Jane Anderson

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-size practices, but noted that its success rests on how it is implemented.

"The devil is in the details," Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, said. "What are going to be the real requirements for physician practices to participate and submit data?"

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning this spring.

Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions that can positively affect patient care processes, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body officially recognized by the Department of Health and Human Services, according to CMS. The core incentive payment to practices will be based on performance on the quality measures, with an enhanced bonus based on how well integrated the EHR is in helping to manage patient care.

"This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care," CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs.

In order to amplify the effect of the project, CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David Dale, president of the American College of Physicians, praised the demonstration project as "an encouraging step in the right direction," and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-size practices, but noted that its success rests on how it is implemented.

"The devil is in the details," Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, said. "What are going to be the real requirements for physician practices to participate and submit data?"

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning this spring.

Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions that can positively affect patient care processes, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body officially recognized by the Department of Health and Human Services, according to CMS. The core incentive payment to practices will be based on performance on the quality measures, with an enhanced bonus based on how well integrated the EHR is in helping to manage patient care.

"This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care," CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs.

In order to amplify the effect of the project, CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David Dale, president of the American College of Physicians, praised the demonstration project as "an encouraging step in the right direction," and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-size practices, but noted that its success rests on how it is implemented.

"The devil is in the details," Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, said. "What are going to be the real requirements for physician practices to participate and submit data?"

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning this spring.

Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions that can positively affect patient care processes, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body officially recognized by the Department of Health and Human Services, according to CMS. The core incentive payment to practices will be based on performance on the quality measures, with an enhanced bonus based on how well integrated the EHR is in helping to manage patient care.

"This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care," CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs.

In order to amplify the effect of the project, CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David Dale, president of the American College of Physicians, praised the demonstration project as "an encouraging step in the right direction," and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

Aetna Inc. reported 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 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 fair reimbursement, "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, and patients therefore don't want to pay the difference.

Aetna "is trying to force physicians back into the [network] fold," Dr. Schorr said, adding that he had complained to the AMA and to the Pennsylvania Medical Society about Aetna's practice. "What we're looking at, in my opinion, is restraint of trade. They're trying to ratchet down physicians' fees," he said.

Aetna Inc. reported 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 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 fair reimbursement, "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, and patients therefore don't want to pay the difference.

Aetna "is trying to force physicians back into the [network] fold," Dr. Schorr said, adding that he had complained to the AMA and to the Pennsylvania Medical Society about Aetna's practice. "What we're looking at, in my opinion, is restraint of trade. They're trying to ratchet down physicians' fees," he said.

Aetna Inc. reported 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 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 fair reimbursement, "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, and patients therefore don't want to pay the difference.

Aetna "is trying to force physicians back into the [network] fold," Dr. Schorr said, adding that he had complained to the AMA and to the Pennsylvania Medical Society about Aetna's practice. "What we're looking at, in my opinion, is restraint of trade. They're trying to ratchet down physicians' fees," he said.

Aetna Inc. announced in January 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 that they did not need to pay the rest.

In a letter to Aetna, Dr. Michael Maves, who is AMA's chief executive officer and senior vice president, noted that Aetna's policy, which was 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 Medi-care to be a fair payment across the board,” Dr. Maves wrote in his letter to Dr. Troyen Brennan, who is Aetna's chief medical officer.

Dr. Maves also noted 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.”

That settlement 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.

Dr. Schorr said that some of his patients have received the Aetna explanations of benefits. “This puts the patient and physician into adversarial roles,” he commented, adding that, although Aetna might believe that 125% of Medicare represents fair reimbursement, “the patient has to have some sense of responsibility.”

But the explanations of benefits from Aetna state that the patient has no responsibility to pay the difference between 125% of Medicare rates and the actual charges, Dr. Schorr commented 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.

He added that he had complained to the AMA and to the Pennsylvania Medical Society about Aetna's practice.

“What we're looking at, in my opinion, is restraint of trade. They are trying to ratchet down physicians' fees,” said Dr. Schorr.

Aetna Inc. announced in January 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 that they did not need to pay the rest.

In a letter to Aetna, Dr. Michael Maves, who is AMA's chief executive officer and senior vice president, noted that Aetna's policy, which was 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 Medi-care to be a fair payment across the board,” Dr. Maves wrote in his letter to Dr. Troyen Brennan, who is Aetna's chief medical officer.

Dr. Maves also noted 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.”

That settlement 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.

Dr. Schorr said that some of his patients have received the Aetna explanations of benefits. “This puts the patient and physician into adversarial roles,” he commented, adding that, although Aetna might believe that 125% of Medicare represents fair reimbursement, “the patient has to have some sense of responsibility.”

But the explanations of benefits from Aetna state that the patient has no responsibility to pay the difference between 125% of Medicare rates and the actual charges, Dr. Schorr commented 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.

He added that he had complained to the AMA and to the Pennsylvania Medical Society about Aetna's practice.

“What we're looking at, in my opinion, is restraint of trade. They are trying to ratchet down physicians' fees,” said Dr. Schorr.

Aetna Inc. announced in January 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 that they did not need to pay the rest.

In a letter to Aetna, Dr. Michael Maves, who is AMA's chief executive officer and senior vice president, noted that Aetna's policy, which was 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 Medi-care to be a fair payment across the board,” Dr. Maves wrote in his letter to Dr. Troyen Brennan, who is Aetna's chief medical officer.

Dr. Maves also noted 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.”

That settlement 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.

Dr. Schorr said that some of his patients have received the Aetna explanations of benefits. “This puts the patient and physician into adversarial roles,” he commented, adding that, although Aetna might believe that 125% of Medicare represents fair reimbursement, “the patient has to have some sense of responsibility.”

But the explanations of benefits from Aetna state that the patient has no responsibility to pay the difference between 125% of Medicare rates and the actual charges, Dr. Schorr commented 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.

He added that he had complained to the AMA and to the Pennsylvania Medical Society about Aetna's practice.

“What we're looking at, in my opinion, is restraint of trade. They are trying to ratchet down physicians' fees,” said Dr. Schorr.

CVS Clinics to Open in Mass.

