Joyce Frieden

The next time a patient presents with a possible case of recalcitrant scabies, look carefully and ask questions.

What you may think is scabies actually may be a manifestation of addiction to methamphetamine, according to Dr. Kathleen Hectorne, a physician at the Mayo Clinic in Rochester, Minn.

It's treated, “and it's not getting better, because it's a [consequence] of meth use where they're picking at their skin,” she said, adding that this disorder is also known as “meth mites.” These same patients also may suffer from anorexia or weight loss.

Another sign of possible methamphetamine use is delusions of parasitosis, in which patients feel like insects are crawling on their skin, although Dr. Hectorne noted that “not all cases feel like bugs. Some people say they think the drug is coming out of their skin.”

To remove the imaginary bugs or other items they think are in their skin, meth users may use safety pins, needles, or other sharp objects, said Dr. Matthew A. Torrington, an addiction medicine physician in Los Angeles. “Patients will tell you they feel like there is something in their skin, and they will [pick at it] to the point that they tear their flesh open,” he said.

These irritations then become infected secondarily, said Dr. Sullivan Smith, an emergency physician in Cookeville, Tenn. “You name it: They will get staph, strep, and all kinds of enterics,” he said. “It's a polymicrobial kind of infection.” Although the infections often can be treated with antibiotics, most of them would go away entirely if the patients stopped scratching.

Patients addicted to methamphetamine have the “typical IV drug users' skin infections and abscesses,” he said. “There are a couple of reasons for that. One is a microbial issue, because they don't use sterile techniques and they share needles. But additionally, meth is not a clean drug—this stuff is made with battery acid, and that causes skin abscesses, too,” said Dr. Smith, who also works as a police officer and has been involved in raids on meth labs.

In addition, the byproducts produced by the meth manufacturing process can be irritating to the skin and cause lesions that look like a rash. No one has done much research on these byproducts because “we've never really focused on what else is in it. We're always just focused on how much meth is there,” Dr. Smith noted.

To treat these patients, physicians first need to establish that they are drug addicts, which can be tricky, Dr. Hectorne said. “It always helps to see if they test positive for the drug, but you need their permission to do that,” she said.

Dr. Torrington agreed. “You're going to have to be able to get the patient's history, and if the patient denies [using meth], it's going to be hard.” There are specific tests that can be done for methamphetamine but the drug is metabolized very quickly by the body, so it might disappear before it can be found. There is also a urine test for amphetamine and methamphetamine, “but they have more cross reactivity with other substances than any other drugs of abuse,” he added.

Dr. Hectorne became interested in the dermatologic manifestations of methamphetamine abuse after a police officer came to the clinic to give a talk on the subject: “I thought, 'This is something we're probably seeing and not picking up on totally.'”

Once the problem has been detected, the only way to cure the dermatologic manifestations is to stop the abuse, Dr. Torrington said. “In most cases, the symptoms will resolve when the meth is removed. It can take a few days or weeks,” although in some addicts the symptoms can persist for months or years afterwards, he said.

Dr. Torrington is an investor in and consultant to Hythiam Inc., a Los Angeles company that is developing a medical treatment called Prometa for methamphetamine addiction.

Although he declined to reveal the treatment's contents, the firm's patent application indicates that Prometa includes intravenous administration of flumazenil or another selective chloride channel modulator, combined with varying doses of other drugs as well as nutritional and vitamin supplements.

Results of a 45-patient open-label trial of the treatment regimen are expected in the first quarter of 2006, Dr. Torrington said.

The next time a patient presents with a possible case of recalcitrant scabies, look carefully and ask questions.

What you may think is scabies actually may be a manifestation of addiction to methamphetamine, according to Dr. Kathleen Hectorne, a physician at the Mayo Clinic in Rochester, Minn.

It's treated, “and it's not getting better, because it's a [consequence] of meth use where they're picking at their skin,” she said, adding that this disorder is also known as “meth mites.” These same patients also may suffer from anorexia or weight loss.

Another sign of possible methamphetamine use is delusions of parasitosis, in which patients feel like insects are crawling on their skin, although Dr. Hectorne noted that “not all cases feel like bugs. Some people say they think the drug is coming out of their skin.”

To remove the imaginary bugs or other items they think are in their skin, meth users may use safety pins, needles, or other sharp objects, said Dr. Matthew A. Torrington, an addiction medicine physician in Los Angeles. “Patients will tell you they feel like there is something in their skin, and they will [pick at it] to the point that they tear their flesh open,” he said.

These irritations then become infected secondarily, said Dr. Sullivan Smith, an emergency physician in Cookeville, Tenn. “You name it: They will get staph, strep, and all kinds of enterics,” he said. “It's a polymicrobial kind of infection.” Although the infections often can be treated with antibiotics, most of them would go away entirely if the patients stopped scratching.

Patients addicted to methamphetamine have the “typical IV drug users' skin infections and abscesses,” he said. “There are a couple of reasons for that. One is a microbial issue, because they don't use sterile techniques and they share needles. But additionally, meth is not a clean drug—this stuff is made with battery acid, and that causes skin abscesses, too,” said Dr. Smith, who also works as a police officer and has been involved in raids on meth labs.

In addition, the byproducts produced by the meth manufacturing process can be irritating to the skin and cause lesions that look like a rash. No one has done much research on these byproducts because “we've never really focused on what else is in it. We're always just focused on how much meth is there,” Dr. Smith noted.

To treat these patients, physicians first need to establish that they are drug addicts, which can be tricky, Dr. Hectorne said. “It always helps to see if they test positive for the drug, but you need their permission to do that,” she said.

Dr. Torrington agreed. “You're going to have to be able to get the patient's history, and if the patient denies [using meth], it's going to be hard.” There are specific tests that can be done for methamphetamine but the drug is metabolized very quickly by the body, so it might disappear before it can be found. There is also a urine test for amphetamine and methamphetamine, “but they have more cross reactivity with other substances than any other drugs of abuse,” he added.

Dr. Hectorne became interested in the dermatologic manifestations of methamphetamine abuse after a police officer came to the clinic to give a talk on the subject: “I thought, 'This is something we're probably seeing and not picking up on totally.'”

Once the problem has been detected, the only way to cure the dermatologic manifestations is to stop the abuse, Dr. Torrington said. “In most cases, the symptoms will resolve when the meth is removed. It can take a few days or weeks,” although in some addicts the symptoms can persist for months or years afterwards, he said.

Dr. Torrington is an investor in and consultant to Hythiam Inc., a Los Angeles company that is developing a medical treatment called Prometa for methamphetamine addiction.

Although he declined to reveal the treatment's contents, the firm's patent application indicates that Prometa includes intravenous administration of flumazenil or another selective chloride channel modulator, combined with varying doses of other drugs as well as nutritional and vitamin supplements.

Results of a 45-patient open-label trial of the treatment regimen are expected in the first quarter of 2006, Dr. Torrington said.

The next time a patient presents with a possible case of recalcitrant scabies, look carefully and ask questions.

What you may think is scabies actually may be a manifestation of addiction to methamphetamine, according to Dr. Kathleen Hectorne, a physician at the Mayo Clinic in Rochester, Minn.

It's treated, “and it's not getting better, because it's a [consequence] of meth use where they're picking at their skin,” she said, adding that this disorder is also known as “meth mites.” These same patients also may suffer from anorexia or weight loss.

Another sign of possible methamphetamine use is delusions of parasitosis, in which patients feel like insects are crawling on their skin, although Dr. Hectorne noted that “not all cases feel like bugs. Some people say they think the drug is coming out of their skin.”

