coverage nationwide increased by 30% (from $8,281 in 2001 to $10,728 in 2005), whereas employee income rose by only 3% during the same time period. Meanwhile, the average cost employers pay for their share of family coverage increased by 28% (from $6,360 to $8,143) during the same time period.

Part D Helps Adherence

The Medicare Part D drug benefit has made it less likely that elderly beneficiaries will forego basic needs such as food or housing in order to pay for medications, a study published in JAMA found. In addition, the study found a small but significant decrease in cost-related medication nonadherence (that is, beneficiaries who fail to adhere to their medication regimens because of cost) among patients with good to excellent health. However, there was no net decrease in cost-related medication nonadherence among the sickest beneficiaries, the study found. Overall, 14% of beneficiaries reported skipping medication doses in 2005, but that figure dropped to less than 12% in 2006 after Part D was introduced.

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored by the Healthcare Information and Management Systems Society.

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, he said.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. “It is a single tool that goes from the initial ambulatory visit to the hospital and back again.”

The electronic medical record module is being used by about 1,500 employed by the Cleveland Clinic and about 4,100 who practice in hospitals in the Cleveland Clinic system. Eventually, the system will serve about 33,000 clinicians and support personnel, he said.

On the inpatient side, the system incorporates a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems. “It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he said, noting that the average Cleveland Clinic patient is 65 years old and takes at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

The Cleveland Clinic is releasing certain routine test results via this online system directly to patients. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. The system also produces a “health issues” list for patients to have and share with their physicians.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand. “What we know is, we're going to have to make these tools available to patients and add value,” Dr. Harris said. “This provides health information so they're not generally searching on the Internet.”

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored by the Healthcare Information and Management Systems Society.

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, he said.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. “It is a single tool that goes from the initial ambulatory visit to the hospital and back again.”

The electronic medical record module is being used by about 1,500 employed by the Cleveland Clinic and about 4,100 who practice in hospitals in the Cleveland Clinic system. Eventually, the system will serve about 33,000 clinicians and support personnel, he said.

On the inpatient side, the system incorporates a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems. “It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he said, noting that the average Cleveland Clinic patient is 65 years old and takes at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

The Cleveland Clinic is releasing certain routine test results via this online system directly to patients. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. The system also produces a “health issues” list for patients to have and share with their physicians.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand. “What we know is, we're going to have to make these tools available to patients and add value,” Dr. Harris said. “This provides health information so they're not generally searching on the Internet.”

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored by the Healthcare Information and Management Systems Society.

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, he said.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. “It is a single tool that goes from the initial ambulatory visit to the hospital and back again.”

The electronic medical record module is being used by about 1,500 employed by the Cleveland Clinic and about 4,100 who practice in hospitals in the Cleveland Clinic system. Eventually, the system will serve about 33,000 clinicians and support personnel, he said.

On the inpatient side, the system incorporates a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems. “It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he said, noting that the average Cleveland Clinic patient is 65 years old and takes at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

The Cleveland Clinic is releasing certain routine test results via this online system directly to patients. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. The system also produces a “health issues” list for patients to have and share with their physicians.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand. “What we know is, we're going to have to make these tools available to patients and add value,” Dr. Harris said. “This provides health information so they're not generally searching on the Internet.”

FDA Hiring Experts

The Food and Drug Administration has begun a multiyear hiring initiative and plans to fill more than 1,300 positions within the next several months—nearly triple the number hired during the period spanning 2005 to 2007, the FDA said. The agency said it plans to hire hundreds of individuals with science and medical backgrounds, including biologists, chemists, medical officers, mathematical statisticians, and investigators, in part to implement the FDA's Food Protection Plan and the Import Safety Action Plan. Because of the critical need for scientific personnel, the federal Office of Personnel Management has granted authority to the FDA to expedite hiring of qualified candidates by eliminating certain rating and ranking preferences, which will make it possible for qualified candidates to start work in as little as 3 weeks.

RUC Recommendations Submitted

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the new Medicare medical home demonstration project to the Centers for Medicare and Medicaid Services. The RUC recommendations are specific to the development of the reporting mechanism and underlying data that CMS will use to determine payments in the medical home demonstration project. These data include physician work relative value and practice expense input recommendations, such as electronic medical record costs and coordination of nursing care. The 3-year medical home demonstration project, which was mandated by Congress in 2006, is slated to begin on Jan. 1, 2009.

Report: Food Safety in Crisis

Approximately 76 million Americans—one in four—are sickened by foodborne illnesses every year, and of these, an estimated 325,000 are hospitalized and 5,000 die, according to a report from the advocacy group Trust for America's Health. Medical care and lost productivity resulting from foodborne illnesses in the United States are estimated to cost $44 billion annually, the report said. The report blamed obsolete laws, the misallocation of resources, and inconsistencies among major food safety agencies for leaving Americans vulnerable to foodborne illnesses. “We can't adequately protect people from contaminated foods if we continue to use 100-year-old practices,” said Dr. Jeff Levi, executive director of the group. “We need to bring food safety into the 21st century. We have the technology. We're way past due for a smart and strategic upgrade.” The report noted that inadequate resources are allocated to fighting modern bacteria threats. It also said that no single agency has ultimate authority or responsibility for food safety, resulting in the fragmentation of federal food safety efforts.

