Jane Anderson

Judge Rules for Journals

A federal judge in Chicago last month ruled that JAMA and the Archives of Internal Medicine do not need to release documents related to the confidential peer review process for studies on cyclooxygenase-2 inhibitors. Attorneys for drugmaker Pfizer Inc. had issued subpoenas last year to obtain all documents relating to the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and their comments, and editors' comments regarding manuscripts, peer review, and publication decisions. But U.S. District Court Judge Arlander Keys of the Northern District of Illinois ruled that the journals can keep the documents confidential. “It is not unreasonable to believe that compelling production of peer review documents would compromise the process,” Judge Keys wrote. Dr. Catherine DeAngelis, JAMA's editor-in-chief, and JAMA's editorial counsel, Joseph Thornton, wrote in an online editorial released March 24 that the ruling supports the confidential peer review process. “For months, JAMA and [Archives of Internal Medicine] consistently argued that the sanctity of the confidential peer review process should not be violated,” they wrote. “JAMA and our Archives journals have historically and deliberately kept unpublished manuscripts and peer review comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment.” A federal judge in Boston has not yet ruled on a similar request by Pfizer to force the release of documents from the New England Journal of Medicine.

Primary Care Survey Planned

The Physicians' Foundation for Health Systems Excellence is seeking to gain insight into the state of primary care through what it says is one of the most ambitious physician surveys ever attempted. Beginning next month, the group will send more than 300,000 surveys to primary care physicians and selected specialists—virtually every active primary care physician nationwide —and to specialists in small, independent practices, according to the group. The survey will ask about the state of primary care practices, and whether or not physicians can maintain patient care services in light of current regulatory and financial burdens. “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” said Dr. Walter Ray, vice president of the Physicians' Foundation and former president of the Medical Association of Georgia, in a statement. The group has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.

FDA to Establish China Offices

In the first step to establishing offices in China, the Food and Drug Administration has received approval from the State Department to create eight full-time permanent FDA positions at U.S. diplomatic posts there, pending authorization from the Chinese government. In addition, the FDA said, it will be hiring five Chinese nationals to work with the new FDA staff at the U.S. Embassy in Beijing and consulates in Shanghai and Guangzhou. The offices will allow greater access for inspections and greater interactions with manufacturers to help assure that products that are shipped to the United States meet U.S. standards for safety and manufacturing quality, the FDA said.

Well-Insured Sent to ASCs

Physicians at physician-owned ambulatory surgery centers are more likely than other providers are to refer well-insured patients to their facilities, while routing Medicaid patients to hospital outpatient clinics, a study in Health Affairs found. The study looked at ASCs in the Philadelphia and Pittsburgh metropolitan areas in 2003. Procedures studied ranged from the removal of benign skin lesions to procedures dealing with hand and wrist disorders such as carpal tunnel syndrome. For most ASCs, the largest common diagnostic groupings were cataract surgery and gastrointestinal disorders and testing, including colonoscopy and endoscopy. The study reviewed the referral patterns of the physicians who accounted for the top 50% of patient referrals to physician-owned ASCs and found that these physicians were significantly more likely to refer Medicaid patients to hospital outpatient departments. The study authors noted that some lawmakers are concerned that continued growth of ASCs will “contribute to a further unraveling of an already fragile safety net. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment. The findings from this paper are consistent with that fear.”

Lottery to Determine Coverage

More than 91,000 Oregonians have signed up for a lottery to determine which uninsured state residents will receive coverage under the Oregon Health Plan, which covers Medicaid-eligible patients and others in the state who can't get coverage, the state's Department of Human Services said. Of the 160,000 uninsured Oregon residents, about 130,000 qualify for the Oregon Health Plan, but the state can afford to cover only up to 24,000 members. Right now, the plan has 17,000 members, and state officials decided that the fairest way to determine who else would receive coverage would be to hold a lottery. Only about 3,000 of the initial 91,000 lottery entrants will receive applications for the health plan, and the state will distribute more applications in batches of 3,000 until program enrollment reaches 24,000, according to the state DHS.

Judge Rules for Journals

A federal judge in Chicago last month ruled that JAMA and the Archives of Internal Medicine do not need to release documents related to the confidential peer review process for studies on cyclooxygenase-2 inhibitors. Attorneys for drugmaker Pfizer Inc. had issued subpoenas last year to obtain all documents relating to the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and their comments, and editors' comments regarding manuscripts, peer review, and publication decisions. But U.S. District Court Judge Arlander Keys of the Northern District of Illinois ruled that the journals can keep the documents confidential. “It is not unreasonable to believe that compelling production of peer review documents would compromise the process,” Judge Keys wrote. Dr. Catherine DeAngelis, JAMA's editor-in-chief, and JAMA's editorial counsel, Joseph Thornton, wrote in an online editorial released March 24 that the ruling supports the confidential peer review process. “For months, JAMA and [Archives of Internal Medicine] consistently argued that the sanctity of the confidential peer review process should not be violated,” they wrote. “JAMA and our Archives journals have historically and deliberately kept unpublished manuscripts and peer review comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment.” A federal judge in Boston has not yet ruled on a similar request by Pfizer to force the release of documents from the New England Journal of Medicine.

Primary Care Survey Planned

The Physicians' Foundation for Health Systems Excellence is seeking to gain insight into the state of primary care through what it says is one of the most ambitious physician surveys ever attempted. Beginning next month, the group will send more than 300,000 surveys to primary care physicians and selected specialists—virtually every active primary care physician nationwide —and to specialists in small, independent practices, according to the group. The survey will ask about the state of primary care practices, and whether or not physicians can maintain patient care services in light of current regulatory and financial burdens. “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” said Dr. Walter Ray, vice president of the Physicians' Foundation and former president of the Medical Association of Georgia, in a statement. The group has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.

FDA to Establish China Offices

In the first step to establishing offices in China, the Food and Drug Administration has received approval from the State Department to create eight full-time permanent FDA positions at U.S. diplomatic posts there, pending authorization from the Chinese government. In addition, the FDA said, it will be hiring five Chinese nationals to work with the new FDA staff at the U.S. Embassy in Beijing and consulates in Shanghai and Guangzhou. The offices will allow greater access for inspections and greater interactions with manufacturers to help assure that products that are shipped to the United States meet U.S. standards for safety and manufacturing quality, the FDA said.

Well-Insured Sent to ASCs

Physicians at physician-owned ambulatory surgery centers are more likely than other providers are to refer well-insured patients to their facilities, while routing Medicaid patients to hospital outpatient clinics, a study in Health Affairs found. The study looked at ASCs in the Philadelphia and Pittsburgh metropolitan areas in 2003. Procedures studied ranged from the removal of benign skin lesions to procedures dealing with hand and wrist disorders such as carpal tunnel syndrome. For most ASCs, the largest common diagnostic groupings were cataract surgery and gastrointestinal disorders and testing, including colonoscopy and endoscopy. The study reviewed the referral patterns of the physicians who accounted for the top 50% of patient referrals to physician-owned ASCs and found that these physicians were significantly more likely to refer Medicaid patients to hospital outpatient departments. The study authors noted that some lawmakers are concerned that continued growth of ASCs will “contribute to a further unraveling of an already fragile safety net. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment. The findings from this paper are consistent with that fear.”

Lottery to Determine Coverage

More than 91,000 Oregonians have signed up for a lottery to determine which uninsured state residents will receive coverage under the Oregon Health Plan, which covers Medicaid-eligible patients and others in the state who can't get coverage, the state's Department of Human Services said. Of the 160,000 uninsured Oregon residents, about 130,000 qualify for the Oregon Health Plan, but the state can afford to cover only up to 24,000 members. Right now, the plan has 17,000 members, and state officials decided that the fairest way to determine who else would receive coverage would be to hold a lottery. Only about 3,000 of the initial 91,000 lottery entrants will receive applications for the health plan, and the state will distribute more applications in batches of 3,000 until program enrollment reaches 24,000, according to the state DHS.

Judge Rules for Journals

A federal judge in Chicago last month ruled that JAMA and the Archives of Internal Medicine do not need to release documents related to the confidential peer review process for studies on cyclooxygenase-2 inhibitors. Attorneys for drugmaker Pfizer Inc. had issued subpoenas last year to obtain all documents relating to the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and their comments, and editors' comments regarding manuscripts, peer review, and publication decisions. But U.S. District Court Judge Arlander Keys of the Northern District of Illinois ruled that the journals can keep the documents confidential. “It is not unreasonable to believe that compelling production of peer review documents would compromise the process,” Judge Keys wrote. Dr. Catherine DeAngelis, JAMA's editor-in-chief, and JAMA's editorial counsel, Joseph Thornton, wrote in an online editorial released March 24 that the ruling supports the confidential peer review process. “For months, JAMA and [Archives of Internal Medicine] consistently argued that the sanctity of the confidential peer review process should not be violated,” they wrote. “JAMA and our Archives journals have historically and deliberately kept unpublished manuscripts and peer review comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment.” A federal judge in Boston has not yet ruled on a similar request by Pfizer to force the release of documents from the New England Journal of Medicine.

Primary Care Survey Planned

The Physicians' Foundation for Health Systems Excellence is seeking to gain insight into the state of primary care through what it says is one of the most ambitious physician surveys ever attempted. Beginning next month, the group will send more than 300,000 surveys to primary care physicians and selected specialists—virtually every active primary care physician nationwide —and to specialists in small, independent practices, according to the group. The survey will ask about the state of primary care practices, and whether or not physicians can maintain patient care services in light of current regulatory and financial burdens. “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” said Dr. Walter Ray, vice president of the Physicians' Foundation and former president of the Medical Association of Georgia, in a statement. The group has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.