To remove the imaginary bugs or other items they think are in their skin, meth users may use safety pins, needles, or other sharp objects, said Dr. Matthew A. Torrington, an addiction medicine physician in Los Angeles. “Patients will tell you they feel like there is something in their skin, and they will [pick at it] to the point that they tear their flesh open,” he said.

These irritations then become infected secondarily, said Dr. Sullivan Smith, an emergency physician in Cookeville, Tenn. “You name it: They will get staph, strep, and all kinds of enterics,” he said. “It's a polymicrobial kind of infection.” Although the infections often can be treated with antibiotics, most of them would go away entirely if the patients stopped scratching.

Patients addicted to methamphetamine have the “typical IV drug users' skin infections and abscesses,” he said. “There are a couple of reasons for that. One is a microbial issue, because they don't use sterile techniques and they share needles. But additionally, meth is not a clean drug—this stuff is made with battery acid, and that causes skin abscesses, too,” said Dr. Smith, who also works as a police officer and has been involved in raids on meth labs.

In addition, the byproducts produced by the meth manufacturing process can be irritating to the skin and cause lesions that look like a rash. No one has done much research on these byproducts because “we've never really focused on what else is in it. We're always just focused on how much meth is there,” Dr. Smith noted.

To treat these patients, physicians first need to establish that they are drug addicts, which can be tricky, Dr. Hectorne said. “It always helps to see if they test positive for the drug, but you need their permission to do that,” she said.

Dr. Torrington agreed. “You're going to have to be able to get the patient's history, and if the patient denies [using meth], it's going to be hard.” There are specific tests that can be done for methamphetamine but the drug is metabolized very quickly by the body, so it might disappear before it can be found. There is also a urine test for amphetamine and methamphetamine, “but they have more cross reactivity with other substances than any other drugs of abuse,” he added.

Dr. Hectorne became interested in the dermatologic manifestations of methamphetamine abuse after a police officer came to the clinic to give a talk on the subject: “I thought, 'This is something we're probably seeing and not picking up on totally.'”

Once the problem has been detected, the only way to cure the dermatologic manifestations is to stop the abuse, Dr. Torrington said. “In most cases, the symptoms will resolve when the meth is removed. It can take a few days or weeks,” although in some addicts the symptoms can persist for months or years afterwards, he said.

Dr. Torrington is an investor in and consultant to Hythiam Inc., a Los Angeles company that is developing a medical treatment called Prometa for methamphetamine addiction.

Although he declined to reveal the treatment's contents, the firm's patent application indicates that Prometa includes intravenous administration of flumazenil or another selective chloride channel modulator, combined with varying doses of other drugs as well as nutritional and vitamin supplements.

Results of a 45-patient open-label trial of the treatment regimen are expected in the first quarter of 2006, Dr. Torrington said.

WASHINGTON — Electronic health records make good business sense for physicians, even those in small and medium-sized medical groups, Stefanos Zenios, Ph.D., said at a health care congress sponsored by the Wall Street Journal and CNBC.

“There is a perception that there's no business case for adopting electronic health records in small or midsize medical groups,” said Dr. Zenios, professor of operations, information, and technology at Stanford (Calif.) University. But that's not the case if one considers the economic data carefully, he said.

Like any other investment, electronic health records (EHRs) entail both short-term and long-term costs. “Initial costs are $43,000 per full-time equivalent [FTE], including software and hardware and productivity losses,” Dr. Zenios said, citing a recent study (Health Affairs 2005;24:1127–37).

However, the same study also showed an $18,000 increase in revenue per FTE due to better billing and better follow-up of patients, Dr. Zenios added. And by the fourth year of using EHRs, the return on investment is 31%.

“If you would take all money you are spending to install and maintain the system, and put it in the bank, on average you would be making 5%–7% [in interest]. Even if you put it in the stock market in the 1990s, you would be making 10% on that money,” he said. “Not even the venture capitalists can see returns as high [as 31%]. So that's a compelling financial case, which primarily comes from better billing.”

Better data mining is another way that practices can increase practice revenue. For instance, one 26-member cardiology group in North Carolina used EHR data to look for patients at risk of sudden coronary death. Out of the 80,000 patient records searched, they found nearly 300 patients who were candidates for primary prevention and more than 1,400 patients who were candidates for secondary prevention.

This then translated into more than 1,300 consultations, 900 echocardiograms, 500 T-wave tests, and 500 implantable cardioverter defibrillator implantations. That had the clinical impact of averting 37 sudden cardiac deaths each year, and the financial impact of bringing $2.8 million in additional revenue to the practice, Dr. Zenios said.

Finally, being an early adopter of EHRs can put practices at a competitive advantage. Dr. Zenios cited another study estimating that widespread use of EHRs in the United States could bring a total estimated savings to the entire health care system of $245 billion. Of that, an estimated $23 billion would come in the form of fewer physician visits (Health Affairs 2005;24:1103–17).

In the face of this possible reduction in business, if all small and medium-sized medical practices were to invest in EHRs, no one's share of the shrinking outpatient market would change, Dr. Zenios said. But if only some groups invested in them, “they would gain an advantage” because of the increases in practice efficiency, while their competitors' market share would go down.

“To protect your business, it may make sense to have an EHR,” he said.

Like any other investment, installing an EHR system is not risk-free, Dr. Zenios warned. He offered several suggestions to help physicians better manage the risks involved:

▸ Redundancy, redundancy, redundancy. “People put a new information technology system in place, and the next morning they turn off their previous system,” he said. “It doesn't make sense. It's costly to have both systems in place, but that protects you. For 3–6 months, there has to be some redundancy.”

▸ Assess the ability of the system to improve your billing processes. For example, the system may be able to flag procedures for which physicians are routinely underbilling and bill them at the proper level.

▸ Assess the system's capability to take advantage of all the data that are going to become available. “Some innovative practices are using this capability to deliver better quality of care to their patients and improve their revenue,” he said.

WASHINGTON — Electronic health records make good business sense for physicians, even those in small and medium-sized medical groups, Stefanos Zenios, Ph.D., said at a health care congress sponsored by the Wall Street Journal and CNBC.

“There is a perception that there's no business case for adopting electronic health records in small or midsize medical groups,” said Dr. Zenios, professor of operations, information, and technology at Stanford (Calif.) University. But that's not the case if one considers the economic data carefully, he said.

Like any other investment, electronic health records (EHRs) entail both short-term and long-term costs. “Initial costs are $43,000 per full-time equivalent [FTE], including software and hardware and productivity losses,” Dr. Zenios said, citing a recent study (Health Affairs 2005;24:1127–37).

However, the same study also showed an $18,000 increase in revenue per FTE due to better billing and better follow-up of patients, Dr. Zenios added. And by the fourth year of using EHRs, the return on investment is 31%.

“If you would take all money you are spending to install and maintain the system, and put it in the bank, on average you would be making 5%–7% [in interest]. Even if you put it in the stock market in the 1990s, you would be making 10% on that money,” he said. “Not even the venture capitalists can see returns as high [as 31%]. So that's a compelling financial case, which primarily comes from better billing.”

Better data mining is another way that practices can increase practice revenue. For instance, one 26-member cardiology group in North Carolina used EHR data to look for patients at risk of sudden coronary death. Out of the 80,000 patient records searched, they found nearly 300 patients who were candidates for primary prevention and more than 1,400 patients who were candidates for secondary prevention.

This then translated into more than 1,300 consultations, 900 echocardiograms, 500 T-wave tests, and 500 implantable cardioverter defibrillator implantations. That had the clinical impact of averting 37 sudden cardiac deaths each year, and the financial impact of bringing $2.8 million in additional revenue to the practice, Dr. Zenios said.

