Jane Anderson

Ex-FDA Chief Fined

Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., Ph.D., has been sentenced to 3 years of supervised probation and fines of slightly less than $90,000 for charges stemming from his ownership of stock in companies regulated by the FDA. The penalty exceeded a $50,000 fine in a plea agreement Dr. Crawford and federal prosecutors struck last year but still spared the former FDA chief jail time. U.S. Magistrate Judge Deborah Robinson of the District Court for the District of Columbia also ordered Dr. Crawford to perform 50 hours of community service. Dr. Crawford resigned his FDA administrator post in September 2005 after just 2 months and did not give a reason for his resignation. In October 2006, he pleaded guilty to charges of having a conflict of interest and false reporting of information about stocks that he and his wife owned. Prosecutors said that Dr. Crawford filed seven incorrect financial reports with a government ethics office and Congress beginning in 2002.

Insurance Cost Sharing

Fewer than 24% of private sector employees covered by employer-sponsored health insurance do not pay a portion of their own premium, down from 35% in 1998, according to a report from the Agency for Healthcare Research and Quality. In both years, employers were more likely to offer no-contribution single coverage than no-contribution family coverage. In 1998, 18% of employees eligible for health insurance from their employer worked in a firm that offered at least one family coverage plan that required no employee contribution; by 2004, that rate had fallen to 13%, the report said.

Majority Want Access Guarantee

Nearly two-thirds of Americans believe that the federal government should guarantee access to health care, and 60% are willing to pay more in taxes for that guarantee, according to a poll released last month by the New York Times and CBS News. Half of those polled said they would be willing to pay as much as $500 a year in additional taxes, while nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the Bush administration's tax cuts. In addition, a quarter of those with insurance said that they or someone in their household had gone without a medical test or treatment because insurance would not cover it; 60% of those without insurance reported the same situation. The nationwide telephone poll of 1,281 adults was conducted in late February 2007.

Hospital Demonstration Extended

The Centers for Medicare and Medicaid Services has approved a 3-year extension of the Premier Hospital Quality Incentive Demonstration, a value-based purchasing project involving more than 260 hospitals across the country. Recently released second-year results of the demonstration show “substantial improvement” in quality of care across five clinical focus areas, including acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement, with total gains in quality over the first 2 years of 11.8 percentage points, according to a CMS statement. The hospitals involved have received incentive payments for providing high-quality care. During the first 3 years of the project, only top-performing hospitals have been eligible for incentive payments, but the 3-year extension will test the effectiveness of offering incentive payments to hospitals achieving a defined level of quality (or quality threshold) or achieving the greatest improvement in quality and a quality threshold.

Medicaid Growth Sustainable

Expected growth in government revenues is likely to be large enough to sustain Medicaid spending increases over the next 40 years while still allowing substantial real growth in spending for other public services, according to a study published in the journal Health Affairs. The analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured looked at both potential long-term Medicaid spending and the availability of government revenues to support it. “While a substantial component of state government spending, Medicaid is not likely to be the financial burden squeezing out other public priorities that some policy makers fear,” said study coauthor Richard Kronick of the University of California, San Diego, in a statement. After accounting for demographic and health coverage trends such as an aging population and declines in employer-sponsored insurance, the study found that Medicaid's share (17% in 2005) of national health expenditures is expected to remain about the same until 2025 and then rise slowly to 19% by 2045. “Efforts to reduce the growth in Medicaid by shifting costs or threatening coverage will ultimately require better controlling the rate of growth of health spending overall,” Diane Rowland, executive director of KFF's commission, said in a statement.

Hospitals Embrace IT

Nearly half of all community hospitals reported moderate or high use of health information technology (IT) in 2006, compared with 37% in 2005, according to recent survey results from the American Hospital Association. Hospitals also reported dramatic increases in the use of computerized alerts to prevent negative drug interactions; in 2006, 51% of hospitals were using real-time drug interaction alerts, up from 23% in 2005. Larger hospitals were more likely than smaller hospitals to have heavy use of health IT, AHA said.

Ex-FDA Chief Fined

Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., Ph.D., has been sentenced to 3 years of supervised probation and fines of slightly less than $90,000 for charges stemming from his ownership of stock in companies regulated by the FDA. The penalty exceeded a $50,000 fine in a plea agreement Dr. Crawford and federal prosecutors struck last year but still spared the former FDA chief jail time. U.S. Magistrate Judge Deborah Robinson of the District Court for the District of Columbia also ordered Dr. Crawford to perform 50 hours of community service. Dr. Crawford resigned his FDA administrator post in September 2005 after just 2 months and did not give a reason for his resignation. In October 2006, he pleaded guilty to charges of having a conflict of interest and false reporting of information about stocks that he and his wife owned. Prosecutors said that Dr. Crawford filed seven incorrect financial reports with a government ethics office and Congress beginning in 2002.

Insurance Cost Sharing

Fewer than 24% of private sector employees covered by employer-sponsored health insurance do not pay a portion of their own premium, down from 35% in 1998, according to a report from the Agency for Healthcare Research and Quality. In both years, employers were more likely to offer no-contribution single coverage than no-contribution family coverage. In 1998, 18% of employees eligible for health insurance from their employer worked in a firm that offered at least one family coverage plan that required no employee contribution; by 2004, that rate had fallen to 13%, the report said.

Majority Want Access Guarantee

Nearly two-thirds of Americans believe that the federal government should guarantee access to health care, and 60% are willing to pay more in taxes for that guarantee, according to a poll released last month by the New York Times and CBS News. Half of those polled said they would be willing to pay as much as $500 a year in additional taxes, while nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the Bush administration's tax cuts. In addition, a quarter of those with insurance said that they or someone in their household had gone without a medical test or treatment because insurance would not cover it; 60% of those without insurance reported the same situation. The nationwide telephone poll of 1,281 adults was conducted in late February 2007.

Hospital Demonstration Extended

The Centers for Medicare and Medicaid Services has approved a 3-year extension of the Premier Hospital Quality Incentive Demonstration, a value-based purchasing project involving more than 260 hospitals across the country. Recently released second-year results of the demonstration show “substantial improvement” in quality of care across five clinical focus areas, including acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement, with total gains in quality over the first 2 years of 11.8 percentage points, according to a CMS statement. The hospitals involved have received incentive payments for providing high-quality care. During the first 3 years of the project, only top-performing hospitals have been eligible for incentive payments, but the 3-year extension will test the effectiveness of offering incentive payments to hospitals achieving a defined level of quality (or quality threshold) or achieving the greatest improvement in quality and a quality threshold.

Medicaid Growth Sustainable

Expected growth in government revenues is likely to be large enough to sustain Medicaid spending increases over the next 40 years while still allowing substantial real growth in spending for other public services, according to a study published in the journal Health Affairs. The analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured looked at both potential long-term Medicaid spending and the availability of government revenues to support it. “While a substantial component of state government spending, Medicaid is not likely to be the financial burden squeezing out other public priorities that some policy makers fear,” said study coauthor Richard Kronick of the University of California, San Diego, in a statement. After accounting for demographic and health coverage trends such as an aging population and declines in employer-sponsored insurance, the study found that Medicaid's share (17% in 2005) of national health expenditures is expected to remain about the same until 2025 and then rise slowly to 19% by 2045. “Efforts to reduce the growth in Medicaid by shifting costs or threatening coverage will ultimately require better controlling the rate of growth of health spending overall,” Diane Rowland, executive director of KFF's commission, said in a statement.

Hospitals Embrace IT

Nearly half of all community hospitals reported moderate or high use of health information technology (IT) in 2006, compared with 37% in 2005, according to recent survey results from the American Hospital Association. Hospitals also reported dramatic increases in the use of computerized alerts to prevent negative drug interactions; in 2006, 51% of hospitals were using real-time drug interaction alerts, up from 23% in 2005. Larger hospitals were more likely than smaller hospitals to have heavy use of health IT, AHA said.

