Joyce Frieden

Indiana Discrimination Case

An Indiana diabetes patient who was turned down for a promotion because of his illness has won a lawsuit in federal court. Gary Branham sued the Internal Revenue Service, claiming that he was unfairly denied a promotion because he had diabetes. The promotion to special agent would have required Mr. Branham to carry a gun. The jury agreed that Branham was qualified for the job despite his diabetes and awarded him $78,000 in back pay, but no damages for pain and suffering. Mr. Branham's attorney, John Griffin, said the verdict “brings to light some of the stereotypes and myths that exist about diabetes. The fact is, it doesn't limit us in doing our job.” Mr. Griffin noted that one of his expert witnesses was Dr. Charles Clark, former president of the American Diabetes Association.

New CEO at JDRF

Arnold Donald has been named the president and CEO of the Juvenile Diabetes Research Foundation. Mr. Donald is chairman and CEO of the Merisant Company, which produces artificial sweeteners Equal and Canderel. He replaces Peter Van Etten, who is retiring after 6 years as president and CEO. “Arnold Donald has a long and successful track record in leading science and consumer-based businesses, and an even longer resume of community involvement, charitable activities, and government advocacy,” said Robert D. German, chairman of the foundation's board of directors. “He is uniquely qualified to build on the strong record that Peter Van Etten helped forge for JDRF in setting the pace and direction for research around the world leading to a cure for type 1 diabetes and its complications.”

Behaviors Leading to Death

By the time they enter adulthood, a large percentage of American youth have already begun the behaviors that lead to preventable causes of death, according to a study from the Carolina Population Center and the University of North Carolina at Chapel Hill. Researchers studied a nationally representative sample of more than 14,000 young adults; they were first interviewed from 1994 to 1995 when they were 12–19 years old, and interviewed again in 2001 and 2002, at ages 19–26 years. For nearly all groups surveyed, diet, obesity, and access to health care worsened; tobacco, alcohol, and illicit drug use and the likelihood of acquiring a sexually transmitted disease increased. This “doesn't bode well for their future health, especially if these habits become established,” said Kathleen M. Harris, Ph.D., the study's principal investigator. The study appears in the January issue of the Archives of Pediatric and Adolescent Medicine.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in prescription drug spending has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, smaller than its share of the increase in recent years. Spending for physician services grew 9% in 2004, nearly the same as the 8.6% increase experienced in 2003.

Passport to Medicaid

Citizens applying for Medicaid may soon have to produce a passport or a birth certificate to prove they are U.S. citizens. Such a requirement will take effect July 1 if Congress passes budget reconciliation legislation that was pending at press time. The new rule also would apply to all citizens currently receiving Medicaid when they seek to renew their Medicaid eligibility, which in most cases must be done every 6 months. The intent of the rule was to prevent illegal immigrants from obtaining Medicaid by falsely claiming citizenship or resident alien status. Yet, the Center on Budget and Policy Priorities said that the provision threatens Medicaid coverage for many patients. Roughly 49 million low-income Americans, including 12 million African Americans and 800,000 elderly African Americans, would be subject to the new requirement between July 2006 and June 2007, the center indicated in a report. “This ill-conceived requirement would exacerbate a historical legacy of discrimination and could cause many elderly African Americans to lose access to health care,” stated Leighton Ku, a senior fellow at the center and coauthor of the report. Many of these individuals lack passports and do not have birth certificates in their possession. Medicaid applicants who have neither of these documents could find that their coverage is denied or seriously delayed.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliations, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “This ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Indiana Discrimination Case

An Indiana diabetes patient who was turned down for a promotion because of his illness has won a lawsuit in federal court. Gary Branham sued the Internal Revenue Service, claiming that he was unfairly denied a promotion because he had diabetes. The promotion to special agent would have required Mr. Branham to carry a gun. The jury agreed that Branham was qualified for the job despite his diabetes and awarded him $78,000 in back pay, but no damages for pain and suffering. Mr. Branham's attorney, John Griffin, said the verdict “brings to light some of the stereotypes and myths that exist about diabetes. The fact is, it doesn't limit us in doing our job.” Mr. Griffin noted that one of his expert witnesses was Dr. Charles Clark, former president of the American Diabetes Association.

New CEO at JDRF

Arnold Donald has been named the president and CEO of the Juvenile Diabetes Research Foundation. Mr. Donald is chairman and CEO of the Merisant Company, which produces artificial sweeteners Equal and Canderel. He replaces Peter Van Etten, who is retiring after 6 years as president and CEO. “Arnold Donald has a long and successful track record in leading science and consumer-based businesses, and an even longer resume of community involvement, charitable activities, and government advocacy,” said Robert D. German, chairman of the foundation's board of directors. “He is uniquely qualified to build on the strong record that Peter Van Etten helped forge for JDRF in setting the pace and direction for research around the world leading to a cure for type 1 diabetes and its complications.”

Behaviors Leading to Death

By the time they enter adulthood, a large percentage of American youth have already begun the behaviors that lead to preventable causes of death, according to a study from the Carolina Population Center and the University of North Carolina at Chapel Hill. Researchers studied a nationally representative sample of more than 14,000 young adults; they were first interviewed from 1994 to 1995 when they were 12–19 years old, and interviewed again in 2001 and 2002, at ages 19–26 years. For nearly all groups surveyed, diet, obesity, and access to health care worsened; tobacco, alcohol, and illicit drug use and the likelihood of acquiring a sexually transmitted disease increased. This “doesn't bode well for their future health, especially if these habits become established,” said Kathleen M. Harris, Ph.D., the study's principal investigator. The study appears in the January issue of the Archives of Pediatric and Adolescent Medicine.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in prescription drug spending has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, smaller than its share of the increase in recent years. Spending for physician services grew 9% in 2004, nearly the same as the 8.6% increase experienced in 2003.

