Joyce Frieden

WASHINGTON — The term “prenatal care” should be rethought to include much more of a woman's life cycle, Dawn Misra, Ph.D., said at a meeting sponsored by the Jacobs Institute of Women's Health.

“We have to go beyond the [typical] prenatal period” that covers only a few months before pregnancy, said Dr. Misra of the University of Michigan, Ann Arbor. When it comes to chronic illnesses that may affect pregnancy, for example, “We have to plan strategies to address these matters across the life course; if we want to fix them, we can't wait until pregnancy to [address] them.”

Dr. Misra gave hypertension as an example. “There really is no good treatment for hypertension once you're pregnant,” she said. “You can do some things to try to moderate its effects and lessen its impact, but you can't fix it. So [instead] we could prevent women from having hypertension and entering pregnancy with hypertension.” This involves addressing such chronic health problems in the preconception period as well as between pregnancies.

She gave several reasons why providers haven't taken this approach. “Public health and medical professionals are wedded to the notion that prenatal care is fundamental,” she said. “There have been a lot of successes with prenatal care, but I would like to take a step back and think about how prenatal care is not the only answer.”

The health care financing system has encouraged this model of prenatal care by the way it reimburses for care, she continued. As a result, “Very few women get no prenatal care, yet we haven't achieved much improvement in terms of infant outcomes.”

Changing this system of care would also mean increasing involvement by providers outside the specialty of ob.gyn., such as pediatricians, Dr. Misra said. “Pediatricians are taking care of future mothers. They could spend time from that perspective thinking about chronic illnesses, keeping [these patients] well, and thinking about what future concerns might be.”

Some of these changes might be fostered by improving medical school training. In addition, people from outside the medical profession such as coaches and personal trainers could be involved in these types of issues, she said.

Pediatricians could also help provide better record transfer, Dr. Misra noted. “We have young girls moving from the pediatrician to the ob.gyn. or the nurse-midwife. A lot is lost when young girls move to those providers, and we need to find better ways to relay their health history.” This is a challenge that needs to be met, especially in the wake of a study showing that 25% of pregnant women have a chronic health condition, Dr. Misra added.

On a broader level, public health officials need to rethink their method of separating chronic disease care from maternal and child health programming, Dr. Misra said.

WASHINGTON — The term “prenatal care” should be rethought to include much more of a woman's life cycle, Dawn Misra, Ph.D., said at a meeting sponsored by the Jacobs Institute of Women's Health.

“We have to go beyond the [typical] prenatal period” that covers only a few months before pregnancy, said Dr. Misra of the University of Michigan, Ann Arbor. When it comes to chronic illnesses that may affect pregnancy, for example, “We have to plan strategies to address these matters across the life course; if we want to fix them, we can't wait until pregnancy to [address] them.”

Dr. Misra gave hypertension as an example. “There really is no good treatment for hypertension once you're pregnant,” she said. “You can do some things to try to moderate its effects and lessen its impact, but you can't fix it. So [instead] we could prevent women from having hypertension and entering pregnancy with hypertension.” This involves addressing such chronic health problems in the preconception period as well as between pregnancies.

She gave several reasons why providers haven't taken this approach. “Public health and medical professionals are wedded to the notion that prenatal care is fundamental,” she said. “There have been a lot of successes with prenatal care, but I would like to take a step back and think about how prenatal care is not the only answer.”

The health care financing system has encouraged this model of prenatal care by the way it reimburses for care, she continued. As a result, “Very few women get no prenatal care, yet we haven't achieved much improvement in terms of infant outcomes.”

Changing this system of care would also mean increasing involvement by providers outside the specialty of ob.gyn., such as pediatricians, Dr. Misra said. “Pediatricians are taking care of future mothers. They could spend time from that perspective thinking about chronic illnesses, keeping [these patients] well, and thinking about what future concerns might be.”

Some of these changes might be fostered by improving medical school training. In addition, people from outside the medical profession such as coaches and personal trainers could be involved in these types of issues, she said.

Pediatricians could also help provide better record transfer, Dr. Misra noted. “We have young girls moving from the pediatrician to the ob.gyn. or the nurse-midwife. A lot is lost when young girls move to those providers, and we need to find better ways to relay their health history.” This is a challenge that needs to be met, especially in the wake of a study showing that 25% of pregnant women have a chronic health condition, Dr. Misra added.