Immediately after Massachusetts regulators approved store-based medical clinics last month, CVS Corp. said it would open as many as 30 in-store MinuteClinics in the state over the next year. CVS said that it plans to have 100-120 clinics in stores across the state within 3-5 years. The nurse practitioners staffing the clinics will treat minor problems such as sore throats and ear infections, but will refer patients with more serious conditions to a physician or an emergency department. The Massachusetts Medical Society, along with organizations representing family physicians, pediatricians, hospitals, and community health centers, raised concerns about retail medical clinics as the state's Department of Public Health considered whether to allow them, according to the medical society. Dr. Bruce Auerbach, MMS president, said in a statement that the department's final regulations seemed to address many of the medical community's biggest concerns about the clinics, including sanitation and infection control, fragmentation of care, and physician oversight.

ED Waits Increase

Waits for emergency care are getting longer each year, with waits for patients who have acute myocardial infarction rising by 150%, according to a study by the Cambridge Health Alliance and Harvard Medical School. The study, which analyzed the time between a patient's arrival in the emergency department and when that patient was first were seen by a physician, found that the increasing delays affected patients from all racial and ethnic groups, regardless of health insurance status. Between 1997 and 2004, waits increased 36% for all patients (from 22 to 30 minutes, on average). But for those classified by a triage nurse as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Patients with acute myocardial infarction waited only 8 minutes in 1997, but waited 20 minutes on average in 2004, and one-quarter of these patients waited 50 minutes or more in 2004 before seeing a physician. The study, published online last month in Health Affairs, analyzed more than 90,000 emergency department visits.

Pandemic Preparation Not Enough

The United States, its international partners, and the pharmaceutical industry are investing substantial resources to address the availability and efficacy of antivirals and vaccines in the case of an influenza pandemic, the U.S. Government Accountability Office said in a report. But antivirals and vaccines might not be very effective in the case of such a pandemic, the GAO said. For effective antiviral use, health authorities must be able to detect a pandemic influenza strain quickly; effectiveness could be limited if antivirals are used more than 48 hours after the onset of symptoms, or by the emergence of strains resistant to antivirals. And, it could take up to 23 weeks to manufacture a pandemic vaccine, so such vaccines are likely to play “little or no role” in efforts to forestall a pandemic in its initial phases, the GAO said in its report, “Influenza Pandemic.”

Blues Launch Campaign

The Blue Cross and Blue Shield Association last month unveiled a 5-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary stages for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

Docs Mistrust Error Report Systems

U.S. physicians are willing to report medical errors but don't trust the current error reporting systems, according to a study in the January/February issue of Health Affairs. Between July 2003 and March 2004, researchers surveyed more than 1,000 physicians in rural and urban areas of Missouri and Washington state. They found that because of their mistrust of current systems, most physicians rely on informal discussion with colleagues as a way to report and share information about errors. Most of the physicians also reported that they had been involved in an error–56% with a serious error, 74% with a minor error, and 66% with a “near miss.” When asked what would increase their willingness to formally report errors, 88% of the respondents said they wanted information to be kept confidential and nondiscoverable, 85% wanted evidence that error information would be used for system improvements, and 53% said they wanted review activities confined to their department. “These findings shed light on an important question–how to create error-reporting programs that will encourage clinician participation,” said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, which funded the study. “Physicians say they want to learn from errors that take place in their institution. We need to build on that willingness with error-reporting programs that encourage their participation.”

CVS Clinics to Open in Mass.

Immediately after Massachusetts regulators approved store-based medical clinics last month, CVS Corp. said it would open as many as 30 in-store MinuteClinics in the state over the next year. CVS said that it plans to have 100-120 clinics in stores across the state within 3-5 years. The nurse practitioners staffing the clinics will treat minor problems such as sore throats and ear infections, but will refer patients with more serious conditions to a physician or an emergency department. The Massachusetts Medical Society, along with organizations representing family physicians, pediatricians, hospitals, and community health centers, raised concerns about retail medical clinics as the state's Department of Public Health considered whether to allow them, according to the medical society. Dr. Bruce Auerbach, MMS president, said in a statement that the department's final regulations seemed to address many of the medical community's biggest concerns about the clinics, including sanitation and infection control, fragmentation of care, and physician oversight.

ED Waits Increase

Waits for emergency care are getting longer each year, with waits for patients who have acute myocardial infarction rising by 150%, according to a study by the Cambridge Health Alliance and Harvard Medical School. The study, which analyzed the time between a patient's arrival in the emergency department and when that patient was first were seen by a physician, found that the increasing delays affected patients from all racial and ethnic groups, regardless of health insurance status. Between 1997 and 2004, waits increased 36% for all patients (from 22 to 30 minutes, on average). But for those classified by a triage nurse as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Patients with acute myocardial infarction waited only 8 minutes in 1997, but waited 20 minutes on average in 2004, and one-quarter of these patients waited 50 minutes or more in 2004 before seeing a physician. The study, published online last month in Health Affairs, analyzed more than 90,000 emergency department visits.

Pandemic Preparation Not Enough

The United States, its international partners, and the pharmaceutical industry are investing substantial resources to address the availability and efficacy of antivirals and vaccines in the case of an influenza pandemic, the U.S. Government Accountability Office said in a report. But antivirals and vaccines might not be very effective in the case of such a pandemic, the GAO said. For effective antiviral use, health authorities must be able to detect a pandemic influenza strain quickly; effectiveness could be limited if antivirals are used more than 48 hours after the onset of symptoms, or by the emergence of strains resistant to antivirals. And, it could take up to 23 weeks to manufacture a pandemic vaccine, so such vaccines are likely to play “little or no role” in efforts to forestall a pandemic in its initial phases, the GAO said in its report, “Influenza Pandemic.”

Blues Launch Campaign

The Blue Cross and Blue Shield Association last month unveiled a 5-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary stages for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

Docs Mistrust Error Report Systems

U.S. physicians are willing to report medical errors but don't trust the current error reporting systems, according to a study in the January/February issue of Health Affairs. Between July 2003 and March 2004, researchers surveyed more than 1,000 physicians in rural and urban areas of Missouri and Washington state. They found that because of their mistrust of current systems, most physicians rely on informal discussion with colleagues as a way to report and share information about errors. Most of the physicians also reported that they had been involved in an error–56% with a serious error, 74% with a minor error, and 66% with a “near miss.” When asked what would increase their willingness to formally report errors, 88% of the respondents said they wanted information to be kept confidential and nondiscoverable, 85% wanted evidence that error information would be used for system improvements, and 53% said they wanted review activities confined to their department. “These findings shed light on an important question–how to create error-reporting programs that will encourage clinician participation,” said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, which funded the study. “Physicians say they want to learn from errors that take place in their institution. We need to build on that willingness with error-reporting programs that encourage their participation.”

CVS Clinics to Open in Mass.