Passport to Medicaid

Citizens applying for Medicaid may soon have to produce a passport or a birth certificate to prove they are U.S. citizens. Such a requirement will take effect July 1 if Congress passes budget reconciliation legislation that was pending at press time. The new rule also would apply to all citizens currently receiving Medicaid when they seek to renew their Medicaid eligibility, which in most cases must be done every 6 months. The intent of the rule was to prevent illegal immigrants from obtaining Medicaid by falsely claiming citizenship or resident alien status. Yet, the Center on Budget and Policy Priorities said that the provision threatens Medicaid coverage for many patients. Roughly 49 million low-income Americans, including 12 million African Americans and 800,000 elderly African Americans, would be subject to the new requirement between July 2006 and June 2007, the center indicated in a report. “This ill-conceived requirement would exacerbate a historical legacy of discrimination and could cause many elderly African Americans to lose access to health care,” stated Leighton Ku, a senior fellow at the center and coauthor of the report. Many of these individuals lack passports and do not have birth certificates in their possession. Medicaid applicants who have neither of these documents could find that their coverage is denied or seriously delayed.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliations, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “This ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Indiana Discrimination Case

An Indiana diabetes patient who was turned down for a promotion because of his illness has won a lawsuit in federal court. Gary Branham sued the Internal Revenue Service, claiming that he was unfairly denied a promotion because he had diabetes. The promotion to special agent would have required Mr. Branham to carry a gun. The jury agreed that Branham was qualified for the job despite his diabetes and awarded him $78,000 in back pay, but no damages for pain and suffering. Mr. Branham's attorney, John Griffin, said the verdict “brings to light some of the stereotypes and myths that exist about diabetes. The fact is, it doesn't limit us in doing our job.” Mr. Griffin noted that one of his expert witnesses was Dr. Charles Clark, former president of the American Diabetes Association.

New CEO at JDRF

Arnold Donald has been named the president and CEO of the Juvenile Diabetes Research Foundation. Mr. Donald is chairman and CEO of the Merisant Company, which produces artificial sweeteners Equal and Canderel. He replaces Peter Van Etten, who is retiring after 6 years as president and CEO. “Arnold Donald has a long and successful track record in leading science and consumer-based businesses, and an even longer resume of community involvement, charitable activities, and government advocacy,” said Robert D. German, chairman of the foundation's board of directors. “He is uniquely qualified to build on the strong record that Peter Van Etten helped forge for JDRF in setting the pace and direction for research around the world leading to a cure for type 1 diabetes and its complications.”

Behaviors Leading to Death

By the time they enter adulthood, a large percentage of American youth have already begun the behaviors that lead to preventable causes of death, according to a study from the Carolina Population Center and the University of North Carolina at Chapel Hill. Researchers studied a nationally representative sample of more than 14,000 young adults; they were first interviewed from 1994 to 1995 when they were 12–19 years old, and interviewed again in 2001 and 2002, at ages 19–26 years. For nearly all groups surveyed, diet, obesity, and access to health care worsened; tobacco, alcohol, and illicit drug use and the likelihood of acquiring a sexually transmitted disease increased. This “doesn't bode well for their future health, especially if these habits become established,” said Kathleen M. Harris, Ph.D., the study's principal investigator. The study appears in the January issue of the Archives of Pediatric and Adolescent Medicine.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in prescription drug spending has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, smaller than its share of the increase in recent years. Spending for physician services grew 9% in 2004, nearly the same as the 8.6% increase experienced in 2003.

Passport to Medicaid

Citizens applying for Medicaid may soon have to produce a passport or a birth certificate to prove they are U.S. citizens. Such a requirement will take effect July 1 if Congress passes budget reconciliation legislation that was pending at press time. The new rule also would apply to all citizens currently receiving Medicaid when they seek to renew their Medicaid eligibility, which in most cases must be done every 6 months. The intent of the rule was to prevent illegal immigrants from obtaining Medicaid by falsely claiming citizenship or resident alien status. Yet, the Center on Budget and Policy Priorities said that the provision threatens Medicaid coverage for many patients. Roughly 49 million low-income Americans, including 12 million African Americans and 800,000 elderly African Americans, would be subject to the new requirement between July 2006 and June 2007, the center indicated in a report. “This ill-conceived requirement would exacerbate a historical legacy of discrimination and could cause many elderly African Americans to lose access to health care,” stated Leighton Ku, a senior fellow at the center and coauthor of the report. Many of these individuals lack passports and do not have birth certificates in their possession. Medicaid applicants who have neither of these documents could find that their coverage is denied or seriously delayed.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliations, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “This ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine “Consumers' Checkbook” in several cities nationwide. “Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with monetary incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said. “It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.” One thing that must be done is to “demystify” the health care industry, he continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine “Consumers' Checkbook” in several cities nationwide. “Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with monetary incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said. “It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.” One thing that must be done is to “demystify” the health care industry, he continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine “Consumers' Checkbook” in several cities nationwide. “Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with monetary incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said. “It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.” One thing that must be done is to “demystify” the health care industry, he continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

EMG Laws Signed in Michigan, NJ

Michigan Gov. Jennifer Granholm (D) recently signed a bill into law that limits the performance of needle electromyography tests only to licensed physicians. A few weeks later, acting Governor. of New Jersey Richard Codey (D) signed into law a similar bill that also stipulates that only a licensed physician, audiologist, or chiropractor may interpret evoked potentials or perform nerve conduction studies. Both pieces of legislation were supported by the American Academy of Neurology and the American Association of Electrodiagnostic Technologists. “This culminates three years of work by the [American Academy of Neurology] to keep nonphysicians from infringing on diagnostic EMG,” the American Academy of Neurology said in a statement. “The victories in Michigan and New Jersey may provide a strong legal foundation for the [American Academy of Neurology's] efforts regarding scope of practice issues in other states.” But a spokesman for the American Physical Therapy Association, some of the members of which have special certification in electrophysiology and perform EMGs, called the new laws “shameful.” “It was very upsetting to see a part of the scope of practice of physical therapists taken away,” said Justin Elliott, associate director for state government affairs at American Physical Therapy Association. Mr. Elliott noted that physical therapists can only perform the test with a referral from a physician, and then must send the test results back to the physician for a diagnosis. He also noted that physical therapists were cost-effective providers of EMGs, citing a 2004 study published in the journal Muscle & Nerve showing that physical therapists were reimbursed at an average rate of $85 per test, compared with $358 for physicians.