On a broader level, public health officials need to rethink their method of separating chronic disease care from maternal and child health programming, Dr. Misra said.

WASHINGTON — The term “prenatal care” should be rethought to include much more of a woman's life cycle, Dawn Misra, Ph.D., said at a meeting sponsored by the Jacobs Institute of Women's Health.

“We have to go beyond the [typical] prenatal period” that covers only a few months before pregnancy, said Dr. Misra of the University of Michigan, Ann Arbor. When it comes to chronic illnesses that may affect pregnancy, for example, “We have to plan strategies to address these matters across the life course; if we want to fix them, we can't wait until pregnancy to [address] them.”

Dr. Misra gave hypertension as an example. “There really is no good treatment for hypertension once you're pregnant,” she said. “You can do some things to try to moderate its effects and lessen its impact, but you can't fix it. So [instead] we could prevent women from having hypertension and entering pregnancy with hypertension.” This involves addressing such chronic health problems in the preconception period as well as between pregnancies.

She gave several reasons why providers haven't taken this approach. “Public health and medical professionals are wedded to the notion that prenatal care is fundamental,” she said. “There have been a lot of successes with prenatal care, but I would like to take a step back and think about how prenatal care is not the only answer.”

The health care financing system has encouraged this model of prenatal care by the way it reimburses for care, she continued. As a result, “Very few women get no prenatal care, yet we haven't achieved much improvement in terms of infant outcomes.”

Changing this system of care would also mean increasing involvement by providers outside the specialty of ob.gyn., such as pediatricians, Dr. Misra said. “Pediatricians are taking care of future mothers. They could spend time from that perspective thinking about chronic illnesses, keeping [these patients] well, and thinking about what future concerns might be.”

Some of these changes might be fostered by improving medical school training. In addition, people from outside the medical profession such as coaches and personal trainers could be involved in these types of issues, she said.

Pediatricians could also help provide better record transfer, Dr. Misra noted. “We have young girls moving from the pediatrician to the ob.gyn. or the nurse-midwife. A lot is lost when young girls move to those providers, and we need to find better ways to relay their health history.” This is a challenge that needs to be met, especially in the wake of a study showing that 25% of pregnant women have a chronic health condition, Dr. Misra added.

On a broader level, public health officials need to rethink their method of separating chronic disease care from maternal and child health programming, Dr. Misra said.

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

“Insurers are recognizing that the 45 million people who are uninsured are a market,” said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. “Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50–$100 per month.”

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. “I think that's a false set of arguments,” he said. “Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance.”

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

“Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care,” she said. “We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet.”

Mr. Laszewski added that although consumer-driven health care “is a wonderful thing,” it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. “It's the sick people who blow through the deductibles and get to the out-of-pocket maximums,” he said. “Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system.”

Efforts to measure physician quality also came in for much discussion. “While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage,” said Ms. Arnold. “The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers.”

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality (OB.GYN. NEWS, June 1, 2005, p. 53). “They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard.”

The second initiative involves a group of employers and consultants who are exploring “care-focused purchasing—that is, getting health plans to aggregate their provider data so that employers and consumers can see which are the highest quality providers.

“Any one health plan can't give you a full picture of [a physician],” she said. “This is an effort by employers to get together to pull providers and health plans in.”

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market. “The biggest insurance company in the world is Medicare, and Medicare is into quality,” he said. “It's only a little bit, but the camel's nose is in the tent, and as long as Medicare is interested in rewarding providers—especially hospitals—[that exhibit] quality, I think other people are going to jump on the bandwagon.”

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

“Insurers are recognizing that the 45 million people who are uninsured are a market,” said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. “Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50–$100 per month.”

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. “I think that's a false set of arguments,” he said. “Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance.”

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

“Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care,” she said. “We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet.”

Mr. Laszewski added that although consumer-driven health care “is a wonderful thing,” it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. “It's the sick people who blow through the deductibles and get to the out-of-pocket maximums,” he said. “Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system.”

Efforts to measure physician quality also came in for much discussion. “While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage,” said Ms. Arnold. “The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers.”

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality (OB.GYN. NEWS, June 1, 2005, p. 53). “They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard.”