Finally, being an early adopter of EHRs can put practices at a competitive advantage. Dr. Zenios cited another study estimating that widespread use of EHRs in the United States could bring a total estimated savings to the entire health care system of $245 billion. Of that, an estimated $23 billion would come in the form of fewer physician visits (Health Affairs 2005;24:1103–17).

In the face of this possible reduction in business, if all small and medium-sized medical practices were to invest in EHRs, no one's share of the shrinking outpatient market would change, Dr. Zenios said. But if only some groups invested in them, “they would gain an advantage” because of the increases in practice efficiency, while their competitors' market share would go down.

“To protect your business, it may make sense to have an EHR,” he said.

Like any other investment, installing an EHR system is not risk-free, Dr. Zenios warned. He offered several suggestions to help physicians better manage the risks involved:

▸ Redundancy, redundancy, redundancy. “People put a new information technology system in place, and the next morning they turn off their previous system,” he said. “It doesn't make sense. It's costly to have both systems in place, but that protects you. For 3–6 months, there has to be some redundancy.”

▸ Assess the ability of the system to improve your billing processes. For example, the system may be able to flag procedures for which physicians are routinely underbilling and bill them at the proper level.

▸ Assess the system's capability to take advantage of all the data that are going to become available. “Some innovative practices are using this capability to deliver better quality of care to their patients and improve their revenue,” he said.

WASHINGTON — Electronic health records make good business sense for physicians, even those in small and medium-sized medical groups, Stefanos Zenios, Ph.D., said at a health care congress sponsored by the Wall Street Journal and CNBC.

“There is a perception that there's no business case for adopting electronic health records in small or midsize medical groups,” said Dr. Zenios, professor of operations, information, and technology at Stanford (Calif.) University. But that's not the case if one considers the economic data carefully, he said.

Like any other investment, electronic health records (EHRs) entail both short-term and long-term costs. “Initial costs are $43,000 per full-time equivalent [FTE], including software and hardware and productivity losses,” Dr. Zenios said, citing a recent study (Health Affairs 2005;24:1127–37).

However, the same study also showed an $18,000 increase in revenue per FTE due to better billing and better follow-up of patients, Dr. Zenios added. And by the fourth year of using EHRs, the return on investment is 31%.

“If you would take all money you are spending to install and maintain the system, and put it in the bank, on average you would be making 5%–7% [in interest]. Even if you put it in the stock market in the 1990s, you would be making 10% on that money,” he said. “Not even the venture capitalists can see returns as high [as 31%]. So that's a compelling financial case, which primarily comes from better billing.”

Better data mining is another way that practices can increase practice revenue. For instance, one 26-member cardiology group in North Carolina used EHR data to look for patients at risk of sudden coronary death. Out of the 80,000 patient records searched, they found nearly 300 patients who were candidates for primary prevention and more than 1,400 patients who were candidates for secondary prevention.

This then translated into more than 1,300 consultations, 900 echocardiograms, 500 T-wave tests, and 500 implantable cardioverter defibrillator implantations. That had the clinical impact of averting 37 sudden cardiac deaths each year, and the financial impact of bringing $2.8 million in additional revenue to the practice, Dr. Zenios said.

Finally, being an early adopter of EHRs can put practices at a competitive advantage. Dr. Zenios cited another study estimating that widespread use of EHRs in the United States could bring a total estimated savings to the entire health care system of $245 billion. Of that, an estimated $23 billion would come in the form of fewer physician visits (Health Affairs 2005;24:1103–17).

In the face of this possible reduction in business, if all small and medium-sized medical practices were to invest in EHRs, no one's share of the shrinking outpatient market would change, Dr. Zenios said. But if only some groups invested in them, “they would gain an advantage” because of the increases in practice efficiency, while their competitors' market share would go down.

“To protect your business, it may make sense to have an EHR,” he said.

Like any other investment, installing an EHR system is not risk-free, Dr. Zenios warned. He offered several suggestions to help physicians better manage the risks involved:

▸ Redundancy, redundancy, redundancy. “People put a new information technology system in place, and the next morning they turn off their previous system,” he said. “It doesn't make sense. It's costly to have both systems in place, but that protects you. For 3–6 months, there has to be some redundancy.”

▸ Assess the ability of the system to improve your billing processes. For example, the system may be able to flag procedures for which physicians are routinely underbilling and bill them at the proper level.

▸ Assess the system's capability to take advantage of all the data that are going to become available. “Some innovative practices are using this capability to deliver better quality of care to their patients and improve their revenue,” he said.

WASHINGTON — Physicians are often reluctant to leap into an EHR 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?” he said.

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,” said Dr. Sands of Harvard University, Boston.

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 step is to use 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 EHR 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?” he said.

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,” said Dr. Sands of Harvard University, Boston.

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 step is to use 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 EHR 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?” he said.

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,” said Dr. Sands of Harvard University, Boston.

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 step is to use 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.

Neurology Outlook for 2006

Malpractice reform will continue to be a top priority for the American Academy of Neurology in 2006, according to Mike Amery, AAN's federal affairs manager, in Washington. Also high on the agenda is Medicare reimbursement. Funding for the National Institutes of Health also is a concern for the academy; NIH ended up with an increase of 1%, to $28.6 billion, in the budget passed by Congress. Ideally, “we'd like to see an 8–10% [increase], but that's not going to happen in these fiscal times,” Mr. Amery said.

Help for Vets with MS Proposed

Sen. Patty Murray (D-Wash.) has proposed legislation to help more veterans with multiple sclerosis qualify for disability benefits from the Department of Veterans Affairs. “A growing number of veterans from the first Gulf War are now developing symptoms of multiple sclerosis, but they often face an uphill battle in obtaining disability benefits from the VA,” the senator's office noted in a press release. Under current law, veterans of the United States military have 7 years after discharge to connect multiple sclerosis to their military service; however, many veterans don't start developing symptoms of the disease until after that time, forcing them to go through a long appeals process to prove their disability is related to their service. The bill would remove the 7-year limitation and make multiple sclerosis a “presumptive disability,” entitling them to care no matter when their symptoms appear. So far, about 500 Gulf War veterans have been diagnosed with service-connected multiple sclerosis, and many more are symptomatic but not yet diagnosed, according to Julie Mock, president of the National Gulf War Resource Center and a patient with multiple sclerosis.

Responders Need Epilepsy Training

The Epilepsy Foundation is calling for better training of first responders after the death of an epilepsy patient who was restrained by emergency personnel. “Unfortunately, first responders all too often employ forcible restraint methods as a means of subduing persons who may appear to be combative but are actually displaying typical symptoms of a seizure,” said foundation president and CEO Eric Hargis. “Avoidable injuries and deaths will persist unless action is taken to educate and train first responders.” In the case of an Arizona State University student, emergency medical technicians, thinking the patient was being combative, forcibly restrained him after he was handcuffed behind his back and left him prone for 20 minutes. The jury found that the technicians were not responsible for the patient's death.

Neurologist Takes FDA Post

Dr. Gerald J. Dal Pan is the new director of the Food and Drug Administration's Office of Drug Safety. In his new position, Dr. Dal Pan is in charge of the FDA's postmarketing drug safety program.

