Joyce Frieden

WASHINGTON — The new system for infusion therapy payments under Medicare shows how difficult it is to base payment on “average” prices, Rep. Nancy Johnson (R-Conn.) said at a conference sponsored by Elsevier Oncology.

“An 'on average' payment system always means some people are below the average, and the question is, are you below average on every drug?” Ms. Johnson said. “Well, then you'd be out of business. I've gotten letters from people who are closing up shop to Medicare patients. That's a very, very serious problem.”

Under the new payment system for infusion therapy, providers have a choice: They can either buy their drugs from vendors that Medicare selects in a competitive bidding process, or they can buy drugs from any vendor and accept Medicare's payment of 106% of the average sales price (ASP). The ASP is determined by data supplied to Medicare by manufacturers and updated every quarter.

Several audience members complained that 106%—also called ASP plus 6%—was nowhere near enough for them to make any profit on the drugs. “I can't purchase any single drug and make any kind of margin on it,” a woman from Alaska said at the meeting. “We send everybody to the hospital [for treatment]. We cannot treat a single person. There's one drug I lose $400 on every time a patient walks in the door.”

Rep. Johnson said there seemed to be “pockets” of the country where too many drugs had such negative margins, “but we can't see any logic yet. Is it certain size practices? Is it certain regions of the country? We need your information, because in the end we want something that pays for drugs in a reasonable and fair process.”

One problem with determining the ASP is that it includes prices received by large-group buyers who get big discounts, as well as others who get 'prompt pay' discounts, Rep. Johnson noted. “Those may be too harsh. That may mean that the little guy who is below the average can't make it.”

A big problem with the payment system for drugs is that it is tied to the sustainable growth rate, a target percentage that Medicare sets each year for allowable growth in the Medicare budget, she said. If spending goes above the target, the budget must be cut the following year to make up for it. Rep. Johnson is sponsoring H.R. 3617, which would repeal the sustainable growth rate altogether and replace it with a payment increase based on the Medicare Economic Index.

That bill is important because increasing payments to physicians is essential for moving toward a pay-for-performance system, she said. “You can't move ahead on pay-for-performance when you're going to cut reimbursement.”

Another area of reimbursement concern was Medicare's oncology demonstration program. Last year, the program paid physicians $130 for each chemotherapy infusion visit as long as participating physicians filled out paperwork stating whether they are following practice guidelines with that particular patient.

This year, the program is paying $23 per evaluation and management visit, explained Dr. Peter Bach, senior advisor to Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. The new system “deemphasizes chemotherapy, removes the incentive for infusions over other treatments such as oral chemo, and it … creates a longitudinal record. The payment for each event is $23 rather than $130, but obviously the number of events is far greater,” he said.

Audience members did not like the changes. “CMS's demonstration project is flawed and extremely burdensome, and $23 is appalling,” said Sharon A. Van Marter, practice administrator at Syracuse (N.Y.) Hematology/Oncology. “It's very nice that [overall Medicare payment rates] have been frozen at 2005 levels,” but because the $130 payment is gone, “we're now looking at a 17% decrease because that isn't there.”

Dr. Bach reminded audience members that the project is voluntary. On the whole, “I'm hearing two signals: One is, 'It's not enough money—we're losing money every time we [do it],' and the other is onslaughts of e-mail from carrier medical directors and practices saying that they have thousands of claims queued up and carriers aren't ready to pay them,” he said. “I can't reconcile those two things. Why do something where you're going to be losing money?”

Because, replied conference chair Dr. Lee Schwartzberg, “you're throwing us a carrot—$23 every time we do it. We don't think the time relationship is right, but it's 23 more dollars. We're losing money across the system. This is the only opportunity that's been given.”

Elsevier Oncology and this newspaper are wholly owned subsidiaries of Elsevier.

WASHINGTON — The new system for infusion therapy payments under Medicare shows how difficult it is to base payment on “average” prices, Rep. Nancy Johnson (R-Conn.) said at a conference sponsored by Elsevier Oncology.

“An 'on average' payment system always means some people are below the average, and the question is, are you below average on every drug?” Ms. Johnson said. “Well, then you'd be out of business. I've gotten letters from people who are closing up shop to Medicare patients. That's a very, very serious problem.”

Under the new payment system for infusion therapy, providers have a choice: They can either buy their drugs from vendors that Medicare selects in a competitive bidding process, or they can buy drugs from any vendor and accept Medicare's payment of 106% of the average sales price (ASP). The ASP is determined by data supplied to Medicare by manufacturers and updated every quarter.

Several audience members complained that 106%—also called ASP plus 6%—was nowhere near enough for them to make any profit on the drugs. “I can't purchase any single drug and make any kind of margin on it,” a woman from Alaska said at the meeting. “We send everybody to the hospital [for treatment]. We cannot treat a single person. There's one drug I lose $400 on every time a patient walks in the door.”

Rep. Johnson said there seemed to be “pockets” of the country where too many drugs had such negative margins, “but we can't see any logic yet. Is it certain size practices? Is it certain regions of the country? We need your information, because in the end we want something that pays for drugs in a reasonable and fair process.”

One problem with determining the ASP is that it includes prices received by large-group buyers who get big discounts, as well as others who get 'prompt pay' discounts, Rep. Johnson noted. “Those may be too harsh. That may mean that the little guy who is below the average can't make it.”

A big problem with the payment system for drugs is that it is tied to the sustainable growth rate, a target percentage that Medicare sets each year for allowable growth in the Medicare budget, she said. If spending goes above the target, the budget must be cut the following year to make up for it. Rep. Johnson is sponsoring H.R. 3617, which would repeal the sustainable growth rate altogether and replace it with a payment increase based on the Medicare Economic Index.

That bill is important because increasing payments to physicians is essential for moving toward a pay-for-performance system, she said. “You can't move ahead on pay-for-performance when you're going to cut reimbursement.”

Another area of reimbursement concern was Medicare's oncology demonstration program. Last year, the program paid physicians $130 for each chemotherapy infusion visit as long as participating physicians filled out paperwork stating whether they are following practice guidelines with that particular patient.

This year, the program is paying $23 per evaluation and management visit, explained Dr. Peter Bach, senior advisor to Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. The new system “deemphasizes chemotherapy, removes the incentive for infusions over other treatments such as oral chemo, and it … creates a longitudinal record. The payment for each event is $23 rather than $130, but obviously the number of events is far greater,” he said.

Audience members did not like the changes. “CMS's demonstration project is flawed and extremely burdensome, and $23 is appalling,” said Sharon A. Van Marter, practice administrator at Syracuse (N.Y.) Hematology/Oncology. “It's very nice that [overall Medicare payment rates] have been frozen at 2005 levels,” but because the $130 payment is gone, “we're now looking at a 17% decrease because that isn't there.”

Dr. Bach reminded audience members that the project is voluntary. On the whole, “I'm hearing two signals: One is, 'It's not enough money—we're losing money every time we [do it],' and the other is onslaughts of e-mail from carrier medical directors and practices saying that they have thousands of claims queued up and carriers aren't ready to pay them,” he said. “I can't reconcile those two things. Why do something where you're going to be losing money?”

Because, replied conference chair Dr. Lee Schwartzberg, “you're throwing us a carrot—$23 every time we do it. We don't think the time relationship is right, but it's 23 more dollars. We're losing money across the system. This is the only opportunity that's been given.”

Elsevier Oncology and this newspaper are wholly owned subsidiaries of Elsevier.

WASHINGTON — The new system for infusion therapy payments under Medicare shows how difficult it is to base payment on “average” prices, Rep. Nancy Johnson (R-Conn.) said at a conference sponsored by Elsevier Oncology.

“An 'on average' payment system always means some people are below the average, and the question is, are you below average on every drug?” Ms. Johnson said. “Well, then you'd be out of business. I've gotten letters from people who are closing up shop to Medicare patients. That's a very, very serious problem.”

Under the new payment system for infusion therapy, providers have a choice: They can either buy their drugs from vendors that Medicare selects in a competitive bidding process, or they can buy drugs from any vendor and accept Medicare's payment of 106% of the average sales price (ASP). The ASP is determined by data supplied to Medicare by manufacturers and updated every quarter.

Several audience members complained that 106%—also called ASP plus 6%—was nowhere near enough for them to make any profit on the drugs. “I can't purchase any single drug and make any kind of margin on it,” a woman from Alaska said at the meeting. “We send everybody to the hospital [for treatment]. We cannot treat a single person. There's one drug I lose $400 on every time a patient walks in the door.”

Rep. Johnson said there seemed to be “pockets” of the country where too many drugs had such negative margins, “but we can't see any logic yet. Is it certain size practices? Is it certain regions of the country? We need your information, because in the end we want something that pays for drugs in a reasonable and fair process.”

One problem with determining the ASP is that it includes prices received by large-group buyers who get big discounts, as well as others who get 'prompt pay' discounts, Rep. Johnson noted. “Those may be too harsh. That may mean that the little guy who is below the average can't make it.”

A big problem with the payment system for drugs is that it is tied to the sustainable growth rate, a target percentage that Medicare sets each year for allowable growth in the Medicare budget, she said. If spending goes above the target, the budget must be cut the following year to make up for it. Rep. Johnson is sponsoring H.R. 3617, which would repeal the sustainable growth rate altogether and replace it with a payment increase based on the Medicare Economic Index.

That bill is important because increasing payments to physicians is essential for moving toward a pay-for-performance system, she said. “You can't move ahead on pay-for-performance when you're going to cut reimbursement.”

Another area of reimbursement concern was Medicare's oncology demonstration program. Last year, the program paid physicians $130 for each chemotherapy infusion visit as long as participating physicians filled out paperwork stating whether they are following practice guidelines with that particular patient.