Ex-FDA Chief Fined

Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., Ph.D., has been sentenced to 3 years of supervised probation and fines of slightly less than $90,000 for charges stemming from his ownership of stock in companies regulated by the FDA. The penalty exceeded a $50,000 fine in a plea agreement Dr. Crawford and federal prosecutors struck last year but still spared the former FDA chief jail time. U.S. Magistrate Judge Deborah Robinson of the District Court for the District of Columbia also ordered Dr. Crawford to perform 50 hours of community service. Dr. Crawford resigned his FDA administrator post in September 2005 after just 2 months and did not give a reason for his resignation. In October 2006, he pleaded guilty to charges of having a conflict of interest and false reporting of information about stocks that he and his wife owned. Prosecutors said that Dr. Crawford filed seven incorrect financial reports with a government ethics office and Congress beginning in 2002.

Insurance Cost Sharing

Fewer than 24% of private sector employees covered by employer-sponsored health insurance do not pay a portion of their own premium, down from 35% in 1998, according to a report from the Agency for Healthcare Research and Quality. In both years, employers were more likely to offer no-contribution single coverage than no-contribution family coverage. In 1998, 18% of employees eligible for health insurance from their employer worked in a firm that offered at least one family coverage plan that required no employee contribution; by 2004, that rate had fallen to 13%, the report said.

Majority Want Access Guarantee

Nearly two-thirds of Americans believe that the federal government should guarantee access to health care, and 60% are willing to pay more in taxes for that guarantee, according to a poll released last month by the New York Times and CBS News. Half of those polled said they would be willing to pay as much as $500 a year in additional taxes, while nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the Bush administration's tax cuts. In addition, a quarter of those with insurance said that they or someone in their household had gone without a medical test or treatment because insurance would not cover it; 60% of those without insurance reported the same situation. The nationwide telephone poll of 1,281 adults was conducted in late February 2007.

Hospital Demonstration Extended

The Centers for Medicare and Medicaid Services has approved a 3-year extension of the Premier Hospital Quality Incentive Demonstration, a value-based purchasing project involving more than 260 hospitals across the country. Recently released second-year results of the demonstration show “substantial improvement” in quality of care across five clinical focus areas, including acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement, with total gains in quality over the first 2 years of 11.8 percentage points, according to a CMS statement. The hospitals involved have received incentive payments for providing high-quality care. During the first 3 years of the project, only top-performing hospitals have been eligible for incentive payments, but the 3-year extension will test the effectiveness of offering incentive payments to hospitals achieving a defined level of quality (or quality threshold) or achieving the greatest improvement in quality and a quality threshold.

Medicaid Growth Sustainable

Expected growth in government revenues is likely to be large enough to sustain Medicaid spending increases over the next 40 years while still allowing substantial real growth in spending for other public services, according to a study published in the journal Health Affairs. The analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured looked at both potential long-term Medicaid spending and the availability of government revenues to support it. “While a substantial component of state government spending, Medicaid is not likely to be the financial burden squeezing out other public priorities that some policy makers fear,” said study coauthor Richard Kronick of the University of California, San Diego, in a statement. After accounting for demographic and health coverage trends such as an aging population and declines in employer-sponsored insurance, the study found that Medicaid's share (17% in 2005) of national health expenditures is expected to remain about the same until 2025 and then rise slowly to 19% by 2045. “Efforts to reduce the growth in Medicaid by shifting costs or threatening coverage will ultimately require better controlling the rate of growth of health spending overall,” Diane Rowland, executive director of KFF's commission, said in a statement.

Hospitals Embrace IT

Nearly half of all community hospitals reported moderate or high use of health information technology (IT) in 2006, compared with 37% in 2005, according to recent survey results from the American Hospital Association. Hospitals also reported dramatic increases in the use of computerized alerts to prevent negative drug interactions; in 2006, 51% of hospitals were using real-time drug interaction alerts, up from 23% in 2005. Larger hospitals were more likely than smaller hospitals to have heavy use of health IT, AHA said.

First-year enrollment in U.S. medical schools is projected to increase 17% over the next 5 years to nearly 19,300 students, helping to ameliorate the real need for new physicians, according to an annual survey of medical-school expansion plans released by the Association of American Medical Colleges.

The estimated expansion would move U.S. medical schools past the halfway point of a 30% enrollment increase recommended by the AAMC in 2006.

The survey of 121 out of 125 U.S. medical-school deans took place last fall, and the information gathered was compared with that of the baseline academic year of 2002–2003, when first-year enrollment totaled 16,488 students.

Survey results indicated that total first-year enrollment in existing U.S. medical schools is projected to increase by 2,558 students (15.5%) by 2012.

Three-quarters of existing medical schools anticipate an increase, compared with 2002 enrollment levels.

However, the report notes that many of these planned increases depend on state support or other outside funding sources. Projected enrollment for new medical schools accounts for an additional 1.5% of the total 17% expansion.

According to the survey, existing U.S. medical schools that are planning to expand will do so through a variety of mechanisms, including new clinical affiliations, expansion of existing campuses, and new regional or branch campuses.

Survey respondents also listed several barriers to enrollment increases, including the cost of such expansion, limited scholarship availability, tight classroom space, and too few ambulatory preceptors. A smaller number of schools reported a lack of basic science faculty, low numbers or variety of patients, problems with regulatory or accreditation requirements, and poor quality applicants as major barriers.

ELSEVIER GLOBAL MEDICAL NEWS

First-year enrollment in U.S. medical schools is projected to increase 17% over the next 5 years to nearly 19,300 students, helping to ameliorate the real need for new physicians, according to an annual survey of medical-school expansion plans released by the Association of American Medical Colleges.

The estimated expansion would move U.S. medical schools past the halfway point of a 30% enrollment increase recommended by the AAMC in 2006.

The survey of 121 out of 125 U.S. medical-school deans took place last fall, and the information gathered was compared with that of the baseline academic year of 2002–2003, when first-year enrollment totaled 16,488 students.

Survey results indicated that total first-year enrollment in existing U.S. medical schools is projected to increase by 2,558 students (15.5%) by 2012.

Three-quarters of existing medical schools anticipate an increase, compared with 2002 enrollment levels.

However, the report notes that many of these planned increases depend on state support or other outside funding sources. Projected enrollment for new medical schools accounts for an additional 1.5% of the total 17% expansion.

According to the survey, existing U.S. medical schools that are planning to expand will do so through a variety of mechanisms, including new clinical affiliations, expansion of existing campuses, and new regional or branch campuses.

Survey respondents also listed several barriers to enrollment increases, including the cost of such expansion, limited scholarship availability, tight classroom space, and too few ambulatory preceptors. A smaller number of schools reported a lack of basic science faculty, low numbers or variety of patients, problems with regulatory or accreditation requirements, and poor quality applicants as major barriers.

ELSEVIER GLOBAL MEDICAL NEWS

First-year enrollment in U.S. medical schools is projected to increase 17% over the next 5 years to nearly 19,300 students, helping to ameliorate the real need for new physicians, according to an annual survey of medical-school expansion plans released by the Association of American Medical Colleges.

The estimated expansion would move U.S. medical schools past the halfway point of a 30% enrollment increase recommended by the AAMC in 2006.

The survey of 121 out of 125 U.S. medical-school deans took place last fall, and the information gathered was compared with that of the baseline academic year of 2002–2003, when first-year enrollment totaled 16,488 students.

Survey results indicated that total first-year enrollment in existing U.S. medical schools is projected to increase by 2,558 students (15.5%) by 2012.

Three-quarters of existing medical schools anticipate an increase, compared with 2002 enrollment levels.

However, the report notes that many of these planned increases depend on state support or other outside funding sources. Projected enrollment for new medical schools accounts for an additional 1.5% of the total 17% expansion.

According to the survey, existing U.S. medical schools that are planning to expand will do so through a variety of mechanisms, including new clinical affiliations, expansion of existing campuses, and new regional or branch campuses.