GAO: Prioritize Infection Control

The federal government is not doing enough to prevent hospital-acquired infections, and the Department of Health and Human Services needs to identify priorities and establish greater consistency in reporting rates, the U.S. Government Accountability Office found in a report. The report, “Health-Care-Associated Infections in Hospitals,” notes that the Centers for Disease Control and Prevention has 13 guidelines for hospitals on infection control and prevention, but HHS has not prioritized these practices. Also, although CDC's guidelines describe specific clinical practices recommended to reduce infections, the infection control standards that CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation.

Insurance Cost Rises Fast

Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their incomes in recent years, according to an analysis of government data. The study, supported by the Robert Wood Johnson Foundation and conducted by researchers at the University of Minnesota, showed that the proportion of insurance premiums that workers pay for family coverage has remained constant over the years, but the dollar amount that workers contribute has increased substantially. The amount workers pay for family coverage nationwide rose by 30% (from $8,281 in 2001 to $10,728 in 2005), while employee income rose by only 3% in the same time period. Meanwhile, the average cost employers pay for their share of family coverage increased by 28% (from $6,360 to $8,143) during the same time period.

Part D Helps Adherence

The Medicare Part D drug benefit has made it less likely that elderly beneficiaries will forego basic needs such as food or housing in order to pay for medications, a study published in JAMA found. In addition, the study found a small but significant decrease in cost-related medication nonadherence (that is, beneficiaries who fail to adhere to their medication regimens because of cost) among patients with good to excellent health. However, there was no net decrease in cost-related medication nonadherence among the sickest beneficiaries, the study found. Overall, 14% of beneficiaries reported skipping medication doses in 2005, but that figure dropped to less than 12% in 2006 after Part D was introduced.

FDA Hiring Experts

The Food and Drug Administration has begun a multiyear hiring initiative and plans to fill more than 1,300 positions within the next several months—nearly triple the number hired during the period spanning 2005 to 2007, the FDA said. The agency said it plans to hire hundreds of individuals with science and medical backgrounds, including biologists, chemists, medical officers, mathematical statisticians, and investigators, in part to implement the FDA's Food Protection Plan and the Import Safety Action Plan. Because of the critical need for scientific personnel, the federal Office of Personnel Management has granted authority to the FDA to expedite hiring of qualified candidates by eliminating certain rating and ranking preferences, which will make it possible for qualified candidates to start work in as little as 3 weeks.

RUC Recommendations Submitted

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the new Medicare medical home demonstration project to the Centers for Medicare and Medicaid Services. The RUC recommendations are specific to the development of the reporting mechanism and underlying data that CMS will use to determine payments in the medical home demonstration project. These data include physician work relative value and practice expense input recommendations, such as electronic medical record costs and coordination of nursing care. The 3-year medical home demonstration project, which was mandated by Congress in 2006, is slated to begin on Jan. 1, 2009.

Report: Food Safety in Crisis

Approximately 76 million Americans—one in four—are sickened by foodborne illnesses every year, and of these, an estimated 325,000 are hospitalized and 5,000 die, according to a report from the advocacy group Trust for America's Health. Medical care and lost productivity resulting from foodborne illnesses in the United States are estimated to cost $44 billion annually, the report said. The report blamed obsolete laws, the misallocation of resources, and inconsistencies among major food safety agencies for leaving Americans vulnerable to foodborne illnesses. “We can't adequately protect people from contaminated foods if we continue to use 100-year-old practices,” said Dr. Jeff Levi, executive director of the group. “We need to bring food safety into the 21st century. We have the technology. We're way past due for a smart and strategic upgrade.” The report noted that inadequate resources are allocated to fighting modern bacteria threats. It also said that no single agency has ultimate authority or responsibility for food safety, resulting in the fragmentation of federal food safety efforts.

GAO: Prioritize Infection Control

The federal government is not doing enough to prevent hospital-acquired infections, and the Department of Health and Human Services needs to identify priorities and establish greater consistency in reporting rates, the U.S. Government Accountability Office found in a report. The report, “Health-Care-Associated Infections in Hospitals,” notes that the Centers for Disease Control and Prevention has 13 guidelines for hospitals on infection control and prevention, but HHS has not prioritized these practices. Also, although CDC's guidelines describe specific clinical practices recommended to reduce infections, the infection control standards that CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation.