Journal Widens Free Access

An increasing number of journals are giving the public free access to more of their recent articles. In that vein, the Journal of Neuroscience announced that it will now allow nonsubscribers to view articles for free online 6 months after publication rather than 12 months later, as the previous policy had dictated. This change “is consistent with the trend toward opening access to published scientific research that is supported by Congress and patient advocacy groups, as well as the National Institutes of Health,” noted the journal's publisher, the Society for Neuroscience. The journal also is raising its submission fee from $50 to $75 and changing the publication fee from $70 per page to a flat $750 per article and $375 for a brief communication. Fees will be prepaid instead of invoiced upon publication as they are now, the society said, noting that it currently has about $120,000 in unpaid page charges that are more than 30 days overdue.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliations, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Behaviors Leading to Death

By the time they enter adulthood, a large percentage of American youth have already begun the behaviors that lead to preventable causes of death, according to a study from the Carolina Population Center and the University of North Carolina at Chapel Hill. Researchers studied a nationally representative sample of more than 14,000 young adults; they were first interviewed from 1994 to 1995 when they were 12–19 years old. Participants underwent repeat interviews again in 2001 and 2002, at ages 19–26 years. For nearly all groups surveyed, diet, obesity, and access to health care worsened between the time the subjects were 12–19 years old and when they had reached 19–26 years of age; tobacco, alcohol, and illicit drug use and the likelihood of acquiring a sexually transmitted disease increased. “Whether or not the trends will continue as they age, we don't know,” said Kathleen M. Harris, Ph.D., the study's principal investigator. “But it doesn't bode well for their future health, especially if these habits become established.” The study appears in the January issue of the Archives of Pediatric and Adolescent Medicine.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in prescription drug spending has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national healthcare expenditures, smaller than its share of the increase in recent years. Spending for physician services grew 9% in 2004, nearly the same as the 8.6% increase experienced in 2003.

EMG Laws Signed in Michigan, NJ

Michigan Gov. Jennifer Granholm (D) recently signed a bill into law that limits the performance of needle electromyography tests only to licensed physicians. A few weeks later, acting Governor. of New Jersey Richard Codey (D) signed into law a similar bill that also stipulates that only a licensed physician, audiologist, or chiropractor may interpret evoked potentials or perform nerve conduction studies. Both pieces of legislation were supported by the American Academy of Neurology and the American Association of Electrodiagnostic Technologists. “This culminates three years of work by the [American Academy of Neurology] to keep nonphysicians from infringing on diagnostic EMG,” the American Academy of Neurology said in a statement. “The victories in Michigan and New Jersey may provide a strong legal foundation for the [American Academy of Neurology's] efforts regarding scope of practice issues in other states.” But a spokesman for the American Physical Therapy Association, some of the members of which have special certification in electrophysiology and perform EMGs, called the new laws “shameful.” “It was very upsetting to see a part of the scope of practice of physical therapists taken away,” said Justin Elliott, associate director for state government affairs at American Physical Therapy Association. Mr. Elliott noted that physical therapists can only perform the test with a referral from a physician, and then must send the test results back to the physician for a diagnosis. He also noted that physical therapists were cost-effective providers of EMGs, citing a 2004 study published in the journal Muscle & Nerve showing that physical therapists were reimbursed at an average rate of $85 per test, compared with $358 for physicians.

Journal Widens Free Access

An increasing number of journals are giving the public free access to more of their recent articles. In that vein, the Journal of Neuroscience announced that it will now allow nonsubscribers to view articles for free online 6 months after publication rather than 12 months later, as the previous policy had dictated. This change “is consistent with the trend toward opening access to published scientific research that is supported by Congress and patient advocacy groups, as well as the National Institutes of Health,” noted the journal's publisher, the Society for Neuroscience. The journal also is raising its submission fee from $50 to $75 and changing the publication fee from $70 per page to a flat $750 per article and $375 for a brief communication. Fees will be prepaid instead of invoiced upon publication as they are now, the society said, noting that it currently has about $120,000 in unpaid page charges that are more than 30 days overdue.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliations, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Behaviors Leading to Death

By the time they enter adulthood, a large percentage of American youth have already begun the behaviors that lead to preventable causes of death, according to a study from the Carolina Population Center and the University of North Carolina at Chapel Hill. Researchers studied a nationally representative sample of more than 14,000 young adults; they were first interviewed from 1994 to 1995 when they were 12–19 years old. Participants underwent repeat interviews again in 2001 and 2002, at ages 19–26 years. For nearly all groups surveyed, diet, obesity, and access to health care worsened between the time the subjects were 12–19 years old and when they had reached 19–26 years of age; tobacco, alcohol, and illicit drug use and the likelihood of acquiring a sexually transmitted disease increased. “Whether or not the trends will continue as they age, we don't know,” said Kathleen M. Harris, Ph.D., the study's principal investigator. “But it doesn't bode well for their future health, especially if these habits become established.” The study appears in the January issue of the Archives of Pediatric and Adolescent Medicine.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in prescription drug spending has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national healthcare expenditures, smaller than its share of the increase in recent years. Spending for physician services grew 9% in 2004, nearly the same as the 8.6% increase experienced in 2003.

EMG Laws Signed in Michigan, NJ

Michigan Gov. Jennifer Granholm (D) recently signed a bill into law that limits the performance of needle electromyography tests only to licensed physicians. A few weeks later, acting Governor. of New Jersey Richard Codey (D) signed into law a similar bill that also stipulates that only a licensed physician, audiologist, or chiropractor may interpret evoked potentials or perform nerve conduction studies. Both pieces of legislation were supported by the American Academy of Neurology and the American Association of Electrodiagnostic Technologists. “This culminates three years of work by the [American Academy of Neurology] to keep nonphysicians from infringing on diagnostic EMG,” the American Academy of Neurology said in a statement. “The victories in Michigan and New Jersey may provide a strong legal foundation for the [American Academy of Neurology's] efforts regarding scope of practice issues in other states.” But a spokesman for the American Physical Therapy Association, some of the members of which have special certification in electrophysiology and perform EMGs, called the new laws “shameful.” “It was very upsetting to see a part of the scope of practice of physical therapists taken away,” said Justin Elliott, associate director for state government affairs at American Physical Therapy Association. Mr. Elliott noted that physical therapists can only perform the test with a referral from a physician, and then must send the test results back to the physician for a diagnosis. He also noted that physical therapists were cost-effective providers of EMGs, citing a 2004 study published in the journal Muscle & Nerve showing that physical therapists were reimbursed at an average rate of $85 per test, compared with $358 for physicians.