FDA to Establish China Offices

In the first step to establishing offices in China, the Food and Drug Administration has received approval from the State Department to create eight full-time permanent FDA positions at U.S. diplomatic posts there, pending authorization from the Chinese government. In addition, the FDA said, it will be hiring five Chinese nationals to work with the new FDA staff at the U.S. Embassy in Beijing and consulates in Shanghai and Guangzhou. The offices will allow greater access for inspections and greater interactions with manufacturers to help assure that products that are shipped to the United States meet U.S. standards for safety and manufacturing quality, the FDA said.

Well-Insured Sent to ASCs

Physicians at physician-owned ambulatory surgery centers are more likely than other providers are to refer well-insured patients to their facilities, while routing Medicaid patients to hospital outpatient clinics, a study in Health Affairs found. The study looked at ASCs in the Philadelphia and Pittsburgh metropolitan areas in 2003. Procedures studied ranged from the removal of benign skin lesions to procedures dealing with hand and wrist disorders such as carpal tunnel syndrome. For most ASCs, the largest common diagnostic groupings were cataract surgery and gastrointestinal disorders and testing, including colonoscopy and endoscopy. The study reviewed the referral patterns of the physicians who accounted for the top 50% of patient referrals to physician-owned ASCs and found that these physicians were significantly more likely to refer Medicaid patients to hospital outpatient departments. The study authors noted that some lawmakers are concerned that continued growth of ASCs will “contribute to a further unraveling of an already fragile safety net. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment. The findings from this paper are consistent with that fear.”

Lottery to Determine Coverage

More than 91,000 Oregonians have signed up for a lottery to determine which uninsured state residents will receive coverage under the Oregon Health Plan, which covers Medicaid-eligible patients and others in the state who can't get coverage, the state's Department of Human Services said. Of the 160,000 uninsured Oregon residents, about 130,000 qualify for the Oregon Health Plan, but the state can afford to cover only up to 24,000 members. Right now, the plan has 17,000 members, and state officials decided that the fairest way to determine who else would receive coverage would be to hold a lottery. Only about 3,000 of the initial 91,000 lottery entrants will receive applications for the health plan, and the state will distribute more applications in batches of 3,000 until program enrollment reaches 24,000, according to the state DHS.

Judge Rules for Journals

A federal judge in Chicago last month ruled that JAMA and the Archives of Internal Medicine do not need to release documents related to the confidential peer review process for studies on cyclooxygenase-2 inhibitors. Attorneys for drugmaker Pfizer Inc. had issued subpoenas last year to obtain all documents relating to the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and their comments, and editors' comments regarding manuscripts, peer review, and publication decisions. But U.S. District Court Judge Arlander Keys of the Northern District of Illinois ruled that the journals can keep the documents confidential. “It is not unreasonable to believe that compelling production of peer review documents would compromise the process,” Judge Keys wrote. Dr. Catherine DeAngelis, JAMA's editor-in-chief, and JAMA's editorial counsel, Joseph Thornton, wrote in an online editorial that the ruling supports the confidential peer review process. “For months, JAMA and [Archives of Internal Medicine] consistently argued that the sanctity of the confidential peer review process should not be violated,” they wrote. “JAMA and our Archives journals have historically and deliberately kept unpublished manuscripts and peer review comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment.” A federal judge in Boston has not yet ruled on a similar request by Pfizer to force the release of documents from the New England Journal of Medicine.

Primary Care Survey Planned

The Physicians' Foundation for Health Systems Excellence is seeking to gain insight into the state of primary care through what it says is one of the most ambitious physician surveys ever attempted. Beginning next month, the group will send more than 300,000 surveys to primary care physicians and selected specialists—virtually every active primary care physician nationwide—and to specialists in small, independent practices, according to the group. The survey will ask about the state of primary care practices, and whether or not physicians can maintain patient care services in light of current regulatory and financial burdens. “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” said Dr. Walter Ray, vice president of the Physicians' Foundation and former president of the Medical Association of Georgia, in a statement. The group has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.

FDA to Establish China Offices

In the first step to establishing offices in China, the Food and Drug Administration has received approval from the State Department to create eight full-time permanent FDA positions at U.S. diplomatic posts there, pending authorization from the Chinese government. In addition, the FDA said, it will be hiring five Chinese nationals to work with the new FDA staff at the U.S. Embassy in Beijing and consulates in Shanghai and Guangzhou. The offices will allow greater access for inspections and greater interactions with manufacturers to help ensure that products that are shipped to the United States meet U.S. standards for safety and manufacturing quality, the FDA said.

Well-Insured Sent to ASCs

Physicians at physician-owned ambulatory surgery centers are more likely than other providers are to refer well-insured patients to their facilities, while routing Medicaid patients to hospital outpatient clinics, a study in Health Affairs found. The study looked at ASCs in the Philadelphia and Pittsburgh metropolitan areas in 2003. Procedures studied ranged from the removal of benign skin lesions to procedures dealing with hand and wrist disorders such as carpal tunnel syndrome. For most ASCs, the largest common diagnostic groupings were cataract surgery and gastrointestinal disorders and testing, including colonoscopy and endoscopy. The study reviewed the referral patterns of the physicians who accounted for the top 50% of patient referrals to physician-owned ASCs and found that these physicians were significantly more likely to ?refer Medicaid patients to hospital outpatient departments. The study authors noted that some lawmakers are concerned that continued growth of ASCs will “contribute to a further unraveling of an already fragile safety net. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment. The findings from this paper are consistent with that fear.”

Lottery to Determine Coverage

More than 91,000 Oregonians have signed up for a lottery to determine which uninsured state residents will receive coverage under the Oregon Health Plan, which covers Medicaid-eligible patients and others in the state who can't get coverage, the state's Department of Human Services said. Of the 160,000 uninsured Oregon residents, about 130,000 qualify for the Oregon Health Plan, but the state can afford to cover only up to 24,000 members. Right now, the plan has 17,000 members, and state officials decided that the fairest way to determine who else would receive coverage would be to hold a lottery. Only about 3,000 of the initial 91,000 lottery entrants will receive applications for the health plan, and the state will distribute more applications in batches of 3,000 until program enrollment reaches 24,000, according to the state DHS.

Judge Rules for Journals

A federal judge in Chicago last month ruled that JAMA and the Archives of Internal Medicine do not need to release documents related to the confidential peer review process for studies on cyclooxygenase-2 inhibitors. Attorneys for drugmaker Pfizer Inc. had issued subpoenas last year to obtain all documents relating to the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and their comments, and editors' comments regarding manuscripts, peer review, and publication decisions. But U.S. District Court Judge Arlander Keys of the Northern District of Illinois ruled that the journals can keep the documents confidential. “It is not unreasonable to believe that compelling production of peer review documents would compromise the process,” Judge Keys wrote. Dr. Catherine DeAngelis, JAMA's editor-in-chief, and JAMA's editorial counsel, Joseph Thornton, wrote in an online editorial that the ruling supports the confidential peer review process. “For months, JAMA and [Archives of Internal Medicine] consistently argued that the sanctity of the confidential peer review process should not be violated,” they wrote. “JAMA and our Archives journals have historically and deliberately kept unpublished manuscripts and peer review comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment.” A federal judge in Boston has not yet ruled on a similar request by Pfizer to force the release of documents from the New England Journal of Medicine.

Primary Care Survey Planned

The Physicians' Foundation for Health Systems Excellence is seeking to gain insight into the state of primary care through what it says is one of the most ambitious physician surveys ever attempted. Beginning next month, the group will send more than 300,000 surveys to primary care physicians and selected specialists—virtually every active primary care physician nationwide—and to specialists in small, independent practices, according to the group. The survey will ask about the state of primary care practices, and whether or not physicians can maintain patient care services in light of current regulatory and financial burdens. “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” said Dr. Walter Ray, vice president of the Physicians' Foundation and former president of the Medical Association of Georgia, in a statement. The group has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.

FDA to Establish China Offices

In the first step to establishing offices in China, the Food and Drug Administration has received approval from the State Department to create eight full-time permanent FDA positions at U.S. diplomatic posts there, pending authorization from the Chinese government. In addition, the FDA said, it will be hiring five Chinese nationals to work with the new FDA staff at the U.S. Embassy in Beijing and consulates in Shanghai and Guangzhou. The offices will allow greater access for inspections and greater interactions with manufacturers to help ensure that products that are shipped to the United States meet U.S. standards for safety and manufacturing quality, the FDA said.

Well-Insured Sent to ASCs

Physicians at physician-owned ambulatory surgery centers are more likely than other providers are to refer well-insured patients to their facilities, while routing Medicaid patients to hospital outpatient clinics, a study in Health Affairs found. The study looked at ASCs in the Philadelphia and Pittsburgh metropolitan areas in 2003. Procedures studied ranged from the removal of benign skin lesions to procedures dealing with hand and wrist disorders such as carpal tunnel syndrome. For most ASCs, the largest common diagnostic groupings were cataract surgery and gastrointestinal disorders and testing, including colonoscopy and endoscopy. The study reviewed the referral patterns of the physicians who accounted for the top 50% of patient referrals to physician-owned ASCs and found that these physicians were significantly more likely to ?refer Medicaid patients to hospital outpatient departments. The study authors noted that some lawmakers are concerned that continued growth of ASCs will “contribute to a further unraveling of an already fragile safety net. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment. The findings from this paper are consistent with that fear.”