This year, the program is paying $23 per evaluation and management visit, explained Dr. Peter Bach, senior advisor to Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. The new system “deemphasizes chemotherapy, removes the incentive for infusions over other treatments such as oral chemo, and it … creates a longitudinal record. The payment for each event is $23 rather than $130, but obviously the number of events is far greater,” he said.

Audience members did not like the changes. “CMS's demonstration project is flawed and extremely burdensome, and $23 is appalling,” said Sharon A. Van Marter, practice administrator at Syracuse (N.Y.) Hematology/Oncology. “It's very nice that [overall Medicare payment rates] have been frozen at 2005 levels,” but because the $130 payment is gone, “we're now looking at a 17% decrease because that isn't there.”

Dr. Bach reminded audience members that the project is voluntary. On the whole, “I'm hearing two signals: One is, 'It's not enough money—we're losing money every time we [do it],' and the other is onslaughts of e-mail from carrier medical directors and practices saying that they have thousands of claims queued up and carriers aren't ready to pay them,” he said. “I can't reconcile those two things. Why do something where you're going to be losing money?”

Because, replied conference chair Dr. Lee Schwartzberg, “you're throwing us a carrot—$23 every time we do it. We don't think the time relationship is right, but it's 23 more dollars. We're losing money across the system. This is the only opportunity that's been given.”

Elsevier Oncology and this newspaper are wholly owned subsidiaries of Elsevier.

WASHINGTON — Health disparities won't go away until the people and institutions that play a role in creating them are held accountable, Dr. Anne C. Beal said at a meeting sponsored by the Department of Health and Human Services and the Office of Minority Health.

“When you ask physicians if racial disparities in health care exist, about 65% say no,” said Dr. Beal, senior program officer at the Commonwealth Fund. “So a lot of work needs to be done in terms of making sure we keep pushing for this agenda, that health disparities is a real issue.”

Measures of health care disparity are essentially quality measures, Dr. Beal said.

“The collection of race and ethnicity data is the basic science of disparities,” she said. Without such data, “we don't know where we're going, we don't know if we're improving, and we don't know if interventions we're trying to implement are making a difference.”

Although health care quality measures were not initially designed to measure disparities, “if you take standard quality measures and stratify them by race and ethnicity, it allows you to identify racial disparities and what I call 'potential accountability,'” she said.

For example, many people have heard that the infant mortality rate is higher for African Americans than it is for whites. “However, there's no sense of ownership when you hear that,” Dr. Beal said. “You sit there and say, 'Um, um, um, that is a shame that we have this.'”

But if a physician gets a report that says his Hispanic patients are not getting immunized at the same rate as his African American patients, “then [he] has a sense of ownership and a sense of responsibility for those results,” she said.

There are several problems with collecting racial and ethnic data, however. One of the problems is how it's done. Dr. Beal quoted a study by Romana Hasnain-Wynia, Ph.D., vice-president for research at the Health Research and Education Trust, which found that 79% of hospitals were collecting racial and ethnic data. However, nearly half of the hospitals collecting the data said the categorization was made by “an admitting clerk, based on observation.”

A better method would be having patients self-identify, she continued. “In the emergency room or admitting area, there is a variety of other tasks you have to complete, not least of which is getting that all-important insurance card, so trying to ask about the patient's race probably falls very low on the list. But in order for us to see how we're doing, we need to develop standards not only in terms of the categories we use, but even with how we ask the question.”

That includes which racial categories to list. “I'm still amazed that in the United States, there are people using 'black, white, and other' as categories,” Dr. Beal said. “Only 80% of hospitals even include a Latino designation.”

Ignatius Bao, director of culturally competent health systems at The California Endowment, said providers should pay more attention to the variety of racial and ethnic groups. He noted that HHS is far behind in complying with standards issued in 1997 by the Office of Management and Budget that list a variety of racial categories government agencies are supposed to document when they issue data.

“I would argue, especially on behalf of Asian Americans, Pacific Islanders, and Native Americans, that we need to do better than these standards. We need to disaggregate the data even further,” Mr. Bao said. “But at the very beginning, every time HHS puts out data, it should have these categories, and if it doesn't, HHS should explain why the data are not there.”

Racial and ethnic designations also need to be made part of any electronic health record (EHR) system, Dr. Beal noted. “Because it's really not high on the agenda of EHR [developers], 10, 15, or 20 years from now we're going to be right back where we started. If we build it in right now, we'll be able to have this capacity moving forward.”

WASHINGTON — Health disparities won't go away until the people and institutions that play a role in creating them are held accountable, Dr. Anne C. Beal said at a meeting sponsored by the Department of Health and Human Services and the Office of Minority Health.

“When you ask physicians if racial disparities in health care exist, about 65% say no,” said Dr. Beal, senior program officer at the Commonwealth Fund. “So a lot of work needs to be done in terms of making sure we keep pushing for this agenda, that health disparities is a real issue.”

Measures of health care disparity are essentially quality measures, Dr. Beal said.

“The collection of race and ethnicity data is the basic science of disparities,” she said. Without such data, “we don't know where we're going, we don't know if we're improving, and we don't know if interventions we're trying to implement are making a difference.”

Although health care quality measures were not initially designed to measure disparities, “if you take standard quality measures and stratify them by race and ethnicity, it allows you to identify racial disparities and what I call 'potential accountability,'” she said.

For example, many people have heard that the infant mortality rate is higher for African Americans than it is for whites. “However, there's no sense of ownership when you hear that,” Dr. Beal said. “You sit there and say, 'Um, um, um, that is a shame that we have this.'”

But if a physician gets a report that says his Hispanic patients are not getting immunized at the same rate as his African American patients, “then [he] has a sense of ownership and a sense of responsibility for those results,” she said.

There are several problems with collecting racial and ethnic data, however. One of the problems is how it's done. Dr. Beal quoted a study by Romana Hasnain-Wynia, Ph.D., vice-president for research at the Health Research and Education Trust, which found that 79% of hospitals were collecting racial and ethnic data. However, nearly half of the hospitals collecting the data said the categorization was made by “an admitting clerk, based on observation.”

A better method would be having patients self-identify, she continued. “In the emergency room or admitting area, there is a variety of other tasks you have to complete, not least of which is getting that all-important insurance card, so trying to ask about the patient's race probably falls very low on the list. But in order for us to see how we're doing, we need to develop standards not only in terms of the categories we use, but even with how we ask the question.”

That includes which racial categories to list. “I'm still amazed that in the United States, there are people using 'black, white, and other' as categories,” Dr. Beal said. “Only 80% of hospitals even include a Latino designation.”

Ignatius Bao, director of culturally competent health systems at The California Endowment, said providers should pay more attention to the variety of racial and ethnic groups. He noted that HHS is far behind in complying with standards issued in 1997 by the Office of Management and Budget that list a variety of racial categories government agencies are supposed to document when they issue data.

“I would argue, especially on behalf of Asian Americans, Pacific Islanders, and Native Americans, that we need to do better than these standards. We need to disaggregate the data even further,” Mr. Bao said. “But at the very beginning, every time HHS puts out data, it should have these categories, and if it doesn't, HHS should explain why the data are not there.”

Racial and ethnic designations also need to be made part of any electronic health record (EHR) system, Dr. Beal noted. “Because it's really not high on the agenda of EHR [developers], 10, 15, or 20 years from now we're going to be right back where we started. If we build it in right now, we'll be able to have this capacity moving forward.”

WASHINGTON — Health disparities won't go away until the people and institutions that play a role in creating them are held accountable, Dr. Anne C. Beal said at a meeting sponsored by the Department of Health and Human Services and the Office of Minority Health.

“When you ask physicians if racial disparities in health care exist, about 65% say no,” said Dr. Beal, senior program officer at the Commonwealth Fund. “So a lot of work needs to be done in terms of making sure we keep pushing for this agenda, that health disparities is a real issue.”

Measures of health care disparity are essentially quality measures, Dr. Beal said.

“The collection of race and ethnicity data is the basic science of disparities,” she said. Without such data, “we don't know where we're going, we don't know if we're improving, and we don't know if interventions we're trying to implement are making a difference.”

Although health care quality measures were not initially designed to measure disparities, “if you take standard quality measures and stratify them by race and ethnicity, it allows you to identify racial disparities and what I call 'potential accountability,'” she said.

For example, many people have heard that the infant mortality rate is higher for African Americans than it is for whites. “However, there's no sense of ownership when you hear that,” Dr. Beal said. “You sit there and say, 'Um, um, um, that is a shame that we have this.'”

But if a physician gets a report that says his Hispanic patients are not getting immunized at the same rate as his African American patients, “then [he] has a sense of ownership and a sense of responsibility for those results,” she said.

There are several problems with collecting racial and ethnic data, however. One of the problems is how it's done. Dr. Beal quoted a study by Romana Hasnain-Wynia, Ph.D., vice-president for research at the Health Research and Education Trust, which found that 79% of hospitals were collecting racial and ethnic data. However, nearly half of the hospitals collecting the data said the categorization was made by “an admitting clerk, based on observation.”

A better method would be having patients self-identify, she continued. “In the emergency room or admitting area, there is a variety of other tasks you have to complete, not least of which is getting that all-important insurance card, so trying to ask about the patient's race probably falls very low on the list. But in order for us to see how we're doing, we need to develop standards not only in terms of the categories we use, but even with how we ask the question.”

That includes which racial categories to list. “I'm still amazed that in the United States, there are people using 'black, white, and other' as categories,” Dr. Beal said. “Only 80% of hospitals even include a Latino designation.”