Journal Widens Free Access

An increasing number of journals are giving the public free access to more of their recent articles. In that vein, the Journal of Neuroscience announced that it will now allow nonsubscribers to view articles for free online 6 months after publication rather than 12 months later, as the previous policy had dictated. This change “is consistent with the trend toward opening access to published scientific research that is supported by Congress and patient advocacy groups, as well as the National Institutes of Health,” noted the journal's publisher, the Society for Neuroscience. The journal also is raising its submission fee from $50 to $75 and changing the publication fee from $70 per page to a flat $750 per article and $375 for a brief communication. Fees will be prepaid instead of invoiced upon publication as they are now, the society said, noting that it currently has about $120,000 in unpaid page charges that are more than 30 days overdue.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliations, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy making and better health care for us all.”

Behaviors Leading to Death

By the time they enter adulthood, a large percentage of American youth have already begun the behaviors that lead to preventable causes of death, according to a study from the Carolina Population Center and the University of North Carolina at Chapel Hill. Researchers studied a nationally representative sample of more than 14,000 young adults; they were first interviewed from 1994 to 1995 when they were 12–19 years old. Participants underwent repeat interviews again in 2001 and 2002, at ages 19–26 years. For nearly all groups surveyed, diet, obesity, and access to health care worsened between the time the subjects were 12–19 years old and when they had reached 19–26 years of age; tobacco, alcohol, and illicit drug use and the likelihood of acquiring a sexually transmitted disease increased. “Whether or not the trends will continue as they age, we don't know,” said Kathleen M. Harris, Ph.D., the study's principal investigator. “But it doesn't bode well for their future health, especially if these habits become established.” The study appears in the January issue of the Archives of Pediatric and Adolescent Medicine.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in prescription drug spending has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national healthcare expenditures, smaller than its share of the increase in recent years. Spending for physician services grew 9% in 2004, nearly the same as the 8.6% increase experienced in 2003.

WASHINGTON — Physicians are often reluctant to leap into an electyronic health record system because of its complexity and the expense involved, Dr. Daniel Sands, said at a health care congress sponsored by the Wall Street Journal and CNBC.

“If you're a doctor, what do you do? How do you get that [EHR] if you can't take the one big leap?” said Dr. Sands, of Harvard University, Boston.

Start by using electronic communications with patients and with office staff, he said.

“Why don't you get rid of those stupid yellow Post-It notes you use for phone messages? A simple step like that is a good way to get people engaged with technology,” according to Dr. Sands.

Electronic prescribing is another way to bridge the gap between paper medical records and electronioc health records (EHRs), said Dr. Sands, who is also chief medical officer of ZixCorp, a Newton, Mass., company that sells electronic prescribing software.

Physicians can write medication prescriptions using various electronic devices, including desktop and laptop computers, handhelds, and even mobile phones.

Since studies have shown that electronic prescribing can reduce medication errors substantially, “this should be the standard of care,” he said.

Another step to take is by using online clinical reference materials, Dr. Sands continued.

“We have lots of data showing that physicians are often faced with questions when taking care of patients, and they can't find the answers because they don't have time, so they just move on. And that's really scary.”

Rather than looking for answers “in a book that's out of date as soon as it's printed, maybe looking online would be a great place to start,” Dr. Sands said.

WASHINGTON — Physicians are often reluctant to leap into an electyronic health record system because of its complexity and the expense involved, Dr. Daniel Sands, said at a health care congress sponsored by the Wall Street Journal and CNBC.

“If you're a doctor, what do you do? How do you get that [EHR] if you can't take the one big leap?” said Dr. Sands, of Harvard University, Boston.

Start by using electronic communications with patients and with office staff, he said.

“Why don't you get rid of those stupid yellow Post-It notes you use for phone messages? A simple step like that is a good way to get people engaged with technology,” according to Dr. Sands.

Electronic prescribing is another way to bridge the gap between paper medical records and electronioc health records (EHRs), said Dr. Sands, who is also chief medical officer of ZixCorp, a Newton, Mass., company that sells electronic prescribing software.

Physicians can write medication prescriptions using various electronic devices, including desktop and laptop computers, handhelds, and even mobile phones.

Since studies have shown that electronic prescribing can reduce medication errors substantially, “this should be the standard of care,” he said.

Another step to take is by using online clinical reference materials, Dr. Sands continued.

“We have lots of data showing that physicians are often faced with questions when taking care of patients, and they can't find the answers because they don't have time, so they just move on. And that's really scary.”

Rather than looking for answers “in a book that's out of date as soon as it's printed, maybe looking online would be a great place to start,” Dr. Sands said.

WASHINGTON — Physicians are often reluctant to leap into an electyronic health record system because of its complexity and the expense involved, Dr. Daniel Sands, said at a health care congress sponsored by the Wall Street Journal and CNBC.

“If you're a doctor, what do you do? How do you get that [EHR] if you can't take the one big leap?” said Dr. Sands, of Harvard University, Boston.

Start by using electronic communications with patients and with office staff, he said.

“Why don't you get rid of those stupid yellow Post-It notes you use for phone messages? A simple step like that is a good way to get people engaged with technology,” according to Dr. Sands.

Electronic prescribing is another way to bridge the gap between paper medical records and electronioc health records (EHRs), said Dr. Sands, who is also chief medical officer of ZixCorp, a Newton, Mass., company that sells electronic prescribing software.

Physicians can write medication prescriptions using various electronic devices, including desktop and laptop computers, handhelds, and even mobile phones.

Since studies have shown that electronic prescribing can reduce medication errors substantially, “this should be the standard of care,” he said.

Another step to take is by using online clinical reference materials, Dr. Sands continued.

“We have lots of data showing that physicians are often faced with questions when taking care of patients, and they can't find the answers because they don't have time, so they just move on. And that's really scary.”