Immediately after Massachusetts regulators approved store-based medical clinics last month, CVS Corp. said it would open as many as 30 in-store MinuteClinics in the state over the next year. CVS said that it plans to have 100-120 clinics in stores across the state within 3-5 years. The nurse practitioners staffing the clinics will treat minor problems such as sore throats and ear infections, but will refer patients with more serious conditions to a physician or an emergency department. The Massachusetts Medical Society, along with organizations representing family physicians, pediatricians, hospitals, and community health centers, raised concerns about retail medical clinics as the state's Department of Public Health considered whether to allow them, according to the medical society. Dr. Bruce Auerbach, MMS president, said in a statement that the department's final regulations seemed to address many of the medical community's biggest concerns about the clinics, including sanitation and infection control, fragmentation of care, and physician oversight.

ED Waits Increase

Waits for emergency care are getting longer each year, with waits for patients who have acute myocardial infarction rising by 150%, according to a study by the Cambridge Health Alliance and Harvard Medical School. The study, which analyzed the time between a patient's arrival in the emergency department and when that patient was first were seen by a physician, found that the increasing delays affected patients from all racial and ethnic groups, regardless of health insurance status. Between 1997 and 2004, waits increased 36% for all patients (from 22 to 30 minutes, on average). But for those classified by a triage nurse as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Patients with acute myocardial infarction waited only 8 minutes in 1997, but waited 20 minutes on average in 2004, and one-quarter of these patients waited 50 minutes or more in 2004 before seeing a physician. The study, published online last month in Health Affairs, analyzed more than 90,000 emergency department visits.

Pandemic Preparation Not Enough

The United States, its international partners, and the pharmaceutical industry are investing substantial resources to address the availability and efficacy of antivirals and vaccines in the case of an influenza pandemic, the U.S. Government Accountability Office said in a report. But antivirals and vaccines might not be very effective in the case of such a pandemic, the GAO said. For effective antiviral use, health authorities must be able to detect a pandemic influenza strain quickly; effectiveness could be limited if antivirals are used more than 48 hours after the onset of symptoms, or by the emergence of strains resistant to antivirals. And, it could take up to 23 weeks to manufacture a pandemic vaccine, so such vaccines are likely to play “little or no role” in efforts to forestall a pandemic in its initial phases, the GAO said in its report, “Influenza Pandemic.”

Blues Launch Campaign

The Blue Cross and Blue Shield Association last month unveiled a 5-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary stages for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

Docs Mistrust Error Report Systems

U.S. physicians are willing to report medical errors but don't trust the current error reporting systems, according to a study in the January/February issue of Health Affairs. Between July 2003 and March 2004, researchers surveyed more than 1,000 physicians in rural and urban areas of Missouri and Washington state. They found that because of their mistrust of current systems, most physicians rely on informal discussion with colleagues as a way to report and share information about errors. Most of the physicians also reported that they had been involved in an error–56% with a serious error, 74% with a minor error, and 66% with a “near miss.” When asked what would increase their willingness to formally report errors, 88% of the respondents said they wanted information to be kept confidential and nondiscoverable, 85% wanted evidence that error information would be used for system improvements, and 53% said they wanted review activities confined to their department. “These findings shed light on an important question–how to create error-reporting programs that will encourage clinician participation,” said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, which funded the study. “Physicians say they want to learn from errors that take place in their institution. We need to build on that willingness with error-reporting programs that encourage their participation.”

CVS Clinics to Open in Mass.

Immediately after Massachusetts regulators approved store-based medical clinics last month, CVS Corp. said it would open as many as 30 in-store MinuteClinics in the state over the next year. CVS said that it plans to have 100–120 clinics in stores across the state in 3–5 years. The nurse practitioners staffing the clinics will treat minor problems such as sore throats and ear infections, but will refer patients with more serious conditions to a physician or an emergency department. The Massachusetts Medical Society, along with organizations representing family physicians, pediatricians, hospitals, and community health centers, raised concerns about retail medical clinics as the state's Department of Public Health considered whether to allow them, according to the medical society. Dr. Bruce Auerbach, MMS president, said in a statement that the department's final regulations seemed to address many of the medical community's biggest concerns about the clinics, including sanitation and infection control, fragmentation of care, and physician oversight.

ED Waits Increase

Waits for emergency care are getting longer each year, with waits for patients who have acute myocardial infarction rising by 150%, according to a study by the Cambridge Health Alliance and Harvard Medical School. The study, which analyzed the time between a patient's arrival in the emergency department and when that patient was first seen by a physician, found that the increasing delays affected patients from all racial and ethnic groups, regardless of health insurance status. Between 1997 and 2004, waits increased 36% for all patients (from 22 to 30 minutes, on average). But for those classified by a triage nurse as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Patients with acute myocardial infarction waited only 8 minutes in 1997, but waited 20 minutes on average in 2004, and one-quarter of these patients waited 50 minutes or more in 2004 before seeing a physician. The study, published online last month in Health Affairs, analyzed more than 90,000 emergency department visits.

Pandemic Preparation Not Enough

The United States, its international partners, and the pharmaceutical industry are investing substantial resources to address the availability and efficacy of antivirals and vaccines in the case of an influenza pandemic, the U.S. Government Accountability Office said in a report. But antivirals and vaccines might not be very effective in the case of such a pandemic, the GAO said. For effective antiviral use, health authorities must be able to detect a pandemic influenza strain quickly; effectiveness could be limited if antivirals are used more than 48 hours after the onset of symptoms, or by the emergence of strains resistant to antivirals. And it could take up to 23 weeks to manufacture a pandemic vaccine, so such vaccines are likely to play “little or no role” in efforts to forestall a pandemic in its initial phases, the GAO said in its report, “Influenza Pandemic.”

Blues Launch Campaign

The Blue Cross and Blue Shield Association last month unveiled a five-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary steps for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

Docs Mistrust Error Report Systems

U.S. physicians are willing to report medical errors but don't trust the current error reporting systems, according to a study in the January/February issue of Health Affairs. Between July 2003 and March 2004, researchers surveyed more than 1,000 physicians in rural and urban areas of Missouri and Washington state. They found that because of their mistrust of current systems, most physicians rely on informal discussion with colleagues as a way to report and share information about errors. Most physicians also reported that they had been involved in an error—56% with a serious error, 74% with a minor error, and 66% with a “near miss.” When asked what would increase their willingness to formally report errors, 88% said they wanted information to be kept confidential and nondiscoverable, 85% wanted evidence that error information would be used for system improvements, and 53% said they wanted review activities confined to their department. “These findings shed light on an important question—how to create error-reporting programs that will encourage clinician participation,” said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, which funded the study. “Physicians say they want to learn from errors that take place in their institution. We need to build on that willingness with error-reporting programs that encourage their participation.”