Neurointensive Subspecialty Approved

The United Council for Neurologic Subspecialties has approved neurointensive care for membership in its organization. The neurointensive care application was sponsored by the American Academy of Neurology's critical care and emergency neurology section as well as the Neurocritical Care Society and the Society of Neurosurgical Anesthesia and Critical Care. The council's accrediting body now will work with the subspecialty on requirements for fellowship programs. The programs will then be able to apply for accreditation by the council. The council also will help develop a neurointensive care certification exam. The subspecialty will be given a voting seat on the council's board of directors. Neurointensive care joins behavioral neurology and neuropsychiatry, neurooncology, clinical neuromuscular pathology, and headache medicine on the list of council-approved subspecialties. The council itself is sponsored by five parent organizations: the AAN, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology Society, and Professors of Child Neurology. Its goal is “to recognize added competence and to assist subspecialties that have matured to the point where accreditation of training programs and certification of graduates is appropriate, yet these subspecialties are not able to seek, or have not grown sufficiently for, American Board of Psychiatry and Neurology certification.”

Neurology Outlook for 2006

Malpractice reform will continue to be a top priority for the American Academy of Neurology in 2006, according to Mike Amery, AAN's federal affairs manager, in Washington. Also high on the agenda is Medicare reimbursement. Funding for the National Institutes of Health also is a concern for the academy; NIH ended up with an increase of 1%, to $28.6 billion, in the budget passed by Congress. Ideally, “we'd like to see an 8–10% [increase], but that's not going to happen in these fiscal times,” Mr. Amery said.

Help for Vets with MS Proposed

Sen. Patty Murray (D-Wash.) has proposed legislation to help more veterans with multiple sclerosis qualify for disability benefits from the Department of Veterans Affairs. “A growing number of veterans from the first Gulf War are now developing symptoms of multiple sclerosis, but they often face an uphill battle in obtaining disability benefits from the VA,” the senator's office noted in a press release. Under current law, veterans of the United States military have 7 years after discharge to connect multiple sclerosis to their military service; however, many veterans don't start developing symptoms of the disease until after that time, forcing them to go through a long appeals process to prove their disability is related to their service. The bill would remove the 7-year limitation and make multiple sclerosis a “presumptive disability,” entitling them to care no matter when their symptoms appear. So far, about 500 Gulf War veterans have been diagnosed with service-connected multiple sclerosis, and many more are symptomatic but not yet diagnosed, according to Julie Mock, president of the National Gulf War Resource Center and a patient with multiple sclerosis.

Responders Need Epilepsy Training

The Epilepsy Foundation is calling for better training of first responders after the death of an epilepsy patient who was restrained by emergency personnel. “Unfortunately, first responders all too often employ forcible restraint methods as a means of subduing persons who may appear to be combative but are actually displaying typical symptoms of a seizure,” said foundation president and CEO Eric Hargis. “Avoidable injuries and deaths will persist unless action is taken to educate and train first responders.” In the case of an Arizona State University student, emergency medical technicians, thinking the patient was being combative, forcibly restrained him after he was handcuffed behind his back and left him prone for 20 minutes. The jury found that the technicians were not responsible for the patient's death.

Neurologist Takes FDA Post

Dr. Gerald J. Dal Pan is the new director of the Food and Drug Administration's Office of Drug Safety. In his new position, Dr. Dal Pan is in charge of the FDA's postmarketing drug safety program.

Neurointensive Subspecialty Approved

The United Council for Neurologic Subspecialties has approved neurointensive care for membership in its organization. The neurointensive care application was sponsored by the American Academy of Neurology's critical care and emergency neurology section as well as the Neurocritical Care Society and the Society of Neurosurgical Anesthesia and Critical Care. The council's accrediting body now will work with the subspecialty on requirements for fellowship programs. The programs will then be able to apply for accreditation by the council. The council also will help develop a neurointensive care certification exam. The subspecialty will be given a voting seat on the council's board of directors. Neurointensive care joins behavioral neurology and neuropsychiatry, neurooncology, clinical neuromuscular pathology, and headache medicine on the list of council-approved subspecialties. The council itself is sponsored by five parent organizations: the AAN, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology Society, and Professors of Child Neurology. Its goal is “to recognize added competence and to assist subspecialties that have matured to the point where accreditation of training programs and certification of graduates is appropriate, yet these subspecialties are not able to seek, or have not grown sufficiently for, American Board of Psychiatry and Neurology certification.”

Neurology Outlook for 2006

Malpractice reform will continue to be a top priority for the American Academy of Neurology in 2006, according to Mike Amery, AAN's federal affairs manager, in Washington. Also high on the agenda is Medicare reimbursement. Funding for the National Institutes of Health also is a concern for the academy; NIH ended up with an increase of 1%, to $28.6 billion, in the budget passed by Congress. Ideally, “we'd like to see an 8–10% [increase], but that's not going to happen in these fiscal times,” Mr. Amery said.

Help for Vets with MS Proposed

Sen. Patty Murray (D-Wash.) has proposed legislation to help more veterans with multiple sclerosis qualify for disability benefits from the Department of Veterans Affairs. “A growing number of veterans from the first Gulf War are now developing symptoms of multiple sclerosis, but they often face an uphill battle in obtaining disability benefits from the VA,” the senator's office noted in a press release. Under current law, veterans of the United States military have 7 years after discharge to connect multiple sclerosis to their military service; however, many veterans don't start developing symptoms of the disease until after that time, forcing them to go through a long appeals process to prove their disability is related to their service. The bill would remove the 7-year limitation and make multiple sclerosis a “presumptive disability,” entitling them to care no matter when their symptoms appear. So far, about 500 Gulf War veterans have been diagnosed with service-connected multiple sclerosis, and many more are symptomatic but not yet diagnosed, according to Julie Mock, president of the National Gulf War Resource Center and a patient with multiple sclerosis.

Responders Need Epilepsy Training

The Epilepsy Foundation is calling for better training of first responders after the death of an epilepsy patient who was restrained by emergency personnel. “Unfortunately, first responders all too often employ forcible restraint methods as a means of subduing persons who may appear to be combative but are actually displaying typical symptoms of a seizure,” said foundation president and CEO Eric Hargis. “Avoidable injuries and deaths will persist unless action is taken to educate and train first responders.” In the case of an Arizona State University student, emergency medical technicians, thinking the patient was being combative, forcibly restrained him after he was handcuffed behind his back and left him prone for 20 minutes. The jury found that the technicians were not responsible for the patient's death.

Neurologist Takes FDA Post

Dr. Gerald J. Dal Pan is the new director of the Food and Drug Administration's Office of Drug Safety. In his new position, Dr. Dal Pan is in charge of the FDA's postmarketing drug safety program.

Neurointensive Subspecialty Approved

The United Council for Neurologic Subspecialties has approved neurointensive care for membership in its organization. The neurointensive care application was sponsored by the American Academy of Neurology's critical care and emergency neurology section as well as the Neurocritical Care Society and the Society of Neurosurgical Anesthesia and Critical Care. The council's accrediting body now will work with the subspecialty on requirements for fellowship programs. The programs will then be able to apply for accreditation by the council. The council also will help develop a neurointensive care certification exam. The subspecialty will be given a voting seat on the council's board of directors. Neurointensive care joins behavioral neurology and neuropsychiatry, neurooncology, clinical neuromuscular pathology, and headache medicine on the list of council-approved subspecialties. The council itself is sponsored by five parent organizations: the AAN, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology Society, and Professors of Child Neurology. Its goal is “to recognize added competence and to assist subspecialties that have matured to the point where accreditation of training programs and certification of graduates is appropriate, yet these subspecialties are not able to seek, or have not grown sufficiently for, American Board of Psychiatry and Neurology certification.”

WASHINGTON — 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 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. The three contractors, who work on a contingency basis, are PRG-Schultz International (California), Health Data Insights (Florida), and Connolly Consulting (New York). Contractors review claims that are at least a year old.

Although the contractors are paid a percentage of what they collect in overpayments, there is no similar incentive for finding underpayments. That's because it would require Medicare to pay money over and above the amount of the underpayment, “and that's money going out of the [Medicare] trust fund, not going back in,” Gerald Walters, director of the financial services group at CMS, told PPAC members at a council meeting.