Lottery to Determine Coverage

More than 91,000 Oregonians have signed up for a lottery to determine which uninsured state residents will receive coverage under the Oregon Health Plan, which covers Medicaid-eligible patients and others in the state who can't get coverage, the state's Department of Human Services said. Of the 160,000 uninsured Oregon residents, about 130,000 qualify for the Oregon Health Plan, but the state can afford to cover only up to 24,000 members. Right now, the plan has 17,000 members, and state officials decided that the fairest way to determine who else would receive coverage would be to hold a lottery. Only about 3,000 of the initial 91,000 lottery entrants will receive applications for the health plan, and the state will distribute more applications in batches of 3,000 until program enrollment reaches 24,000, according to the state DHS.

Judge Rules for Journals

A federal judge in Chicago last month ruled that JAMA and the Archives of Internal Medicine do not need to release documents related to the confidential peer review process for studies on cyclooxygenase-2 inhibitors. Attorneys for drugmaker Pfizer Inc. had issued subpoenas last year to obtain all documents relating to the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and their comments, and editors' comments regarding manuscripts, peer review, and publication decisions. But U.S. District Court Judge Arlander Keys of the Northern District of Illinois ruled that the journals can keep the documents confidential. “It is not unreasonable to believe that compelling production of peer review documents would compromise the process,” Judge Keys wrote. Dr. Catherine DeAngelis, JAMA's editor-in-chief, and JAMA's editorial counsel, Joseph Thornton, wrote in an online editorial that the ruling supports the confidential peer review process. “For months, JAMA and [Archives of Internal Medicine] consistently argued that the sanctity of the confidential peer review process should not be violated,” they wrote. “JAMA and our Archives journals have historically and deliberately kept unpublished manuscripts and peer review comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment.” A federal judge in Boston has not yet ruled on a similar request by Pfizer to force the release of documents from the New England Journal of Medicine.

Primary Care Survey Planned

The Physicians' Foundation for Health Systems Excellence is seeking to gain insight into the state of primary care through what it says is one of the most ambitious physician surveys ever attempted. Beginning next month, the group will send more than 300,000 surveys to primary care physicians and selected specialists—virtually every active primary care physician nationwide—and to specialists in small, independent practices, according to the group. The survey will ask about the state of primary care practices, and whether or not physicians can maintain patient care services in light of current regulatory and financial burdens. “If the survey indicates that medical practice itself is in jeopardy, that urgent message needs to be heard by policy makers and the public,” said Dr. Walter Ray, vice president of the Physicians' Foundation and former president of the Medical Association of Georgia, in a statement. The group has partnered with national physician search and consulting firm Merritt, Hawkins & Associates to develop and mail the survey.

FDA to Establish China Offices

In the first step to establishing offices in China, the Food and Drug Administration has received approval from the State Department to create eight full-time permanent FDA positions at U.S. diplomatic posts there, pending authorization from the Chinese government. In addition, the FDA said, it will be hiring five Chinese nationals to work with the new FDA staff at the U.S. Embassy in Beijing and consulates in Shanghai and Guangzhou. The offices will allow greater access for inspections and greater interactions with manufacturers to help ensure that products that are shipped to the United States meet U.S. standards for safety and manufacturing quality, the FDA said.

Well-Insured Sent to ASCs

Physicians at physician-owned ambulatory surgery centers are more likely than other providers are to refer well-insured patients to their facilities, while routing Medicaid patients to hospital outpatient clinics, a study in Health Affairs found. The study looked at ASCs in the Philadelphia and Pittsburgh metropolitan areas in 2003. Procedures studied ranged from the removal of benign skin lesions to procedures dealing with hand and wrist disorders such as carpal tunnel syndrome. For most ASCs, the largest common diagnostic groupings were cataract surgery and gastrointestinal disorders and testing, including colonoscopy and endoscopy. The study reviewed the referral patterns of the physicians who accounted for the top 50% of patient referrals to physician-owned ASCs and found that these physicians were significantly more likely to ?refer Medicaid patients to hospital outpatient departments. The study authors noted that some lawmakers are concerned that continued growth of ASCs will “contribute to a further unraveling of an already fragile safety net. The worry is that physician-owned facilities will siphon off profit centers that have traditionally cross-subsidized care for uninsured and Medicaid patients, as well as unprofitable services such as burn treatment. The findings from this paper are consistent with that fear.”

Lottery to Determine Coverage

More than 91,000 Oregonians have signed up for a lottery to determine which uninsured state residents will receive coverage under the Oregon Health Plan, which covers Medicaid-eligible patients and others in the state who can't get coverage, the state's Department of Human Services said. Of the 160,000 uninsured Oregon residents, about 130,000 qualify for the Oregon Health Plan, but the state can afford to cover only up to 24,000 members. Right now, the plan has 17,000 members, and state officials decided that the fairest way to determine who else would receive coverage would be to hold a lottery. Only about 3,000 of the initial 91,000 lottery entrants will receive applications for the health plan, and the state will distribute more applications in batches of 3,000 until program enrollment reaches 24,000, according to the state DHS.

MassHealth, Massachusetts' Medicaid program, has begun requiring primary care doctors and nurses to use a standardized behavioral health screening tool at every well-child visit for children under the age of 21.

The new requirement—which took effect Dec. 31—resulted from a 2007 U.S. District Court decision in Rosie D. v. Romney. In its decision, the court ruled that Medicaid-eligible children with “serious emotional disturbances” were not receiving appropriate mental health screenings, service coordination, and home-based treatment services, and ordered MassHealth to implement a plan to improve care.

As a result, MassHealth is putting in place several initiatives designed to improve mental health services for Medicaid beneficiaries under age 21 years, said MassHealth spokeswoman Jennifer Kritz in an interview.

For the new standardized behavioral health screens by primary care physicians and nurses, Medicaid will ask clinicians to choose from among eight standardized tools for the screening, depending on the age of the patient, and will pay for the screening in addition to the standard office visit reimbursement.

The goal is to help detect issues with behavioral health, social-emotional well-being, or mental health in the state's 460,000 children and young adults covered by Medicaid, Ms. Kritz said. If a potential problem is detected, the primary care provider will refer the patient to a mental health practitioner, according to the state. A parent or guardian can decline screening for a child if they wish.

Other measures prompted by the Rosie D. case will take effect over the next 2 years, Ms. Kritz said.

Starting in late 2008, children who see a behavioral health provider will be assessed by that provider using the Child and Adolescent Needs and Strengths (CANS) tool.

Massachusetts faces challenges in providing mental health services to those additional children and young adults who are expected to be identified as part of the stepped-up screening, according to the Massachusetts Medicaid Policy Institute.

“Massachusetts faces a shortage of qualified 'child-trained' providers … as well as an inadequate number of bilingual and multicultural providers,” the institute said in an issue brief last year. “Existing providers also are not spread out evenly across the state, making access a problem in many areas. One of the state's biggest challenges will be to engage more qualified providers and train them in the new delivery structure, which is vastly different from the existing model of care that most clinicians are used to.”

MassHealth, Massachusetts' Medicaid program, has begun requiring primary care doctors and nurses to use a standardized behavioral health screening tool at every well-child visit for children under the age of 21.

The new requirement—which took effect Dec. 31—resulted from a 2007 U.S. District Court decision in Rosie D. v. Romney. In its decision, the court ruled that Medicaid-eligible children with “serious emotional disturbances” were not receiving appropriate mental health screenings, service coordination, and home-based treatment services, and ordered MassHealth to implement a plan to improve care.

As a result, MassHealth is putting in place several initiatives designed to improve mental health services for Medicaid beneficiaries under age 21 years, said MassHealth spokeswoman Jennifer Kritz in an interview.

For the new standardized behavioral health screens by primary care physicians and nurses, Medicaid will ask clinicians to choose from among eight standardized tools for the screening, depending on the age of the patient, and will pay for the screening in addition to the standard office visit reimbursement.

The goal is to help detect issues with behavioral health, social-emotional well-being, or mental health in the state's 460,000 children and young adults covered by Medicaid, Ms. Kritz said. If a potential problem is detected, the primary care provider will refer the patient to a mental health practitioner, according to the state. A parent or guardian can decline screening for a child if they wish.

Other measures prompted by the Rosie D. case will take effect over the next 2 years, Ms. Kritz said.

Starting in late 2008, children who see a behavioral health provider will be assessed by that provider using the Child and Adolescent Needs and Strengths (CANS) tool.

Massachusetts faces challenges in providing mental health services to those additional children and young adults who are expected to be identified as part of the stepped-up screening, according to the Massachusetts Medicaid Policy Institute.

“Massachusetts faces a shortage of qualified 'child-trained' providers … as well as an inadequate number of bilingual and multicultural providers,” the institute said in an issue brief last year. “Existing providers also are not spread out evenly across the state, making access a problem in many areas. One of the state's biggest challenges will be to engage more qualified providers and train them in the new delivery structure, which is vastly different from the existing model of care that most clinicians are used to.”

MassHealth, Massachusetts' Medicaid program, has begun requiring primary care doctors and nurses to use a standardized behavioral health screening tool at every well-child visit for children under the age of 21.

The new requirement—which took effect Dec. 31—resulted from a 2007 U.S. District Court decision in Rosie D. v. Romney. In its decision, the court ruled that Medicaid-eligible children with “serious emotional disturbances” were not receiving appropriate mental health screenings, service coordination, and home-based treatment services, and ordered MassHealth to implement a plan to improve care.

As a result, MassHealth is putting in place several initiatives designed to improve mental health services for Medicaid beneficiaries under age 21 years, said MassHealth spokeswoman Jennifer Kritz in an interview.

For the new standardized behavioral health screens by primary care physicians and nurses, Medicaid will ask clinicians to choose from among eight standardized tools for the screening, depending on the age of the patient, and will pay for the screening in addition to the standard office visit reimbursement.