Ignatius Bao, director of culturally competent health systems at The California Endowment, said providers should pay more attention to the variety of racial and ethnic groups. He noted that HHS is far behind in complying with standards issued in 1997 by the Office of Management and Budget that list a variety of racial categories government agencies are supposed to document when they issue data.

“I would argue, especially on behalf of Asian Americans, Pacific Islanders, and Native Americans, that we need to do better than these standards. We need to disaggregate the data even further,” Mr. Bao said. “But at the very beginning, every time HHS puts out data, it should have these categories, and if it doesn't, HHS should explain why the data are not there.”

Racial and ethnic designations also need to be made part of any electronic health record (EHR) system, Dr. Beal noted. “Because it's really not high on the agenda of EHR [developers], 10, 15, or 20 years from now we're going to be right back where we started. If we build it in right now, we'll be able to have this capacity moving forward.”

WASHINGTON — The new system for infusion therapy payments under Medicare shows how difficult it is to base payment on "average" prices, Rep. Nancy Johnson (R-Conn.) said at a conference sponsored by Elsevier Oncology.

"An 'on average' payment system always means some people are below the average, and the question is, are you below average on every drug?" Ms. Johnson said. "Well, then you'd be out of business. I've gotten letters from people who are closing up shop to Medicare patients. That's a very, very serious problem."

Under the new payment system for infusion therapy, providers have a choice: They can either buy their drugs from vendors that Medicare selects in a competitive bidding process, or they can buy drugs from any vendor and accept Medicare's payment of 106% of the average sales price (ASP). The ASP is determined by data supplied to Medicare by manufacturers and updated every quarter.

Several audience members complained that 106%—also called ASP plus 6%—was nowhere near enough for them to make any profit on the drugs. "I can't purchase any single drug and make any kind of margin on it," a woman from Alaska said at the meeting. "We send everybody to the hospital [for treatment]; we cannot treat a single person. There's one drug I lose $400 on every time a patient walks in the door."

Rep. Johnson said there seemed to be "pockets" of the country where too many drugs had such negative margins, "but we can't see any logic yet. Is it certain size practices? Is it certain regions of the country? We need your information, because in the end we want something that pays for drugs in a reasonable and fair process."

One problem with determining the ASP is that it includes prices received by large-group buyers who get big discounts, as well as others who get 'prompt pay' discounts, Rep. Johnson noted. "Those may be too harsh. That may mean that the little guy who is below the average can't make it."

A big problem with the payment system for drugs is that it is tied to the sustainable growth rate, a target percentage that Medicare sets each year for allowable growth in the Medicare budget, she said. If spending goes above the target, the budget must be cut the following year to make up for it. Rep. Johnson is sponsoring H.R. 3617, which would repeal the sustainable growth rate altogether and replace it with a payment increase based on the Medicare Economic Index. The bill is important because increasing payments to physicians is essential to move toward a pay-for-performance system, she said.

Another area of reimbursement concern was Medicare's oncology demonstration program. Last year, the program paid physicians $130 for each chemotherapy infusion visit as long as participating physicians filled out paperwork stating whether they are following practice guidelines with that particular patient.

This year, the program is paying $23 per evaluation and management visit, explained Dr. Peter Bach, senior advisor to Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. The new system "deemphasizes chemotherapy, removes the incentive for infusions over other treatments such as oral chemo, and it … creates a longitudinal record. The payment for each event is $23 rather than $130, but obviously the number of events is far greater," he said.

Audience members did not like the changes. "CMS's demonstration project is flawed and extremely burdensome, and $23 is appalling," said Sharon A. Van Marter, practice administrator at Syracuse (N.Y.) Hematology/Oncology.

Dr. Bach reminded audience members that the project is voluntary. On the whole, "I'm hearing two signals: One is, 'It's not enough money; we're losing money every time we [do it],' and the other is onslaughts of e-mail from carrier medical directors and practices saying that they have thousands of claims queued up and carriers aren't ready to pay them," he said. "I can't reconcile those two things. Why do something where you're going to be losing money?"

Because, replied conference chair Dr. Lee Schwartzberg, "you're throwing us a carrot—$23 every time we do it. We don't think the time relationship is right, but it's 23 more dollars. We're losing money across the system; this is the only opportunity that's been given." Elsevier Oncology and this news organization are wholly owned subsidiaries of Elsevier.

WASHINGTON — The new system for infusion therapy payments under Medicare shows how difficult it is to base payment on "average" prices, Rep. Nancy Johnson (R-Conn.) said at a conference sponsored by Elsevier Oncology.

"An 'on average' payment system always means some people are below the average, and the question is, are you below average on every drug?" Ms. Johnson said. "Well, then you'd be out of business. I've gotten letters from people who are closing up shop to Medicare patients. That's a very, very serious problem."

Under the new payment system for infusion therapy, providers have a choice: They can either buy their drugs from vendors that Medicare selects in a competitive bidding process, or they can buy drugs from any vendor and accept Medicare's payment of 106% of the average sales price (ASP). The ASP is determined by data supplied to Medicare by manufacturers and updated every quarter.

Several audience members complained that 106%—also called ASP plus 6%—was nowhere near enough for them to make any profit on the drugs. "I can't purchase any single drug and make any kind of margin on it," a woman from Alaska said at the meeting. "We send everybody to the hospital [for treatment]; we cannot treat a single person. There's one drug I lose $400 on every time a patient walks in the door."

Rep. Johnson said there seemed to be "pockets" of the country where too many drugs had such negative margins, "but we can't see any logic yet. Is it certain size practices? Is it certain regions of the country? We need your information, because in the end we want something that pays for drugs in a reasonable and fair process."

One problem with determining the ASP is that it includes prices received by large-group buyers who get big discounts, as well as others who get 'prompt pay' discounts, Rep. Johnson noted. "Those may be too harsh. That may mean that the little guy who is below the average can't make it."

A big problem with the payment system for drugs is that it is tied to the sustainable growth rate, a target percentage that Medicare sets each year for allowable growth in the Medicare budget, she said. If spending goes above the target, the budget must be cut the following year to make up for it. Rep. Johnson is sponsoring H.R. 3617, which would repeal the sustainable growth rate altogether and replace it with a payment increase based on the Medicare Economic Index. The bill is important because increasing payments to physicians is essential to move toward a pay-for-performance system, she said.

Another area of reimbursement concern was Medicare's oncology demonstration program. Last year, the program paid physicians $130 for each chemotherapy infusion visit as long as participating physicians filled out paperwork stating whether they are following practice guidelines with that particular patient.

This year, the program is paying $23 per evaluation and management visit, explained Dr. Peter Bach, senior advisor to Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. The new system "deemphasizes chemotherapy, removes the incentive for infusions over other treatments such as oral chemo, and it … creates a longitudinal record. The payment for each event is $23 rather than $130, but obviously the number of events is far greater," he said.

Audience members did not like the changes. "CMS's demonstration project is flawed and extremely burdensome, and $23 is appalling," said Sharon A. Van Marter, practice administrator at Syracuse (N.Y.) Hematology/Oncology.

Dr. Bach reminded audience members that the project is voluntary. On the whole, "I'm hearing two signals: One is, 'It's not enough money; we're losing money every time we [do it],' and the other is onslaughts of e-mail from carrier medical directors and practices saying that they have thousands of claims queued up and carriers aren't ready to pay them," he said. "I can't reconcile those two things. Why do something where you're going to be losing money?"

Because, replied conference chair Dr. Lee Schwartzberg, "you're throwing us a carrot—$23 every time we do it. We don't think the time relationship is right, but it's 23 more dollars. We're losing money across the system; this is the only opportunity that's been given." Elsevier Oncology and this news organization are wholly owned subsidiaries of Elsevier.

WASHINGTON — The new system for infusion therapy payments under Medicare shows how difficult it is to base payment on "average" prices, Rep. Nancy Johnson (R-Conn.) said at a conference sponsored by Elsevier Oncology.

"An 'on average' payment system always means some people are below the average, and the question is, are you below average on every drug?" Ms. Johnson said. "Well, then you'd be out of business. I've gotten letters from people who are closing up shop to Medicare patients. That's a very, very serious problem."

Under the new payment system for infusion therapy, providers have a choice: They can either buy their drugs from vendors that Medicare selects in a competitive bidding process, or they can buy drugs from any vendor and accept Medicare's payment of 106% of the average sales price (ASP). The ASP is determined by data supplied to Medicare by manufacturers and updated every quarter.

Several audience members complained that 106%—also called ASP plus 6%—was nowhere near enough for them to make any profit on the drugs. "I can't purchase any single drug and make any kind of margin on it," a woman from Alaska said at the meeting. "We send everybody to the hospital [for treatment]; we cannot treat a single person. There's one drug I lose $400 on every time a patient walks in the door."

Rep. Johnson said there seemed to be "pockets" of the country where too many drugs had such negative margins, "but we can't see any logic yet. Is it certain size practices? Is it certain regions of the country? We need your information, because in the end we want something that pays for drugs in a reasonable and fair process."

One problem with determining the ASP is that it includes prices received by large-group buyers who get big discounts, as well as others who get 'prompt pay' discounts, Rep. Johnson noted. "Those may be too harsh. That may mean that the little guy who is below the average can't make it."

A big problem with the payment system for drugs is that it is tied to the sustainable growth rate, a target percentage that Medicare sets each year for allowable growth in the Medicare budget, she said. If spending goes above the target, the budget must be cut the following year to make up for it. Rep. Johnson is sponsoring H.R. 3617, which would repeal the sustainable growth rate altogether and replace it with a payment increase based on the Medicare Economic Index. The bill is important because increasing payments to physicians is essential to move toward a pay-for-performance system, she said.