Council member Dr. Peter D. Grimm, a radiation oncologist in Seattle, said he would gladly give some of the underpayment money he was due back to the contractor.

Mr. Walters said that idea had been suggested to him before, but under the terms of the demonstration program, “if even one person says, 'I'm not going to pay, give me my money,' I can't do it.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, noted that there is a “cottage industry” of companies that volunteer to review physicians' claims, find examples of undercoding, and help the physicians resubmit the claims for more money. “If you sell this as a service, it would be a reasonable business thing to do,” she said.

Council chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said he had spoken with one of the contractors who “definitely had sent out demand letters [to providers], but had not found any underpayments.” Mr. Walters said that CMS “believes it has found a way to incentivize” the contractors to target underpayments, but he did not elaborate further. Once an underpayment has been identified, the contractor must notify the appropriate Medicare carrier, which will adjust the claim and pay the provider.

Dr. Castellanos said he was happy that CMS officials had met with hospitals and physician organizations to explain the program, but he was concerned that the agency had not yet met with any carrier medical directors. The council passed a resolution urging CMS to meet with them. CMS will share data on the program with PPAC at a future meeting, and also will issue a report to Congress about the program, Mr. Walters said.

WASHINGTON — 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 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. The three contractors, who work on a contingency basis, are PRG-Schultz International (California), Health Data Insights (Florida), and Connolly Consulting (New York). Contractors review claims that are at least a year old.

Although the contractors are paid a percentage of what they collect in overpayments, there is no similar incentive for finding underpayments. That's because it would require Medicare to pay money over and above the amount of the underpayment, “and that's money going out of the [Medicare] trust fund, not going back in,” Gerald Walters, director of the financial services group at CMS, told PPAC members at a council meeting.

Council member Dr. Peter D. Grimm, a radiation oncologist in Seattle, said he would gladly give some of the underpayment money he was due back to the contractor.

Mr. Walters said that idea had been suggested to him before, but under the terms of the demonstration program, “if even one person says, 'I'm not going to pay, give me my money,' I can't do it.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, noted that there is a “cottage industry” of companies that volunteer to review physicians' claims, find examples of undercoding, and help the physicians resubmit the claims for more money. “If you sell this as a service, it would be a reasonable business thing to do,” she said.

Council chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said he had spoken with one of the contractors who “definitely had sent out demand letters [to providers], but had not found any underpayments.” Mr. Walters said that CMS “believes it has found a way to incentivize” the contractors to target underpayments, but he did not elaborate further. Once an underpayment has been identified, the contractor must notify the appropriate Medicare carrier, which will adjust the claim and pay the provider.

Dr. Castellanos said he was happy that CMS officials had met with hospitals and physician organizations to explain the program, but he was concerned that the agency had not yet met with any carrier medical directors. The council passed a resolution urging CMS to meet with them. CMS will share data on the program with PPAC at a future meeting, and also will issue a report to Congress about the program, Mr. Walters said.

WASHINGTON — 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 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. The three contractors, who work on a contingency basis, are PRG-Schultz International (California), Health Data Insights (Florida), and Connolly Consulting (New York). Contractors review claims that are at least a year old.

Although the contractors are paid a percentage of what they collect in overpayments, there is no similar incentive for finding underpayments. That's because it would require Medicare to pay money over and above the amount of the underpayment, “and that's money going out of the [Medicare] trust fund, not going back in,” Gerald Walters, director of the financial services group at CMS, told PPAC members at a council meeting.

Council member Dr. Peter D. Grimm, a radiation oncologist in Seattle, said he would gladly give some of the underpayment money he was due back to the contractor.

Mr. Walters said that idea had been suggested to him before, but under the terms of the demonstration program, “if even one person says, 'I'm not going to pay, give me my money,' I can't do it.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, noted that there is a “cottage industry” of companies that volunteer to review physicians' claims, find examples of undercoding, and help the physicians resubmit the claims for more money. “If you sell this as a service, it would be a reasonable business thing to do,” she said.

Council chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said he had spoken with one of the contractors who “definitely had sent out demand letters [to providers], but had not found any underpayments.” Mr. Walters said that CMS “believes it has found a way to incentivize” the contractors to target underpayments, but he did not elaborate further. Once an underpayment has been identified, the contractor must notify the appropriate Medicare carrier, which will adjust the claim and pay the provider.

Dr. Castellanos said he was happy that CMS officials had met with hospitals and physician organizations to explain the program, but he was concerned that the agency had not yet met with any carrier medical directors. The council passed a resolution urging CMS to meet with them. CMS will share data on the program with PPAC at a future meeting, and also will issue a report to Congress about the program, Mr. Walters said.

WASHINGTON — Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.

Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.

When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “Hospitals are afraid to even report information about quality, but the idea that they could be penalized financially … the [AHA] thought it would never happen. But there were 300 hospitals on board immediately.”

Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would volunteer to report 36 pieces of data on their practices. The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” he said.

Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance. That doesn't mean the AMA is going to support it.”

The program uses “G codes” to enter the data, which can make for a bit of a hassle for physicians not familiar with them. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.

Other pay-for-performance demonstration projects include:

▸ Group Physician Practice Demonstration. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.

▸ Coordinated Care Demonstration. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.

▸ Benefits Improvement and Protection Act (BIPA) Disease Management Demonstration. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.

“Watch the demonstrations—watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”

WASHINGTON — Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.

Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.

When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “Hospitals are afraid to even report information about quality, but the idea that they could be penalized financially … the [AHA] thought it would never happen. But there were 300 hospitals on board immediately.”

Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would volunteer to report 36 pieces of data on their practices. The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” he said.

Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance. That doesn't mean the AMA is going to support it.”

The program uses “G codes” to enter the data, which can make for a bit of a hassle for physicians not familiar with them. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.

Other pay-for-performance demonstration projects include:

▸ Group Physician Practice Demonstration. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.

▸ Coordinated Care Demonstration. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.

▸ Benefits Improvement and Protection Act (BIPA) Disease Management Demonstration. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.

“Watch the demonstrations—watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”

WASHINGTON — Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.

Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.

When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “Hospitals are afraid to even report information about quality, but the idea that they could be penalized financially … the [AHA] thought it would never happen. But there were 300 hospitals on board immediately.”

Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would volunteer to report 36 pieces of data on their practices. The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” he said.

Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance. That doesn't mean the AMA is going to support it.”

The program uses “G codes” to enter the data, which can make for a bit of a hassle for physicians not familiar with them. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.

Other pay-for-performance demonstration projects include:

▸ Group Physician Practice Demonstration. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.

▸ Coordinated Care Demonstration. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.

▸ Benefits Improvement and Protection Act (BIPA) Disease Management Demonstration. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.

“Watch the demonstrations—watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”

APA Policy Outlook for 2006

The American Psychiatric Association is keeping an eye on a host of issues for the New Year. Once again, securing parity for mental health care treatment is at the top of the APA's list of priorities. Other issues being watched by the organization are expansion of the psychiatric workforce, implementation of the Medicare drug benefit, and National Institutes of Health (NIH) funding, according to Nicholas Meyers, director of government relations at the APA, Arlington, Va.

Mental Health Parity

The APA hopes that Congress will pass legislation requiring nondiscriminatory coverage for treatment of mental illness. “We have last year's bill introduced in the House, with the addition of [parity for] alcohol and substance abuse treatment,” Mr. Meyers said. He said the group is waiting for Sen. Ted Kennedy [D-Mass.] and Sen. Pete Domenici [R-N.M.] to introduce companion legislation in the Senate. The last parity bill in Congress had the support of two-thirds of the Senate and half of the House. Why did it not pass? “Timing is everything. The issue isn't parity; it's business objections to what they perceive is a coverage mandate,” he said. Further, he said, Congress has been preoccupied with Iraq and issues such as Medicare and Medicaid.