The second initiative involves a group of employers and consultants who are exploring “care-focused purchasing—that is, getting health plans to aggregate their provider data so that employers and consumers can see which are the highest quality providers.

“Any one health plan can't give you a full picture of [a physician],” she said. “This is an effort by employers to get together to pull providers and health plans in.”

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market. “The biggest insurance company in the world is Medicare, and Medicare is into quality,” he said. “It's only a little bit, but the camel's nose is in the tent, and as long as Medicare is interested in rewarding providers—especially hospitals—[that exhibit] quality, I think other people are going to jump on the bandwagon.”

WASHINGTON — Expect more health plans to offer limited insurance policies for people who are currently uninsured, Robert Laszewski said at a press briefing sponsored by the Center for Studying Health System Change.

“Insurers are recognizing that the 45 million people who are uninsured are a market,” said Mr. Laszewski, founder and president of Health Policy and Strategy Associates, a consulting firm. “Now, they're not a market for comprehensive major medical insurance, but they are a market for very limited benefits programs, programs that cost perhaps $50–$100 per month.”

He added that such plans—which typically include a wellness checkup every other year, a few visits to a primary care physician, and a drug benefit based on generic drugs—have come under criticism for not doing enough to help the uninsured. “I think that's a false set of arguments,” he said. “Of course they're not going to solve the problems of the uninsured, but [they] do respond to the needs of people who cannot afford health insurance.”

Most speakers at the conference also were upbeat about the future of consumer-driven health plans, such as health savings accounts (HSAs), although Christine Arnold, an executive director specializing in managed care at New York brokerage firm Morgan Stanley, noted that such plans are still a very small part of employers' health insurance offerings.

“Less than 5% of any HMO's total book of business is right now in any form of consumer-directed health care,” she said. “We may be on the cusp of a product revolution, which I've been hoping for, but I don't think it's here yet.”

Mr. Laszewski added that although consumer-driven health care “is a wonderful thing,” it focuses on first-dollar benefits rather than on the real problem in health care spending: that 75% of the costs are incurred by the 15% of people who are very ill. “It's the sick people who blow through the deductibles and get to the out-of-pocket maximums,” he said. “Sick people are the ones who control costs. Consumer-driven health care is a wonderful thing, but when the day is done, the incentives haven't fundamentally changed. In about another year or two, we're going to get this out of our system.”

Efforts to measure physician quality also came in for much discussion. “While I think 'sabotage' is a strong word, I would say there has been resistance by the health plans because each of them is trying to use this initiative as a competitive advantage,” said Ms. Arnold. “The tug of war is that employers want this on a macro basis—they want a Consumer Reports for providers.”

Two new initiatives could help consumers and employers compare health care quality, Ms. Arnold said. One is the Ambulatory Care Quality Alliance, a project of the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality (OB.GYN. NEWS, June 1, 2005, p. 53). “They are trying to put together an objective list of measures. How do we measure who is a good provider? As we think about ways to assess quality, I think we need a standard.”

The second initiative involves a group of employers and consultants who are exploring “care-focused purchasing—that is, getting health plans to aggregate their provider data so that employers and consumers can see which are the highest quality providers.

“Any one health plan can't give you a full picture of [a physician],” she said. “This is an effort by employers to get together to pull providers and health plans in.”

Frederic Martucci, a managing director specializing in not-for-profit companies at Fitch Ratings, a New York credit-rating firm, said that Medicare's efforts to measure provider quality are likely to have a big impact on the health care market. “The biggest insurance company in the world is Medicare, and Medicare is into quality,” he said. “It's only a little bit, but the camel's nose is in the tent, and as long as Medicare is interested in rewarding providers—especially hospitals—[that exhibit] quality, I think other people are going to jump on the bandwagon.”

WASHINGTON — The Centers for Medicare and Medicaid Services has revised its rules for reimbursement for power wheelchairs and scooters.

“This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility,” CMS Administrator Mark McClellan, M.D., said in a statement. The rule “is part of a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending.”

Physicians and other providers criticized the old reimbursement criteria as too burdensome, since they required physicians to provide a certificate of medical necessity before the wheelchair could be covered. But CMS officials were wary of loosening coverage requirements because of a rash of fraudulent wheelchair and scooter claims. The fraud reached such a high level that CMS launched its “Operator Wheeler Dealer” campaign to stop it.