Another area of reimbursement concern was Medicare's oncology demonstration program. Last year, the program paid physicians $130 for each chemotherapy infusion visit as long as participating physicians filled out paperwork stating whether they are following practice guidelines with that particular patient.

This year, the program is paying $23 per evaluation and management visit, explained Dr. Peter Bach, senior advisor to Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. The new system "deemphasizes chemotherapy, removes the incentive for infusions over other treatments such as oral chemo, and it … creates a longitudinal record. The payment for each event is $23 rather than $130, but obviously the number of events is far greater," he said.

Audience members did not like the changes. "CMS's demonstration project is flawed and extremely burdensome, and $23 is appalling," said Sharon A. Van Marter, practice administrator at Syracuse (N.Y.) Hematology/Oncology.

Dr. Bach reminded audience members that the project is voluntary. On the whole, "I'm hearing two signals: One is, 'It's not enough money; we're losing money every time we [do it],' and the other is onslaughts of e-mail from carrier medical directors and practices saying that they have thousands of claims queued up and carriers aren't ready to pay them," he said. "I can't reconcile those two things. Why do something where you're going to be losing money?"

Because, replied conference chair Dr. Lee Schwartzberg, "you're throwing us a carrot—$23 every time we do it. We don't think the time relationship is right, but it's 23 more dollars. We're losing money across the system; this is the only opportunity that's been given." Elsevier Oncology and this news organization are wholly owned subsidiaries of Elsevier.

WASHINGTON — Payments for drugs to treat cancer deserve more scrutiny, Dr. Lee Newcomer, an Oncology Services for United Healthcare executive, said at a conference sponsored by Elsevier Oncology.

For example, he said, United Healthcare decided to take a closer look at 180 breast cancer patients who were prescribed trastuzumab (Herceptin), a drug indicated only for patients who have a HER2/neu gene. “I asked the oncology office to send us the report; 12% of patients who were getting Herceptin did not have a HER2/neu gene anywhere in their medical records,” he said. “That's a dangerous drug. It's got a high incidence of heart failure.”

As a result, Dr. Newcomer said he had no choice but to require physicians who prescribed the drug to staple a report showing the patient had the gene to their first Herceptin prescription claim. After the first prescription, “the rest will go straight through,” he added.

Another issue is how to make chemotherapy more cost effective. “Right now, in the world of oncology, you have every incentive to use the most expensive chemotherapy regimen that works” because there is more profit in the expensive drugs, said Dr. Newcomer, formerly an oncologist in private practice. “That is part of how you make your practice income. I used to make my income that way.”

Dr. Newcomer is considering a program in which United pays physicians the same profit they used to get from each chemotherapy regimen—in the form of a disease-management fee—but the plan also buys the drugs instead of having the physicians buy them. “You let me go out and get the best possible price for that drug, because as United Healthcare, I've got a little more clout than your office does,” he said, noting that he spent $1.1 billion on drugs last year.

Under that plan, “[oncologists] win—you still keep the margins at your office,” he continued. “I win because patients are going to get a lower premium. [Large pharmaceutical companies] lose, but that's going to happen.”

The idea behind the proposal is that “I want to pay you a lung cancer management fee, but have you be indifferent to which drug gives you the best margin, because we're going to go out and purchase it directly from the manufacturers,” Dr. Newcomer said. “Your money doesn't come any more from which drug you choose. It comes from the disease-management fee.”

Dr. Newcomer also wants to look more closely at off-label use of cancer drugs. This issue came to his attention when he looked at prescriptions for bevacizumab (Avastin), a colorectal cancer drug, and found that over a 4-month period, 80% of the prescriptions were for colorectal cancer, but the other 20% were for “every other cancer you can imagine—head and neck cancer, pancreas, bone, you name it. Every cancer was on that list, and I have to ask, why? Where's the evidence? Who really benefits from that?” One way to find out the results of off-label use of cancer drugs is to enroll the patient in a clinical trial of an off-label drug. United already pays patient expenses in clinical trials that are approved by the National Cancer Institute, according to Dr. Newcomer.

The other option, he continued, is to create registries—possibly in conjunction with the Centers for Medicare and Medicaid Services, “and start finding out whether this stuff works [off-label] or not, instead of having every single office in the country try one or two patients and we never gain any knowledge from that endeavor.”

Another area Dr. Newcomer's office is examining is rationalizing end-of-life care for cancer patients. “This is of personal interest to me because in my six-man [oncology] group, three of us had almost 90% of our patients die in the hospital, and the other three, where I was, had 90% of our patients die in hospice,” he said. “As we had discussions about that, it was a difference in philosophy, but we couldn't quite figure out how we would approach what the right number was.” Dr. Newcomer referred to a study by the Quality Oncology Practice Initiative that looked at end-of-life chemotherapy in about 30 oncology practices. The study found that in some practices, patients got no chemotherapy in the last few weeks of life, and in other practices, 40%–50% of terminally ill patients were getting chemotherapy.

Elsevier Oncology and this news organization are both wholly owned subsidiaries of Elsevier.

WASHINGTON — Payments for drugs to treat cancer deserve more scrutiny, Dr. Lee Newcomer, an Oncology Services for United Healthcare executive, said at a conference sponsored by Elsevier Oncology.

For example, he said, United Healthcare decided to take a closer look at 180 breast cancer patients who were prescribed trastuzumab (Herceptin), a drug indicated only for patients who have a HER2/neu gene. “I asked the oncology office to send us the report; 12% of patients who were getting Herceptin did not have a HER2/neu gene anywhere in their medical records,” he said. “That's a dangerous drug. It's got a high incidence of heart failure.”

As a result, Dr. Newcomer said he had no choice but to require physicians who prescribed the drug to staple a report showing the patient had the gene to their first Herceptin prescription claim. After the first prescription, “the rest will go straight through,” he added.

Another issue is how to make chemotherapy more cost effective. “Right now, in the world of oncology, you have every incentive to use the most expensive chemotherapy regimen that works” because there is more profit in the expensive drugs, said Dr. Newcomer, formerly an oncologist in private practice. “That is part of how you make your practice income. I used to make my income that way.”

Dr. Newcomer is considering a program in which United pays physicians the same profit they used to get from each chemotherapy regimen—in the form of a disease-management fee—but the plan also buys the drugs instead of having the physicians buy them. “You let me go out and get the best possible price for that drug, because as United Healthcare, I've got a little more clout than your office does,” he said, noting that he spent $1.1 billion on drugs last year.

Under that plan, “[oncologists] win—you still keep the margins at your office,” he continued. “I win because patients are going to get a lower premium. [Large pharmaceutical companies] lose, but that's going to happen.”

The idea behind the proposal is that “I want to pay you a lung cancer management fee, but have you be indifferent to which drug gives you the best margin, because we're going to go out and purchase it directly from the manufacturers,” Dr. Newcomer said. “Your money doesn't come any more from which drug you choose. It comes from the disease-management fee.”

Dr. Newcomer also wants to look more closely at off-label use of cancer drugs. This issue came to his attention when he looked at prescriptions for bevacizumab (Avastin), a colorectal cancer drug, and found that over a 4-month period, 80% of the prescriptions were for colorectal cancer, but the other 20% were for “every other cancer you can imagine—head and neck cancer, pancreas, bone, you name it. Every cancer was on that list, and I have to ask, why? Where's the evidence? Who really benefits from that?” One way to find out the results of off-label use of cancer drugs is to enroll the patient in a clinical trial of an off-label drug. United already pays patient expenses in clinical trials that are approved by the National Cancer Institute, according to Dr. Newcomer.

The other option, he continued, is to create registries—possibly in conjunction with the Centers for Medicare and Medicaid Services, “and start finding out whether this stuff works [off-label] or not, instead of having every single office in the country try one or two patients and we never gain any knowledge from that endeavor.”

Another area Dr. Newcomer's office is examining is rationalizing end-of-life care for cancer patients. “This is of personal interest to me because in my six-man [oncology] group, three of us had almost 90% of our patients die in the hospital, and the other three, where I was, had 90% of our patients die in hospice,” he said. “As we had discussions about that, it was a difference in philosophy, but we couldn't quite figure out how we would approach what the right number was.” Dr. Newcomer referred to a study by the Quality Oncology Practice Initiative that looked at end-of-life chemotherapy in about 30 oncology practices. The study found that in some practices, patients got no chemotherapy in the last few weeks of life, and in other practices, 40%–50% of terminally ill patients were getting chemotherapy.

Elsevier Oncology and this news organization are both wholly owned subsidiaries of Elsevier.

WASHINGTON — Payments for drugs to treat cancer deserve more scrutiny, Dr. Lee Newcomer, an Oncology Services for United Healthcare executive, said at a conference sponsored by Elsevier Oncology.

For example, he said, United Healthcare decided to take a closer look at 180 breast cancer patients who were prescribed trastuzumab (Herceptin), a drug indicated only for patients who have a HER2/neu gene. “I asked the oncology office to send us the report; 12% of patients who were getting Herceptin did not have a HER2/neu gene anywhere in their medical records,” he said. “That's a dangerous drug. It's got a high incidence of heart failure.”

As a result, Dr. Newcomer said he had no choice but to require physicians who prescribed the drug to staple a report showing the patient had the gene to their first Herceptin prescription claim. After the first prescription, “the rest will go straight through,” he added.

Another issue is how to make chemotherapy more cost effective. “Right now, in the world of oncology, you have every incentive to use the most expensive chemotherapy regimen that works” because there is more profit in the expensive drugs, said Dr. Newcomer, formerly an oncologist in private practice. “That is part of how you make your practice income. I used to make my income that way.”