The goal is to help detect issues with behavioral health, social-emotional well-being, or mental health in the state's 460,000 children and young adults covered by Medicaid, Ms. Kritz said. If a potential problem is detected, the primary care provider will refer the patient to a mental health practitioner, according to the state. A parent or guardian can decline screening for a child if they wish.

Other measures prompted by the Rosie D. case will take effect over the next 2 years, Ms. Kritz said.

Starting in late 2008, children who see a behavioral health provider will be assessed by that provider using the Child and Adolescent Needs and Strengths (CANS) tool.

Massachusetts faces challenges in providing mental health services to those additional children and young adults who are expected to be identified as part of the stepped-up screening, according to the Massachusetts Medicaid Policy Institute.

“Massachusetts faces a shortage of qualified 'child-trained' providers … as well as an inadequate number of bilingual and multicultural providers,” the institute said in an issue brief last year. “Existing providers also are not spread out evenly across the state, making access a problem in many areas. One of the state's biggest challenges will be to engage more qualified providers and train them in the new delivery structure, which is vastly different from the existing model of care that most clinicians are used to.”

Nursery Product Injuries Rise

Nursery products such as cribs, high chairs, and walkers were involved in 66,400 injuries to children under age 5 years who were treated in emergency departments in 2006, an 8% increase over 2005, the Consumer Product Safety Commission (CPSC) said. Infant carriers, car seats, cribs, crib mattresses, strollers, and baby carriages were associated with the most injuries. Falls were the leading cause of injury, and the head was the most frequently injured body part, the CPSC said. In addition, during 2002–2004, CPSC staff received reports of 241 deaths (an average of 80 per year) associated with nursery products among children in the same age group. Cribs, baby baths, bath seats, and playpens were associated with most of the deaths. The products themselves weren't necessarily to blame for the injuries and deaths, according to the report: “It is important to note that many of the incidents were associated with a nursery product but not necessarily caused by the product.”

Care Continuity Improves Screening

Complete continuity of care in infancy—seeing the same physician or provider for every visit—dramatically improved the likelihood that children received critical health screenings during their first 2 years, researchers reported in Pediatrics. The investigators looked at Medicaid-enrolled infants and found that for total ambulatory visits, children who had complete continuity of care were more than twice as likely to receive lead screening, compared with children who saw a different practitioner for every visit. In addition, children with complete continuity were 1.5–2 times more likely to have been screened for tuberculosis. Continuity also showed a lesser but still significant effect on anemia screening. It was critical for the infants to see the same practitioner at every visit, not just at well-child care visits, the researchers said. “Continuity of care is an important part of ensuring adequate preventive service delivery to a vulnerable population,” they concluded.

Head Start Warns of Cuts

The National Head Start Association (NHSA) has warned that the Bush administration is using a series of enrollment cuts and new regulatory requirements in an attempt to dismantle the Head Start program. The administration's proposed 2009 budget—which will require congressional approval—would slice more than 14,065 Head Start child slots, according to the White House. That makes it the first enrollment reduction to be included in a president's formal budget proposal since the program's launch in 1965, the NHSA said. In addition, cuts of more than $10 million in 2008 funding left many Head Start programs underfunded, the NHSA said. California, Texas, New York, Illinois, Ohio, and Florida stand to lose the most slots for Head Start enrollment, the group said.

Senators Promote Dental Care Bill

Three U.S. lawmakers have introduced legislation designed to increase access to dental care among poor children in an effort to prevent more children from dying because of complications from an untreated tooth ache. The bill from Sen. Sherrod Brown (D-Ohio), Sen. Thad Cochran (R-Miss.), and Rep. Elijah Cummings (D-Md.) would provide grants to community health centers to expand dental services; provide tax credits for dentists who treat Medicaid, Children's Health Insurance Program (CHIP), and uninsured patients; and create a new allied dental health professional pilot program. The legislation also would direct the Centers for Disease Control and Prevention to launch a public education campaign on children's dental health, and would provide grants to train dentists, hygienists, and dental students in pediatric dentistry. In February 2007, 12-year-old Maryland resident Deamonte Driver, who was homeless, died when an untreated tooth infection spread to his brain. “There is no excuse for Deamonte Driver's death, and the fault lies with every single one of us for letting this child slip through the cracks,” said Rep. Cummings in a statement.

Abuse of Children on the Rise

Children accounted for more than half of all abuse cases treated at U.S. hospitals in 2005, according to the Agency for Healthcare Research and Quality (AHRQ). About one-third of those children suffered from neglect, physical and psychological abuse, or physical battery such as shaken child syndrome, the agency said in its most recent News and Numbers release. The number of violence-related hospitalizations among both adults and children increased by 24,000 between 2002 and 2005, and about 4% of these patients were victims of sexual or other abuse, AHRQ said. Roughly 66% of all patients admitted to the hospital because of violence had attempted suicide or injured themselves on purpose and about 31% were victims of attempted murder, fights, rape, or other assaults.

Nursery Product Injuries Rise

Nursery products such as cribs, high chairs, and walkers were involved in 66,400 injuries to children under age 5 years who were treated in emergency departments in 2006, an 8% increase over 2005, the Consumer Product Safety Commission (CPSC) said. Infant carriers, car seats, cribs, crib mattresses, strollers, and baby carriages were associated with the most injuries. Falls were the leading cause of injury, and the head was the most frequently injured body part, the CPSC said. In addition, during 2002–2004, CPSC staff received reports of 241 deaths (an average of 80 per year) associated with nursery products among children in the same age group. Cribs, baby baths, bath seats, and playpens were associated with most of the deaths. The products themselves weren't necessarily to blame for the injuries and deaths, according to the report: “It is important to note that many of the incidents were associated with a nursery product but not necessarily caused by the product.”

Care Continuity Improves Screening

Complete continuity of care in infancy—seeing the same physician or provider for every visit—dramatically improved the likelihood that children received critical health screenings during their first 2 years, researchers reported in Pediatrics. The investigators looked at Medicaid-enrolled infants and found that for total ambulatory visits, children who had complete continuity of care were more than twice as likely to receive lead screening, compared with children who saw a different practitioner for every visit. In addition, children with complete continuity were 1.5–2 times more likely to have been screened for tuberculosis. Continuity also showed a lesser but still significant effect on anemia screening. It was critical for the infants to see the same practitioner at every visit, not just at well-child care visits, the researchers said. “Continuity of care is an important part of ensuring adequate preventive service delivery to a vulnerable population,” they concluded.

Head Start Warns of Cuts

The National Head Start Association (NHSA) has warned that the Bush administration is using a series of enrollment cuts and new regulatory requirements in an attempt to dismantle the Head Start program. The administration's proposed 2009 budget—which will require congressional approval—would slice more than 14,065 Head Start child slots, according to the White House. That makes it the first enrollment reduction to be included in a president's formal budget proposal since the program's launch in 1965, the NHSA said. In addition, cuts of more than $10 million in 2008 funding left many Head Start programs underfunded, the NHSA said. California, Texas, New York, Illinois, Ohio, and Florida stand to lose the most slots for Head Start enrollment, the group said.

Senators Promote Dental Care Bill

Three U.S. lawmakers have introduced legislation designed to increase access to dental care among poor children in an effort to prevent more children from dying because of complications from an untreated tooth ache. The bill from Sen. Sherrod Brown (D-Ohio), Sen. Thad Cochran (R-Miss.), and Rep. Elijah Cummings (D-Md.) would provide grants to community health centers to expand dental services; provide tax credits for dentists who treat Medicaid, Children's Health Insurance Program (CHIP), and uninsured patients; and create a new allied dental health professional pilot program. The legislation also would direct the Centers for Disease Control and Prevention to launch a public education campaign on children's dental health, and would provide grants to train dentists, hygienists, and dental students in pediatric dentistry. In February 2007, 12-year-old Maryland resident Deamonte Driver, who was homeless, died when an untreated tooth infection spread to his brain. “There is no excuse for Deamonte Driver's death, and the fault lies with every single one of us for letting this child slip through the cracks,” said Rep. Cummings in a statement.

Abuse of Children on the Rise

Children accounted for more than half of all abuse cases treated at U.S. hospitals in 2005, according to the Agency for Healthcare Research and Quality (AHRQ). About one-third of those children suffered from neglect, physical and psychological abuse, or physical battery such as shaken child syndrome, the agency said in its most recent News and Numbers release. The number of violence-related hospitalizations among both adults and children increased by 24,000 between 2002 and 2005, and about 4% of these patients were victims of sexual or other abuse, AHRQ said. Roughly 66% of all patients admitted to the hospital because of violence had attempted suicide or injured themselves on purpose and about 31% were victims of attempted murder, fights, rape, or other assaults.

Nursery Product Injuries Rise

Nursery products such as cribs, high chairs, and walkers were involved in 66,400 injuries to children under age 5 years who were treated in emergency departments in 2006, an 8% increase over 2005, the Consumer Product Safety Commission (CPSC) said. Infant carriers, car seats, cribs, crib mattresses, strollers, and baby carriages were associated with the most injuries. Falls were the leading cause of injury, and the head was the most frequently injured body part, the CPSC said. In addition, during 2002–2004, CPSC staff received reports of 241 deaths (an average of 80 per year) associated with nursery products among children in the same age group. Cribs, baby baths, bath seats, and playpens were associated with most of the deaths. The products themselves weren't necessarily to blame for the injuries and deaths, according to the report: “It is important to note that many of the incidents were associated with a nursery product but not necessarily caused by the product.”