Addressing Medicare

The parity bills now in Congress apply only to private health insurance plans, Mr. Meyers pointed out. The bills do not address Medicare, even though Medicare beneficiaries have to pay a higher copay–50% of the bill–for mental health care than they do for physical health care, for which they pay only 20%. There are bills in both the Senate and the House that would gradually phase out the 50% copay and lower it to 20%, the same as for all other services, he said.

New Drug Benefit

The APA also is aiming for technical changes to the new Medicare drug benefit–for instance, making sure mental health patients have appropriate access to psychotropic drugs. One problem is the exclusion of benzodiazepines from the new coverage, “but there are lots of ways of limiting access beyond not covering a drug, like tiered pricing and 'fail first' policies,” Mr. Meyers said. The association is concerned that various Medicare prescription drug plans are treating coverage for buprenorphine and other alcohol-abuse and opioid-dependence drugs in different ways. Then there is the fate of dual eligibles–mental health patients who are on both Medicare and Medicaid. They formerly got drug coverage through the Medicaid program, but they now will get coverage through Medicare. “This requires a broad knowledge base and a lot of work by psychiatrists, who will be asked questions by patients and have to know what happens if they prescribe a particular medication and it's not covered, or if the patient will have to pay more, or if it's not covered until the patient has failed on another drug that [the psychiatrist] knows isn't going to work.”

NIH Issues

The APA has two areas of concern when it comes to NIH: reorganization and budget issues, Mr. Meyers said. “Potentially, the reorganization of NIH would be an attempt to restructure it.” In written testimony to the House Committee on Energy and Commerce last July, NIH Director Dr. Elias A. Zerhouni did not address reorganization directly, except to say, “I agree that each institute and center should have a defined purpose in support of the overall mission of NIH.” He also talked about having an office that would coordinate research projects that spanned various NIH institutes. Mr. Meyers also is concerned about a slowdown in funding for NIH. He predicted that the agency would still get an increase in funding but that it would be smaller than that seen over the last several years.

Psychiatric Subspecialties

Another issue of importance to the APA is keeping up the supply of practitioners in some of the psychiatric subspecialties, particularly geriatric psychiatrists and child and adolescent psychiatrists. The association is interested in a bill sponsored by Rep. Patrick Kennedy (D-R.I.) that would allow the government to repay up to $35,000 in educational loans or provide scholarships to medical students who agree to provide child and adolescent mental health care for at least 2 years. On the geriatric side, the Positive Aging Act, sponsored by Sen. Hillary Rodham Clinton (D-N.Y.) in the Senate and Rep. Kennedy in the House, would establish a deputy director for older adult mental health services within the Substance Abuse and Mental Health Services Administration to “develop model training programs for mental health professionals and caregivers serving older adults,” among other responsibilities.

Privacy Concerns

Health privacy is also a major issue. “We have really serious concerns about maintenance of medical records confidentiality” under laws such as the Patriot Act and the Health Insurance Portability and Accountability Act, Mr. Meyers said. “We are concerned about the ability of government agencies to snoop in people's health records.” In addition, the advent of electronic health records brings its own privacy concerns. “On the plus side, electronic records help reduce medical errors and assure that physicians are able to get real-time records about what kind of medications patients are on,” he said. “On the other hand, unless there are acceptable standards for the protection of records, such as informed consent with regard to their release, we are obviously concerned about what effect this has on patients.”

APA Policy Outlook for 2006

The American Psychiatric Association is keeping an eye on a host of issues for the New Year. Once again, securing parity for mental health care treatment is at the top of the APA's list of priorities. Other issues being watched by the organization are expansion of the psychiatric workforce, implementation of the Medicare drug benefit, and National Institutes of Health (NIH) funding, according to Nicholas Meyers, director of government relations at the APA, Arlington, Va.

Mental Health Parity

The APA hopes that Congress will pass legislation requiring nondiscriminatory coverage for treatment of mental illness. “We have last year's bill introduced in the House, with the addition of [parity for] alcohol and substance abuse treatment,” Mr. Meyers said. He said the group is waiting for Sen. Ted Kennedy [D-Mass.] and Sen. Pete Domenici [R-N.M.] to introduce companion legislation in the Senate. The last parity bill in Congress had the support of two-thirds of the Senate and half of the House. Why did it not pass? “Timing is everything. The issue isn't parity; it's business objections to what they perceive is a coverage mandate,” he said. Further, he said, Congress has been preoccupied with Iraq and issues such as Medicare and Medicaid.

Addressing Medicare

The parity bills now in Congress apply only to private health insurance plans, Mr. Meyers pointed out. The bills do not address Medicare, even though Medicare beneficiaries have to pay a higher copay–50% of the bill–for mental health care than they do for physical health care, for which they pay only 20%. There are bills in both the Senate and the House that would gradually phase out the 50% copay and lower it to 20%, the same as for all other services, he said.

New Drug Benefit

The APA also is aiming for technical changes to the new Medicare drug benefit–for instance, making sure mental health patients have appropriate access to psychotropic drugs. One problem is the exclusion of benzodiazepines from the new coverage, “but there are lots of ways of limiting access beyond not covering a drug, like tiered pricing and 'fail first' policies,” Mr. Meyers said. The association is concerned that various Medicare prescription drug plans are treating coverage for buprenorphine and other alcohol-abuse and opioid-dependence drugs in different ways. Then there is the fate of dual eligibles–mental health patients who are on both Medicare and Medicaid. They formerly got drug coverage through the Medicaid program, but they now will get coverage through Medicare. “This requires a broad knowledge base and a lot of work by psychiatrists, who will be asked questions by patients and have to know what happens if they prescribe a particular medication and it's not covered, or if the patient will have to pay more, or if it's not covered until the patient has failed on another drug that [the psychiatrist] knows isn't going to work.”

NIH Issues

The APA has two areas of concern when it comes to NIH: reorganization and budget issues, Mr. Meyers said. “Potentially, the reorganization of NIH would be an attempt to restructure it.” In written testimony to the House Committee on Energy and Commerce last July, NIH Director Dr. Elias A. Zerhouni did not address reorganization directly, except to say, “I agree that each institute and center should have a defined purpose in support of the overall mission of NIH.” He also talked about having an office that would coordinate research projects that spanned various NIH institutes. Mr. Meyers also is concerned about a slowdown in funding for NIH. He predicted that the agency would still get an increase in funding but that it would be smaller than that seen over the last several years.

Psychiatric Subspecialties

Another issue of importance to the APA is keeping up the supply of practitioners in some of the psychiatric subspecialties, particularly geriatric psychiatrists and child and adolescent psychiatrists. The association is interested in a bill sponsored by Rep. Patrick Kennedy (D-R.I.) that would allow the government to repay up to $35,000 in educational loans or provide scholarships to medical students who agree to provide child and adolescent mental health care for at least 2 years. On the geriatric side, the Positive Aging Act, sponsored by Sen. Hillary Rodham Clinton (D-N.Y.) in the Senate and Rep. Kennedy in the House, would establish a deputy director for older adult mental health services within the Substance Abuse and Mental Health Services Administration to “develop model training programs for mental health professionals and caregivers serving older adults,” among other responsibilities.