Dr. Newcomer is considering a program in which United pays physicians the same profit they used to get from each chemotherapy regimen—in the form of a disease-management fee—but the plan also buys the drugs instead of having the physicians buy them. “You let me go out and get the best possible price for that drug, because as United Healthcare, I've got a little more clout than your office does,” he said, noting that he spent $1.1 billion on drugs last year.

Under that plan, “[oncologists] win—you still keep the margins at your office,” he continued. “I win because patients are going to get a lower premium. [Large pharmaceutical companies] lose, but that's going to happen.”

The idea behind the proposal is that “I want to pay you a lung cancer management fee, but have you be indifferent to which drug gives you the best margin, because we're going to go out and purchase it directly from the manufacturers,” Dr. Newcomer said. “Your money doesn't come any more from which drug you choose. It comes from the disease-management fee.”

Dr. Newcomer also wants to look more closely at off-label use of cancer drugs. This issue came to his attention when he looked at prescriptions for bevacizumab (Avastin), a colorectal cancer drug, and found that over a 4-month period, 80% of the prescriptions were for colorectal cancer, but the other 20% were for “every other cancer you can imagine—head and neck cancer, pancreas, bone, you name it. Every cancer was on that list, and I have to ask, why? Where's the evidence? Who really benefits from that?” One way to find out the results of off-label use of cancer drugs is to enroll the patient in a clinical trial of an off-label drug. United already pays patient expenses in clinical trials that are approved by the National Cancer Institute, according to Dr. Newcomer.

The other option, he continued, is to create registries—possibly in conjunction with the Centers for Medicare and Medicaid Services, “and start finding out whether this stuff works [off-label] or not, instead of having every single office in the country try one or two patients and we never gain any knowledge from that endeavor.”

Another area Dr. Newcomer's office is examining is rationalizing end-of-life care for cancer patients. “This is of personal interest to me because in my six-man [oncology] group, three of us had almost 90% of our patients die in the hospital, and the other three, where I was, had 90% of our patients die in hospice,” he said. “As we had discussions about that, it was a difference in philosophy, but we couldn't quite figure out how we would approach what the right number was.” Dr. Newcomer referred to a study by the Quality Oncology Practice Initiative that looked at end-of-life chemotherapy in about 30 oncology practices. The study found that in some practices, patients got no chemotherapy in the last few weeks of life, and in other practices, 40%–50% of terminally ill patients were getting chemotherapy.

Elsevier Oncology and this news organization are both wholly owned subsidiaries of Elsevier.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you—provided you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of major retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which planned to roll out the new service this month. “By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee—with plans to expand as soon as possible.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company. Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a particular patient will see all the new prescriptions and refills that the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than just relying on insurance claims is that the pharmacy data includes the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed. They can pick people they need to focus in on and see why they're not taking their medications.”

Physicians will be able to use the service in two ways, Mr. Hutchinson said. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data falls under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem; patients signing the HIPAA form at their doctor's office have given their physician permission to look at this type of data, he added.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you—provided you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of major retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which planned to roll out the new service this month. “By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee—with plans to expand as soon as possible.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company. Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a particular patient will see all the new prescriptions and refills that the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than just relying on insurance claims is that the pharmacy data includes the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed. They can pick people they need to focus in on and see why they're not taking their medications.”

Physicians will be able to use the service in two ways, Mr. Hutchinson said. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data falls under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem; patients signing the HIPAA form at their doctor's office have given their physician permission to look at this type of data, he added.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you—provided you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of major retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which planned to roll out the new service this month. “By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee—with plans to expand as soon as possible.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company. Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a particular patient will see all the new prescriptions and refills that the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than just relying on insurance claims is that the pharmacy data includes the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed. They can pick people they need to focus in on and see why they're not taking their medications.”

Physicians will be able to use the service in two ways, Mr. Hutchinson said. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data falls under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem; patients signing the HIPAA form at their doctor's office have given their physician permission to look at this type of data, he added.

WASHINGTON — Although consumer-driven health care puts much more decision making in the hands of consumers, employers, and insurers still have a role to play, several speakers said at a meeting on health care competition sponsored by Health Affairs journal and the Center for Studying Health System Change.

Employers will have a role because “as there's labor competition for offering health benefits, we have to offer health plans,” said Dr. Robert Galvin, director of corporate health care programs for General Electric. “You're going to see much more [emphasis] on financial incentives for employees staying healthy and making [good] choices on doctors and hospitals and health plans.”

Another role for employers—although it gets denigrated a bit—is providing access to meaningful, usable, and accurate information “as long as the market isn't working on its own, and it certainly isn't today,” Dr. Galvin said. “This is a responsibility of ours to keep driving at.”

He noted that within GE, officials believe “if information is not readable, it isn't going to be read.” In light of that philosophy, the company has come up with a “health index” that tells employees things such as how healthy they are, compared with how healthy they want to be; how much money is in their wellness account; and when it's time to schedule their children's physicals. It also can include a scorecard about the providers they use.

This information could be integrated into employee e-mail accounts—a sort of “You've Got Health” idea, Dr. Galvin said.

Although employers can act as intermediaries, insurers also have a role, said Dr. Samuel Nussbaum, executive vice president and chief medical officer at WellPoint Inc., a multistate Blue Cross and Blue Shield company based in Indianapolis. One of their roles is to make consumers more aware of how much their choices are costing them.

“Most Americans consider health care an entitlement, not a consumer product,” Dr. Nussbaum said. “And consumers are insulated from the true costs of health care services and products. So a prerequisite for health care competition is to have accurate, usable information about cost and quality.”

WASHINGTON — Although consumer-driven health care puts much more decision making in the hands of consumers, employers, and insurers still have a role to play, several speakers said at a meeting on health care competition sponsored by Health Affairs journal and the Center for Studying Health System Change.

Employers will have a role because “as there's labor competition for offering health benefits, we have to offer health plans,” said Dr. Robert Galvin, director of corporate health care programs for General Electric. “You're going to see much more [emphasis] on financial incentives for employees staying healthy and making [good] choices on doctors and hospitals and health plans.”

Another role for employers—although it gets denigrated a bit—is providing access to meaningful, usable, and accurate information “as long as the market isn't working on its own, and it certainly isn't today,” Dr. Galvin said. “This is a responsibility of ours to keep driving at.”

He noted that within GE, officials believe “if information is not readable, it isn't going to be read.” In light of that philosophy, the company has come up with a “health index” that tells employees things such as how healthy they are, compared with how healthy they want to be; how much money is in their wellness account; and when it's time to schedule their children's physicals. It also can include a scorecard about the providers they use.

This information could be integrated into employee e-mail accounts—a sort of “You've Got Health” idea, Dr. Galvin said.

Although employers can act as intermediaries, insurers also have a role, said Dr. Samuel Nussbaum, executive vice president and chief medical officer at WellPoint Inc., a multistate Blue Cross and Blue Shield company based in Indianapolis. One of their roles is to make consumers more aware of how much their choices are costing them.

“Most Americans consider health care an entitlement, not a consumer product,” Dr. Nussbaum said. “And consumers are insulated from the true costs of health care services and products. So a prerequisite for health care competition is to have accurate, usable information about cost and quality.”

WASHINGTON — Although consumer-driven health care puts much more decision making in the hands of consumers, employers, and insurers still have a role to play, several speakers said at a meeting on health care competition sponsored by Health Affairs journal and the Center for Studying Health System Change.

Employers will have a role because “as there's labor competition for offering health benefits, we have to offer health plans,” said Dr. Robert Galvin, director of corporate health care programs for General Electric. “You're going to see much more [emphasis] on financial incentives for employees staying healthy and making [good] choices on doctors and hospitals and health plans.”

Another role for employers—although it gets denigrated a bit—is providing access to meaningful, usable, and accurate information “as long as the market isn't working on its own, and it certainly isn't today,” Dr. Galvin said. “This is a responsibility of ours to keep driving at.”

He noted that within GE, officials believe “if information is not readable, it isn't going to be read.” In light of that philosophy, the company has come up with a “health index” that tells employees things such as how healthy they are, compared with how healthy they want to be; how much money is in their wellness account; and when it's time to schedule their children's physicals. It also can include a scorecard about the providers they use.

This information could be integrated into employee e-mail accounts—a sort of “You've Got Health” idea, Dr. Galvin said.

Although employers can act as intermediaries, insurers also have a role, said Dr. Samuel Nussbaum, executive vice president and chief medical officer at WellPoint Inc., a multistate Blue Cross and Blue Shield company based in Indianapolis. One of their roles is to make consumers more aware of how much their choices are costing them.

“Most Americans consider health care an entitlement, not a consumer product,” Dr. Nussbaum said. “And consumers are insulated from the true costs of health care services and products. So a prerequisite for health care competition is to have accurate, usable information about cost and quality.”

As President Bush puts health savings accounts higher on his agenda, experts continue to debate whether they are a good idea for solving the problems of the uninsured.

“The more I think about these proposals, the more troubling I find them to be,” Leonard Burman, codirector of the Urban-Brookings Tax Policy Center, said in a teleconference sponsored by the Center on Budget and Policy Priorities (CBPP). “I don't think the idea [that people will be more cost conscious] is really going to play out.”

HSAs are accounts to which employees contribute to pay for the first several thousand dollars of their health care costs. The accounts are almost always combined with a high-deductible health insurance plan. Contributions to the HSA are tax free, as is money withdrawn for covered medical expenses. If the money is not used in a particular year, it can accumulate in the account.