Care Continuity Improves Screening

Complete continuity of care in infancy—seeing the same physician or provider for every visit—dramatically improved the likelihood that children received critical health screenings during their first 2 years, researchers reported in Pediatrics. The investigators looked at Medicaid-enrolled infants and found that for total ambulatory visits, children who had complete continuity of care were more than twice as likely to receive lead screening, compared with children who saw a different practitioner for every visit. In addition, children with complete continuity were 1.5–2 times more likely to have been screened for tuberculosis. Continuity also showed a lesser but still significant effect on anemia screening. It was critical for the infants to see the same practitioner at every visit, not just at well-child care visits, the researchers said. “Continuity of care is an important part of ensuring adequate preventive service delivery to a vulnerable population,” they concluded.

Head Start Warns of Cuts

The National Head Start Association (NHSA) has warned that the Bush administration is using a series of enrollment cuts and new regulatory requirements in an attempt to dismantle the Head Start program. The administration's proposed 2009 budget—which will require congressional approval—would slice more than 14,065 Head Start child slots, according to the White House. That makes it the first enrollment reduction to be included in a president's formal budget proposal since the program's launch in 1965, the NHSA said. In addition, cuts of more than $10 million in 2008 funding left many Head Start programs underfunded, the NHSA said. California, Texas, New York, Illinois, Ohio, and Florida stand to lose the most slots for Head Start enrollment, the group said.

Senators Promote Dental Care Bill

Three U.S. lawmakers have introduced legislation designed to increase access to dental care among poor children in an effort to prevent more children from dying because of complications from an untreated tooth ache. The bill from Sen. Sherrod Brown (D-Ohio), Sen. Thad Cochran (R-Miss.), and Rep. Elijah Cummings (D-Md.) would provide grants to community health centers to expand dental services; provide tax credits for dentists who treat Medicaid, Children's Health Insurance Program (CHIP), and uninsured patients; and create a new allied dental health professional pilot program. The legislation also would direct the Centers for Disease Control and Prevention to launch a public education campaign on children's dental health, and would provide grants to train dentists, hygienists, and dental students in pediatric dentistry. In February 2007, 12-year-old Maryland resident Deamonte Driver, who was homeless, died when an untreated tooth infection spread to his brain. “There is no excuse for Deamonte Driver's death, and the fault lies with every single one of us for letting this child slip through the cracks,” said Rep. Cummings in a statement.

Abuse of Children on the Rise

Children accounted for more than half of all abuse cases treated at U.S. hospitals in 2005, according to the Agency for Healthcare Research and Quality (AHRQ). About one-third of those children suffered from neglect, physical and psychological abuse, or physical battery such as shaken child syndrome, the agency said in its most recent News and Numbers release. The number of violence-related hospitalizations among both adults and children increased by 24,000 between 2002 and 2005, and about 4% of these patients were victims of sexual or other abuse, AHRQ said. Roughly 66% of all patients admitted to the hospital because of violence had attempted suicide or injured themselves on purpose and about 31% were victims of attempted murder, fights, rape, or other assaults.

Massachusetts health authorities, facing huge demands for vaccines to prevent meningitis, diphtheria/tetanus/pertussis, and chickenpox, have asked the state's pediatricians to limit use of the shots in older children under the state's free vaccine program.

Although state officials said that no child will go without needed vaccines, pediatricians in Massachusetts said the shortage, plus a state decision last year not to cover the quadrivalent human papillomavirus vaccine (Gardasil), marks the end of the state's universal vaccination program, and is leading to additional red tape for them.

Previously, Massachusetts provided all childhood vaccinations for every child, regardless of insurance coverage or coverage by the joint federal-state Vaccines for Children (VFC) program. In the past, as shots were added, the state Department of Public Health (DPH) typically bought enough vaccine stock to cover the children in the age group recommended, plus a bit more to help older children “catch up,” DPH spokeswoman Donna Rheaume said in an interview.

Massachusetts has been in the forefront of states that buy vaccines for children and then distribute them to physicians, and will spend about $40 million this year to buy pediatric vaccines, she said.

But this year, the state has seen unprecedented demand for three vaccines—conjugate meningococcal vaccine (MCV4) (Menactra), tetanus-diphtheria acellular pertussis (Tdap; Adacel or Boostrix), and varicella vaccine (Varivax), Ms. Rheaume said. Therefore, there is only enough vaccine left to cover seventh-graders, the group that is routinely given the shots.

“The only change now is that providers will have to bill the insurance companies for non-VFC-eligible children—children who have private health insurance,” said Ms. Rheaume. There are no plans to buy additional vaccine doses, she said, adding that “in 5 years, we anticipate all children will have received these vaccines.”

But Massachusetts insurers are not set up to pay for childhood vaccines because the state has provided them for free until now, said Dr. David Link, chief of pediatrics at Cambridge Health Alliance. “What was taken for granted—that all children would have full access to vaccines—that compact has now disappeared,” he said in an interview.

“We're now creating disparities we never have had before,” added Dr. Sean Palfrey, professor of pediatrics at Boston University and former president of the Massachusetts chapter of the American Academy of Pediatrics.

Both Dr. Palfrey and Dr. Link said that pediatricians are facing huge paperwork hurdles to prove children are eligible for the free federal-state program, and that they also have needed to chase down doses of the three vaccines in question for children whose vaccinations now must be paid for by private insurance companies.

The reason for the changes in state policy is the much higher cost of newer vaccines, such as Menactra and Gardasil, said Dr. Link.

In fact, he said, the decision by the Massachusetts legislature in 2007 not to cover the HPV vaccine—which would have cost up to $14 million a year—marked the end of the last state program that provided free, universal vaccinations. Despite heavy lobbying of Massachusetts lawmakers by physicians and children's advocates, there currently are not enough votes to reverse the decisions to curtail the vaccine program, he said.

Eventually, there will be outbreaks of preventable disease, Dr. Link predicted: “Some kid is going to wind up very damaged or dead because of this, because we decided we preferred some more asphalt [instead of] protecting kids.”

Massachusetts health authorities, facing huge demands for vaccines to prevent meningitis, diphtheria/tetanus/pertussis, and chickenpox, have asked the state's pediatricians to limit use of the shots in older children under the state's free vaccine program.

Although state officials said that no child will go without needed vaccines, pediatricians in Massachusetts said the shortage, plus a state decision last year not to cover the quadrivalent human papillomavirus vaccine (Gardasil), marks the end of the state's universal vaccination program, and is leading to additional red tape for them.

Previously, Massachusetts provided all childhood vaccinations for every child, regardless of insurance coverage or coverage by the joint federal-state Vaccines for Children (VFC) program. In the past, as shots were added, the state Department of Public Health (DPH) typically bought enough vaccine stock to cover the children in the age group recommended, plus a bit more to help older children “catch up,” DPH spokeswoman Donna Rheaume said in an interview.

Massachusetts has been in the forefront of states that buy vaccines for children and then distribute them to physicians, and will spend about $40 million this year to buy pediatric vaccines, she said.

But this year, the state has seen unprecedented demand for three vaccines—conjugate meningococcal vaccine (MCV4) (Menactra), tetanus-diphtheria acellular pertussis (Tdap; Adacel or Boostrix), and varicella vaccine (Varivax), Ms. Rheaume said. Therefore, there is only enough vaccine left to cover seventh-graders, the group that is routinely given the shots.

“The only change now is that providers will have to bill the insurance companies for non-VFC-eligible children—children who have private health insurance,” said Ms. Rheaume. There are no plans to buy additional vaccine doses, she said, adding that “in 5 years, we anticipate all children will have received these vaccines.”

But Massachusetts insurers are not set up to pay for childhood vaccines because the state has provided them for free until now, said Dr. David Link, chief of pediatrics at Cambridge Health Alliance. “What was taken for granted—that all children would have full access to vaccines—that compact has now disappeared,” he said in an interview.

“We're now creating disparities we never have had before,” added Dr. Sean Palfrey, professor of pediatrics at Boston University and former president of the Massachusetts chapter of the American Academy of Pediatrics.

Both Dr. Palfrey and Dr. Link said that pediatricians are facing huge paperwork hurdles to prove children are eligible for the free federal-state program, and that they also have needed to chase down doses of the three vaccines in question for children whose vaccinations now must be paid for by private insurance companies.

The reason for the changes in state policy is the much higher cost of newer vaccines, such as Menactra and Gardasil, said Dr. Link.

In fact, he said, the decision by the Massachusetts legislature in 2007 not to cover the HPV vaccine—which would have cost up to $14 million a year—marked the end of the last state program that provided free, universal vaccinations. Despite heavy lobbying of Massachusetts lawmakers by physicians and children's advocates, there currently are not enough votes to reverse the decisions to curtail the vaccine program, he said.

Eventually, there will be outbreaks of preventable disease, Dr. Link predicted: “Some kid is going to wind up very damaged or dead because of this, because we decided we preferred some more asphalt [instead of] protecting kids.”

Massachusetts health authorities, facing huge demands for vaccines to prevent meningitis, diphtheria/tetanus/pertussis, and chickenpox, have asked the state's pediatricians to limit use of the shots in older children under the state's free vaccine program.

Although state officials said that no child will go without needed vaccines, pediatricians in Massachusetts said the shortage, plus a state decision last year not to cover the quadrivalent human papillomavirus vaccine (Gardasil), marks the end of the state's universal vaccination program, and is leading to additional red tape for them.

Previously, Massachusetts provided all childhood vaccinations for every child, regardless of insurance coverage or coverage by the joint federal-state Vaccines for Children (VFC) program. In the past, as shots were added, the state Department of Public Health (DPH) typically bought enough vaccine stock to cover the children in the age group recommended, plus a bit more to help older children “catch up,” DPH spokeswoman Donna Rheaume said in an interview.