Privacy Concerns

Health privacy is also a major issue. “We have really serious concerns about maintenance of medical records confidentiality” under laws such as the Patriot Act and the Health Insurance Portability and Accountability Act, Mr. Meyers said. “We are concerned about the ability of government agencies to snoop in people's health records.” In addition, the advent of electronic health records brings its own privacy concerns. “On the plus side, electronic records help reduce medical errors and assure that physicians are able to get real-time records about what kind of medications patients are on,” he said. “On the other hand, unless there are acceptable standards for the protection of records, such as informed consent with regard to their release, we are obviously concerned about what effect this has on patients.”

APA Policy Outlook for 2006

The American Psychiatric Association is keeping an eye on a host of issues for the New Year. Once again, securing parity for mental health care treatment is at the top of the APA's list of priorities. Other issues being watched by the organization are expansion of the psychiatric workforce, implementation of the Medicare drug benefit, and National Institutes of Health (NIH) funding, according to Nicholas Meyers, director of government relations at the APA, Arlington, Va.

Mental Health Parity

The APA hopes that Congress will pass legislation requiring nondiscriminatory coverage for treatment of mental illness. “We have last year's bill introduced in the House, with the addition of [parity for] alcohol and substance abuse treatment,” Mr. Meyers said. He said the group is waiting for Sen. Ted Kennedy [D-Mass.] and Sen. Pete Domenici [R-N.M.] to introduce companion legislation in the Senate. The last parity bill in Congress had the support of two-thirds of the Senate and half of the House. Why did it not pass? “Timing is everything. The issue isn't parity; it's business objections to what they perceive is a coverage mandate,” he said. Further, he said, Congress has been preoccupied with Iraq and issues such as Medicare and Medicaid.

Addressing Medicare

The parity bills now in Congress apply only to private health insurance plans, Mr. Meyers pointed out. The bills do not address Medicare, even though Medicare beneficiaries have to pay a higher copay–50% of the bill–for mental health care than they do for physical health care, for which they pay only 20%. There are bills in both the Senate and the House that would gradually phase out the 50% copay and lower it to 20%, the same as for all other services, he said.

New Drug Benefit

The APA also is aiming for technical changes to the new Medicare drug benefit–for instance, making sure mental health patients have appropriate access to psychotropic drugs. One problem is the exclusion of benzodiazepines from the new coverage, “but there are lots of ways of limiting access beyond not covering a drug, like tiered pricing and 'fail first' policies,” Mr. Meyers said. The association is concerned that various Medicare prescription drug plans are treating coverage for buprenorphine and other alcohol-abuse and opioid-dependence drugs in different ways. Then there is the fate of dual eligibles–mental health patients who are on both Medicare and Medicaid. They formerly got drug coverage through the Medicaid program, but they now will get coverage through Medicare. “This requires a broad knowledge base and a lot of work by psychiatrists, who will be asked questions by patients and have to know what happens if they prescribe a particular medication and it's not covered, or if the patient will have to pay more, or if it's not covered until the patient has failed on another drug that [the psychiatrist] knows isn't going to work.”

NIH Issues

The APA has two areas of concern when it comes to NIH: reorganization and budget issues, Mr. Meyers said. “Potentially, the reorganization of NIH would be an attempt to restructure it.” In written testimony to the House Committee on Energy and Commerce last July, NIH Director Dr. Elias A. Zerhouni did not address reorganization directly, except to say, “I agree that each institute and center should have a defined purpose in support of the overall mission of NIH.” He also talked about having an office that would coordinate research projects that spanned various NIH institutes. Mr. Meyers also is concerned about a slowdown in funding for NIH. He predicted that the agency would still get an increase in funding but that it would be smaller than that seen over the last several years.

Psychiatric Subspecialties

Another issue of importance to the APA is keeping up the supply of practitioners in some of the psychiatric subspecialties, particularly geriatric psychiatrists and child and adolescent psychiatrists. The association is interested in a bill sponsored by Rep. Patrick Kennedy (D-R.I.) that would allow the government to repay up to $35,000 in educational loans or provide scholarships to medical students who agree to provide child and adolescent mental health care for at least 2 years. On the geriatric side, the Positive Aging Act, sponsored by Sen. Hillary Rodham Clinton (D-N.Y.) in the Senate and Rep. Kennedy in the House, would establish a deputy director for older adult mental health services within the Substance Abuse and Mental Health Services Administration to “develop model training programs for mental health professionals and caregivers serving older adults,” among other responsibilities.

Privacy Concerns

Health privacy is also a major issue. “We have really serious concerns about maintenance of medical records confidentiality” under laws such as the Patriot Act and the Health Insurance Portability and Accountability Act, Mr. Meyers said. “We are concerned about the ability of government agencies to snoop in people's health records.” In addition, the advent of electronic health records brings its own privacy concerns. “On the plus side, electronic records help reduce medical errors and assure that physicians are able to get real-time records about what kind of medications patients are on,” he said. “On the other hand, unless there are acceptable standards for the protection of records, such as informed consent with regard to their release, we are obviously concerned about what effect this has on patients.”

WASHINGTON – Physicians who are too nervous to completely convert their offices to electronic health 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 EHR 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 [EHR] 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 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 who are too nervous to completely convert their offices to electronic health 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 EHR 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 [EHR] 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 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 who are too nervous to completely convert their offices to electronic health 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 EHR 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 [EHR] 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 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.

MONTREAL – Attention-deficit hyperactivity disorder is underdiagnosed among African American children, but African American parents suspect otherwise, Dr. Rahn Bailey said at the annual meeting of the American Academy of Psychiatry and the Law.

In a survey of 226 African American parents and 262 white parents, Dr. Bailey, a psychiatrist in private practice in League City, Tex., found striking differences in their perception of ADHD and its diagnosis. For instance, 41% of African Americans surveyed agreed that “African Americans are more likely than other ethnic groups to be diagnosed with ADHD,” compared with 13% of white respondents.

Similarly, 45% of African Americans agreed with the statement, “Teachers are more likely to suspect ADHD in African American children with learning or behavioral problems than in other ethnic groups.” About 12% of white parents agreed with that statement.

African Americans also were more concerned about the disease itself, with 71% saying that they “would be very concerned” if their children were diagnosed with ADHD, compared with 53% of white respondents. In addition, fewer African Americans–64% vs. 79% of whites–said they would know where to go for help if their children were diagnosed with the disorder.

“African Americans are less likely to go for diagnosis and care, and if they get the medicine, are less likely to take it,” Dr. Bailey said. And although African Americans think ADHD is overdiagnosed in their population, it is actually underdiagnosed because school personnel suspect conditions such as oppositional defiant disorder or conduct disorder, without being aware that those conditions can coexist with ADHD, he added.

African American parents also are less familiar with ADHD in general, with 10% saying they are “not at all familiar” with it, compared with 2% of white parents. And misperceptions about the disorder are common. One survey, for example, found that twice as many African American parents–59%–as white parents attribute ADHD to sugar in the diet.

“That's a point for education, for all doctors, to be aware of,” Dr. Bailey said. “It emphasizes that the misperceptions people get from the media can have more impact on what they believe and their resulting behavior than what they receive from physicians.”

As a result of this lack of knowledge, “it just stands to reason that in that setting, you are a lot less likely to receive a positive outcome or a fair outcome or a good outcome,” Dr. Bailey said.

“These families are less likely to go for diagnosis and care, and if they do go, they are more likely to go late. If they get a prescription, they are less likely to take it. It's very clear that, in the African American community, the prescription least likely to be filled in the first place is an ADHD prescription.”

MONTREAL – Attention-deficit hyperactivity disorder is underdiagnosed among African American children, but African American parents suspect otherwise, Dr. Rahn Bailey said at the annual meeting of the American Academy of Psychiatry and the Law.