Rather than looking for answers “in a book that's out of date as soon as it's printed, maybe looking online would be a great place to start,” Dr. Sands said.

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine “Consumers' Checkbook” in several cities nationwide.

“Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with monetary incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said.

“It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.” It's time to “demystify” the health care industry, Mr. Tyson continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine “Consumers' Checkbook” in several cities nationwide.

“Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with monetary incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said.

“It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.” It's time to “demystify” the health care industry, Mr. Tyson continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine “Consumers' Checkbook” in several cities nationwide.

“Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with monetary incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said.

“It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.” It's time to “demystify” the health care industry, Mr. Tyson continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — Medicare is all about overpayments, but underpayments? Not so much.

Members of the Practicing Physician Advisory Council wanted to know why a new demonstration program from the Centers for Medicare and Medicaid Services rewards contractors financially for finding money owed to the Medicare program, but not for finding money that Medicare has underpaid to physicians.

Under the program, known as the Recovery Audit Contractors program, three contractors hired by CMS look for overpayments and underpayments made by Medicare to physicians and hospitals, and try to recover the overpayments.

The program, which began last spring, operates in the three states with the largest Medicare beneficiary populations: California, Florida, and New York. Contractors review claims of at least a year old.

Contractors are paid a percentage of what they collect in overpayments, but there is no similar incentive for finding underpayments. That's because Medicare would have to pay out more money than the amount of the underpayment, “and that's money going out of the [Medicare] trust fund,” Gerald Walters, director of the financial services group at CMS, told PPAC members at a council meeting. He said CMS “believes it has found a way to incentivize” the contractors to target underpayments, but he did not elaborate.

WASHINGTON — Medicare is all about overpayments, but underpayments? Not so much.

Members of the Practicing Physician Advisory Council wanted to know why a new demonstration program from the Centers for Medicare and Medicaid Services rewards contractors financially for finding money owed to the Medicare program, but not for finding money that Medicare has underpaid to physicians.

Under the program, known as the Recovery Audit Contractors program, three contractors hired by CMS look for overpayments and underpayments made by Medicare to physicians and hospitals, and try to recover the overpayments.

The program, which began last spring, operates in the three states with the largest Medicare beneficiary populations: California, Florida, and New York. Contractors review claims of at least a year old.

Contractors are paid a percentage of what they collect in overpayments, but there is no similar incentive for finding underpayments. That's because Medicare would have to pay out more money than the amount of the underpayment, “and that's money going out of the [Medicare] trust fund,” Gerald Walters, director of the financial services group at CMS, told PPAC members at a council meeting. He said CMS “believes it has found a way to incentivize” the contractors to target underpayments, but he did not elaborate.

WASHINGTON — Medicare is all about overpayments, but underpayments? Not so much.

Members of the Practicing Physician Advisory Council wanted to know why a new demonstration program from the Centers for Medicare and Medicaid Services rewards contractors financially for finding money owed to the Medicare program, but not for finding money that Medicare has underpaid to physicians.

Under the program, known as the Recovery Audit Contractors program, three contractors hired by CMS look for overpayments and underpayments made by Medicare to physicians and hospitals, and try to recover the overpayments.

The program, which began last spring, operates in the three states with the largest Medicare beneficiary populations: California, Florida, and New York. Contractors review claims of at least a year old.

Contractors are paid a percentage of what they collect in overpayments, but there is no similar incentive for finding underpayments. That's because Medicare would have to pay out more money than the amount of the underpayment, “and that's money going out of the [Medicare] trust fund,” Gerald Walters, director of the financial services group at CMS, told PPAC members at a council meeting. He said CMS “believes it has found a way to incentivize” the contractors to target underpayments, but he did not elaborate.

WASHINGTON — Physicians who are too nervous to completely convert their offices to electronic medical records can start the process with a few “baby steps” to make it less intimidating, Dr. Daniel Sands said at a health care congress sponsored by the Wall Street Journal and CNBC.

Physicians are often reluctant to leap into an EMR system because of its complexity and the expense involved, said Dr. Sands, of Harvard University, Boston. “If you're a doctor, what do you do? How do you get that [EMR] if you can't take the one big leap?”

One way to start is by using electronic communications with patients and with office staff, he said. “Why don't you get rid of those stupid yellow Post-It notes you use for phone messages? A simple step like that is a good way to get people engaged with technology.”

Electronic prescribing is another way to bridge the gap, said Dr. Sands, who is also chief medical officer of ZixCorp, a Newton, Mass., company that sells electronic prescribing software. Medications can be prescribed using various electronic devices, including desktop and laptop computers, handhelds, and even mobile phones. Since studies have shown that electronic prescribing can reduce medication errors substantially, “this should be the standard of care,” he said.

Another baby step is to use online clinical reference materials, Dr. Sands said. “We have lots of data showing physicians are often faced with questions when taking care of patients, and they can't find the answers because they don't have time, so they just move on. And that's really scary.”

Rather than looking for answers “in a book that's out of date as soon as it's printed, maybe looking online would be a great place to start,” Dr. Sands said.

WASHINGTON — Physicians who are too nervous to completely convert their offices to electronic medical records can start the process with a few “baby steps” to make it less intimidating, Dr. Daniel Sands said at a health care congress sponsored by the Wall Street Journal and CNBC.

Physicians are often reluctant to leap into an EMR system because of its complexity and the expense involved, said Dr. Sands, of Harvard University, Boston. “If you're a doctor, what do you do? How do you get that [EMR] if you can't take the one big leap?”

One way to start is by using electronic communications with patients and with office staff, he said. “Why don't you get rid of those stupid yellow Post-It notes you use for phone messages? A simple step like that is a good way to get people engaged with technology.”

Electronic prescribing is another way to bridge the gap, said Dr. Sands, who is also chief medical officer of ZixCorp, a Newton, Mass., company that sells electronic prescribing software. Medications can be prescribed using various electronic devices, including desktop and laptop computers, handhelds, and even mobile phones. Since studies have shown that electronic prescribing can reduce medication errors substantially, “this should be the standard of care,” he said.

Another baby step is to use online clinical reference materials, Dr. Sands said. “We have lots of data showing physicians are often faced with questions when taking care of patients, and they can't find the answers because they don't have time, so they just move on. And that's really scary.”