Massachusetts has been in the forefront of states that buy vaccines for children and then distribute them to physicians, and will spend about $40 million this year to buy pediatric vaccines, she said.

But this year, the state has seen unprecedented demand for three vaccines—conjugate meningococcal vaccine (MCV4) (Menactra), tetanus-diphtheria acellular pertussis (Tdap; Adacel or Boostrix), and varicella vaccine (Varivax), Ms. Rheaume said. Therefore, there is only enough vaccine left to cover seventh-graders, the group that is routinely given the shots.

“The only change now is that providers will have to bill the insurance companies for non-VFC-eligible children—children who have private health insurance,” said Ms. Rheaume. There are no plans to buy additional vaccine doses, she said, adding that “in 5 years, we anticipate all children will have received these vaccines.”

But Massachusetts insurers are not set up to pay for childhood vaccines because the state has provided them for free until now, said Dr. David Link, chief of pediatrics at Cambridge Health Alliance. “What was taken for granted—that all children would have full access to vaccines—that compact has now disappeared,” he said in an interview.

“We're now creating disparities we never have had before,” added Dr. Sean Palfrey, professor of pediatrics at Boston University and former president of the Massachusetts chapter of the American Academy of Pediatrics.

Both Dr. Palfrey and Dr. Link said that pediatricians are facing huge paperwork hurdles to prove children are eligible for the free federal-state program, and that they also have needed to chase down doses of the three vaccines in question for children whose vaccinations now must be paid for by private insurance companies.

The reason for the changes in state policy is the much higher cost of newer vaccines, such as Menactra and Gardasil, said Dr. Link.

In fact, he said, the decision by the Massachusetts legislature in 2007 not to cover the HPV vaccine—which would have cost up to $14 million a year—marked the end of the last state program that provided free, universal vaccinations. Despite heavy lobbying of Massachusetts lawmakers by physicians and children's advocates, there currently are not enough votes to reverse the decisions to curtail the vaccine program, he said.

Eventually, there will be outbreaks of preventable disease, Dr. Link predicted: “Some kid is going to wind up very damaged or dead because of this, because we decided we preferred some more asphalt [instead of] protecting kids.”

MDs Not Sleeping Enough

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Dr. Sidney Wolfe, director of Public Citizen Health Research Group, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict and controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.” CDER is charged with assuring that safe and effective drugs, including prescription, over-the-counter, and generic products, are available to Americans.

CMS Finds Improper Payments

More than $371 million in improper Medicare payments was collected from or repaid to health care providers and suppliers in 2007 as part of a demonstration program that used recovery audit contractors in California, Florida, and New York, the Centers for Medicare and Medicaid Services announced. Almost all the improper payments (96%) identified in 2007 were overpayments collected from providers, while the remaining 4% were underpayments that were repaid to providers. Most of the improper payments occurred when providers submitted claims that did not comply with Medicare's coverage or coding rules, and more than 85% of the overpayments collected and almost all underpayments refunded were from claims submitted by inpatient hospitals. The demonstration program began in 2005 and was expanded to include Massachusetts, South Carolina, and Arizona in 2007.

NYC Implementing EMRs

New York City is in the process of computerizing the medical records of patients for hospitals, community health clinics, and private physicians in a project that has cost about $60 million to date, Mayor Michael Bloomberg said. More than 200 health care providers—serving more than 200,000 city residents—already are online, putting New York on track to reach its goal of signing up 1,000 providers by the end of the year, Mayor Bloomberg said in a statement. “That will make our city home to the largest community network of electronic health records anywhere in the country,” he said. “And it will allow New Yorkers to spend more time with their doctors, and less time filling out paperwork in the waiting room.” The new system, a software package developed with funding from the city, state, and federal governments, will integrate patients' medical histories, lab results, and pharmaceutical records.

Trouble Paying for Rx

Four in 10 Americans—and half those regularly taking at least one medication—reported that they have trouble paying for drugs, skip prescriptions, or cut pills because of the cost of their prescriptions, a poll jointly conducted by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed. People were most likely to report one of those three issues if they lack drug coverage, if they have low incomes, or if they take four or more drugs regularly. The survey found that while the public values the products drug companies produce, they do not like what they charge and are suspicious of their motivation. Nearly 80% of Americans said that the cost of prescription drugs is unreasonable, and about 70% said pharmaceutical companies are too concerned about making profits and not concerned enough about helping people. But at the same time, the public overwhelmingly believes that recent advances in prescription drugs provide benefits, the survey found.

Retiree Health Costs $225,000

A 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical expenses in retirement, according to Fidelity Investments' most recent health care cost estimate. The estimate assumes individuals do not have employer-sponsored retiree coverage and includes expenses associated with Medicare Part B and D premiums (30% of the total), Medicare cost-sharing provisions (39% of the total), and prescription drug out-of-pocket costs (31%). It does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Since the retirement health care expense estimate was first calculated in 2002, it has risen a total of 41%.

MDs Not Sleeping Enough

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Dr. Sidney Wolfe, director of Public Citizen Health Research Group, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict and controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.” CDER is charged with assuring that safe and effective drugs, including prescription, over-the-counter, and generic products, are available to Americans.

CMS Finds Improper Payments

More than $371 million in improper Medicare payments was collected from or repaid to health care providers and suppliers in 2007 as part of a demonstration program that used recovery audit contractors in California, Florida, and New York, the Centers for Medicare and Medicaid Services announced. Almost all the improper payments (96%) identified in 2007 were overpayments collected from providers, while the remaining 4% were underpayments that were repaid to providers. Most of the improper payments occurred when providers submitted claims that did not comply with Medicare's coverage or coding rules, and more than 85% of the overpayments collected and almost all underpayments refunded were from claims submitted by inpatient hospitals. The demonstration program began in 2005 and was expanded to include Massachusetts, South Carolina, and Arizona in 2007.

NYC Implementing EMRs

New York City is in the process of computerizing the medical records of patients for hospitals, community health clinics, and private physicians in a project that has cost about $60 million to date, Mayor Michael Bloomberg said. More than 200 health care providers—serving more than 200,000 city residents—already are online, putting New York on track to reach its goal of signing up 1,000 providers by the end of the year, Mayor Bloomberg said in a statement. “That will make our city home to the largest community network of electronic health records anywhere in the country,” he said. “And it will allow New Yorkers to spend more time with their doctors, and less time filling out paperwork in the waiting room.” The new system, a software package developed with funding from the city, state, and federal governments, will integrate patients' medical histories, lab results, and pharmaceutical records.

Trouble Paying for Rx

Four in 10 Americans—and half those regularly taking at least one medication—reported that they have trouble paying for drugs, skip prescriptions, or cut pills because of the cost of their prescriptions, a poll jointly conducted by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed. People were most likely to report one of those three issues if they lack drug coverage, if they have low incomes, or if they take four or more drugs regularly. The survey found that while the public values the products drug companies produce, they do not like what they charge and are suspicious of their motivation. Nearly 80% of Americans said that the cost of prescription drugs is unreasonable, and about 70% said pharmaceutical companies are too concerned about making profits and not concerned enough about helping people. But at the same time, the public overwhelmingly believes that recent advances in prescription drugs provide benefits, the survey found.

Retiree Health Costs $225,000

A 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical expenses in retirement, according to Fidelity Investments' most recent health care cost estimate. The estimate assumes individuals do not have employer-sponsored retiree coverage and includes expenses associated with Medicare Part B and D premiums (30% of the total), Medicare cost-sharing provisions (39% of the total), and prescription drug out-of-pocket costs (31%). It does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Since the retirement health care expense estimate was first calculated in 2002, it has risen a total of 41%.

MDs Not Sleeping Enough

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Dr. Sidney Wolfe, director of Public Citizen Health Research Group, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict and controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.” CDER is charged with assuring that safe and effective drugs, including prescription, over-the-counter, and generic products, are available to Americans.

CMS Finds Improper Payments

More than $371 million in improper Medicare payments was collected from or repaid to health care providers and suppliers in 2007 as part of a demonstration program that used recovery audit contractors in California, Florida, and New York, the Centers for Medicare and Medicaid Services announced. Almost all the improper payments (96%) identified in 2007 were overpayments collected from providers, while the remaining 4% were underpayments that were repaid to providers. Most of the improper payments occurred when providers submitted claims that did not comply with Medicare's coverage or coding rules, and more than 85% of the overpayments collected and almost all underpayments refunded were from claims submitted by inpatient hospitals. The demonstration program began in 2005 and was expanded to include Massachusetts, South Carolina, and Arizona in 2007.

NYC Implementing EMRs

New York City is in the process of computerizing the medical records of patients for hospitals, community health clinics, and private physicians in a project that has cost about $60 million to date, Mayor Michael Bloomberg said. More than 200 health care providers—serving more than 200,000 city residents—already are online, putting New York on track to reach its goal of signing up 1,000 providers by the end of the year, Mayor Bloomberg said in a statement. “That will make our city home to the largest community network of electronic health records anywhere in the country,” he said. “And it will allow New Yorkers to spend more time with their doctors, and less time filling out paperwork in the waiting room.” The new system, a software package developed with funding from the city, state, and federal governments, will integrate patients' medical histories, lab results, and pharmaceutical records.

Trouble Paying for Rx

Four in 10 Americans—and half those regularly taking at least one medication—reported that they have trouble paying for drugs, skip prescriptions, or cut pills because of the cost of their prescriptions, a poll jointly conducted by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed. People were most likely to report one of those three issues if they lack drug coverage, if they have low incomes, or if they take four or more drugs regularly. The survey found that while the public values the products drug companies produce, they do not like what they charge and are suspicious of their motivation. Nearly 80% of Americans said that the cost of prescription drugs is unreasonable, and about 70% said pharmaceutical companies are too concerned about making profits and not concerned enough about helping people. But at the same time, the public overwhelmingly believes that recent advances in prescription drugs provide benefits, the survey found.