Survey respondents also listed several barriers to enrollment increases, including the cost of such expansion, limited scholarship availability, tight classroom space, and too few ambulatory preceptors. A smaller number of schools reported a lack of basic science faculty, low numbers or variety of patients, problems with regulatory or accreditation requirements, and poor quality applicants as major barriers.

ELSEVIER GLOBAL MEDICAL NEWS

Laboratory proficiency testing for testosterone should be based on the ability to accurately and precisely measure a sample containing a known concentration of testosterone, not upon agreement with peers using the same method, a panel of endocrinologists concluded in a new Endocrine Society guideline on testosterone measurement.

In “Utility, Limitations and Pitfalls in Measuring Testosterone: An Endocrine Society Position Statement,” which was published online in the Journal of Clinical Endocrinology and Metabolism, the panel urged physicians ordering and using androgen assays to know the type and quality of the assay that is being used, along with the properly established and validated reference intervals for that assay (J. Clin. Endocrinol. Metab. 2007;92:405–13).

The panel also noted that, in the absence of other information, direct assays perform poorly at low testosterone concentrations such as those found in women, children, and hypogonadal men, and therefore should be avoided. The guideline summarizes and evaluates the laboratory methods in use currently to measure testosterone.

In the October issue of the Journal of Clinical Endocrinology and Metabolism, the Endocrine Society issued a strong word of caution on the topic of androgen therapy with a new clinical practice guideline that recommends against diagnosing and treating androgen deficiency in women. That guideline cites the “lack of a well-defined clinical syndrome” and the “lack of normative data on total or free testosterone levels across the lifespan” as reasons against making the diagnosis (J. Clin. Endocrinol. Metab. 2006; 91:3697–710).

Dr. Andre Guay, director of the Center for Sexual Function at the Lahey Clinic in Peabody, Mass., admitted that “the measurement of total testosterone leaves a lot to be desired.” But he added that the androgen therapy guidelines “don't emphasize the clinical point that before a clinician should treat, there needs to be [both] some biochemical measure of low androgen and the proper clinical symptoms. We don't treat with only a testosterone level or with a symptom alone.”

However, Dr. Neil Goodman, professor of medicine at the University of Miami, argued that inaccurate results aren't useful to clinicians. “If we can't measure the test accurately, then how are we going to know if someone is deficient?” he asked, “If you send a woman's blood to five different labs, you're going to get five different answers.”

Dr. Goodman said that endocrinologists and the companies that make the laboratory instruments to measure testosterone are moving toward adopting a standard, which will likely be tandem mass spectrometry.

American Association of Clinical Endocrinologists (AACE) President Dr. Steven Petak said that testosterone testing using radioimmunoassay “can be adequately standardized for detection of hyperandrogenism in women, providing the laboratory normal ranges have been adequately determined based on women without hyperandrogenic symptoms and with normal cycles by basal body temperature charts.” Dr. Petak noted that AACE has published guidelines pertaining to hyperandrogenism as well as menopause guidelines that include androgen assessment along with caveats pertaining to the measurement of androgens.

The Endocrine Society's position statement on measuring testosterone was chaired by Dr. William Rosner and included Dr. Richard Auchus, Dr. Ricardo Azziz, Dr. Patrick Sluss, and Dr. Hershel Raff.

The AACE has hyperandrogenism guidelines and menopause guidelines that include androgen assessment. DR. PETAK

Laboratory proficiency testing for testosterone should be based on the ability to accurately and precisely measure a sample containing a known concentration of testosterone, not upon agreement with peers using the same method, a panel of endocrinologists concluded in a new Endocrine Society guideline on testosterone measurement.

In “Utility, Limitations and Pitfalls in Measuring Testosterone: An Endocrine Society Position Statement,” which was published online in the Journal of Clinical Endocrinology and Metabolism, the panel urged physicians ordering and using androgen assays to know the type and quality of the assay that is being used, along with the properly established and validated reference intervals for that assay (J. Clin. Endocrinol. Metab. 2007;92:405–13).

The panel also noted that, in the absence of other information, direct assays perform poorly at low testosterone concentrations such as those found in women, children, and hypogonadal men, and therefore should be avoided. The guideline summarizes and evaluates the laboratory methods in use currently to measure testosterone.

In the October issue of the Journal of Clinical Endocrinology and Metabolism, the Endocrine Society issued a strong word of caution on the topic of androgen therapy with a new clinical practice guideline that recommends against diagnosing and treating androgen deficiency in women. That guideline cites the “lack of a well-defined clinical syndrome” and the “lack of normative data on total or free testosterone levels across the lifespan” as reasons against making the diagnosis (J. Clin. Endocrinol. Metab. 2006; 91:3697–710).

Dr. Andre Guay, director of the Center for Sexual Function at the Lahey Clinic in Peabody, Mass., admitted that “the measurement of total testosterone leaves a lot to be desired.” But he added that the androgen therapy guidelines “don't emphasize the clinical point that before a clinician should treat, there needs to be [both] some biochemical measure of low androgen and the proper clinical symptoms. We don't treat with only a testosterone level or with a symptom alone.”

However, Dr. Neil Goodman, professor of medicine at the University of Miami, argued that inaccurate results aren't useful to clinicians. “If we can't measure the test accurately, then how are we going to know if someone is deficient?” he asked, “If you send a woman's blood to five different labs, you're going to get five different answers.”

Dr. Goodman said that endocrinologists and the companies that make the laboratory instruments to measure testosterone are moving toward adopting a standard, which will likely be tandem mass spectrometry.

American Association of Clinical Endocrinologists (AACE) President Dr. Steven Petak said that testosterone testing using radioimmunoassay “can be adequately standardized for detection of hyperandrogenism in women, providing the laboratory normal ranges have been adequately determined based on women without hyperandrogenic symptoms and with normal cycles by basal body temperature charts.” Dr. Petak noted that AACE has published guidelines pertaining to hyperandrogenism as well as menopause guidelines that include androgen assessment along with caveats pertaining to the measurement of androgens.

The Endocrine Society's position statement on measuring testosterone was chaired by Dr. William Rosner and included Dr. Richard Auchus, Dr. Ricardo Azziz, Dr. Patrick Sluss, and Dr. Hershel Raff.

The AACE has hyperandrogenism guidelines and menopause guidelines that include androgen assessment. DR. PETAK

Laboratory proficiency testing for testosterone should be based on the ability to accurately and precisely measure a sample containing a known concentration of testosterone, not upon agreement with peers using the same method, a panel of endocrinologists concluded in a new Endocrine Society guideline on testosterone measurement.

In “Utility, Limitations and Pitfalls in Measuring Testosterone: An Endocrine Society Position Statement,” which was published online in the Journal of Clinical Endocrinology and Metabolism, the panel urged physicians ordering and using androgen assays to know the type and quality of the assay that is being used, along with the properly established and validated reference intervals for that assay (J. Clin. Endocrinol. Metab. 2007;92:405–13).

The panel also noted that, in the absence of other information, direct assays perform poorly at low testosterone concentrations such as those found in women, children, and hypogonadal men, and therefore should be avoided. The guideline summarizes and evaluates the laboratory methods in use currently to measure testosterone.

In the October issue of the Journal of Clinical Endocrinology and Metabolism, the Endocrine Society issued a strong word of caution on the topic of androgen therapy with a new clinical practice guideline that recommends against diagnosing and treating androgen deficiency in women. That guideline cites the “lack of a well-defined clinical syndrome” and the “lack of normative data on total or free testosterone levels across the lifespan” as reasons against making the diagnosis (J. Clin. Endocrinol. Metab. 2006; 91:3697–710).

Dr. Andre Guay, director of the Center for Sexual Function at the Lahey Clinic in Peabody, Mass., admitted that “the measurement of total testosterone leaves a lot to be desired.” But he added that the androgen therapy guidelines “don't emphasize the clinical point that before a clinician should treat, there needs to be [both] some biochemical measure of low androgen and the proper clinical symptoms. We don't treat with only a testosterone level or with a symptom alone.”