Rather than looking for answers “in a book that's out of date as soon as it's printed, maybe looking online would be a great place to start,” Dr. Sands said.

WASHINGTON — Physicians who are too nervous to completely convert their offices to electronic medical records can start the process with a few “baby steps” to make it less intimidating, Dr. Daniel Sands said at a health care congress sponsored by the Wall Street Journal and CNBC.

Physicians are often reluctant to leap into an EMR system because of its complexity and the expense involved, said Dr. Sands, of Harvard University, Boston. “If you're a doctor, what do you do? How do you get that [EMR] if you can't take the one big leap?”

One way to start is by using electronic communications with patients and with office staff, he said. “Why don't you get rid of those stupid yellow Post-It notes you use for phone messages? A simple step like that is a good way to get people engaged with technology.”

Electronic prescribing is another way to bridge the gap, said Dr. Sands, who is also chief medical officer of ZixCorp, a Newton, Mass., company that sells electronic prescribing software. Medications can be prescribed using various electronic devices, including desktop and laptop computers, handhelds, and even mobile phones. Since studies have shown that electronic prescribing can reduce medication errors substantially, “this should be the standard of care,” he said.

Another baby step is to use online clinical reference materials, Dr. Sands said. “We have lots of data showing physicians are often faced with questions when taking care of patients, and they can't find the answers because they don't have time, so they just move on. And that's really scary.”

Rather than looking for answers “in a book that's out of date as soon as it's printed, maybe looking online would be a great place to start,” Dr. Sands said.

The experience of the drug discount card program that Medicare beneficiaries participated in prior to the launch of the Medicare drug benefit offers some lessons for the Centers for Medicare and Medicaid Services, the Government Accountability Office said in two reports.

In its first report, the GAO said that although the Centers for Medicare and Medicaid Services (CMS) had identified and corrected some problems with the entities that sponsored the drug cards, it also “had some limitations with respect to the timeliness of oversight activities and the guidance provided to sponsors.”

For instance, the report noted, “CMS finalized guidance on how drug card sponsors should report data on price concessions from manufacturers and pharmacies in November 2004, about 5 months after the program began. According to CMS, as of August 2005, the overall quality of that data remained questionable, with problems such as outliers and missing data.”

The report also noted that a CMS contractor requested two preenrollment information packets from six drug card sponsors.

“All the packets were noncompliant with program requirements,” the report said. “Most packets were missing materials required by CMS and some materials had not been previously approved for distribution by the CMS contractor. The contractor never received several requested packets.” CMS told the GAO that it had worked with the sponsors to resolve the problems.

For its part, CMS said in a letter to the GAO that the report “did not paint a full picture of the depth and breadth of the actual monitoring and oversight activities.” Dr. Mark B. McClellan, CMS administrator, acknowledged that with the discount card program, “we have learned many valuable lessons that will inform our future efforts as we plan for the drug benefit in 2006.”

The second report looked at CMS's beneficiary and outreach education efforts for the discount card program. In general, the GAO found that “CMS's efforts did not consistently provide information that was clear, accurate, and accessible, and they collectively fell short of conveying program features.” The report did add, however, that the GAO got this impression by looking at assessments that CMS has done on its own programs, and “these assessments acknowledge the actions taken by CMS to address some of these problems.”

Beneficiary confusion about the discount card program was a particular problem, the report said. In spite of CMS's outreach efforts, “beneficiaries confused the drug card with the 2006 prescription drug benefit, and some beneficiaries did not enroll because they were under the impression that Medicare would be sending them a card. Furthermore, the concept of a private drug card sponsor was difficult for many beneficiaries to understand.”

Beneficiaries also were confused about eligibility, the report said. CMS's own research found that some beneficiaries might not have enrolled because they thought they were not eligible for the discount cards. “Specifically, many beneficiaries incorrectly thought that the drug card was only for low-income people, and those who likely qualified for the $600 in transitional assistance did not believe they qualified for it, even after having the income criteria explained to them,” the report noted.

In response to the second report, Dr. McClellan said that it, like the first report, did not address the “full picture of the depth and breadth of the actual activities undertaken.” Dr. McClellan said that the number of education and outreach activities was “unprecedented for a program of limited duration.”

As he had done in the first report, Dr. McClellan said that the lessons learned from this portion of the discount card program would be applied to the drug benefit.

But he also added, “From a public service perspective, the most important question about the drug discount card is whether the program provided discounts and access to prescription drugs for any beneficiary who wanted help. The answer is yes, immediately.”

The reports are available atwww.gao.gov

The experience of the drug discount card program that Medicare beneficiaries participated in prior to the launch of the Medicare drug benefit offers some lessons for the Centers for Medicare and Medicaid Services, the Government Accountability Office said in two reports.

In its first report, the GAO said that although the Centers for Medicare and Medicaid Services (CMS) had identified and corrected some problems with the entities that sponsored the drug cards, it also “had some limitations with respect to the timeliness of oversight activities and the guidance provided to sponsors.”

For instance, the report noted, “CMS finalized guidance on how drug card sponsors should report data on price concessions from manufacturers and pharmacies in November 2004, about 5 months after the program began. According to CMS, as of August 2005, the overall quality of that data remained questionable, with problems such as outliers and missing data.”

The report also noted that a CMS contractor requested two preenrollment information packets from six drug card sponsors.

“All the packets were noncompliant with program requirements,” the report said. “Most packets were missing materials required by CMS and some materials had not been previously approved for distribution by the CMS contractor. The contractor never received several requested packets.” CMS told the GAO that it had worked with the sponsors to resolve the problems.

For its part, CMS said in a letter to the GAO that the report “did not paint a full picture of the depth and breadth of the actual monitoring and oversight activities.” Dr. Mark B. McClellan, CMS administrator, acknowledged that with the discount card program, “we have learned many valuable lessons that will inform our future efforts as we plan for the drug benefit in 2006.”

The second report looked at CMS's beneficiary and outreach education efforts for the discount card program. In general, the GAO found that “CMS's efforts did not consistently provide information that was clear, accurate, and accessible, and they collectively fell short of conveying program features.” The report did add, however, that the GAO got this impression by looking at assessments that CMS has done on its own programs, and “these assessments acknowledge the actions taken by CMS to address some of these problems.”