Under the new regulations, the medical necessity certificate has been eliminated, but in its place, the agency is requiring certain clinical documentation items from the patient's medical record, along with a written prescription—given within 30 days of the evaluation—issued to the supplier. And the rules keep the requirement that physicians must conduct a face-to-face examination of the patient before prescribing a mobility device.

Medicare already pays for this evaluation visit. However, because of the additional documentation required under the new rules, CMS is authorizing an additional payment to physicians for preparing the paperwork. Physicians must include a special billing code on the office visit claim in order to receive this extra payment.

The agency also is removing the requirement that only certain specialists—physiatrists, orthopedic surgeons, neurologists, and rheumatologists—to prescribe power scooters. Instead, all physicians and treating practitioners will be able to prescribe scooters and power wheelchairs.

The Power Mobility Coalition (PMC), a group of mobility-device manufacturers, expressed concern that the new rules would make it tougher for physicians to comply.

“The PMC agrees with CMS that the treating physician is in the best position to assess the need for power mobility devices, but is concerned that, in order to fully succeed, CMS and its contractors will have to conduct a comprehensive review of the benefit for physicians,” the organization said in a statement. “Physicians may not be fully aware of the analytical standard that will be applied to claims, let alone which of the 49 new product codes most appropriately meets beneficiary needs.

“The PMC also has concerns over the 30-day time frame for submission of a [mobility device] claim after a physician face-to-face visit,” the statement continued. “Given the extensive documentation requirement, suppliers, especially those in rural areas, may find the 30-day time frame too tight to obtain and submit all relevant parts of the medical record, as well as the necessary supporting documentation.”

The new rules, which were published in the Aug. 26 Federal Register, will take effect Oct. 25. CMS will accept comments on the rules until Nov. 25, and a final rule will be published “at a later date,” according to the agency.

The interim final rule and accompanying fact sheet can be found online at www.cms.hhs.gov/coverage/wheelchairs.asp

WASHINGTON — The Centers for Medicare and Medicaid Services has revised its rules for reimbursement for power wheelchairs and scooters.

“This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility,” CMS Administrator Mark McClellan, M.D., said in a statement. The rule “is part of a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending.”

Physicians and other providers criticized the old reimbursement criteria as too burdensome, since they required physicians to provide a certificate of medical necessity before the wheelchair could be covered. But CMS officials were wary of loosening coverage requirements because of a rash of fraudulent wheelchair and scooter claims. The fraud reached such a high level that CMS launched its “Operator Wheeler Dealer” campaign to stop it.

Under the new regulations, the medical necessity certificate has been eliminated, but in its place, the agency is requiring certain clinical documentation items from the patient's medical record, along with a written prescription—given within 30 days of the evaluation—issued to the supplier. And the rules keep the requirement that physicians must conduct a face-to-face examination of the patient before prescribing a mobility device.

Medicare already pays for this evaluation visit. However, because of the additional documentation required under the new rules, CMS is authorizing an additional payment to physicians for preparing the paperwork. Physicians must include a special billing code on the office visit claim in order to receive this extra payment.

The agency also is removing the requirement that only certain specialists—physiatrists, orthopedic surgeons, neurologists, and rheumatologists—to prescribe power scooters. Instead, all physicians and treating practitioners will be able to prescribe scooters and power wheelchairs.

The Power Mobility Coalition (PMC), a group of mobility-device manufacturers, expressed concern that the new rules would make it tougher for physicians to comply.

“The PMC agrees with CMS that the treating physician is in the best position to assess the need for power mobility devices, but is concerned that, in order to fully succeed, CMS and its contractors will have to conduct a comprehensive review of the benefit for physicians,” the organization said in a statement. “Physicians may not be fully aware of the analytical standard that will be applied to claims, let alone which of the 49 new product codes most appropriately meets beneficiary needs.

“The PMC also has concerns over the 30-day time frame for submission of a [mobility device] claim after a physician face-to-face visit,” the statement continued. “Given the extensive documentation requirement, suppliers, especially those in rural areas, may find the 30-day time frame too tight to obtain and submit all relevant parts of the medical record, as well as the necessary supporting documentation.”