In a survey of 226 African American parents and 262 white parents, Dr. Bailey, a psychiatrist in private practice in League City, Tex., found striking differences in their perception of ADHD and its diagnosis. For instance, 41% of African Americans surveyed agreed that “African Americans are more likely than other ethnic groups to be diagnosed with ADHD,” compared with 13% of white respondents.

Similarly, 45% of African Americans agreed with the statement, “Teachers are more likely to suspect ADHD in African American children with learning or behavioral problems than in other ethnic groups.” About 12% of white parents agreed with that statement.

African Americans also were more concerned about the disease itself, with 71% saying that they “would be very concerned” if their children were diagnosed with ADHD, compared with 53% of white respondents. In addition, fewer African Americans–64% vs. 79% of whites–said they would know where to go for help if their children were diagnosed with the disorder.

“African Americans are less likely to go for diagnosis and care, and if they get the medicine, are less likely to take it,” Dr. Bailey said. And although African Americans think ADHD is overdiagnosed in their population, it is actually underdiagnosed because school personnel suspect conditions such as oppositional defiant disorder or conduct disorder, without being aware that those conditions can coexist with ADHD, he added.

African American parents also are less familiar with ADHD in general, with 10% saying they are “not at all familiar” with it, compared with 2% of white parents. And misperceptions about the disorder are common. One survey, for example, found that twice as many African American parents–59%–as white parents attribute ADHD to sugar in the diet.

“That's a point for education, for all doctors, to be aware of,” Dr. Bailey said. “It emphasizes that the misperceptions people get from the media can have more impact on what they believe and their resulting behavior than what they receive from physicians.”

As a result of this lack of knowledge, “it just stands to reason that in that setting, you are a lot less likely to receive a positive outcome or a fair outcome or a good outcome,” Dr. Bailey said.

“These families are less likely to go for diagnosis and care, and if they do go, they are more likely to go late. If they get a prescription, they are less likely to take it. It's very clear that, in the African American community, the prescription least likely to be filled in the first place is an ADHD prescription.”

MONTREAL – Attention-deficit hyperactivity disorder is underdiagnosed among African American children, but African American parents suspect otherwise, Dr. Rahn Bailey said at the annual meeting of the American Academy of Psychiatry and the Law.

In a survey of 226 African American parents and 262 white parents, Dr. Bailey, a psychiatrist in private practice in League City, Tex., found striking differences in their perception of ADHD and its diagnosis. For instance, 41% of African Americans surveyed agreed that “African Americans are more likely than other ethnic groups to be diagnosed with ADHD,” compared with 13% of white respondents.

Similarly, 45% of African Americans agreed with the statement, “Teachers are more likely to suspect ADHD in African American children with learning or behavioral problems than in other ethnic groups.” About 12% of white parents agreed with that statement.

African Americans also were more concerned about the disease itself, with 71% saying that they “would be very concerned” if their children were diagnosed with ADHD, compared with 53% of white respondents. In addition, fewer African Americans–64% vs. 79% of whites–said they would know where to go for help if their children were diagnosed with the disorder.

“African Americans are less likely to go for diagnosis and care, and if they get the medicine, are less likely to take it,” Dr. Bailey said. And although African Americans think ADHD is overdiagnosed in their population, it is actually underdiagnosed because school personnel suspect conditions such as oppositional defiant disorder or conduct disorder, without being aware that those conditions can coexist with ADHD, he added.

African American parents also are less familiar with ADHD in general, with 10% saying they are “not at all familiar” with it, compared with 2% of white parents. And misperceptions about the disorder are common. One survey, for example, found that twice as many African American parents–59%–as white parents attribute ADHD to sugar in the diet.

“That's a point for education, for all doctors, to be aware of,” Dr. Bailey said. “It emphasizes that the misperceptions people get from the media can have more impact on what they believe and their resulting behavior than what they receive from physicians.”

As a result of this lack of knowledge, “it just stands to reason that in that setting, you are a lot less likely to receive a positive outcome or a fair outcome or a good outcome,” Dr. Bailey said.

“These families are less likely to go for diagnosis and care, and if they do go, they are more likely to go late. If they get a prescription, they are less likely to take it. It's very clear that, in the African American community, the prescription least likely to be filled in the first place is an ADHD prescription.”

WASHINGTON – Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.

Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.

When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “But there were 300 hospitals on board immediately.”

Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would report 36 pieces of data on their practices.

The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” said Mr. Flick. “But it is a very important step that CMS is taking, and it is physicians saying, 'I want to report information because I'd like to know if my performance varies in a significant way from my peers.'

Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance.”

The program uses “G codes” to enter the data, which can make for a bit of a hassle for those unfamiliar. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.

Other projects demonstrating pay-for-performance include:

▸ Group Physician Practice. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.

▸ Coordinated Care. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.

▸ Benefits Improvement and Protection Act (BIPA) Disease Management. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.

“Watch the demonstrations–watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”

WASHINGTON – Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.

Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.

When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “But there were 300 hospitals on board immediately.”

Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would report 36 pieces of data on their practices.

The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” said Mr. Flick. “But it is a very important step that CMS is taking, and it is physicians saying, 'I want to report information because I'd like to know if my performance varies in a significant way from my peers.'

Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance.”

The program uses “G codes” to enter the data, which can make for a bit of a hassle for those unfamiliar. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.

Other projects demonstrating pay-for-performance include:

▸ Group Physician Practice. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.

▸ Coordinated Care. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.

▸ Benefits Improvement and Protection Act (BIPA) Disease Management. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.

“Watch the demonstrations–watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”

WASHINGTON – Provider groups are behind the curve when it comes to anticipating acceptance of pay-for-performance programs, Jeff Flick said at a health care congress sponsored by the Wall Street Journal and the CNBC.

Take, for instance, the Premier Hospital Quality Incentive Demonstration program funded by the Centers for Medicare and Medicaid Services, under which hospitals report data on 34 quality measures, said Mr. Flick, the CMS regional administrator in San Francisco. The program gives a bonus each year to the 20% of hospitals with the highest score, but those who have not improved a certain amount after 3 years are penalized.

When the program was launched several years ago, “The American Hospital Association said, 'No hospital is going to do this,'” Mr. Flick said. “But there were 300 hospitals on board immediately.”

Similarly, the American Medical Association recently said it did not support CMS's new physician voluntary reporting program, under which physicians would report 36 pieces of data on their practices.

The AMA's opposition “is not a shock; those kinds of organizations are very nervous about this,” said Mr. Flick. “But it is a very important step that CMS is taking, and it is physicians saying, 'I want to report information because I'd like to know if my performance varies in a significant way from my peers.'

Many physicians are ready to start focusing on quality, he continued. “They want to publish information, they want to know how they compare, they want to be paid based on performance.”

The program uses “G codes” to enter the data, which can make for a bit of a hassle for those unfamiliar. “If every physician in this country had an [electronic health record], this would be easy; I think this would be done,” he said.

Other projects demonstrating pay-for-performance include:

▸ Group Physician Practice. Large multispecialty practices will be rewarded financially for improving care for chronically ill Medicare patients.

▸ Coordinated Care. Hospitals and other health care organizations in 15 sites are trying to prove that providing coordinated care for patients with particular chronic illnesses will increase patient satisfaction and save Medicare money.

▸ Benefits Improvement and Protection Act (BIPA) Disease Management. This program coordinates care and provides a prescription drug benefit for up to 30,000 patients with diabetes, congestive heart failure, and coronary artery disease.

“Watch the demonstrations–watch them very carefully,” Mr. Flick said. “They give a very good picture of where CMS thinks it's going to go.”