However, Dr. Neil Goodman, professor of medicine at the University of Miami, argued that inaccurate results aren't useful to clinicians. “If we can't measure the test accurately, then how are we going to know if someone is deficient?” he asked, “If you send a woman's blood to five different labs, you're going to get five different answers.”

Dr. Goodman said that endocrinologists and the companies that make the laboratory instruments to measure testosterone are moving toward adopting a standard, which will likely be tandem mass spectrometry.

American Association of Clinical Endocrinologists (AACE) President Dr. Steven Petak said that testosterone testing using radioimmunoassay “can be adequately standardized for detection of hyperandrogenism in women, providing the laboratory normal ranges have been adequately determined based on women without hyperandrogenic symptoms and with normal cycles by basal body temperature charts.” Dr. Petak noted that AACE has published guidelines pertaining to hyperandrogenism as well as menopause guidelines that include androgen assessment along with caveats pertaining to the measurement of androgens.

The Endocrine Society's position statement on measuring testosterone was chaired by Dr. William Rosner and included Dr. Richard Auchus, Dr. Ricardo Azziz, Dr. Patrick Sluss, and Dr. Hershel Raff.

The AACE has hyperandrogenism guidelines and menopause guidelines that include androgen assessment. DR. PETAK

Practicing endocrinologists are in short supply in many areas of the country, and the situation only has worsened since a 2003 study that showed the national supply to be 12% lower than demand, according to several experts.

There are no easy solutions to increase the number of endocrinologists in practice, they say, because the problems are deeply embedded in the nature of the specialty and encompass issues involving training, satisfaction, and reimbursement. Because of these problems, fewer young physicians are entering the specialty, while some older physicians are choosing early retirement.

This shortage may reach a critical stage over the next few years, with diabetes and obesity cases on the rise at the same time that many doctors are retiring.

“The crisis is not getting any better,” said Dr. Helena Rodbard, an endocrinologist in Rockville, Md., who cowrote the original study. “At the time, the data showed there was a 12% shortage of endocrinologists, and it was projected to only keep growing.” She estimated that the shortfall could be 15% or greater now.

Dr. Hossein Gharib, professor of medicine at the Mayo Clinic, in Rochester, Minn., and past president of the American Association of Clinical Endocrinologists (AACE), went even further. He estimated that there are about 5,000 practicing endocrinologists in the United States, and “to double that would be a reasonable number. If we had 10,000 endocrinologists, every one of them would be busy and would have a full practice.”

Dr. Gharib said that the shortage of practicing endocrinologists is felt the most keenly in the Midwest. “Jobs for endocrinologists are plentiful, although the east and west coasts and urban areas are fairly well supported.” He said new endocrinologists finishing training programs can easily find more work than they can handle if they move to a midsize Midwestern city.

And Dr. Herbert Rettinger, professor of clinical medicine at the University of California at Irvine and vice president of the California AACE chapter, noted that the patient load is increasing while the number of endocrinologists is decreasing.

“The population we serve has increased dramatically with the advent of obesity, and with the fact that we are much more astute in finding diabetes,” he said.

The original endocrinology workforce study looked at the balance between supply and demand of practicing endocrinologists between 1999 and projected through 2020. The study found that there were 3,623 adult endocrinologists in the workforce in 1999, of whom 2,389 (66%) were in office-based practice (J. Clin. Endocrinol. Metab. 2003;88:1979-87). Many were older; the median age was 49 years. The study also found that the number of endocrinologists entering practice fell continuously from 1995 to 1999.

“I think it's extremely attractive, but it is an intellectual pursuit,” Dr. Rodbard said. “It's not a big moneymaker. We have very few procedures.”

Added Dr. Rettinger: “Each patient requires a lot of work and a lot of insight. Reimbursement is less for our subspecialty. The specialty is attractive to those of us that are already here, but it may not be as attractive to those we're trying to draw in.”

And that's a big part of the problem. According to data on the Web site of the Accreditation Council on Graduate Medical Education, there are 123 endocrinology programs, with a total of 564 slots. Of those slots, 507 were filled--leaving about 11% empty.

“The more competitive programs--the better ones--have more than enough candidates,” Dr. Rodbard said. These include programs at Albert Einstein College of Medicine, Mount Sinai School of Medicine, Massachusetts General Hospital, and UCLA Medical Center, she said.

However, the “second tier” programs often have empty slots, she said, adding, “The key factor is limited reimbursement.” Medical students graduating with tens of thousands of dollars in debt may believe they need to go into a higher-paying specialty, she said.

AACE has begun reaching out to medical students and has developed a brochure to “show them early on that endocrinology is a good specialty,” Dr. Gharib said.

However, one factor that could be negatively affecting the number of new doctors choosing endocrinology is the trend for endocrine training programs to add a year of pure research to their 2-year programs, Dr. Rettinger said. “For someone who's interested in clinical practice, the year in the lab may not be attractive,” he said.

To boost numbers of practicing endocrinologists, leaders recommend educating medical students about the specialty and streamlining training programs. But they also stress that action needs to be taken on decreasing disincentives to enter and stay in practice.

Because of declining reimbursement and increasing hassles--problems common to many specialties that do few procedures--older endocrinologists are becoming disillusioned and are leaving.

“Many endocrinologists are retiring at age 60 or 65 because of the hassles of practice,” Dr. Gharib said. Added Dr. Rettinger: “A lot of older endocrinologists are leaving the field earlier than they might otherwise because of paperwork hassles.”

With endocrinologists in short supply, internists and family physicians are stepping in to take up the slack in treating patients with diabetes, hyperlipidemia, and obesity, Dr. Gharib said. But that doesn't always lead to optimal care, he said.

Dr. Rettinger admitted there are no easy answers to increasing the number of endocrinologists. However, he said, making changes to training programs to eliminate mandatory research could help, and continuing to have a strong advocacy group will help educate payers and lawmakers and could lead to improvements.

Dr. Helena Rodbard, an endocrinologist in Rockville, Md., estimates that the shortfall of endocrinologists could now be 15% or greater. Sheri Mattes/Elsevier Global Medical News

Practicing endocrinologists are in short supply in many areas of the country, and the situation only has worsened since a 2003 study that showed the national supply to be 12% lower than demand, according to several experts.

There are no easy solutions to increase the number of endocrinologists in practice, they say, because the problems are deeply embedded in the nature of the specialty and encompass issues involving training, satisfaction, and reimbursement. Because of these problems, fewer young physicians are entering the specialty, while some older physicians are choosing early retirement.

This shortage may reach a critical stage over the next few years, with diabetes and obesity cases on the rise at the same time that many doctors are retiring.

“The crisis is not getting any better,” said Dr. Helena Rodbard, an endocrinologist in Rockville, Md., who cowrote the original study. “At the time, the data showed there was a 12% shortage of endocrinologists, and it was projected to only keep growing.” She estimated that the shortfall could be 15% or greater now.

Dr. Hossein Gharib, professor of medicine at the Mayo Clinic, in Rochester, Minn., and past president of the American Association of Clinical Endocrinologists (AACE), went even further. He estimated that there are about 5,000 practicing endocrinologists in the United States, and “to double that would be a reasonable number. If we had 10,000 endocrinologists, every one of them would be busy and would have a full practice.”

Dr. Gharib said that the shortage of practicing endocrinologists is felt the most keenly in the Midwest. “Jobs for endocrinologists are plentiful, although the east and west coasts and urban areas are fairly well supported.” He said new endocrinologists finishing training programs can easily find more work than they can handle if they move to a midsize Midwestern city.

And Dr. Herbert Rettinger, professor of clinical medicine at the University of California at Irvine and vice president of the California AACE chapter, noted that the patient load is increasing while the number of endocrinologists is decreasing.

“The population we serve has increased dramatically with the advent of obesity, and with the fact that we are much more astute in finding diabetes,” he said.

The original endocrinology workforce study looked at the balance between supply and demand of practicing endocrinologists between 1999 and projected through 2020. The study found that there were 3,623 adult endocrinologists in the workforce in 1999, of whom 2,389 (66%) were in office-based practice (J. Clin. Endocrinol. Metab. 2003;88:1979-87). Many were older; the median age was 49 years. The study also found that the number of endocrinologists entering practice fell continuously from 1995 to 1999.