The new rules, which were published in the Aug. 26 Federal Register, will take effect Oct. 25. CMS will accept comments on the rules until Nov. 25, and a final rule will be published “at a later date,” according to the agency.

The interim final rule and accompanying fact sheet can be found online at www.cms.hhs.gov/coverage/wheelchairs.asp

WASHINGTON — The Centers for Medicare and Medicaid Services has revised its rules for reimbursement for power wheelchairs and scooters.

“This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility,” CMS Administrator Mark McClellan, M.D., said in a statement. The rule “is part of a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending.”

Physicians and other providers criticized the old reimbursement criteria as too burdensome, since they required physicians to provide a certificate of medical necessity before the wheelchair could be covered. But CMS officials were wary of loosening coverage requirements because of a rash of fraudulent wheelchair and scooter claims. The fraud reached such a high level that CMS launched its “Operator Wheeler Dealer” campaign to stop it.

Under the new regulations, the medical necessity certificate has been eliminated, but in its place, the agency is requiring certain clinical documentation items from the patient's medical record, along with a written prescription—given within 30 days of the evaluation—issued to the supplier. And the rules keep the requirement that physicians must conduct a face-to-face examination of the patient before prescribing a mobility device.

Medicare already pays for this evaluation visit. However, because of the additional documentation required under the new rules, CMS is authorizing an additional payment to physicians for preparing the paperwork. Physicians must include a special billing code on the office visit claim in order to receive this extra payment.

The agency also is removing the requirement that only certain specialists—physiatrists, orthopedic surgeons, neurologists, and rheumatologists—to prescribe power scooters. Instead, all physicians and treating practitioners will be able to prescribe scooters and power wheelchairs.

The Power Mobility Coalition (PMC), a group of mobility-device manufacturers, expressed concern that the new rules would make it tougher for physicians to comply.

“The PMC agrees with CMS that the treating physician is in the best position to assess the need for power mobility devices, but is concerned that, in order to fully succeed, CMS and its contractors will have to conduct a comprehensive review of the benefit for physicians,” the organization said in a statement. “Physicians may not be fully aware of the analytical standard that will be applied to claims, let alone which of the 49 new product codes most appropriately meets beneficiary needs.

“The PMC also has concerns over the 30-day time frame for submission of a [mobility device] claim after a physician face-to-face visit,” the statement continued. “Given the extensive documentation requirement, suppliers, especially those in rural areas, may find the 30-day time frame too tight to obtain and submit all relevant parts of the medical record, as well as the necessary supporting documentation.”

The new rules, which were published in the Aug. 26 Federal Register, will take effect Oct. 25. CMS will accept comments on the rules until Nov. 25, and a final rule will be published “at a later date,” according to the agency.

The interim final rule and accompanying fact sheet can be found online at www.cms.hhs.gov/coverage/wheelchairs.asp

Imaging Self-Referral Ban Proposed

A proposed ban on self-referral for certain imaging procedures used in Medicare patients has drawn criticism from the American Society of Neuroimaging. “We are concerned with the overall tone of the proposed rule as it relates to imaging,” the society wrote in its comments to the Centers for Medicare and Medicaid Services. “There are broad assumptions that mimic the [Medicare Payment Advisory Commission] report [saying] that much of the growth in imaging services is due to inappropriate self-referral for financial gain. We would strongly disagree with this.” The proposed regulation, which was published in the Aug. 8 Federal Register, bars physician self-referral for PET scans and other nuclear medicine procedures performed at outside facilities in which the referring physician has a financial interest. The ban would not affect services performed at the physician's office. The ASN praised the agency for keeping that “in-office ancillary exception,” noting that the exception is “critically important … for patient access and high-quality imaging.”

Visually Induced Seizure Guidelines

The Epilepsy Foundation has released recommendations for reducing seizures triggered by flashing images and other patterns on television and in video games and computers. The guidelines, which appeared in the September issue of Epilepsia and on the foundation's Web site, address light intensity, flicker, contrast, duration, and pattern and define the technical parameters within these factors that are most likely to provoke seizures in people who are susceptible to them. Although no numbers are available on how many people experience seizures while watching television or surfing the Internet, some epileptologists say they have noticed an increase in the number of young people coming to them with this complaint. “Children and young adults 7–19 years of age are especially susceptible to visually induced seizures,” the journal said in a statement. Although flashing images and other patterns don't cause epilepsy, “some children will have a seizure when exposed to a specific video game and will not have another seizure unless again exposed to the same stimulus,” said Giuseppe Erba, M.D., of the neurology and pediatrics departments at the University of Rochester (N.Y.), who led the development of the recommendations. “This doesn't mean that the video game caused the epilepsy, but it reveals the vulnerability of individuals who carry the photosensitive trait when they are exposed to visual stimuli capable of triggering the abnormal response.”