Beneficiary confusion about the discount card program was a particular problem, the report said. In spite of CMS's outreach efforts, “beneficiaries confused the drug card with the 2006 prescription drug benefit, and some beneficiaries did not enroll because they were under the impression that Medicare would be sending them a card. Furthermore, the concept of a private drug card sponsor was difficult for many beneficiaries to understand.”

Beneficiaries also were confused about eligibility, the report said. CMS's own research found that some beneficiaries might not have enrolled because they thought they were not eligible for the discount cards. “Specifically, many beneficiaries incorrectly thought that the drug card was only for low-income people, and those who likely qualified for the $600 in transitional assistance did not believe they qualified for it, even after having the income criteria explained to them,” the report noted.

In response to the second report, Dr. McClellan said that it, like the first report, did not address the “full picture of the depth and breadth of the actual activities undertaken.” Dr. McClellan said that the number of education and outreach activities was “unprecedented for a program of limited duration.”

As he had done in the first report, Dr. McClellan said that the lessons learned from this portion of the discount card program would be applied to the drug benefit.

But he also added, “From a public service perspective, the most important question about the drug discount card is whether the program provided discounts and access to prescription drugs for any beneficiary who wanted help. The answer is yes, immediately.”

The reports are available atwww.gao.gov

The experience of the drug discount card program that Medicare beneficiaries participated in prior to the launch of the Medicare drug benefit offers some lessons for the Centers for Medicare and Medicaid Services, the Government Accountability Office said in two reports.

In its first report, the GAO said that although the Centers for Medicare and Medicaid Services (CMS) had identified and corrected some problems with the entities that sponsored the drug cards, it also “had some limitations with respect to the timeliness of oversight activities and the guidance provided to sponsors.”

For instance, the report noted, “CMS finalized guidance on how drug card sponsors should report data on price concessions from manufacturers and pharmacies in November 2004, about 5 months after the program began. According to CMS, as of August 2005, the overall quality of that data remained questionable, with problems such as outliers and missing data.”

The report also noted that a CMS contractor requested two preenrollment information packets from six drug card sponsors.

“All the packets were noncompliant with program requirements,” the report said. “Most packets were missing materials required by CMS and some materials had not been previously approved for distribution by the CMS contractor. The contractor never received several requested packets.” CMS told the GAO that it had worked with the sponsors to resolve the problems.

For its part, CMS said in a letter to the GAO that the report “did not paint a full picture of the depth and breadth of the actual monitoring and oversight activities.” Dr. Mark B. McClellan, CMS administrator, acknowledged that with the discount card program, “we have learned many valuable lessons that will inform our future efforts as we plan for the drug benefit in 2006.”

The second report looked at CMS's beneficiary and outreach education efforts for the discount card program. In general, the GAO found that “CMS's efforts did not consistently provide information that was clear, accurate, and accessible, and they collectively fell short of conveying program features.” The report did add, however, that the GAO got this impression by looking at assessments that CMS has done on its own programs, and “these assessments acknowledge the actions taken by CMS to address some of these problems.”

Beneficiary confusion about the discount card program was a particular problem, the report said. In spite of CMS's outreach efforts, “beneficiaries confused the drug card with the 2006 prescription drug benefit, and some beneficiaries did not enroll because they were under the impression that Medicare would be sending them a card. Furthermore, the concept of a private drug card sponsor was difficult for many beneficiaries to understand.”

Beneficiaries also were confused about eligibility, the report said. CMS's own research found that some beneficiaries might not have enrolled because they thought they were not eligible for the discount cards. “Specifically, many beneficiaries incorrectly thought that the drug card was only for low-income people, and those who likely qualified for the $600 in transitional assistance did not believe they qualified for it, even after having the income criteria explained to them,” the report noted.

In response to the second report, Dr. McClellan said that it, like the first report, did not address the “full picture of the depth and breadth of the actual activities undertaken.” Dr. McClellan said that the number of education and outreach activities was “unprecedented for a program of limited duration.”

As he had done in the first report, Dr. McClellan said that the lessons learned from this portion of the discount card program would be applied to the drug benefit.

But he also added, “From a public service perspective, the most important question about the drug discount card is whether the program provided discounts and access to prescription drugs for any beneficiary who wanted help. The answer is yes, immediately.”

The reports are available atwww.gao.gov

WASHINGTON — Aiming for computerization of physician order entry at health care institutions isn't the right course to take, Dr. Stephen T. Lawless said at a health care congress sponsored by the Wall Street Journal and CNBC.

“That's the wrong goal,” said Dr. Lawless, who is chief knowledge and quality officer at Nemours, a Wilmington, Del., pediatric subspecialty practice with about 1 million patient encounters per year. “The right goal is NPOE—no physician order entry. Just tell us what you want and we'll have the best person [enter] it for you.”

With this caveat, computerized order entry still remains an important tool in reducing medication errors, said Dr. Lawless, who also is a professor of pediatrics at Jefferson Medical College, Philadelphia.

He said that the hospital where he practices—the Alfred I. DuPont Hospital for Children, Wilmington—partnered with a large pharmacy chain and asked the pharmacy to find the errors in the hospital's handwritten prescriptions. Of the handwritten prescriptions, 35%–40% had errors, he said. “Of those, 53% had legibility problems, 36% had issues with completeness, and 11% had content errors.”

The hospital's use of electronic prescribing has eliminated legibility errors, but that still leaves the other half of the errors to be resolved, he said. That's where the “decision support” piece comes in, which has encountered some resistance from providers. “We're forcing people by saying, 'You've picked this drug at this time, at this dose, at this range. Thank you very much.' It's very hard to make people do that.”

“Discipline” measures such as checklists are often resisted by the medical community because “we all think it's about health care professionals being industrialized. I say it's [about] health care craftsmen fighting being professionalized,” he said.

WASHINGTON — Aiming for computerization of physician order entry at health care institutions isn't the right course to take, Dr. Stephen T. Lawless said at a health care congress sponsored by the Wall Street Journal and CNBC.