“I think it's extremely attractive, but it is an intellectual pursuit,” Dr. Rodbard said. “It's not a big moneymaker. We have very few procedures.”

Added Dr. Rettinger: “Each patient requires a lot of work and a lot of insight. Reimbursement is less for our subspecialty. The specialty is attractive to those of us that are already here, but it may not be as attractive to those we're trying to draw in.”

And that's a big part of the problem. According to data on the Web site of the Accreditation Council on Graduate Medical Education, there are 123 endocrinology programs, with a total of 564 slots. Of those slots, 507 were filled--leaving about 11% empty.

“The more competitive programs--the better ones--have more than enough candidates,” Dr. Rodbard said. These include programs at Albert Einstein College of Medicine, Mount Sinai School of Medicine, Massachusetts General Hospital, and UCLA Medical Center, she said.

However, the “second tier” programs often have empty slots, she said, adding, “The key factor is limited reimbursement.” Medical students graduating with tens of thousands of dollars in debt may believe they need to go into a higher-paying specialty, she said.

AACE has begun reaching out to medical students and has developed a brochure to “show them early on that endocrinology is a good specialty,” Dr. Gharib said.

However, one factor that could be negatively affecting the number of new doctors choosing endocrinology is the trend for endocrine training programs to add a year of pure research to their 2-year programs, Dr. Rettinger said. “For someone who's interested in clinical practice, the year in the lab may not be attractive,” he said.

To boost numbers of practicing endocrinologists, leaders recommend educating medical students about the specialty and streamlining training programs. But they also stress that action needs to be taken on decreasing disincentives to enter and stay in practice.

Because of declining reimbursement and increasing hassles--problems common to many specialties that do few procedures--older endocrinologists are becoming disillusioned and are leaving.

“Many endocrinologists are retiring at age 60 or 65 because of the hassles of practice,” Dr. Gharib said. Added Dr. Rettinger: “A lot of older endocrinologists are leaving the field earlier than they might otherwise because of paperwork hassles.”

With endocrinologists in short supply, internists and family physicians are stepping in to take up the slack in treating patients with diabetes, hyperlipidemia, and obesity, Dr. Gharib said. But that doesn't always lead to optimal care, he said.

Dr. Rettinger admitted there are no easy answers to increasing the number of endocrinologists. However, he said, making changes to training programs to eliminate mandatory research could help, and continuing to have a strong advocacy group will help educate payers and lawmakers and could lead to improvements.

Dr. Helena Rodbard, an endocrinologist in Rockville, Md., estimates that the shortfall of endocrinologists could now be 15% or greater. Sheri Mattes/Elsevier Global Medical News

Practicing endocrinologists are in short supply in many areas of the country, and the situation only has worsened since a 2003 study that showed the national supply to be 12% lower than demand, according to several experts.

There are no easy solutions to increase the number of endocrinologists in practice, they say, because the problems are deeply embedded in the nature of the specialty and encompass issues involving training, satisfaction, and reimbursement. Because of these problems, fewer young physicians are entering the specialty, while some older physicians are choosing early retirement.

This shortage may reach a critical stage over the next few years, with diabetes and obesity cases on the rise at the same time that many doctors are retiring.

“The crisis is not getting any better,” said Dr. Helena Rodbard, an endocrinologist in Rockville, Md., who cowrote the original study. “At the time, the data showed there was a 12% shortage of endocrinologists, and it was projected to only keep growing.” She estimated that the shortfall could be 15% or greater now.

Dr. Hossein Gharib, professor of medicine at the Mayo Clinic, in Rochester, Minn., and past president of the American Association of Clinical Endocrinologists (AACE), went even further. He estimated that there are about 5,000 practicing endocrinologists in the United States, and “to double that would be a reasonable number. If we had 10,000 endocrinologists, every one of them would be busy and would have a full practice.”

Dr. Gharib said that the shortage of practicing endocrinologists is felt the most keenly in the Midwest. “Jobs for endocrinologists are plentiful, although the east and west coasts and urban areas are fairly well supported.” He said new endocrinologists finishing training programs can easily find more work than they can handle if they move to a midsize Midwestern city.

And Dr. Herbert Rettinger, professor of clinical medicine at the University of California at Irvine and vice president of the California AACE chapter, noted that the patient load is increasing while the number of endocrinologists is decreasing.

“The population we serve has increased dramatically with the advent of obesity, and with the fact that we are much more astute in finding diabetes,” he said.

The original endocrinology workforce study looked at the balance between supply and demand of practicing endocrinologists between 1999 and projected through 2020. The study found that there were 3,623 adult endocrinologists in the workforce in 1999, of whom 2,389 (66%) were in office-based practice (J. Clin. Endocrinol. Metab. 2003;88:1979-87). Many were older; the median age was 49 years. The study also found that the number of endocrinologists entering practice fell continuously from 1995 to 1999.

“I think it's extremely attractive, but it is an intellectual pursuit,” Dr. Rodbard said. “It's not a big moneymaker. We have very few procedures.”

Added Dr. Rettinger: “Each patient requires a lot of work and a lot of insight. Reimbursement is less for our subspecialty. The specialty is attractive to those of us that are already here, but it may not be as attractive to those we're trying to draw in.”

And that's a big part of the problem. According to data on the Web site of the Accreditation Council on Graduate Medical Education, there are 123 endocrinology programs, with a total of 564 slots. Of those slots, 507 were filled--leaving about 11% empty.

“The more competitive programs--the better ones--have more than enough candidates,” Dr. Rodbard said. These include programs at Albert Einstein College of Medicine, Mount Sinai School of Medicine, Massachusetts General Hospital, and UCLA Medical Center, she said.

However, the “second tier” programs often have empty slots, she said, adding, “The key factor is limited reimbursement.” Medical students graduating with tens of thousands of dollars in debt may believe they need to go into a higher-paying specialty, she said.

AACE has begun reaching out to medical students and has developed a brochure to “show them early on that endocrinology is a good specialty,” Dr. Gharib said.

However, one factor that could be negatively affecting the number of new doctors choosing endocrinology is the trend for endocrine training programs to add a year of pure research to their 2-year programs, Dr. Rettinger said. “For someone who's interested in clinical practice, the year in the lab may not be attractive,” he said.

To boost numbers of practicing endocrinologists, leaders recommend educating medical students about the specialty and streamlining training programs. But they also stress that action needs to be taken on decreasing disincentives to enter and stay in practice.

Because of declining reimbursement and increasing hassles--problems common to many specialties that do few procedures--older endocrinologists are becoming disillusioned and are leaving.

“Many endocrinologists are retiring at age 60 or 65 because of the hassles of practice,” Dr. Gharib said. Added Dr. Rettinger: “A lot of older endocrinologists are leaving the field earlier than they might otherwise because of paperwork hassles.”

With endocrinologists in short supply, internists and family physicians are stepping in to take up the slack in treating patients with diabetes, hyperlipidemia, and obesity, Dr. Gharib said. But that doesn't always lead to optimal care, he said.

Dr. Rettinger admitted there are no easy answers to increasing the number of endocrinologists. However, he said, making changes to training programs to eliminate mandatory research could help, and continuing to have a strong advocacy group will help educate payers and lawmakers and could lead to improvements.

Dr. Helena Rodbard, an endocrinologist in Rockville, Md., estimates that the shortfall of endocrinologists could now be 15% or greater. Sheri Mattes/Elsevier Global Medical News

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults), had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, “we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults), had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, “we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults), had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, “we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

Also, despite the expectations of some policy-makers that the lower premiums and tax benefits of CDHPs would greatly reduce the number of people without health insurance, “We did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

It's no surprise that employers and employees have been cautious in adopting CDHPs, since effecting change in the health insurance industry can be very difficult, said Karen Atwood, senior vice president for national accounts at Blue Cross and Blue Shield of Illinois.