CVS Clinics to Open in Mass.

Immediately after Massachusetts regulators approved store-based medical clinics last month, CVS Corp. said it would open as many as 30 in-store MinuteClinics in the state over the next year. CVS said that it plans to have 100–120 clinics in stores across the state in 3–5 years. The nurse practitioners staffing the clinics will treat minor problems such as sore throats and ear infections, but will refer patients with more serious conditions to a physician or an emergency department. The Massachusetts Medical Society, along with organizations representing family physicians, pediatricians, hospitals, and community health centers, raised concerns about retail medical clinics as the state's Department of Public Health considered whether to allow them, according to the medical society. Dr. Bruce Auerbach, MMS president, said in a statement that the department's final regulations seemed to address many of the medical community's biggest concerns about the clinics, including sanitation and infection control, fragmentation of care, and physician oversight.

ED Waits Increase

Waits for emergency care are getting longer each year, with waits for patients who have acute myocardial infarction rising by 150%, according to a study by the Cambridge Health Alliance and Harvard Medical School. The study, which analyzed the time between a patient's arrival in the emergency department and when that patient was first seen by a physician, found that the increasing delays affected patients from all racial and ethnic groups, regardless of health insurance status. Between 1997 and 2004, waits increased 36% for all patients (from 22 to 30 minutes, on average). But for those classified by a triage nurse as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Patients with acute myocardial infarction waited only 8 minutes in 1997, but waited 20 minutes on average in 2004, and one-quarter of these patients waited 50 minutes or more in 2004 before seeing a physician. The study, published online last month in Health Affairs, analyzed more than 90,000 emergency department visits.

Pandemic Preparation Not Enough

The United States, its international partners, and the pharmaceutical industry are investing substantial resources to address the availability and efficacy of antivirals and vaccines in the case of an influenza pandemic, the U.S. Government Accountability Office said in a report. But antivirals and vaccines might not be very effective in the case of such a pandemic, the GAO said. For effective antiviral use, health authorities must be able to detect a pandemic influenza strain quickly; effectiveness could be limited if antivirals are used more than 48 hours after the onset of symptoms, or by the emergence of strains resistant to antivirals. And it could take up to 23 weeks to manufacture a pandemic vaccine, so such vaccines are likely to play “little or no role” in efforts to forestall a pandemic in its initial phases, the GAO said in its report, “Influenza Pandemic.”

Blues Launch Campaign

The Blue Cross and Blue Shield Association last month unveiled a five-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary steps for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

Docs Mistrust Error Report Systems

U.S. physicians are willing to report medical errors but don't trust the current error reporting systems, according to a study in the January/February issue of Health Affairs. Between July 2003 and March 2004, researchers surveyed more than 1,000 physicians in rural and urban areas of Missouri and Washington state. They found that because of their mistrust of current systems, most physicians rely on informal discussion with colleagues as a way to report and share information about errors. Most physicians also reported that they had been involved in an error—56% with a serious error, 74% with a minor error, and 66% with a “near miss.” When asked what would increase their willingness to formally report errors, 88% said they wanted information to be kept confidential and nondiscoverable, 85% wanted evidence that error information would be used for system improvements, and 53% said they wanted review activities confined to their department. “These findings shed light on an important question—how to create error-reporting programs that will encourage clinician participation,” said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, which funded the study. “Physicians say they want to learn from errors that take place in their institution. We need to build on that willingness with error-reporting programs that encourage their participation.”

CVS Clinics to Open in Mass.

Immediately after Massachusetts regulators approved store-based medical clinics last month, CVS Corp. said it would open as many as 30 in-store MinuteClinics in the state over the next year. CVS said that it plans to have 100–120 clinics in stores across the state in 3–5 years. The nurse practitioners staffing the clinics will treat minor problems such as sore throats and ear infections, but will refer patients with more serious conditions to a physician or an emergency department. The Massachusetts Medical Society, along with organizations representing family physicians, pediatricians, hospitals, and community health centers, raised concerns about retail medical clinics as the state's Department of Public Health considered whether to allow them, according to the medical society. Dr. Bruce Auerbach, MMS president, said in a statement that the department's final regulations seemed to address many of the medical community's biggest concerns about the clinics, including sanitation and infection control, fragmentation of care, and physician oversight.

ED Waits Increase

Waits for emergency care are getting longer each year, with waits for patients who have acute myocardial infarction rising by 150%, according to a study by the Cambridge Health Alliance and Harvard Medical School. The study, which analyzed the time between a patient's arrival in the emergency department and when that patient was first seen by a physician, found that the increasing delays affected patients from all racial and ethnic groups, regardless of health insurance status. Between 1997 and 2004, waits increased 36% for all patients (from 22 to 30 minutes, on average). But for those classified by a triage nurse as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Patients with acute myocardial infarction waited only 8 minutes in 1997, but waited 20 minutes on average in 2004, and one-quarter of these patients waited 50 minutes or more in 2004 before seeing a physician. The study, published online last month in Health Affairs, analyzed more than 90,000 emergency department visits.

Pandemic Preparation Not Enough

The United States, its international partners, and the pharmaceutical industry are investing substantial resources to address the availability and efficacy of antivirals and vaccines in the case of an influenza pandemic, the U.S. Government Accountability Office said in a report. But antivirals and vaccines might not be very effective in the case of such a pandemic, the GAO said. For effective antiviral use, health authorities must be able to detect a pandemic influenza strain quickly; effectiveness could be limited if antivirals are used more than 48 hours after the onset of symptoms, or by the emergence of strains resistant to antivirals. And it could take up to 23 weeks to manufacture a pandemic vaccine, so such vaccines are likely to play “little or no role” in efforts to forestall a pandemic in its initial phases, the GAO said in its report, “Influenza Pandemic.”