“That's the wrong goal,” said Dr. Lawless, who is chief knowledge and quality officer at Nemours, a Wilmington, Del., pediatric subspecialty practice with about 1 million patient encounters per year. “The right goal is NPOE—no physician order entry. Just tell us what you want and we'll have the best person [enter] it for you.”

With this caveat, computerized order entry still remains an important tool in reducing medication errors, said Dr. Lawless, who also is a professor of pediatrics at Jefferson Medical College, Philadelphia.

He said that the hospital where he practices—the Alfred I. DuPont Hospital for Children, Wilmington—partnered with a large pharmacy chain and asked the pharmacy to find the errors in the hospital's handwritten prescriptions. Of the handwritten prescriptions, 35%–40% had errors, he said. “Of those, 53% had legibility problems, 36% had issues with completeness, and 11% had content errors.”

The hospital's use of electronic prescribing has eliminated legibility errors, but that still leaves the other half of the errors to be resolved, he said. That's where the “decision support” piece comes in, which has encountered some resistance from providers. “We're forcing people by saying, 'You've picked this drug at this time, at this dose, at this range. Thank you very much.' It's very hard to make people do that.”

“Discipline” measures such as checklists are often resisted by the medical community because “we all think it's about health care professionals being industrialized. I say it's [about] health care craftsmen fighting being professionalized,” he said.

WASHINGTON — Aiming for computerization of physician order entry at health care institutions isn't the right course to take, Dr. Stephen T. Lawless said at a health care congress sponsored by the Wall Street Journal and CNBC.

“That's the wrong goal,” said Dr. Lawless, who is chief knowledge and quality officer at Nemours, a Wilmington, Del., pediatric subspecialty practice with about 1 million patient encounters per year. “The right goal is NPOE—no physician order entry. Just tell us what you want and we'll have the best person [enter] it for you.”

With this caveat, computerized order entry still remains an important tool in reducing medication errors, said Dr. Lawless, who also is a professor of pediatrics at Jefferson Medical College, Philadelphia.

He said that the hospital where he practices—the Alfred I. DuPont Hospital for Children, Wilmington—partnered with a large pharmacy chain and asked the pharmacy to find the errors in the hospital's handwritten prescriptions. Of the handwritten prescriptions, 35%–40% had errors, he said. “Of those, 53% had legibility problems, 36% had issues with completeness, and 11% had content errors.”

The hospital's use of electronic prescribing has eliminated legibility errors, but that still leaves the other half of the errors to be resolved, he said. That's where the “decision support” piece comes in, which has encountered some resistance from providers. “We're forcing people by saying, 'You've picked this drug at this time, at this dose, at this range. Thank you very much.' It's very hard to make people do that.”

“Discipline” measures such as checklists are often resisted by the medical community because “we all think it's about health care professionals being industrialized. I say it's [about] health care craftsmen fighting being professionalized,” he said.

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine Consumers' Checkbook in several cities nationwide. “Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate'” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said. “It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.”

One thing that must be done is to “demystify” the health care industry, Mr. Tyson continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine Consumers' Checkbook in several cities nationwide. “Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate'” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said. “It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.”

One thing that must be done is to “demystify” the health care industry, Mr. Tyson continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”

WASHINGTON — The lists of “best doctors” published in magazines may not be all they're cracked up to be, several speakers said at a health care competition conference sponsored by Health Affairs journal and the Center for Studying Health System Change.

“Outcomes are much more difficult to measure in health care” than in other industries like auto repair or roofing, said Robert Krughoff, president and founder of the Center for the Study of Services, which publishes the service-rating magazine Consumers' Checkbook in several cities nationwide. “Consumers know right away if [the plumber is good]. With a health care provider, they may not know until 5 or 10 years out.”

Further, an outcome cannot always be attributed to the intervention of the health care provider, he said. And because of health insurance, consumers often are insulated from the true costs of care, so it's hard to talk about who provides the best value for the money.

Taking a regional approach to physician rating could have value, Mr. Krughoff suggested. “Patients would report their experience with physicians—they would tell how well the physician listens, how well he or she coordinates care, and whether they are good at working with patients to devise acceptable prevention behaviors,” he said.

The cost of doing such a survey would be a concern, but Mr. Krughoff said he thought it could be done for less than $200 per physician and it wouldn't have to be done annually, although a physician should be able to pay for a re-survey if he or she made improvements to the practice.

Tom Scully, former administrator of the Centers for Medicare and Medicaid Services, agreed that information is key to getting patients involved as consumers.

“The health care system is pitiful when it comes to public information,” said Mr. Scully, now senior counsel at Alston & Bird LLP, a Washington law firm. “As much as people avoid it and fight it, it works to change behavior. I've never run across any instance where providers, as much as they didn't like it when they were forced to share information, didn't come back a year or two later and say, 'You know what? It's worked out pretty well, it's changed my behavior, and it wasn't that difficult after all.'”

Although health care in this country will never be a pure market economy, “in some sense supply and demand will help, and there is no way to have supply and demand if you don't send consumers information and give them some understanding of what they're buying and what the relative price and quality is,” Mr. Scully said. The problem is getting providers to provide the information, and the best way to do that is with incentives.

For example, when CMS wanted hospitals to voluntarily report on 10 quality measures, “we put through a little teeny thing [into the Medicare budget legislation] that said, 'It's totally voluntary; you don't have to give us the 10 measures, but if you don't, we'll volunteer to pay four-tenths of a percent less of the market-basket rate'” for hospital costs, he said. “We went from zero compliance to 99% compliance in a year. I personally believe as a Republican that you shouldn't mandate anything—just voluntarily pay people less if they don't behave right.”

That may work for health care providers, but the health care industry alone can't make patients better consumers, said Bernard Tyson, senior vice president for brand strategy and management for Kaiser Foundation Health Plan.

“There isn't a health care system in place today that can support that kind of consumer interaction and behavior,” he said. “It will take forces outside the industry itself to enforce that change. Two outside forces that can really help move this are government and employers.”

One thing that must be done is to “demystify” the health care industry, Mr. Tyson continued. “The average consumer does not know how to measure [health care] and really doesn't know how to define [its] value.”