“We are in the early stages of trying to understand how consumerism can be part of the solution,” said Ms. Atwood, who added that such plans also need to have tools in place to address lifestyle behaviors and choices. “We need good plans, well-crafted network options, and incentives to reward people for doing the right thing.”

The survey of 3,158 U.S. adults aged 21–64 was conducted in September 2006 through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

Also, despite the expectations of some policy-makers that the lower premiums and tax benefits of CDHPs would greatly reduce the number of people without health insurance, “We did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

It's no surprise that employers and employees have been cautious in adopting CDHPs, since effecting change in the health insurance industry can be very difficult, said Karen Atwood, senior vice president for national accounts at Blue Cross and Blue Shield of Illinois.

“We are in the early stages of trying to understand how consumerism can be part of the solution,” said Ms. Atwood, who added that such plans also need to have tools in place to address lifestyle behaviors and choices. “We need good plans, well-crafted network options, and incentives to reward people for doing the right thing.”

The survey of 3,158 U.S. adults aged 21–64 was conducted in September 2006 through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

Also, despite the expectations of some policy-makers that the lower premiums and tax benefits of CDHPs would greatly reduce the number of people without health insurance, “We did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

It's no surprise that employers and employees have been cautious in adopting CDHPs, since effecting change in the health insurance industry can be very difficult, said Karen Atwood, senior vice president for national accounts at Blue Cross and Blue Shield of Illinois.

“We are in the early stages of trying to understand how consumerism can be part of the solution,” said Ms. Atwood, who added that such plans also need to have tools in place to address lifestyle behaviors and choices. “We need good plans, well-crafted network options, and incentives to reward people for doing the right thing.”

The survey of 3,158 U.S. adults aged 21–64 was conducted in September 2006 through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, “we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

It's no surprise that employers and employees have been cautious in adopting CDHPs, since effecting change in the health insurance industry can be very difficult, said Karen Atwood, senior vice president for national accounts at Blue Cross and Blue Shield of Illinois.

“We are in the early stages of trying to understand how consumerism can be part of the solution,” said Atwood, who added that such plans also need to have tools in place to address lifestyle behaviors and choices. “We need good plans, well-crafted network options, and incentives to reward people for doing the right thing.”

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, “we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

It's no surprise that employers and employees have been cautious in adopting CDHPs, since effecting change in the health insurance industry can be very difficult, said Karen Atwood, senior vice president for national accounts at Blue Cross and Blue Shield of Illinois.

“We are in the early stages of trying to understand how consumerism can be part of the solution,” said Atwood, who added that such plans also need to have tools in place to address lifestyle behaviors and choices. “We need good plans, well-crafted network options, and incentives to reward people for doing the right thing.”

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

“Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured,” said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, were enrolled in CDHPs in September 2006, unchanged from the year before—despite the widespread attention the new plans have received. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of the plans before switching coverage to CDHPs, Dr. Davis said.

“The plans are not well known at this point,” said Paul Fronstin, EBRI senior research associate. “Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'”

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, “we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan,” said Mr. Fronstin.

Satisfaction lags in the plans, compared with more comprehensive health insurance, the survey found. And, 38% of those with consumer-driven coverage said that they delayed or avoided getting needed health care because of cost over the last 12 months, compared with 19% of those with comprehensive insurance.

It's no surprise that employers and employees have been cautious in adopting CDHPs, since effecting change in the health insurance industry can be very difficult, said Karen Atwood, senior vice president for national accounts at Blue Cross and Blue Shield of Illinois.

“We are in the early stages of trying to understand how consumerism can be part of the solution,” said Atwood, who added that such plans also need to have tools in place to address lifestyle behaviors and choices. “We need good plans, well-crafted network options, and incentives to reward people for doing the right thing.”

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

Nursing home use by the “oldest old”—or those aged 85 and older—has declined sharply since 1984, according the Lewin Group. The national health care and human services consulting firm cites less disability, new alternatives to nursing homes, and changes in the pattern of nursing home care for the decline.

In a study released in November, the Lewin Group found that if all older adults (ages 65 and older) had continued to use nursing homes as they did in 1985, 1.95 million older adults would reside in nursing homes today. Instead, just 1.32 million residents ages 65 and older lived in nursing homes in 2004.

At the same time, “the total number of people age 85 and older nearly doubled over the period,” but the number of individuals age 85 and over in nursing homes “remained about the same,” wrote Lisa Alecxih, vice president of the Lewin Group and author of the report, “Nursing Home Use by 'Oldest Old' Sharply Declines.” Consequently, the use rate among the oldest old fell from 21.1% in 1985 to 13.9% in 2004, and is likely to drop further, the study found.

The finding reflects a desire of many older adults to continue to live in the community, and also suggests continued change as the Baby Boom generation begins to need long-term care, Ms. Alecxih concluded in her report.

Several factors likely contributed to the decline in use rate, she said. First, age-adjusted disability rates among the elderly declined from 1984 to 1999, although the decline was somewhat less among the oldest old. And, the poverty rate for individuals 85 and older dropped 28%, from 18.7% in 1985 to 13.4% in 2005. The poverty rate for all seniors also dropped about 20%.

Changes in Medicare reimbursement have led to more of a focus on postacute stays and shorter custodial stays, resulting in a decline of average length of stay from 2.9 years in 1985 to 2.4 years in 2004, and in median length of stay from 1.7 years to about 1.3 years.

At the same time, alternatives to nursing homes, such as assisted-living facilities, continued to develop. They now boast approximately 1 million residents with an average age over 80, said Ms. Alecxih, who leads the group's Center for Long-Term Care. She also has spent more than 15 years advising federal and state policy makers regarding long-term care financing and elderly health issues.

Many states have tried to reduce the number of Medicaid recipients in nursing homes by providing more home and community-based services, while implementing pre-admission screening or single entry point systems in order to divert people away from nursing homes, the report said.

With the aging of the Baby Boom generation, the United States will see twice as many older adults in 2030 as in 2006. But if the demand for nursing homes continues to decline at just half the national average over the past 20 years, the use rate among older adults would drop from a projected 3.2% to 2.5% in 2030, Ms. Alecxih said.

That would mean an increase of just 320,000 adults age 65 and older in nursing homes by 2030, Ms. Alecxih wrote.

The decline in nursing home use among the “oldest old” may be more related to how states define and regulate nursing homes, according to Brenda Spillman, Ph.D., senior research associate at the Urban Institute's Health Policy Center.

“States have begun licensing other types of long-term care settings and other supportive residential care settings, and some of the more marginal places changed licensure,” she said in an interview.

That could mean some institutions now are classified as assisted-living facilities rather than as nursing homes, even though the care provided in them hasn't changed. “They may not be nursing homes any longer, but Mrs. Jones may be sitting in the same bed in the same room. And, there may be less quality oversight,” said Dr. Spillman.

Nursing home use by the “oldest old”—or those aged 85 and older—has declined sharply since 1984, according the Lewin Group. The national health care and human services consulting firm cites less disability, new alternatives to nursing homes, and changes in the pattern of nursing home care for the decline.

In a study released in November, the Lewin Group found that if all older adults (ages 65 and older) had continued to use nursing homes as they did in 1985, 1.95 million older adults would reside in nursing homes today. Instead, just 1.32 million residents ages 65 and older lived in nursing homes in 2004.

At the same time, “the total number of people age 85 and older nearly doubled over the period,” but the number of individuals age 85 and over in nursing homes “remained about the same,” wrote Lisa Alecxih, vice president of the Lewin Group and author of the report, “Nursing Home Use by 'Oldest Old' Sharply Declines.” Consequently, the use rate among the oldest old fell from 21.1% in 1985 to 13.9% in 2004, and is likely to drop further, the study found.

The finding reflects a desire of many older adults to continue to live in the community, and also suggests continued change as the Baby Boom generation begins to need long-term care, Ms. Alecxih concluded in her report.