NIH Eases Stock Rules

Officials at the Department of Health and Human Services have loosened restrictions on ownership of pharmaceutical and biotech company stocks for employees of the National Institutes of Health under a final rule on conflict of interest. However, the final regulation continues to bar NIH employees from engaging in outside consulting relationships with industry. The rule represents a shift in the policy spelled out in February 2005, under which about 6,000 top NIH employees would have been required to sell all of their stock holdings in companies impacted by NIH decisions. Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families will be required to divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006. The final rule does not impose restrictions on extramural scientists, but NIH Director Elias Zerhouni, M.D., said it's important to have a broad dialogue on conflict of interest with the entire scientific community. “This debate is way beyond that of NIH,” he said.

Walter Reed to Close

Walter Reed Army Medical Center in Washington, which has cared for hundreds of thousands of soldiers and dignitaries over the past 96 years, is slated to be shuttered. The Department of Defense's recommendation for Walter Reed's closure was recently approved by members of the Defense Base Realignment and Closure Commission. The commission sent its final report to President Bush on Sept. 8. If the president agrees with the recommendations, he will send the entire list to Congress for a vote. Congress must accept or reject the list in full, but cannot amend it. Not included in the closure plan is the National Museum of Health and Medicine, which is on the hospital grounds and houses a neuroanatomic collection with more than 35,000 specimens. If the closure is approved, most of the staff and services from the army hospital will be combined with services at the National Naval Medical Center in Bethesda, Md., and renamed the Walter Reed National Military Medical Center. Other services will be moved to Fort Belvoir, Va.

Imaging Self-Referral Ban Proposed

A proposed ban on self-referral for certain imaging procedures used in Medicare patients has drawn criticism from the American Society of Neuroimaging. “We are concerned with the overall tone of the proposed rule as it relates to imaging,” the society wrote in its comments to the Centers for Medicare and Medicaid Services. “There are broad assumptions that mimic the [Medicare Payment Advisory Commission] report [saying] that much of the growth in imaging services is due to inappropriate self-referral for financial gain. We would strongly disagree with this.” The proposed regulation, which was published in the Aug. 8 Federal Register, bars physician self-referral for PET scans and other nuclear medicine procedures performed at outside facilities in which the referring physician has a financial interest. The ban would not affect services performed at the physician's office. The ASN praised the agency for keeping that “in-office ancillary exception,” noting that the exception is “critically important … for patient access and high-quality imaging.”

Visually Induced Seizure Guidelines

The Epilepsy Foundation has released recommendations for reducing seizures triggered by flashing images and other patterns on television and in video games and computers. The guidelines, which appeared in the September issue of Epilepsia and on the foundation's Web site, address light intensity, flicker, contrast, duration, and pattern and define the technical parameters within these factors that are most likely to provoke seizures in people who are susceptible to them. Although no numbers are available on how many people experience seizures while watching television or surfing the Internet, some epileptologists say they have noticed an increase in the number of young people coming to them with this complaint. “Children and young adults 7–19 years of age are especially susceptible to visually induced seizures,” the journal said in a statement. Although flashing images and other patterns don't cause epilepsy, “some children will have a seizure when exposed to a specific video game and will not have another seizure unless again exposed to the same stimulus,” said Giuseppe Erba, M.D., of the neurology and pediatrics departments at the University of Rochester (N.Y.), who led the development of the recommendations. “This doesn't mean that the video game caused the epilepsy, but it reveals the vulnerability of individuals who carry the photosensitive trait when they are exposed to visual stimuli capable of triggering the abnormal response.”