Blues Launch Campaign

The Blue Cross and Blue Shield Association last month unveiled a five-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary steps for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

Docs Mistrust Error Report Systems

U.S. physicians are willing to report medical errors but don't trust the current error reporting systems, according to a study in the January/February issue of Health Affairs. Between July 2003 and March 2004, researchers surveyed more than 1,000 physicians in rural and urban areas of Missouri and Washington state. They found that because of their mistrust of current systems, most physicians rely on informal discussion with colleagues as a way to report and share information about errors. Most physicians also reported that they had been involved in an error—56% with a serious error, 74% with a minor error, and 66% with a “near miss.” When asked what would increase their willingness to formally report errors, 88% said they wanted information to be kept confidential and nondiscoverable, 85% wanted evidence that error information would be used for system improvements, and 53% said they wanted review activities confined to their department. “These findings shed light on an important question—how to create error-reporting programs that will encourage clinician participation,” said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, which funded the study. “Physicians say they want to learn from errors that take place in their institution. We need to build on that willingness with error-reporting programs that encourage their participation.”

Blue Cross/Shield Sets Campaign

The Blue Cross and Blue Shield Association last month unveiled a five-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary steps for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

AAA: Car Seat Laws Inadequate

Parents strongly support child safety seats and the laws requiring their use, but nearly 100 children under age 5 years die annually in automobile accidents they could have survived if they had been using child safety seats correctly, according to AAA. In a survey released by AAA to coincide with the 30th anniversary of Tennessee's first-in-the-nation child safety seat law, more than half of all parents said they look to their state law for guidance on how to restrain their children. Almost all parents reported that they are aware of their state's child restraint laws, and 86% said the laws should be consistent across the country. However, only 39% surveyed could accurately identify the age at which their state allows a child to ride with only a lap and shoulder belt. “Parents look to the law to provide guidance about when and how their children should be restrained but, in many cases, the laws are letting them down,” said Robert Darbelnet, president and CEO of AAA, in a statement. Every state has a provision for children under age 4 years, but just 18 states and the District of Columbia require children up to the age of 8 years or older to use a booster seat.

N.J. Triples Medicaid Rates

Physicians and others who provide health care to poor children in New Jersey are getting their first increase in Medicaid rates in 2 decades, with reimbursement more than tripling. Last summer, Gov. Jon Corzine (D) added $10 million in state funds for Medicaid reimbursement for 2008, and the federal government will match the money for a total of $20 million dedicated to pediatric providers. This means, for example, that physicians who were previously paid $23.02 for a visit now will be paid $73.70, and dentists who previously were paid $18.02 for an examination now will be paid $64. Like many states, New Jersey's budget constraints prevented Medicaid rate increases, and rates have remained static for about 20 years. “These new rates will benefit existing Medicaid providers and will help the Department of Human Services attract new ones,” said Human Services Commissioner Jennifer Velez in a statement.

AAP Wants DC Gun Ban Upheld

The American Academy of Pediatrics has called on the U.S. Supreme Court to uphold the District of Columbia's handgun ban. Joining four other groups, including the Society for Adolescent Medicine, The Children's Defense Fund, Women Against Gun Violence and Youth Alive!, the AAP argued in its Jan. 11 friend-of-the-court brief that “the absence of handguns from children's homes and communities is the most reliable and effective method to prevent firearms-related injuries to children and adolescents.” The 31-year-old ban, which was overturned in March 2007 by the U.S. Court of Appeals for the D.C. Circuit, makes it illegal to own handguns in the District and requires that shotgun and rifle owners unload and disassemble their guns, or use a trigger lock, if the guns are kept at home. Oral arguments in the case, District of Columbia v. Heller, will be heard this spring.

School Scoliosis Screening Urged

The American Association of Orthopaedic Surgeons has called for more states to adopt a school-based screening policy for scoliosis. About half the states currently require and pay for adolescents to get screened for the disease. The AAOS has teamed with the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the AAP to educate lawmakers on the importance of scoliosis screening in schools. Dr. Michael Vitale, director of pediatric spine surgery at the Morgan Stanley Children's Hospital of New York-Presbyterian, said in a commentary published in the January issue of Journal of Bone and Joint Surgery that states may be concerned about the cost of screening and diagnosis for those children picked up as possible scoliosis patients during the screening. “Early screening does pick up some scoliosis in the early stages, but it is controversial because some feel it is not cost effective,” Dr. Vitale wrote. “That sends a message to society that it is not important to look at our children's spines.”

Blue Cross/Shield Sets Campaign

The Blue Cross and Blue Shield Association last month unveiled a five-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary steps for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

AAA: Car Seat Laws Inadequate

Parents strongly support child safety seats and the laws requiring their use, but nearly 100 children under age 5 years die annually in automobile accidents they could have survived if they had been using child safety seats correctly, according to AAA. In a survey released by AAA to coincide with the 30th anniversary of Tennessee's first-in-the-nation child safety seat law, more than half of all parents said they look to their state law for guidance on how to restrain their children. Almost all parents reported that they are aware of their state's child restraint laws, and 86% said the laws should be consistent across the country. However, only 39% surveyed could accurately identify the age at which their state allows a child to ride with only a lap and shoulder belt. “Parents look to the law to provide guidance about when and how their children should be restrained but, in many cases, the laws are letting them down,” said Robert Darbelnet, president and CEO of AAA, in a statement. Every state has a provision for children under age 4 years, but just 18 states and the District of Columbia require children up to the age of 8 years or older to use a booster seat.

N.J. Triples Medicaid Rates

Physicians and others who provide health care to poor children in New Jersey are getting their first increase in Medicaid rates in 2 decades, with reimbursement more than tripling. Last summer, Gov. Jon Corzine (D) added $10 million in state funds for Medicaid reimbursement for 2008, and the federal government will match the money for a total of $20 million dedicated to pediatric providers. This means, for example, that physicians who were previously paid $23.02 for a visit now will be paid $73.70, and dentists who previously were paid $18.02 for an examination now will be paid $64. Like many states, New Jersey's budget constraints prevented Medicaid rate increases, and rates have remained static for about 20 years. “These new rates will benefit existing Medicaid providers and will help the Department of Human Services attract new ones,” said Human Services Commissioner Jennifer Velez in a statement.

AAP Wants DC Gun Ban Upheld

The American Academy of Pediatrics has called on the U.S. Supreme Court to uphold the District of Columbia's handgun ban. Joining four other groups, including the Society for Adolescent Medicine, The Children's Defense Fund, Women Against Gun Violence and Youth Alive!, the AAP argued in its Jan. 11 friend-of-the-court brief that “the absence of handguns from children's homes and communities is the most reliable and effective method to prevent firearms-related injuries to children and adolescents.” The 31-year-old ban, which was overturned in March 2007 by the U.S. Court of Appeals for the D.C. Circuit, makes it illegal to own handguns in the District and requires that shotgun and rifle owners unload and disassemble their guns, or use a trigger lock, if the guns are kept at home. Oral arguments in the case, District of Columbia v. Heller, will be heard this spring.