The Galen Institute, a group that supports consumer-driven health care, has a more positive view of HSAs. “HSAs give consumers even more control over their health spending decisions—and provide them an incentive to spend wisely and save for future health care needs,” according to a statement from Galen. Critics argue that sick people are not always in a position to shop around for care; that making consumers more cost conscious won't help lower health care costs, because most health care spending is for expenses higher than the amount of the deductible, which is out of consumer control; and that HSAs tend to attract mostly healthy people, driving up premiums for sicker individuals who remain in more traditional plans.

President Bush highlighted HSAs in his State of the Union address, vowing to “strengthen health savings accounts—making sure individuals and small business employees can buy insurance with the same advantages that people working for big businesses now get.”

In a more detailed statement, White House officials said that the president “proposes making premiums for HSA-compatible insurance policies deductible from income taxes when [these policies are] purchased by individuals outside of work. In addition, an income tax credit would offset payroll taxes paid on premiums paid for their HSA policies.”

The president is also proposing to allow any spending on out-of-pocket health expenses incurred by HSA enrollees—up to $10,500 per family—to be tax free, not just expenses pertaining to the deductible, as allowed under current law.

Such changes would make HSAs even more tempting to some people, said Jason Furman, senior fellow at the CBPP. “HSAs are already an unprecedentedly favored tax vehicle. This proposal now takes a system already tilted and adds a new tax credit.”

If enacted, these proposals could make HSAs so attractive financially that they could begin to rival 401(k) plans as retirement savings vehicles, Mr. Furman said.

For example, suppose a family in a 25% tax bracket contributed the maximum $10,500 to an HSA that is invested at a 3% interest rate. Under the Bush proposal, they would owe a payroll tax of $1,607 but would also get a tax credit for that amount, so the entire $10,500 would stay in the account. If they put the same amount into a 401(k), they would still owe the payroll tax, but would not get a tax credit, so only $8,893 would be deposited into the 401(k) account. Thus the HSA would have $25,486 in it by 2036, versus $21,587 for the 401(k), Mr. Furman said.

With such results, “a lot of employers who offer 401(k) plans would have a lot less of an incentive to,” he added. “Their employees could go on their own and get a much better deal from an HSA than from a 401(k), and avoid nondiscrimination rules.” The payroll taxes that HSA account holders no longer have to pay would also put a dent in the federal budget, he said.

Barry Barnett, a principal in PriceWaterhouseCoopers' human resource solutions practice, acknowledged that the proposal would result in substantial tax incentives but said he did not think employers were going to get rid of their 401(k) offerings because of it.

Ever since employers have switched to defined contribution retirement plans, “there has been enough noise in the system by employees feeling they've lost the entitlement to a defined benefit plan in retirement,” Mr. Barnett said.

As President Bush puts health savings accounts higher on his agenda, experts continue to debate whether they are a good idea for solving the problems of the uninsured.

“The more I think about these proposals, the more troubling I find them to be,” Leonard Burman, codirector of the Urban-Brookings Tax Policy Center, said in a teleconference sponsored by the Center on Budget and Policy Priorities (CBPP). “I don't think the idea [that people will be more cost conscious] is really going to play out.”

HSAs are accounts to which employees contribute to pay for the first several thousand dollars of their health care costs. The accounts are almost always combined with a high-deductible health insurance plan. Contributions to the HSA are tax free, as is money withdrawn for covered medical expenses. If the money is not used in a particular year, it can accumulate in the account.

The Galen Institute, a group that supports consumer-driven health care, has a more positive view of HSAs. “HSAs give consumers even more control over their health spending decisions—and provide them an incentive to spend wisely and save for future health care needs,” according to a statement from Galen. Critics argue that sick people are not always in a position to shop around for care; that making consumers more cost conscious won't help lower health care costs, because most health care spending is for expenses higher than the amount of the deductible, which is out of consumer control; and that HSAs tend to attract mostly healthy people, driving up premiums for sicker individuals who remain in more traditional plans.

President Bush highlighted HSAs in his State of the Union address, vowing to “strengthen health savings accounts—making sure individuals and small business employees can buy insurance with the same advantages that people working for big businesses now get.”

In a more detailed statement, White House officials said that the president “proposes making premiums for HSA-compatible insurance policies deductible from income taxes when [these policies are] purchased by individuals outside of work. In addition, an income tax credit would offset payroll taxes paid on premiums paid for their HSA policies.”

The president is also proposing to allow any spending on out-of-pocket health expenses incurred by HSA enrollees—up to $10,500 per family—to be tax free, not just expenses pertaining to the deductible, as allowed under current law.

Such changes would make HSAs even more tempting to some people, said Jason Furman, senior fellow at the CBPP. “HSAs are already an unprecedentedly favored tax vehicle. This proposal now takes a system already tilted and adds a new tax credit.”

If enacted, these proposals could make HSAs so attractive financially that they could begin to rival 401(k) plans as retirement savings vehicles, Mr. Furman said.

For example, suppose a family in a 25% tax bracket contributed the maximum $10,500 to an HSA that is invested at a 3% interest rate. Under the Bush proposal, they would owe a payroll tax of $1,607 but would also get a tax credit for that amount, so the entire $10,500 would stay in the account. If they put the same amount into a 401(k), they would still owe the payroll tax, but would not get a tax credit, so only $8,893 would be deposited into the 401(k) account. Thus the HSA would have $25,486 in it by 2036, versus $21,587 for the 401(k), Mr. Furman said.

With such results, “a lot of employers who offer 401(k) plans would have a lot less of an incentive to,” he added. “Their employees could go on their own and get a much better deal from an HSA than from a 401(k), and avoid nondiscrimination rules.” The payroll taxes that HSA account holders no longer have to pay would also put a dent in the federal budget, he said.

Barry Barnett, a principal in PriceWaterhouseCoopers' human resource solutions practice, acknowledged that the proposal would result in substantial tax incentives but said he did not think employers were going to get rid of their 401(k) offerings because of it.

Ever since employers have switched to defined contribution retirement plans, “there has been enough noise in the system by employees feeling they've lost the entitlement to a defined benefit plan in retirement,” Mr. Barnett said.

As President Bush puts health savings accounts higher on his agenda, experts continue to debate whether they are a good idea for solving the problems of the uninsured.

“The more I think about these proposals, the more troubling I find them to be,” Leonard Burman, codirector of the Urban-Brookings Tax Policy Center, said in a teleconference sponsored by the Center on Budget and Policy Priorities (CBPP). “I don't think the idea [that people will be more cost conscious] is really going to play out.”

HSAs are accounts to which employees contribute to pay for the first several thousand dollars of their health care costs. The accounts are almost always combined with a high-deductible health insurance plan. Contributions to the HSA are tax free, as is money withdrawn for covered medical expenses. If the money is not used in a particular year, it can accumulate in the account.

The Galen Institute, a group that supports consumer-driven health care, has a more positive view of HSAs. “HSAs give consumers even more control over their health spending decisions—and provide them an incentive to spend wisely and save for future health care needs,” according to a statement from Galen. Critics argue that sick people are not always in a position to shop around for care; that making consumers more cost conscious won't help lower health care costs, because most health care spending is for expenses higher than the amount of the deductible, which is out of consumer control; and that HSAs tend to attract mostly healthy people, driving up premiums for sicker individuals who remain in more traditional plans.

President Bush highlighted HSAs in his State of the Union address, vowing to “strengthen health savings accounts—making sure individuals and small business employees can buy insurance with the same advantages that people working for big businesses now get.”

In a more detailed statement, White House officials said that the president “proposes making premiums for HSA-compatible insurance policies deductible from income taxes when [these policies are] purchased by individuals outside of work. In addition, an income tax credit would offset payroll taxes paid on premiums paid for their HSA policies.”

The president is also proposing to allow any spending on out-of-pocket health expenses incurred by HSA enrollees—up to $10,500 per family—to be tax free, not just expenses pertaining to the deductible, as allowed under current law.

Such changes would make HSAs even more tempting to some people, said Jason Furman, senior fellow at the CBPP. “HSAs are already an unprecedentedly favored tax vehicle. This proposal now takes a system already tilted and adds a new tax credit.”

If enacted, these proposals could make HSAs so attractive financially that they could begin to rival 401(k) plans as retirement savings vehicles, Mr. Furman said.

For example, suppose a family in a 25% tax bracket contributed the maximum $10,500 to an HSA that is invested at a 3% interest rate. Under the Bush proposal, they would owe a payroll tax of $1,607 but would also get a tax credit for that amount, so the entire $10,500 would stay in the account. If they put the same amount into a 401(k), they would still owe the payroll tax, but would not get a tax credit, so only $8,893 would be deposited into the 401(k) account. Thus the HSA would have $25,486 in it by 2036, versus $21,587 for the 401(k), Mr. Furman said.

With such results, “a lot of employers who offer 401(k) plans would have a lot less of an incentive to,” he added. “Their employees could go on their own and get a much better deal from an HSA than from a 401(k), and avoid nondiscrimination rules.” The payroll taxes that HSA account holders no longer have to pay would also put a dent in the federal budget, he said.

Barry Barnett, a principal in PriceWaterhouseCoopers' human resource solutions practice, acknowledged that the proposal would result in substantial tax incentives but said he did not think employers were going to get rid of their 401(k) offerings because of it.

Ever since employers have switched to defined contribution retirement plans, “there has been enough noise in the system by employees feeling they've lost the entitlement to a defined benefit plan in retirement,” Mr. Barnett said.

The fill rate for family medicine residency slots was up slightly from last year, but leaders in the field continue to be concerned about overall interest in the specialty as well as interest among U.S. medical school graduates.

This year, family medicine had 2,711 residency slots; 85.1% of those were filled, a slight increase over last year's fill rate of 82.4%. U.S. seniors filled 41.4% of the slots this year, compared with 40.5% last year.