Insurance Cost Rises Fast

Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their incomes in recent years, according to an analysis of government data. The study, supported by the Robert Wood Johnson Foundation and conducted by researchers at the University of Minnesota, showed that the proportion of insurance premiums that workers pay for family coverage has remained constant over the years, but the dollar amount that workers contribute has increased substantially. The amount workers pay for family coverage nationwide rose by 30% (from $8,281 in 2001 to $10,728 in 2005), while employee income rose by only 3% in the same time period. Meanwhile, the average cost employers pay for their share of family coverage increased by 28% (from $6,360 to $8,143) during the same time period.

Part D Helps Adherence

The Medicare Part D drug benefit has made it less likely that elderly beneficiaries will forego basic needs such as food or housing in order to pay for medications, a study published in JAMA found. In addition, the study found a small but significant decrease in cost-related medication nonadherence (that is, beneficiaries who fail to adhere to their medication regimens because of cost) among patients with good to excellent health. However, there was no net decrease in cost-related medication nonadherence among the sickest beneficiaries, the study found. Overall, 14% of beneficiaries reported skipping medication doses in 2005, but that figure dropped to less than 12% in 2006 after Part D was introduced.

FDA Hiring Experts

The Food and Drug Administration has begun a multiyear hiring initiative and plans to fill more than 1,300 positions within the next several months—nearly triple the number hired during the period spanning 2005 to 2007, the FDA said. The agency said it plans to hire hundreds of individuals with science and medical backgrounds, including biologists, chemists, medical officers, mathematical statisticians, and investigators, in part to implement the FDA's Food Protection Plan and the Import Safety Action Plan. Because of the critical need for scientific personnel, the federal Office of Personnel Management has granted authority to the FDA to expedite hiring of qualified candidates by eliminating certain rating and ranking preferences, which will make it possible for qualified candidates to start work in as little as 3 weeks.

RUC Recommendations Submitted

The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the new Medicare medical home demonstration project to the Centers for Medicare and Medicaid Services. The RUC recommendations are specific to the development of the reporting mechanism and underlying data that CMS will use to determine payments in the medical home demonstration project. These data include physician work relative value and practice expense input recommendations, such as electronic medical record costs and coordination of nursing care. The 3-year medical home demonstration project, which was mandated by Congress in 2006, is slated to begin on Jan. 1, 2009.

Report: Food Safety in Crisis

Approximately 76 million Americans—one in four—are sickened by foodborne illnesses every year, and of these, an estimated 325,000 are hospitalized and 5,000 die, according to a report from the advocacy group Trust for America's Health. Medical care and lost productivity resulting from foodborne illnesses in the United States are estimated to cost $44 billion annually, the report said. The report blamed obsolete laws, the misallocation of resources, and inconsistencies among major food safety agencies for leaving Americans vulnerable to foodborne illnesses. “We can't adequately protect people from contaminated foods if we continue to use 100-year-old practices,” said Dr. Jeff Levi, executive director of the group. “We need to bring food safety into the 21st century. We have the technology. We're way past due for a smart and strategic upgrade.” The report noted that inadequate resources are allocated to fighting modern bacteria threats. It also said that no single agency has ultimate authority or responsibility for food safety, resulting in the fragmentation of federal food safety efforts.

GAO: Prioritize Infection Control

The federal government is not doing enough to prevent hospital-acquired infections, and the Department of Health and Human Services needs to identify priorities and establish greater consistency in reporting rates, the U.S. Government Accountability Office found in a report. The report, “Health-Care-Associated Infections in Hospitals,” notes that the Centers for Disease Control and Prevention has 13 guidelines for hospitals on infection control and prevention, but HHS has not prioritized these practices. Also, although CDC's guidelines describe specific clinical practices recommended to reduce infections, the infection control standards that CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation.

Insurance Cost Rises Fast

Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their incomes in recent years, according to an analysis of government data. The study, supported by the Robert Wood Johnson Foundation and conducted by researchers at the University of Minnesota, showed that the proportion of insurance premiums that workers pay for family coverage has remained constant over the years, but the dollar amount that workers contribute has increased substantially. The amount workers pay for family coverage nationwide rose by 30% (from $8,281 in 2001 to $10,728 in 2005), while employee income rose by only 3% in the same time period. Meanwhile, the average cost employers pay for their share of family coverage increased by 28% (from $6,360 to $8,143) during the same time period.

Part D Helps Adherence

The Medicare Part D drug benefit has made it less likely that elderly beneficiaries will forego basic needs such as food or housing in order to pay for medications, a study published in JAMA found. In addition, the study found a small but significant decrease in cost-related medication nonadherence (that is, beneficiaries who fail to adhere to their medication regimens because of cost) among patients with good to excellent health. However, there was no net decrease in cost-related medication nonadherence among the sickest beneficiaries, the study found. Overall, 14% of beneficiaries reported skipping medication doses in 2005, but that figure dropped to less than 12% in 2006 after Part D was introduced.