School Scoliosis Screening Urged

The American Association of Orthopaedic Surgeons has called for more states to adopt a school-based screening policy for scoliosis. About half the states currently require and pay for adolescents to get screened for the disease. The AAOS has teamed with the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the AAP to educate lawmakers on the importance of scoliosis screening in schools. Dr. Michael Vitale, director of pediatric spine surgery at the Morgan Stanley Children's Hospital of New York-Presbyterian, said in a commentary published in the January issue of Journal of Bone and Joint Surgery that states may be concerned about the cost of screening and diagnosis for those children picked up as possible scoliosis patients during the screening. “Early screening does pick up some scoliosis in the early stages, but it is controversial because some feel it is not cost effective,” Dr. Vitale wrote. “That sends a message to society that it is not important to look at our children's spines.”

Blue Cross/Shield Sets Campaign

The Blue Cross and Blue Shield Association last month unveiled a five-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured. For each of the five action steps, the proposal outlines what Blues plans are doing in their local communities, and lists the necessary steps for implementing the steps nationwide. The BCBSA said that it and its 39 member plans will promote the plan in a multifaceted campaign this year.

AAA: Car Seat Laws Inadequate

Parents strongly support child safety seats and the laws requiring their use, but nearly 100 children under age 5 years die annually in automobile accidents they could have survived if they had been using child safety seats correctly, according to AAA. In a survey released by AAA to coincide with the 30th anniversary of Tennessee's first-in-the-nation child safety seat law, more than half of all parents said they look to their state law for guidance on how to restrain their children. Almost all parents reported that they are aware of their state's child restraint laws, and 86% said the laws should be consistent across the country. However, only 39% surveyed could accurately identify the age at which their state allows a child to ride with only a lap and shoulder belt. “Parents look to the law to provide guidance about when and how their children should be restrained but, in many cases, the laws are letting them down,” said Robert Darbelnet, president and CEO of AAA, in a statement. Every state has a provision for children under age 4 years, but just 18 states and the District of Columbia require children up to the age of 8 years or older to use a booster seat.

N.J. Triples Medicaid Rates

Physicians and others who provide health care to poor children in New Jersey are getting their first increase in Medicaid rates in 2 decades, with reimbursement more than tripling. Last summer, Gov. Jon Corzine (D) added $10 million in state funds for Medicaid reimbursement for 2008, and the federal government will match the money for a total of $20 million dedicated to pediatric providers. This means, for example, that physicians who were previously paid $23.02 for a visit now will be paid $73.70, and dentists who previously were paid $18.02 for an examination now will be paid $64. Like many states, New Jersey's budget constraints prevented Medicaid rate increases, and rates have remained static for about 20 years. “These new rates will benefit existing Medicaid providers and will help the Department of Human Services attract new ones,” said Human Services Commissioner Jennifer Velez in a statement.

AAP Wants DC Gun Ban Upheld

The American Academy of Pediatrics has called on the U.S. Supreme Court to uphold the District of Columbia's handgun ban. Joining four other groups, including the Society for Adolescent Medicine, The Children's Defense Fund, Women Against Gun Violence and Youth Alive!, the AAP argued in its Jan. 11 friend-of-the-court brief that “the absence of handguns from children's homes and communities is the most reliable and effective method to prevent firearms-related injuries to children and adolescents.” The 31-year-old ban, which was overturned in March 2007 by the U.S. Court of Appeals for the D.C. Circuit, makes it illegal to own handguns in the District and requires that shotgun and rifle owners unload and disassemble their guns, or use a trigger lock, if the guns are kept at home. Oral arguments in the case, District of Columbia v. Heller, will be heard this spring.

School Scoliosis Screening Urged

The American Association of Orthopaedic Surgeons has called for more states to adopt a school-based screening policy for scoliosis. About half the states currently require and pay for adolescents to get screened for the disease. The AAOS has teamed with the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the AAP to educate lawmakers on the importance of scoliosis screening in schools. Dr. Michael Vitale, director of pediatric spine surgery at the Morgan Stanley Children's Hospital of New York-Presbyterian, said in a commentary published in the January issue of Journal of Bone and Joint Surgery that states may be concerned about the cost of screening and diagnosis for those children picked up as possible scoliosis patients during the screening. “Early screening does pick up some scoliosis in the early stages, but it is controversial because some feel it is not cost effective,” Dr. Vitale wrote. “That sends a message to society that it is not important to look at our children's spines.”

Low-Income Seniors Helped

The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.

Coverage Improves Health

Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.

Grant Funds Medical Home Study

The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President, Dr. Michael Barr, who is directing the study, said in a statement.

Retiree Benefits Can be Cut

A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.

Expanded INR Monitor Coverage

CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage of monitoring to those patients with chronic atrial fibrillation or deep-vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.

Judge Overturns Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyse, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.

Low-Income Seniors Helped

The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.

Coverage Improves Health

Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.

Grant Funds Medical Home Study

The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President, Dr. Michael Barr, who is directing the study, said in a statement.

Retiree Benefits Can be Cut

A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.

Expanded INR Monitor Coverage

CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage of monitoring to those patients with chronic atrial fibrillation or deep-vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.

Judge Overturns Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyse, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.

Low-Income Seniors Helped

The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.

Coverage Improves Health

Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.

Grant Funds Medical Home Study

The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President, Dr. Michael Barr, who is directing the study, said in a statement.

Retiree Benefits Can be Cut

A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.

Expanded INR Monitor Coverage

CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage of monitoring to those patients with chronic atrial fibrillation or deep-vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.

Judge Overturns Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyse, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.

Poor and uninsured Americans are less likely than wealthy or insured Americans to receive free drug samples, according to a study by physicians from Cambridge Health Alliance and Harvard Medical School.

The study found that, in 2003, 12% of Americans received at least one free drug sample. More people who were continuously insured received a free sample than people who were uninsured for all or part of the year, and the poorest third were less likely to receive free samples than were those with incomes at 400% of the federal poverty level or more.

“We know that many doctors try to get free samples to needy patients,” said study senior author Dr. David Himmelstein in a statement. “We found that such efforts do not counter society-wide factors that determine access to care and selectively direct free samples to the affluent. Our findings strongly suggest that free drug samples serve as a marketing tool, not as a safety net.”

But Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America, said in a statement that free samples help millions of Americans, regardless of income, and “offer an option for those who have difficulty affording their medicines.”

The study was slated to appear in the February issue of the American Journal of Public Health.

Poor and uninsured Americans are less likely than wealthy or insured Americans to receive free drug samples, according to a study by physicians from Cambridge Health Alliance and Harvard Medical School.

The study found that, in 2003, 12% of Americans received at least one free drug sample. More people who were continuously insured received a free sample than people who were uninsured for all or part of the year, and the poorest third were less likely to receive free samples than were those with incomes at 400% of the federal poverty level or more.

“We know that many doctors try to get free samples to needy patients,” said study senior author Dr. David Himmelstein in a statement. “We found that such efforts do not counter society-wide factors that determine access to care and selectively direct free samples to the affluent. Our findings strongly suggest that free drug samples serve as a marketing tool, not as a safety net.”

But Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America, said in a statement that free samples help millions of Americans, regardless of income, and “offer an option for those who have difficulty affording their medicines.”

The study was slated to appear in the February issue of the American Journal of Public Health.

Poor and uninsured Americans are less likely than wealthy or insured Americans to receive free drug samples, according to a study by physicians from Cambridge Health Alliance and Harvard Medical School.

The study found that, in 2003, 12% of Americans received at least one free drug sample. More people who were continuously insured received a free sample than people who were uninsured for all or part of the year, and the poorest third were less likely to receive free samples than were those with incomes at 400% of the federal poverty level or more.

“We know that many doctors try to get free samples to needy patients,” said study senior author Dr. David Himmelstein in a statement. “We found that such efforts do not counter society-wide factors that determine access to care and selectively direct free samples to the affluent. Our findings strongly suggest that free drug samples serve as a marketing tool, not as a safety net.”

But Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America, said in a statement that free samples help millions of Americans, regardless of income, and “offer an option for those who have difficulty affording their medicines.”

The study was slated to appear in the February issue of the American Journal of Public Health.

Low-Income Seniors Helped

The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.

Coverage Improves Health

Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.

Grant Funds Medical Home Study

The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President Dr. Michael Barr, who is directing the study, said in a statement.

Retiree Benefits Can Be Cut

A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. The EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.

Expanded INR Monitor Coverage

CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage to those patients with chronic atrial fibrillation or deep vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.

Judge Overturns Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyze, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.

Low-Income Seniors Helped

The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.

Coverage Improves Health

Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.

Grant Funds Medical Home Study

The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President Dr. Michael Barr, who is directing the study, said in a statement.

Retiree Benefits Can Be Cut

A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. The EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.

Expanded INR Monitor Coverage

CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage to those patients with chronic atrial fibrillation or deep vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.

Judge Overturns Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyze, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.

Low-Income Seniors Helped

The Centers for Medicare and Medicaid Services has proposed new rules that would allow more low-income Medicare beneficiaries to remain in their current prescription drug plan without having to pay a premium. Each year, CMS recalculates the amount of premium that will be paid by Medicare for low-income beneficiaries in each region, meaning that individual Part D plans might be fully covered by the subsidy in one year but not the next year. Until now, CMS has randomly reassigned some beneficiaries to another Part D plan if their current plan's premium would be higher than the subsidy amount. The new rules, proposed last month and slated to be finalized in time for the 2009 plan year, would allow some prescription plan sponsors to offer a reduced premium to some individuals eligible for the low-income subsidy. The proposal would apply in regions where there otherwise would be fewer than five prescription drug plan sponsors with a “zero-premium” plan option for low-income beneficiaries.

Coverage Improves Health

Uninsured adults 55–64 years old, particularly those with cardiovascular disease or diabetes, saw their health improve significantly once they became eligible for Medicare, a study from Harvard Medical School, Boston, reported. The study looked at more than 5,000 adults who were continuously insured and more than 2,200 who were uninsured persistently or intermittently in the decade before they became eligible for Medicare. The researchers found that, compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65, both overall and for measures related to mobility, agility, and adverse cardiovascular outcomes. Depressive symptoms did not improve significantly in uninsured individuals with these other conditions once they became eligible for Medicare, but depressive symptoms did improve in previously uninsured adults without these other conditions once they became eligible for Medicare. By age 70, the differences in health status between the previously uninsured and those who had been insured continuously were reduced by about half. The study appeared in the Dec. 26 issue of JAMA.

Grant Funds Medical Home Study

The American College of Physicians has received a $225,000 grant from the Commonwealth Fund to study the cost of providing a patient-centered medical home. The grant, part of the Commonwealth Fund's Patient-Centered Primary Care Initiative, will help underwrite a 10-month study which began in November. ACP committed matching funds late in 2007, the organization said. “Understanding the economics of the patient-centered medical home is essential to the development of payment strategies that support the adoption and spread of the model,” ACP Vice President Dr. Michael Barr, who is directing the study, said in a statement.

Retiree Benefits Can Be Cut

A new federal regulation will allow employers to provide more limited health care benefits for retirees who are eligible for Medicare. The rule, which the Equal Employment Opportunity Commission released in late December, responds to a court of appeals case in which the court held that health insurance benefits provided to Medicare-eligible retirees must cost the same as those provided to early retirees. Both labor unions and employers complained to the EEOC that compliance with the decision would force companies to reduce or eliminate current retiree health benefits. The EEOC said that the new rule makes it clear that employers are allowed to coordinate retiree benefits with the Medicare program. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits, which are increasingly less available and less generous,” said EEOC chair Naomi Earp in a statement. AARP sharply panned the new policy. “It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age,” said AARP legislative policy director David Certner in a statement.

Expanded INR Monitor Coverage

CMS is considering expanding coverage for home prothrombin time (international normalized ratio) monitoring. Currently, monitoring is limited to patients with mechanical heart valves. The agency proposes to expand coverage to those patients with chronic atrial fibrillation or deep vein thrombosis who require chronic oral anticoagulation with warfarin, have been anticoagulated for at least 3 months, have undergone an educational program on anticoagulation management and demonstrated the correct use of the device, continue to correctly use the device, and use the device to self-test no more than once a week. CMS said it will gather feedback on its proposal, but did not provide a timetable for a final decision.

Judge Overturns Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law was challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyze, and sell such data to pharmaceutical manufacturers. The companies also argued that the law bucks a national trend toward greater transparency in health care information.