Retiree Health Costs $225,000

A 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical expenses in retirement, according to Fidelity Investments' most recent health care cost estimate. The estimate assumes individuals do not have employer-sponsored retiree coverage and includes expenses associated with Medicare Part B and D premiums (30% of the total), Medicare cost-sharing provisions (39% of the total), and prescription drug out-of-pocket costs (31%). It does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Since the retirement health care expense estimate was first calculated in 2002, it has risen a total of 41%.

MDs Not Sleeping Enough

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients and pharmaceutical research companies,” said a statement from the group. But Dr. Sidney Wolfe, director of Public Citizen Health Research Group, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict and controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.” CDER is charged with assuring that safe and effective drugs, including prescription, over-the-counter, and generic products, are available to Americans.

CMS Finds Improper Payments

More than $371 million in improper Medicare payments was collected from or repaid to health care providers and suppliers in 2007 as part of a demonstration program that used recovery audit contractors in California, Florida, and New York, the Centers for Medicare and Medicaid Services announced. Almost all the improper payments (96%) identified in 2007 were overpayments collected from providers, while the remaining 4% were underpayments that were repaid to providers. Most of the improper payments occurred when providers submitted claims that did not comply with Medicare's coverage or coding rules, and more than 85% of the overpayments collected and almost all underpayments refunded were from claims submitted by inpatient hospitals. The demonstration program began in 2005 and was expanded to include Arizona, Massachusetts, and South Carolina in 2007.

NYC Implementing EMRs

New York City is in the process of computerizing the medical records of patients for hospitals, community health clinics, and private physicians in a project that has cost about $60 million to date, Mayor Michael Bloomberg said. More than 200 health care providers—serving more than 200,000 city residents—already are online, putting New York on track to reach its goal of signing up 1,000 providers by the end of the year, Mayor Bloomberg said in a statement. “That will make our city home to the largest community network of electronic health records anywhere in the country,” he said. “And it will allow New Yorkers to spend more time with their doctors, and less time filling out paperwork in the waiting room.” The new system, a software package developed with funding from the city, state, and federal governments, will integrate patients' medical histories, lab results, and pharmaceutical records.

Trouble Paying for Rx

Four in 10 Americans—and half those regularly taking at least one medication—reported that they have trouble paying for drugs, skip prescriptions, or cut pills because of the cost of their prescriptions, a poll jointly conducted by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed. People were most likely to report one of those three issues if they lack drug coverage, if they have low incomes, or if they take four or more drugs regularly. The survey found that while the public values the products drug companies produce, they do not like what they charge and are suspicious of their motivation. Nearly 80% of Americans said that the cost of prescription drugs is unreasonable, and about 70% said pharmaceutical companies are too concerned about making profits and not concerned enough about helping people. But at the same time, the public overwhelmingly believes that recent advances in prescription drugs provide benefits, the survey found.

Retiree Health Costs $225,000

A 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical expenses in retirement, according to Fidelity Investments' most recent health care cost estimate. The estimate assumes individuals do not have employer-sponsored retiree coverage and includes expenses associated with Medicare Part B and D premiums (30% of the total), Medicare cost-sharing provisions (39% of the total), and prescription drug out-of-pocket costs (31%). It does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Since the retirement health care expense estimate was first calculated in 2002, it has risen a total of 41%.

MDs Not Sleeping Enough

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients and pharmaceutical research companies,” said a statement from the group. But Dr. Sidney Wolfe, director of Public Citizen Health Research Group, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict and controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.” CDER is charged with assuring that safe and effective drugs, including prescription, over-the-counter, and generic products, are available to Americans.

CMS Finds Improper Payments

More than $371 million in improper Medicare payments was collected from or repaid to health care providers and suppliers in 2007 as part of a demonstration program that used recovery audit contractors in California, Florida, and New York, the Centers for Medicare and Medicaid Services announced. Almost all the improper payments (96%) identified in 2007 were overpayments collected from providers, while the remaining 4% were underpayments that were repaid to providers. Most of the improper payments occurred when providers submitted claims that did not comply with Medicare's coverage or coding rules, and more than 85% of the overpayments collected and almost all underpayments refunded were from claims submitted by inpatient hospitals. The demonstration program began in 2005 and was expanded to include Arizona, Massachusetts, and South Carolina in 2007.

NYC Implementing EMRs

New York City is in the process of computerizing the medical records of patients for hospitals, community health clinics, and private physicians in a project that has cost about $60 million to date, Mayor Michael Bloomberg said. More than 200 health care providers—serving more than 200,000 city residents—already are online, putting New York on track to reach its goal of signing up 1,000 providers by the end of the year, Mayor Bloomberg said in a statement. “That will make our city home to the largest community network of electronic health records anywhere in the country,” he said. “And it will allow New Yorkers to spend more time with their doctors, and less time filling out paperwork in the waiting room.” The new system, a software package developed with funding from the city, state, and federal governments, will integrate patients' medical histories, lab results, and pharmaceutical records.

Trouble Paying for Rx

Four in 10 Americans—and half those regularly taking at least one medication—reported that they have trouble paying for drugs, skip prescriptions, or cut pills because of the cost of their prescriptions, a poll jointly conducted by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed. People were most likely to report one of those three issues if they lack drug coverage, if they have low incomes, or if they take four or more drugs regularly. The survey found that while the public values the products drug companies produce, they do not like what they charge and are suspicious of their motivation. Nearly 80% of Americans said that the cost of prescription drugs is unreasonable, and about 70% said pharmaceutical companies are too concerned about making profits and not concerned enough about helping people. But at the same time, the public overwhelmingly believes that recent advances in prescription drugs provide benefits, the survey found.

Retiree Health Costs $225,000

A 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical expenses in retirement, according to Fidelity Investments' most recent health care cost estimate. The estimate assumes individuals do not have employer-sponsored retiree coverage and includes expenses associated with Medicare Part B and D premiums (30% of the total), Medicare cost-sharing provisions (39% of the total), and prescription drug out-of-pocket costs (31%). It does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Since the retirement health care expense estimate was first calculated in 2002, it has risen a total of 41%.

MDs Not Sleeping Enough

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients and pharmaceutical research companies,” said a statement from the group. But Dr. Sidney Wolfe, director of Public Citizen Health Research Group, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict and controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.” CDER is charged with assuring that safe and effective drugs, including prescription, over-the-counter, and generic products, are available to Americans.

CMS Finds Improper Payments

More than $371 million in improper Medicare payments was collected from or repaid to health care providers and suppliers in 2007 as part of a demonstration program that used recovery audit contractors in California, Florida, and New York, the Centers for Medicare and Medicaid Services announced. Almost all the improper payments (96%) identified in 2007 were overpayments collected from providers, while the remaining 4% were underpayments that were repaid to providers. Most of the improper payments occurred when providers submitted claims that did not comply with Medicare's coverage or coding rules, and more than 85% of the overpayments collected and almost all underpayments refunded were from claims submitted by inpatient hospitals. The demonstration program began in 2005 and was expanded to include Arizona, Massachusetts, and South Carolina in 2007.

NYC Implementing EMRs

New York City is in the process of computerizing the medical records of patients for hospitals, community health clinics, and private physicians in a project that has cost about $60 million to date, Mayor Michael Bloomberg said. More than 200 health care providers—serving more than 200,000 city residents—already are online, putting New York on track to reach its goal of signing up 1,000 providers by the end of the year, Mayor Bloomberg said in a statement. “That will make our city home to the largest community network of electronic health records anywhere in the country,” he said. “And it will allow New Yorkers to spend more time with their doctors, and less time filling out paperwork in the waiting room.” The new system, a software package developed with funding from the city, state, and federal governments, will integrate patients' medical histories, lab results, and pharmaceutical records.

Trouble Paying for Rx

Four in 10 Americans—and half those regularly taking at least one medication—reported that they have trouble paying for drugs, skip prescriptions, or cut pills because of the cost of their prescriptions, a poll jointly conducted by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed. People were most likely to report one of those three issues if they lack drug coverage, if they have low incomes, or if they take four or more drugs regularly. The survey found that while the public values the products drug companies produce, they do not like what they charge and are suspicious of their motivation. Nearly 80% of Americans said that the cost of prescription drugs is unreasonable, and about 70% said pharmaceutical companies are too concerned about making profits and not concerned enough about helping people. But at the same time, the public overwhelmingly believes that recent advances in prescription drugs provide benefits, the survey found.

Retiree Health Costs $225,000

A 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical expenses in retirement, according to Fidelity Investments' most recent health care cost estimate. The estimate assumes individuals do not have employer-sponsored retiree coverage and includes expenses associated with Medicare Part B and D premiums (30% of the total), Medicare cost-sharing provisions (39% of the total), and prescription drug out-of-pocket costs (31%). It does not include other health-related expenses, such as over-the-counter medications, most dental services, and long-term care. Since the retirement health care expense estimate was first calculated in 2002, it has risen a total of 41%.

Better Appeals Process Needed

Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.

FDA Issues Food Co. Injunction

Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.- based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.

Copays, Caps May Reduce Use

Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.

Medco Launches e-Rx Drive

As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.

CVS Caremark Settles Suit

CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.

Better Appeals Process Needed

Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.

FDA Issues Food Co. Injunction

Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.- based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.

Copays, Caps May Reduce Use

Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.