Dr. Larry Fields, president of the American Academy of Family Physicians, noted that while more people matched to family medicine this year, compared with last, there were also fewer slots available.

As for the high percentage of residency positions being filled by international medical graduates, “we are certainly concerned about that,” said Dr. Fields, who practices in Ashland, Ky. The reason for the low fill rate among U.S. graduates is pretty simple: “It's basically the high amount of student debt combined with postresidency income potential,” he said.

To combat these problems, “The [AAFP] is working very hard to change the postresidency environment so that it is an inducement for people to select the specialty,” he said. “Nobody has any argument with the fact that family medicine is the most rewarding career you can have because of the ongoing relationship with patients and families. It comes down to what your environment is going to be after you finish training.”

The academy is focusing on payment in particular. “We are working very hard on changing payment systems both with private [insurers] and with Medicare, and we hope to see some efforts come to fruition fairly soon,” said Dr. Fields. “For instance, we're all working on changing the Medicare payment formula, which would help everyone. We are also working to increase the value of the evaluation and management codes we use every day in our offices.”

Medical liability reform is another area of concern “because that's such a large component of office overhead,” he said. “If that was under control, and people didn't have to practice such a large amount of defensive medicine, [it] would be a lot easier as well.”

Like family medicine, the match rate for internal medicine residencies also increased slightly, from 97.2% last year to 97.9% this year; 56.3% of the slots were filled by U.S. graduates. Despite the increase, however, the American College of Physicians remained concerned about what appeared to be a decreased level of interest in general internal medicine.

“We're not as much concerned about internal medicine overall if you look at all the subspecialties,” said Dr. Steven E. Weinberger, senior vice president for medical knowledge and education at the American College of Physicians in Philadelphia. “The concern is with the number of people going into primary care.”

Match Day itself doesn't reveal how many medical students plan to go into internal medicine subspecialties instead of primary care, “in part because a lot of them don't know yet,” Dr. Weinberger said. But the ACP also gives residents a questionnaire asking about their plans. “In 1998, 54% of graduating residents were choosing to go into general internal medicine; the comparable number for residents graduating in 2005 was only 20%,” he said. “With the aging of Baby Boomers who have more complex chronic diseases, it's going to be harder to find people to coordinate their care, so that's going to be a concern.”

Perceived lifestyle issues play a part in graduates' choices, Dr. Weinberger noted. “Medical students are going into things they view as having more regular hours and a better lifestyle,” he said. “Some of that is attributed to Generation Y having a different set of values and priorities than an older generation of physicians had. I don't know whether that is truly the case or not, but people do say lifestyle is an issue.”

That view was echoed by the National Resident Matching Program (NRMP), which runs Match Day. In a statement, NRMP noted that graduates continued their increasing interest in “lifestyle” specialties that are considered to have more reasonable work hours. For example, 100% of first-year dermatology residency slots were filled, with U.S. seniors filling 93.3% of the slots. In anesthesiology, 97% of the positions were filled, including more than 80% by U.S. seniors.

Overall, more than 26,000 seniors graduating from medical schools—including more than 15,000 U.S. seniors—participated in the match. Nearly 22% of available slots were in internal medicine, making it the largest specialty, according to the NRMP.

Pediatrics was also popular, with 96.5% of its 2,288 slots filled; 72.9% were filled by U.S. seniors. And ob.gyn. continued its upward trend, with 97.9% of its slots filled, 72.4% of them by U.S. seniors. Otolaryngology was new to the match this year and got off to a good start: 98% of the 264 slots offered were filled, 92% by U.S. medical school seniors.

The fill rate for family medicine residency slots was up slightly from last year, but leaders in the field continue to be concerned about overall interest in the specialty as well as interest among U.S. medical school graduates.

This year, family medicine had 2,711 residency slots; 85.1% of those were filled, a slight increase over last year's fill rate of 82.4%. U.S. seniors filled 41.4% of the slots this year, compared with 40.5% last year.

Dr. Larry Fields, president of the American Academy of Family Physicians, noted that while more people matched to family medicine this year, compared with last, there were also fewer slots available.

As for the high percentage of residency positions being filled by international medical graduates, “we are certainly concerned about that,” said Dr. Fields, who practices in Ashland, Ky. The reason for the low fill rate among U.S. graduates is pretty simple: “It's basically the high amount of student debt combined with postresidency income potential,” he said.

To combat these problems, “The [AAFP] is working very hard to change the postresidency environment so that it is an inducement for people to select the specialty,” he said. “Nobody has any argument with the fact that family medicine is the most rewarding career you can have because of the ongoing relationship with patients and families. It comes down to what your environment is going to be after you finish training.”

The academy is focusing on payment in particular. “We are working very hard on changing payment systems both with private [insurers] and with Medicare, and we hope to see some efforts come to fruition fairly soon,” said Dr. Fields. “For instance, we're all working on changing the Medicare payment formula, which would help everyone. We are also working to increase the value of the evaluation and management codes we use every day in our offices.”

Medical liability reform is another area of concern “because that's such a large component of office overhead,” he said. “If that was under control, and people didn't have to practice such a large amount of defensive medicine, [it] would be a lot easier as well.”

Like family medicine, the match rate for internal medicine residencies also increased slightly, from 97.2% last year to 97.9% this year; 56.3% of the slots were filled by U.S. graduates. Despite the increase, however, the American College of Physicians remained concerned about what appeared to be a decreased level of interest in general internal medicine.

“We're not as much concerned about internal medicine overall if you look at all the subspecialties,” said Dr. Steven E. Weinberger, senior vice president for medical knowledge and education at the American College of Physicians in Philadelphia. “The concern is with the number of people going into primary care.”

Match Day itself doesn't reveal how many medical students plan to go into internal medicine subspecialties instead of primary care, “in part because a lot of them don't know yet,” Dr. Weinberger said. But the ACP also gives residents a questionnaire asking about their plans. “In 1998, 54% of graduating residents were choosing to go into general internal medicine; the comparable number for residents graduating in 2005 was only 20%,” he said. “With the aging of Baby Boomers who have more complex chronic diseases, it's going to be harder to find people to coordinate their care, so that's going to be a concern.”

Perceived lifestyle issues play a part in graduates' choices, Dr. Weinberger noted. “Medical students are going into things they view as having more regular hours and a better lifestyle,” he said. “Some of that is attributed to Generation Y having a different set of values and priorities than an older generation of physicians had. I don't know whether that is truly the case or not, but people do say lifestyle is an issue.”

That view was echoed by the National Resident Matching Program (NRMP), which runs Match Day. In a statement, NRMP noted that graduates continued their increasing interest in “lifestyle” specialties that are considered to have more reasonable work hours. For example, 100% of first-year dermatology residency slots were filled, with U.S. seniors filling 93.3% of the slots. In anesthesiology, 97% of the positions were filled, including more than 80% by U.S. seniors.

Overall, more than 26,000 seniors graduating from medical schools—including more than 15,000 U.S. seniors—participated in the match. Nearly 22% of available slots were in internal medicine, making it the largest specialty, according to the NRMP.

Pediatrics was also popular, with 96.5% of its 2,288 slots filled; 72.9% were filled by U.S. seniors. And ob.gyn. continued its upward trend, with 97.9% of its slots filled, 72.4% of them by U.S. seniors. Otolaryngology was new to the match this year and got off to a good start: 98% of the 264 slots offered were filled, 92% by U.S. medical school seniors.

The fill rate for family medicine residency slots was up slightly from last year, but leaders in the field continue to be concerned about overall interest in the specialty as well as interest among U.S. medical school graduates.

This year, family medicine had 2,711 residency slots; 85.1% of those were filled, a slight increase over last year's fill rate of 82.4%. U.S. seniors filled 41.4% of the slots this year, compared with 40.5% last year.

Dr. Larry Fields, president of the American Academy of Family Physicians, noted that while more people matched to family medicine this year, compared with last, there were also fewer slots available.

As for the high percentage of residency positions being filled by international medical graduates, “we are certainly concerned about that,” said Dr. Fields, who practices in Ashland, Ky. The reason for the low fill rate among U.S. graduates is pretty simple: “It's basically the high amount of student debt combined with postresidency income potential,” he said.

To combat these problems, “The [AAFP] is working very hard to change the postresidency environment so that it is an inducement for people to select the specialty,” he said. “Nobody has any argument with the fact that family medicine is the most rewarding career you can have because of the ongoing relationship with patients and families. It comes down to what your environment is going to be after you finish training.”

The academy is focusing on payment in particular. “We are working very hard on changing payment systems both with private [insurers] and with Medicare, and we hope to see some efforts come to fruition fairly soon,” said Dr. Fields. “For instance, we're all working on changing the Medicare payment formula, which would help everyone. We are also working to increase the value of the evaluation and management codes we use every day in our offices.”

Medical liability reform is another area of concern “because that's such a large component of office overhead,” he said. “If that was under control, and people didn't have to practice such a large amount of defensive medicine, [it] would be a lot easier as well.”

Like family medicine, the match rate for internal medicine residencies also increased slightly, from 97.2% last year to 97.9% this year; 56.3% of the slots were filled by U.S. graduates. Despite the increase, however, the American College of Physicians remained concerned about what appeared to be a decreased level of interest in general internal medicine.

“We're not as much concerned about internal medicine overall if you look at all the subspecialties,” said Dr. Steven E. Weinberger, senior vice president for medical knowledge and education at the American College of Physicians in Philadelphia. “The concern is with the number of people going into primary care.”