Concern Over Medical Home Bill

The American Academy of Family Physicians has raised concerns about a bill that would provide federal funding for patient-centered medical home demonstration projects within Medicaid and the State Children's Health Insurance Program, saying that the bill's language does not provide enough guidance for setting the care management fee to be paid to physicians. The legislation, introduced by Sen. Richard Durbin (D-Ill.) and Sen. Richard Burr (R-N.C.), also would create local medical management committees to establish standards and measures for patient-centered medical homes. It would require Medicaid and SCHIP to pay participating physician practices a minimum management fee of $2.50 per member per month. AAFP Board Chair Rick Kellerman noted in a letter to the senators that the legislation “does not provide the states or CMS with guidance for determining how much this fee should be. As a result, states are likely to use this floor as the payment amount.” Instead, Dr. Kellerman said, the fee should be set in each state based on a recommendation from a team that includes primary care physician organization representatives.

More Action Needed on MRSA

U.S. health care facilities are not doing enough to protect patients from methicillin-resistant Staphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority of infection control professionals (59%) responded that their health care facilities have stepped up efforts to curb MRSA in the past 6 months. But half said their facilities were “not doing as much as [they] could or should” to stop the transmission of MRSA. “MRSA could be beaten if the leadership at hospitals moved more aggressively to adopt strategies proven to protect patients from these virulent infections,” said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign. “We need to require hospitals to report their infection rates so the public can see if they are achieving results.” Consumers Union has worked to help pass laws in 20 states requiring hospitals to report their patient infection rates, and it supports a federal infection reporting law. The Centers for Disease Control and Prevention estimates that nearly 95,000 patients developed MRSA infections in 2005–most of which were acquired in health care facilities–and almost 19,000 people died.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face numerous challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could shave $4 billion annually off the total U.S. health care bill. The group advocates creating a workable pathway to approving generic biopharmaceutical medicines and preventing state governments from barring generic substitution for various therapeutic classes of medicines.

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is necessary to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” HHS Inspector General Daniel Levinson said in a statement. “[Medicare] should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the CMS on enrollees' additional drug coverage data. And 34% of Part D plans–covering nearly half of Part D enrollees–did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight the CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized the FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues during the first year of the program.

Concern Over Medical Home Bill

The American Academy of Family Physicians has raised concerns about a bill that would provide federal funding for patient-centered medical home demonstration projects within Medicaid and the State Children's Health Insurance Program, saying that the bill's language does not provide enough guidance for setting the care management fee to be paid to physicians. The legislation, introduced by Sen. Richard Durbin (D-Ill.) and Sen. Richard Burr (R-N.C.), also would create local medical management committees to establish standards and measures for patient-centered medical homes. It would require Medicaid and SCHIP to pay participating physician practices a minimum management fee of $2.50 per member per month. AAFP Board Chair Rick Kellerman noted in a letter to the senators that the legislation “does not provide the states or CMS with guidance for determining how much this fee should be. As a result, states are likely to use this floor as the payment amount.” Instead, Dr. Kellerman said, the fee should be set in each state based on a recommendation from a team that includes primary care physician organization representatives.

More Action Needed on MRSA

U.S. health care facilities are not doing enough to protect patients from methicillin-resistant Staphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority of infection control professionals (59%) responded that their health care facilities have stepped up efforts to curb MRSA in the past 6 months. But half said their facilities were “not doing as much as [they] could or should” to stop the transmission of MRSA. “MRSA could be beaten if the leadership at hospitals moved more aggressively to adopt strategies proven to protect patients from these virulent infections,” said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign. “We need to require hospitals to report their infection rates so the public can see if they are achieving results.” Consumers Union has worked to help pass laws in 20 states requiring hospitals to report their patient infection rates, and it supports a federal infection reporting law. The Centers for Disease Control and Prevention estimates that nearly 95,000 patients developed MRSA infections in 2005–most of which were acquired in health care facilities–and almost 19,000 people died.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face numerous challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could shave $4 billion annually off the total U.S. health care bill. The group advocates creating a workable pathway to approving generic biopharmaceutical medicines and preventing state governments from barring generic substitution for various therapeutic classes of medicines.

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is necessary to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” HHS Inspector General Daniel Levinson said in a statement. “[Medicare] should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the CMS on enrollees' additional drug coverage data. And 34% of Part D plans–covering nearly half of Part D enrollees–did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight the CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized the FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues during the first year of the program.

Concern Over Medical Home Bill

The American Academy of Family Physicians has raised concerns about a bill that would provide federal funding for patient-centered medical home demonstration projects within Medicaid and the State Children's Health Insurance Program, saying that the bill's language does not provide enough guidance for setting the care management fee to be paid to physicians. The legislation, introduced by Sen. Richard Durbin (D-Ill.) and Sen. Richard Burr (R-N.C.), also would create local medical management committees to establish standards and measures for patient-centered medical homes. It would require Medicaid and SCHIP to pay participating physician practices a minimum management fee of $2.50 per member per month. AAFP Board Chair Rick Kellerman noted in a letter to the senators that the legislation “does not provide the states or CMS with guidance for determining how much this fee should be. As a result, states are likely to use this floor as the payment amount.” Instead, Dr. Kellerman said, the fee should be set in each state based on a recommendation from a team that includes primary care physician organization representatives.

More Action Needed on MRSA

U.S. health care facilities are not doing enough to protect patients from methicillin-resistant Staphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority of infection control professionals (59%) responded that their health care facilities have stepped up efforts to curb MRSA in the past 6 months. But half said their facilities were “not doing as much as [they] could or should” to stop the transmission of MRSA. “MRSA could be beaten if the leadership at hospitals moved more aggressively to adopt strategies proven to protect patients from these virulent infections,” said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign. “We need to require hospitals to report their infection rates so the public can see if they are achieving results.” Consumers Union has worked to help pass laws in 20 states requiring hospitals to report their patient infection rates, and it supports a federal infection reporting law. The Centers for Disease Control and Prevention estimates that nearly 95,000 patients developed MRSA infections in 2005–most of which were acquired in health care facilities–and almost 19,000 people died.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face numerous challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could shave $4 billion annually off the total U.S. health care bill. The group advocates creating a workable pathway to approving generic biopharmaceutical medicines and preventing state governments from barring generic substitution for various therapeutic classes of medicines.

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is necessary to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” HHS Inspector General Daniel Levinson said in a statement. “[Medicare] should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the CMS on enrollees' additional drug coverage data. And 34% of Part D plans–covering nearly half of Part D enrollees–did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight the CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized the FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues during the first year of the program.