Several factors likely contributed to the decline in use rate, she said. First, age-adjusted disability rates among the elderly declined from 1984 to 1999, although the decline was somewhat less among the oldest old. And, the poverty rate for individuals 85 and older dropped 28%, from 18.7% in 1985 to 13.4% in 2005. The poverty rate for all seniors also dropped about 20%.

Changes in Medicare reimbursement have led to more of a focus on postacute stays and shorter custodial stays, resulting in a decline of average length of stay from 2.9 years in 1985 to 2.4 years in 2004, and in median length of stay from 1.7 years to about 1.3 years.

At the same time, alternatives to nursing homes, such as assisted-living facilities, continued to develop. They now boast approximately 1 million residents with an average age over 80, said Ms. Alecxih, who leads the group's Center for Long-Term Care. She also has spent more than 15 years advising federal and state policy makers regarding long-term care financing and elderly health issues.

Many states have tried to reduce the number of Medicaid recipients in nursing homes by providing more home and community-based services, while implementing pre-admission screening or single entry point systems in order to divert people away from nursing homes, the report said.

With the aging of the Baby Boom generation, the United States will see twice as many older adults in 2030 as in 2006. But if the demand for nursing homes continues to decline at just half the national average over the past 20 years, the use rate among older adults would drop from a projected 3.2% to 2.5% in 2030, Ms. Alecxih said.

That would mean an increase of just 320,000 adults age 65 and older in nursing homes by 2030, Ms. Alecxih wrote.

The decline in nursing home use among the “oldest old” may be more related to how states define and regulate nursing homes, according to Brenda Spillman, Ph.D., senior research associate at the Urban Institute's Health Policy Center.

“States have begun licensing other types of long-term care settings and other supportive residential care settings, and some of the more marginal places changed licensure,” she said in an interview.

That could mean some institutions now are classified as assisted-living facilities rather than as nursing homes, even though the care provided in them hasn't changed. “They may not be nursing homes any longer, but Mrs. Jones may be sitting in the same bed in the same room. And, there may be less quality oversight,” said Dr. Spillman.

Nursing home use by the “oldest old”—or those aged 85 and older—has declined sharply since 1984, according the Lewin Group. The national health care and human services consulting firm cites less disability, new alternatives to nursing homes, and changes in the pattern of nursing home care for the decline.

In a study released in November, the Lewin Group found that if all older adults (ages 65 and older) had continued to use nursing homes as they did in 1985, 1.95 million older adults would reside in nursing homes today. Instead, just 1.32 million residents ages 65 and older lived in nursing homes in 2004.

At the same time, “the total number of people age 85 and older nearly doubled over the period,” but the number of individuals age 85 and over in nursing homes “remained about the same,” wrote Lisa Alecxih, vice president of the Lewin Group and author of the report, “Nursing Home Use by 'Oldest Old' Sharply Declines.” Consequently, the use rate among the oldest old fell from 21.1% in 1985 to 13.9% in 2004, and is likely to drop further, the study found.

The finding reflects a desire of many older adults to continue to live in the community, and also suggests continued change as the Baby Boom generation begins to need long-term care, Ms. Alecxih concluded in her report.

Several factors likely contributed to the decline in use rate, she said. First, age-adjusted disability rates among the elderly declined from 1984 to 1999, although the decline was somewhat less among the oldest old. And, the poverty rate for individuals 85 and older dropped 28%, from 18.7% in 1985 to 13.4% in 2005. The poverty rate for all seniors also dropped about 20%.

Changes in Medicare reimbursement have led to more of a focus on postacute stays and shorter custodial stays, resulting in a decline of average length of stay from 2.9 years in 1985 to 2.4 years in 2004, and in median length of stay from 1.7 years to about 1.3 years.

At the same time, alternatives to nursing homes, such as assisted-living facilities, continued to develop. They now boast approximately 1 million residents with an average age over 80, said Ms. Alecxih, who leads the group's Center for Long-Term Care. She also has spent more than 15 years advising federal and state policy makers regarding long-term care financing and elderly health issues.

Many states have tried to reduce the number of Medicaid recipients in nursing homes by providing more home and community-based services, while implementing pre-admission screening or single entry point systems in order to divert people away from nursing homes, the report said.

With the aging of the Baby Boom generation, the United States will see twice as many older adults in 2030 as in 2006. But if the demand for nursing homes continues to decline at just half the national average over the past 20 years, the use rate among older adults would drop from a projected 3.2% to 2.5% in 2030, Ms. Alecxih said.

That would mean an increase of just 320,000 adults age 65 and older in nursing homes by 2030, Ms. Alecxih wrote.

The decline in nursing home use among the “oldest old” may be more related to how states define and regulate nursing homes, according to Brenda Spillman, Ph.D., senior research associate at the Urban Institute's Health Policy Center.

“States have begun licensing other types of long-term care settings and other supportive residential care settings, and some of the more marginal places changed licensure,” she said in an interview.

That could mean some institutions now are classified as assisted-living facilities rather than as nursing homes, even though the care provided in them hasn't changed. “They may not be nursing homes any longer, but Mrs. Jones may be sitting in the same bed in the same room. And, there may be less quality oversight,” said Dr. Spillman.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and the Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

"Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured," said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, was enrolled in CDHPs in September 2006, unchanged from the year before—despite widespread attention. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of CDHPs before switching coverage, Dr. Davis said.

"The plans are not well known at this point," said Paul Fronstin, EBRI senior research associate. "Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'"

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, "we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan," said Mr. Fronstin.

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and the Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

"Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured," said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, was enrolled in CDHPs in September 2006, unchanged from the year before—despite widespread attention. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of CDHPs before switching coverage, Dr. Davis said.

"The plans are not well known at this point," said Paul Fronstin, EBRI senior research associate. "Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'"

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, "we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan," said Mr. Fronstin.

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

American consumers and their employers are treading cautiously when it comes to switching from traditional, more comprehensive health insurance to consumer-driven health plans, with few actually adopting the new plans, according to survey results from the Employee Benefit Research Institute (EBRI) and the Commonwealth Fund.

In addition, satisfaction among members in consumer-driven health plans (CDHPs) was considerably lower than satisfaction among individuals in more traditional plans, and more members in CDHPs reported that they had delayed getting needed medical care.

The Consumerism in Health Care Survey tracks public opinion on consumer-driven and high-deductible plans, defined as those plans with deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage. The plans also feature one of two kinds of tax-exempt savings accounts: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Employees can use money in the accounts without tax penalty to pay for medical expenses not covered by their health plans.

"Consumer-driven health plans aim to control costs largely through demand-side incentives, and to make premiums more affordable for the uninsured," said Karen Davis, Ph.D., president of the Commonwealth Fund, at a press teleconference sponsored by EBRI and the Commonwealth Fund.

But the survey found that the plans have been slow to catch on. Just 1% of the privately insured U.S. population aged 21–64 years, or 1.3 million individuals, was enrolled in CDHPs in September 2006, unchanged from the year before—despite widespread attention. Another 7% (8.5 million adults) had plans with deductibles high enough to qualify for health savings accounts but did not have an account.

Employers are cautiously awaiting data on the cost and effectiveness of CDHPs before switching coverage, Dr. Davis said.

"The plans are not well known at this point," said Paul Fronstin, EBRI senior research associate. "Only 7% of the population responded that they are 'very familiar' with consumer-directed health plans, while 13% said they were 'somewhat familiar.'"

In addition, despite the expectations of some policy makers that the lower premiums and tax benefits of CDHPs would substantially reduce the number of people without health insurance, "we did find that individuals in consumer-directed plans were not more likely to have been uninsured than those enrolled in a conventional plan," said Mr. Fronstin.

The survey of 3,158 U.S. adults aged 21–64 was conducted in September through a 14-minute Internet survey.

The National Committee for Quality Assurance is finalizing new performance measures that will look at quality of care all the way down to the physician group and even the individual physician level.

The measures, which will form the foundation of a new Health Employer Data and Information Set (HEDIS), could require physicians to begin reporting some quality data to health plans directly—echoing other performance measurement efforts underway nationwide.

The draft ambulatory care quality measures were released for public comment in October. Final measures are expected before the end of the year, according to an NCQA spokesman.