Match Day itself doesn't reveal how many medical students plan to go into internal medicine subspecialties instead of primary care, “in part because a lot of them don't know yet,” Dr. Weinberger said. But the ACP also gives residents a questionnaire asking about their plans. “In 1998, 54% of graduating residents were choosing to go into general internal medicine; the comparable number for residents graduating in 2005 was only 20%,” he said. “With the aging of Baby Boomers who have more complex chronic diseases, it's going to be harder to find people to coordinate their care, so that's going to be a concern.”

Perceived lifestyle issues play a part in graduates' choices, Dr. Weinberger noted. “Medical students are going into things they view as having more regular hours and a better lifestyle,” he said. “Some of that is attributed to Generation Y having a different set of values and priorities than an older generation of physicians had. I don't know whether that is truly the case or not, but people do say lifestyle is an issue.”

That view was echoed by the National Resident Matching Program (NRMP), which runs Match Day. In a statement, NRMP noted that graduates continued their increasing interest in “lifestyle” specialties that are considered to have more reasonable work hours. For example, 100% of first-year dermatology residency slots were filled, with U.S. seniors filling 93.3% of the slots. In anesthesiology, 97% of the positions were filled, including more than 80% by U.S. seniors.

Overall, more than 26,000 seniors graduating from medical schools—including more than 15,000 U.S. seniors—participated in the match. Nearly 22% of available slots were in internal medicine, making it the largest specialty, according to the NRMP.

Pediatrics was also popular, with 96.5% of its 2,288 slots filled; 72.9% were filled by U.S. seniors. And ob.gyn. continued its upward trend, with 97.9% of its slots filled, 72.4% of them by U.S. seniors. Otolaryngology was new to the match this year and got off to a good start: 98% of the 264 slots offered were filled, 92% by U.S. medical school seniors.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you … if you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which rolls out the new service this month. “By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee. SureScripts hopes to expand the service in the future.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company.

Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a particular patient will see all the new prescriptions and refills that the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other future data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than insurance claims is that the pharmacy data includes the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed.”

Physicians will be able to use this service in two ways, according to Mr. Hutchinson. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data falls under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem, especially since patients signing the HIPAA form at their doctor's office have given their physician permission to look at this type of data, he added.

Kirk Nahra, a Washington lawyer specializing in health privacy, said the program is a good example of the tension between providing better health care and giving up some privacy rights. “With all of these e-initiatives—e-prescribing, electronic health records—the whole purpose is to give a lot more people access to a lot more information,” he said.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you … if you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which rolls out the new service this month. “By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee. SureScripts hopes to expand the service in the future.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company.

Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a particular patient will see all the new prescriptions and refills that the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other future data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than insurance claims is that the pharmacy data includes the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed.”

Physicians will be able to use this service in two ways, according to Mr. Hutchinson. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data falls under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem, especially since patients signing the HIPAA form at their doctor's office have given their physician permission to look at this type of data, he added.

Kirk Nahra, a Washington lawyer specializing in health privacy, said the program is a good example of the tension between providing better health care and giving up some privacy rights. “With all of these e-initiatives—e-prescribing, electronic health records—the whole purpose is to give a lot more people access to a lot more information,” he said.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you … if you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which rolls out the new service this month. “By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee. SureScripts hopes to expand the service in the future.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company.

Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a particular patient will see all the new prescriptions and refills that the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other future data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than insurance claims is that the pharmacy data includes the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed.”

Physicians will be able to use this service in two ways, according to Mr. Hutchinson. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data falls under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem, especially since patients signing the HIPAA form at their doctor's office have given their physician permission to look at this type of data, he added.

Kirk Nahra, a Washington lawyer specializing in health privacy, said the program is a good example of the tension between providing better health care and giving up some privacy rights. “With all of these e-initiatives—e-prescribing, electronic health records—the whole purpose is to give a lot more people access to a lot more information,” he said.

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you— if you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of major retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which rolls out the new service this month.

“By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee. SureScripts hopes to expand the service in the future.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company.

Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a patient will see all the new prescriptions and refills the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other future data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than just relying on insurance claims is that the pharmacy data include the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed. They can pick people they need to focus in on and see why they're not taking their medications.”

Physicians will be able to use this service in two ways, according to Mr. Hutchinson. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data fall under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem, especially since patients signing the HIPAA form at their doctor's office have given their physician permission to look at these types of data, he added.

Kirk Nahra, a Washington lawyer who specializes in health privacy issues, said this program is a good example of the tension between providing better health care and giving up some privacy rights. “With all of these e-initiatives—e-prescribing, electronic health records—the whole purpose is to give a lot more people access to a lot more information,” he said. “In order to do that, we've got to recognize that this has an impact on privacy rights,” he noted.

“There's this idea that HIPAA and other privacy rules are giving patients the ability to control their information. For the most part, it's not true.”

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you— if you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of major retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which rolls out the new service this month.

“By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee. SureScripts hopes to expand the service in the future.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company.

Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a patient will see all the new prescriptions and refills the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other future data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than just relying on insurance claims is that the pharmacy data include the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed. They can pick people they need to focus in on and see why they're not taking their medications.”

Physicians will be able to use this service in two ways, according to Mr. Hutchinson. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data fall under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem, especially since patients signing the HIPAA form at their doctor's office have given their physician permission to look at these types of data, he added.

Kirk Nahra, a Washington lawyer who specializes in health privacy issues, said this program is a good example of the tension between providing better health care and giving up some privacy rights. “With all of these e-initiatives—e-prescribing, electronic health records—the whole purpose is to give a lot more people access to a lot more information,” he said. “In order to do that, we've got to recognize that this has an impact on privacy rights,” he noted.

“There's this idea that HIPAA and other privacy rules are giving patients the ability to control their information. For the most part, it's not true.”

Want to see all the medications your patient is on before you write that next prescription? A pharmacy trade group is ready to help you— if you have electronic health record or e-prescribing software.

New software from SureScripts, a technology offshoot of the National Community Pharmacists Association and the National Association of Chain Drug Stores, will allow physicians to view information on all prescriptions filled by a patient at a wide variety of major retailers and pharmacies.

The purpose of the software is to get more physicians interested in e-prescribing, according to Kevin Hutchinson, CEO of SureScripts, which rolls out the new service this month.

“By providing a medication history, we start making e-prescribing more attractive to the 75% of physicians who are not using anything today. It gives them a 'business case' to provide an EHR or a stand-alone e-prescribing application.”

The service is available initially in select areas of six states—Florida, Massachusetts, Nevada, New Jersey, Rhode Island, and Tennessee. SureScripts hopes to expand the service in the future.

SureScripts was founded in 2001 by the National Community Pharmacists Association and the National Association of Chain Drug Stores. Its goal is to improve electronic connectivity between physicians and pharmacies by providing the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible, according to the company.

Its revenues come entirely from pharmacies that become members; any income generated is redistributed to members.

Under the program, which cost $6 million to develop, physicians requesting the medication history of a patient will see all the new prescriptions and refills the patient has obtained at Walgreen's, CVS, Wal-Mart, and other large pharmacy chains.

“The prescribing process doesn't stop at sending the prescription to the pharmacy,” Mr. Hutchinson said. “We have to give more clinical information to providers—physicians as well as pharmacists—so they can take better care of patients and know what they're taking that the doctors might not have prescribed themselves. It's really about driving adherence and compliance.”

SureScripts is working on getting mail-order pharmacies to sign on to provide data. “We've had expressions of interest and commitment, but they won't be part of the pilot,” he said. Other future data sources could include insurers, pharmacy benefit management companies, and pharmacies in hospitals and long-term care facilities.

The good thing about using pharmacy data rather than just relying on insurance claims is that the pharmacy data include the date the patient picked up the medication, not just the date that a claim was approved, Mr. Hutchinson said. That information will help physicians “track their patients' compliance and figure out, for example, how many of their diabetic patients are not taking their medications as prescribed. They can pick people they need to focus in on and see why they're not taking their medications.”

Physicians will be able to use this service in two ways, according to Mr. Hutchinson. “Some may prefer to send a request at night looking at their patient schedule for the next day” so that they'll have the medication history in front of them before each patient even gets to the office. For walk-ins, “there will be a button that says 'Get medication history,' which the front desk can do prior to the patient going back to the exam room.”

With data coming from many different sources, patient verification is an important part of the process, he noted. The company is using a master patient index from Initiate Systems Inc. to verify records.

“Think of it as a record locator service,” Mr. Hutchinson said. Initiate Systems will send SureScripts the patient's demographic information and other distinguishing data elements, and SureScripts will match it up with the pharmacy data and decide whether to send the information on to the physician, based on how confident the software is of the match.

“We set thresholds based on what constitutes a more accurate match than nonaccurate,” he explained. “We err on the side of caution, so if any patients may not match who we think they are, we don't send that information. Absent a national patient identifier, this is the only way you can do the matching.”

Since many physicians have their own identification numbers for patients, SureScripts is looking at eventually using those numbers to provide accurate prescribing information. This might entail having pharmacies electronically store the patient identifier numbers for each of the different physicians that a patient sees, Mr. Hutchinson said.

Like other medical information, prescribing data fall under the Health Insurance Portability and Accountability Act (HIPAA). Because SureScripts is considered a “business associate” of both the physician and the pharmacy under the law, its data transmission does not present a problem, especially since patients signing the HIPAA form at their doctor's office have given their physician permission to look at these types of data, he added.

Kirk Nahra, a Washington lawyer who specializes in health privacy issues, said this program is a good example of the tension between providing better health care and giving up some privacy rights. “With all of these e-initiatives—e-prescribing, electronic health records—the whole purpose is to give a lot more people access to a lot more information,” he said. “In order to do that, we've got to recognize that this has an impact on privacy rights,” he noted.

“There's this idea that HIPAA and other privacy rules are giving patients the ability to control their information. For the most part, it's not true.”