Medco Launches e-Rx Drive

As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.

CVS Caremark Settles Suit

CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.

Better Appeals Process Needed

Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.

FDA Issues Food Co. Injunction

Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.- based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.

Copays, Caps May Reduce Use

Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.

Medco Launches e-Rx Drive

As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.

CVS Caremark Settles Suit

CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.

Better Appeals Process Needed

Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.

FDA Issues Food Co. Injunction

Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.-based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.

Copays, Caps May Reduce Use

Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.

Medco Launches e-Rx Drive

As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.

CVS Caremark Settles Suit

CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.

Better Appeals Process Needed

Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.

FDA Issues Food Co. Injunction

Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.-based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.

Copays, Caps May Reduce Use

Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.

Medco Launches e-Rx Drive

As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.

CVS Caremark Settles Suit

CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.

Better Appeals Process Needed

Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.

FDA Issues Food Co. Injunction

Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.-based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.

Copays, Caps May Reduce Use

Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.

Medco Launches e-Rx Drive

As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.

CVS Caremark Settles Suit

CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.

Aetna Inc. said that it is working with the American Medical Association and state medical societies to resolve issues involving nonparticipating physicians after the AMA complained that the insurer was paying those physicians just 125% of Medicare rates and then telling patients they didn't need to pay the rest.

In a recent letter to Aetna, Dr. Michael Maves, AMA's chief executive officer and senior vice president, noted that Aetna's policy—implemented last June—fails to take into account different practice costs that are reflected by physicians' billed charges.

“It is simply arbitrary and capricious for Aetna to deem 125% of Medicare to be a fair payment across the board,” Dr. Maves wrote in his letter to Dr. Troyen Brennan, Aetna's chief medical officer.

Dr. Maves also said in the letter that physicians nationwide are reporting receiving Aetna Explanation of Benefits (EOB) forms stating that the patient has no obligation to pay the nonparticipating physician the difference between the physician's charge and the amount Aetna has paid.

This practice, Dr. Maves said, potentially violates the 2003 settlement agreement with Aetna in Multidistrict Litigation 1334, the large class action lawsuit in which physicians sued large managed care companies, including Aetna, over business practices.

However, Dr. Brennan said in an interview that the settlement in that case “clearly differentiates between HMO-based plans and traditional plans.” It requires Aetna to tell members in traditional plans that they can be balance-billed by nonparticipating physicians, but it treats HMO plans differently, he said.

HMO members receive an EOB stating that Aetna does not contract with a nonparticipating provider, and that the provider might not accept Aetna's payment as payment in full for services, Dr. Brennan said. “In the notice, we inform the member that we 'seek to ensure that they do not pay this provider any amount above any applicable copayment, coinsurance, or deductible at the in-network (referred) benefit level,' and if they receive a bill for the difference, they should send the bill to us,” Dr. Brennan said.

Aetna believes it has complied with the 2003 settlement agreement “in all respects,” but is in discussions with the AMA and state medical societies about the issues involved, Dr. Brennan said. However, “no substantive discussions have occurred as of yet with the AMA,” said AMA spokesman Robert Mills.

Meanwhile, nonparticipating physicians are being placed in an awkward situation, said Dr. Alan Schorr, a Langhorne, Pa.-based endocrinologist who does not participate with Aetna. Some of his patients have received the Aetna EOBs.

“This puts the patient and physician into adversarial roles,” said Dr. Schorr, who added that, although Aetna might believe that 125% of Medicare represents a fair fee, “the patient has to have some sense of responsibility.”

But the EOBs from Aetna state that the patient has no responsibility to pay the difference between 125% of Medicare rates and the actual charges, Dr. Schorr said in an interview, and patients therefore don't want to pay the difference. “We've had comments made to our office manager along the lines of 'Just write off the difference—you make enough anyway,'” he said.

Aetna “is trying to force physicians back into the [network] fold,” Dr. Schorr said, adding that he had complained to the AMA and his state medical society. “They're trying to ratchet down physicians' fees.”

Aetna Inc. said that it is working with the American Medical Association and state medical societies to resolve issues involving nonparticipating physicians after the AMA complained that the insurer was paying those physicians just 125% of Medicare rates and then telling patients they didn't need to pay the rest.

In a recent letter to Aetna, Dr. Michael Maves, AMA's chief executive officer and senior vice president, noted that Aetna's policy—implemented last June—fails to take into account different practice costs that are reflected by physicians' billed charges.

“It is simply arbitrary and capricious for Aetna to deem 125% of Medicare to be a fair payment across the board,” Dr. Maves wrote in his letter to Dr. Troyen Brennan, Aetna's chief medical officer.

Dr. Maves also said in the letter that physicians nationwide are reporting receiving Aetna Explanation of Benefits (EOB) forms stating that the patient has no obligation to pay the nonparticipating physician the difference between the physician's charge and the amount Aetna has paid.

This practice, Dr. Maves said, potentially violates the 2003 settlement agreement with Aetna in Multidistrict Litigation 1334, the large class action lawsuit in which physicians sued large managed care companies, including Aetna, over business practices.

However, Dr. Brennan said in an interview that the settlement in that case “clearly differentiates between HMO-based plans and traditional plans.” It requires Aetna to tell members in traditional plans that they can be balance-billed by nonparticipating physicians, but it treats HMO plans differently, he said.

HMO members receive an EOB stating that Aetna does not contract with a nonparticipating provider, and that the provider might not accept Aetna's payment as payment in full for services, Dr. Brennan said. “In the notice, we inform the member that we 'seek to ensure that they do not pay this provider any amount above any applicable copayment, coinsurance, or deductible at the in-network (referred) benefit level,' and if they receive a bill for the difference, they should send the bill to us,” Dr. Brennan said.

Aetna believes it has complied with the 2003 settlement agreement “in all respects,” but is in discussions with the AMA and state medical societies about the issues involved, Dr. Brennan said. However, “no substantive discussions have occurred as of yet with the AMA,” said AMA spokesman Robert Mills.

Meanwhile, nonparticipating physicians are being placed in an awkward situation, said Dr. Alan Schorr, a Langhorne, Pa.-based endocrinologist who does not participate with Aetna. Some of his patients have received the Aetna EOBs.

“This puts the patient and physician into adversarial roles,” said Dr. Schorr, who added that, although Aetna might believe that 125% of Medicare represents a fair fee, “the patient has to have some sense of responsibility.”

But the EOBs from Aetna state that the patient has no responsibility to pay the difference between 125% of Medicare rates and the actual charges, Dr. Schorr said in an interview, and patients therefore don't want to pay the difference. “We've had comments made to our office manager along the lines of 'Just write off the difference—you make enough anyway,'” he said.

Aetna “is trying to force physicians back into the [network] fold,” Dr. Schorr said, adding that he had complained to the AMA and his state medical society. “They're trying to ratchet down physicians' fees.”

Aetna Inc. said that it is working with the American Medical Association and state medical societies to resolve issues involving nonparticipating physicians after the AMA complained that the insurer was paying those physicians just 125% of Medicare rates and then telling patients they didn't need to pay the rest.

In a recent letter to Aetna, Dr. Michael Maves, AMA's chief executive officer and senior vice president, noted that Aetna's policy—implemented last June—fails to take into account different practice costs that are reflected by physicians' billed charges.

“It is simply arbitrary and capricious for Aetna to deem 125% of Medicare to be a fair payment across the board,” Dr. Maves wrote in his letter to Dr. Troyen Brennan, Aetna's chief medical officer.

Dr. Maves also said in the letter that physicians nationwide are reporting receiving Aetna Explanation of Benefits (EOB) forms stating that the patient has no obligation to pay the nonparticipating physician the difference between the physician's charge and the amount Aetna has paid.

This practice, Dr. Maves said, potentially violates the 2003 settlement agreement with Aetna in Multidistrict Litigation 1334, the large class action lawsuit in which physicians sued large managed care companies, including Aetna, over business practices.

However, Dr. Brennan said in an interview that the settlement in that case “clearly differentiates between HMO-based plans and traditional plans.” It requires Aetna to tell members in traditional plans that they can be balance-billed by nonparticipating physicians, but it treats HMO plans differently, he said.

HMO members receive an EOB stating that Aetna does not contract with a nonparticipating provider, and that the provider might not accept Aetna's payment as payment in full for services, Dr. Brennan said. “In the notice, we inform the member that we 'seek to ensure that they do not pay this provider any amount above any applicable copayment, coinsurance, or deductible at the in-network (referred) benefit level,' and if they receive a bill for the difference, they should send the bill to us,” Dr. Brennan said.

Aetna believes it has complied with the 2003 settlement agreement “in all respects,” but is in discussions with the AMA and state medical societies about the issues involved, Dr. Brennan said. However, “no substantive discussions have occurred as of yet with the AMA,” said AMA spokesman Robert Mills.

Meanwhile, nonparticipating physicians are being placed in an awkward situation, said Dr. Alan Schorr, a Langhorne, Pa.-based endocrinologist who does not participate with Aetna. Some of his patients have received the Aetna EOBs.

“This puts the patient and physician into adversarial roles,” said Dr. Schorr, who added that, although Aetna might believe that 125% of Medicare represents a fair fee, “the patient has to have some sense of responsibility.”

But the EOBs from Aetna state that the patient has no responsibility to pay the difference between 125% of Medicare rates and the actual charges, Dr. Schorr said in an interview, and patients therefore don't want to pay the difference. “We've had comments made to our office manager along the lines of 'Just write off the difference—you make enough anyway,'” he said.

Aetna “is trying to force physicians back into the [network] fold,” Dr. Schorr said, adding that he had complained to the AMA and his state medical society. “They're trying to ratchet down physicians' fees.”