“This is a big change,” said Dr. Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians (AAFP) and a member of the NCQA committee that approved the draft measures. “Physicians now will begin to report some data from their clinical records, such as 'Why I didn't give an indicated medication.'”

HEDIS, which measures quality of care, is the main tool that health plans use to track and report on their performance to payers.

Until now, HEDIS has used administrative claims data “almost exclusively” to measure quality at the health plan level, said Dr. Bagley. Now, “NCQA has rewritten these specifications so that it's possible to drive the measures down to the physician level. The measures can be used at the plan level or at the physician group level or even at the individual physician level, if there are enough patients.”

The draft measures are designed to allow health plans to report on physician performance for their networks. They include six prevention measures, such as breast cancer screening and influenza vaccination rates, as well as measures that address care for coronary artery disease, depression, and asthma. Measures addressing overuse and misuse of health care services also are part of the proposed HEDIS addition. The measures include detailed technical specifications and implementation methods, such as appropriate sample sizing, for use by health plans.

The draft measures are not new, Dr. Bagley pointed out. They were included in the National Quality Forum-endorsed National Voluntary Consensus Standards for Physician-Focused Ambulatory Care, and the AQA (formerly the Ambulatory Care Quality Alliance) adopted these measures as part of its Recommended Starter Set of Clinical Performance Measures for Ambulatory Care. Therefore, physician organizations have had an opportunity to see them and comment on them prior to their release as part of HEDIS, Dr. Bagley said.

“We see these [measures] as supplementing a number of national and regional physician-level measurement efforts that are already underway,” said NCQA spokesman Jeff Van Ness. Because NCQA included detailed instructions for implementation, “this lowers the hurdle for plans to begin to move and implement these among physicians,” he said.

Nonetheless, Dr. Bagley said, once these measures are made part of HEDIS, physicians and their groups will need to develop methods to collect the necessary information without resorting to retrospective chart audits.

“We're promoting prospective data collection,” such as checklists that can be filled out at the time of the patient visit, he said.

NCQA released the draft measures for public comment in October. Mr. Van Ness said that most of the comments NCQA has collected have come from large national health plans, although some comments have come from physicians and other stakeholders. He declined to provide information on the content of the comments, citing privacy concerns.

Dr. Lynne Kirk, president of the American College of Physicians, said that her organization's main concern about the new quality measures was any additional paperwork and cost burden they might add to physicians' workloads.

The National Committee for Quality Assurance is finalizing new performance measures that will look at quality of care all the way down to the physician group and even the individual physician level.

The measures, which will form the foundation of a new Health Employer Data and Information Set (HEDIS), could require physicians to begin reporting some quality data to health plans directly—echoing other performance measurement efforts underway nationwide.

The draft ambulatory care quality measures were released for public comment in October. Final measures are expected before the end of the year, according to an NCQA spokesman.

“This is a big change,” said Dr. Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians (AAFP) and a member of the NCQA committee that approved the draft measures. “Physicians now will begin to report some data from their clinical records, such as 'Why I didn't give an indicated medication.'”

HEDIS, which measures quality of care, is the main tool that health plans use to track and report on their performance to payers.

Until now, HEDIS has used administrative claims data “almost exclusively” to measure quality at the health plan level, said Dr. Bagley. Now, “NCQA has rewritten these specifications so that it's possible to drive the measures down to the physician level. The measures can be used at the plan level or at the physician group level or even at the individual physician level, if there are enough patients.”

The draft measures are designed to allow health plans to report on physician performance for their networks. They include six prevention measures, such as breast cancer screening and influenza vaccination rates, as well as measures that address care for coronary artery disease, depression, and asthma. Measures addressing overuse and misuse of health care services also are part of the proposed HEDIS addition. The measures include detailed technical specifications and implementation methods, such as appropriate sample sizing, for use by health plans.

The draft measures are not new, Dr. Bagley pointed out. They were included in the National Quality Forum-endorsed National Voluntary Consensus Standards for Physician-Focused Ambulatory Care, and the AQA (formerly the Ambulatory Care Quality Alliance) adopted these measures as part of its Recommended Starter Set of Clinical Performance Measures for Ambulatory Care. Therefore, physician organizations have had an opportunity to see them and comment on them prior to their release as part of HEDIS, Dr. Bagley said.

“We see these [measures] as supplementing a number of national and regional physician-level measurement efforts that are already underway,” said NCQA spokesman Jeff Van Ness. Because NCQA included detailed instructions for implementation, “this lowers the hurdle for plans to begin to move and implement these among physicians,” he said.

Nonetheless, Dr. Bagley said, once these measures are made part of HEDIS, physicians and their groups will need to develop methods to collect the necessary information without resorting to retrospective chart audits.

“We're promoting prospective data collection,” such as checklists that can be filled out at the time of the patient visit, he said.

NCQA released the draft measures for public comment in October. Mr. Van Ness said that most of the comments NCQA has collected have come from large national health plans, although some comments have come from physicians and other stakeholders. He declined to provide information on the content of the comments, citing privacy concerns.

Dr. Lynne Kirk, president of the American College of Physicians, said that her organization's main concern about the new quality measures was any additional paperwork and cost burden they might add to physicians' workloads.

The National Committee for Quality Assurance is finalizing new performance measures that will look at quality of care all the way down to the physician group and even the individual physician level.

The measures, which will form the foundation of a new Health Employer Data and Information Set (HEDIS), could require physicians to begin reporting some quality data to health plans directly—echoing other performance measurement efforts underway nationwide.

The draft ambulatory care quality measures were released for public comment in October. Final measures are expected before the end of the year, according to an NCQA spokesman.

“This is a big change,” said Dr. Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians (AAFP) and a member of the NCQA committee that approved the draft measures. “Physicians now will begin to report some data from their clinical records, such as 'Why I didn't give an indicated medication.'”

HEDIS, which measures quality of care, is the main tool that health plans use to track and report on their performance to payers.

Until now, HEDIS has used administrative claims data “almost exclusively” to measure quality at the health plan level, said Dr. Bagley. Now, “NCQA has rewritten these specifications so that it's possible to drive the measures down to the physician level. The measures can be used at the plan level or at the physician group level or even at the individual physician level, if there are enough patients.”

The draft measures are designed to allow health plans to report on physician performance for their networks. They include six prevention measures, such as breast cancer screening and influenza vaccination rates, as well as measures that address care for coronary artery disease, depression, and asthma. Measures addressing overuse and misuse of health care services also are part of the proposed HEDIS addition. The measures include detailed technical specifications and implementation methods, such as appropriate sample sizing, for use by health plans.

The draft measures are not new, Dr. Bagley pointed out. They were included in the National Quality Forum-endorsed National Voluntary Consensus Standards for Physician-Focused Ambulatory Care, and the AQA (formerly the Ambulatory Care Quality Alliance) adopted these measures as part of its Recommended Starter Set of Clinical Performance Measures for Ambulatory Care. Therefore, physician organizations have had an opportunity to see them and comment on them prior to their release as part of HEDIS, Dr. Bagley said.

“We see these [measures] as supplementing a number of national and regional physician-level measurement efforts that are already underway,” said NCQA spokesman Jeff Van Ness. Because NCQA included detailed instructions for implementation, “this lowers the hurdle for plans to begin to move and implement these among physicians,” he said.

Nonetheless, Dr. Bagley said, once these measures are made part of HEDIS, physicians and their groups will need to develop methods to collect the necessary information without resorting to retrospective chart audits.

“We're promoting prospective data collection,” such as checklists that can be filled out at the time of the patient visit, he said.

NCQA released the draft measures for public comment in October. Mr. Van Ness said that most of the comments NCQA has collected have come from large national health plans, although some comments have come from physicians and other stakeholders. He declined to provide information on the content of the comments, citing privacy concerns.

Dr. Lynne Kirk, president of the American College of Physicians, said that her organization's main concern about the new quality measures was any additional paperwork and cost burden they might add to physicians' workloads.