NIH Eases Stock Rules

Officials at the Department of Health and Human Services have loosened restrictions on ownership of pharmaceutical and biotech company stocks for employees of the National Institutes of Health under a final rule on conflict of interest. However, the final regulation continues to bar NIH employees from engaging in outside consulting relationships with industry. The rule represents a shift in the policy spelled out in February 2005, under which about 6,000 top NIH employees would have been required to sell all of their stock holdings in companies impacted by NIH decisions. Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families will be required to divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006. The final rule does not impose restrictions on extramural scientists, but NIH Director Elias Zerhouni, M.D., said it's important to have a broad dialogue on conflict of interest with the entire scientific community. “This debate is way beyond that of NIH,” he said.

Walter Reed to Close

Walter Reed Army Medical Center in Washington, which has cared for hundreds of thousands of soldiers and dignitaries over the past 96 years, is slated to be shuttered. The Department of Defense's recommendation for Walter Reed's closure was recently approved by members of the Defense Base Realignment and Closure Commission. The commission sent its final report to President Bush on Sept. 8. If the president agrees with the recommendations, he will send the entire list to Congress for a vote. Congress must accept or reject the list in full, but cannot amend it. Not included in the closure plan is the National Museum of Health and Medicine, which is on the hospital grounds and houses a neuroanatomic collection with more than 35,000 specimens. If the closure is approved, most of the staff and services from the army hospital will be combined with services at the National Naval Medical Center in Bethesda, Md., and renamed the Walter Reed National Military Medical Center. Other services will be moved to Fort Belvoir, Va.

Imaging Self-Referral Ban Proposed

A proposed ban on self-referral for certain imaging procedures used in Medicare patients has drawn criticism from the American Society of Neuroimaging. “We are concerned with the overall tone of the proposed rule as it relates to imaging,” the society wrote in its comments to the Centers for Medicare and Medicaid Services. “There are broad assumptions that mimic the [Medicare Payment Advisory Commission] report [saying] that much of the growth in imaging services is due to inappropriate self-referral for financial gain. We would strongly disagree with this.” The proposed regulation, which was published in the Aug. 8 Federal Register, bars physician self-referral for PET scans and other nuclear medicine procedures performed at outside facilities in which the referring physician has a financial interest. The ban would not affect services performed at the physician's office. The ASN praised the agency for keeping that “in-office ancillary exception,” noting that the exception is “critically important … for patient access and high-quality imaging.”

Visually Induced Seizure Guidelines

The Epilepsy Foundation has released recommendations for reducing seizures triggered by flashing images and other patterns on television and in video games and computers. The guidelines, which appeared in the September issue of Epilepsia and on the foundation's Web site, address light intensity, flicker, contrast, duration, and pattern and define the technical parameters within these factors that are most likely to provoke seizures in people who are susceptible to them. Although no numbers are available on how many people experience seizures while watching television or surfing the Internet, some epileptologists say they have noticed an increase in the number of young people coming to them with this complaint. “Children and young adults 7–19 years of age are especially susceptible to visually induced seizures,” the journal said in a statement. Although flashing images and other patterns don't cause epilepsy, “some children will have a seizure when exposed to a specific video game and will not have another seizure unless again exposed to the same stimulus,” said Giuseppe Erba, M.D., of the neurology and pediatrics departments at the University of Rochester (N.Y.), who led the development of the recommendations. “This doesn't mean that the video game caused the epilepsy, but it reveals the vulnerability of individuals who carry the photosensitive trait when they are exposed to visual stimuli capable of triggering the abnormal response.”

NIH Eases Stock Rules

Officials at the Department of Health and Human Services have loosened restrictions on ownership of pharmaceutical and biotech company stocks for employees of the National Institutes of Health under a final rule on conflict of interest. However, the final regulation continues to bar NIH employees from engaging in outside consulting relationships with industry. The rule represents a shift in the policy spelled out in February 2005, under which about 6,000 top NIH employees would have been required to sell all of their stock holdings in companies impacted by NIH decisions. Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families will be required to divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006. The final rule does not impose restrictions on extramural scientists, but NIH Director Elias Zerhouni, M.D., said it's important to have a broad dialogue on conflict of interest with the entire scientific community. “This debate is way beyond that of NIH,” he said.

Walter Reed to Close

Walter Reed Army Medical Center in Washington, which has cared for hundreds of thousands of soldiers and dignitaries over the past 96 years, is slated to be shuttered. The Department of Defense's recommendation for Walter Reed's closure was recently approved by members of the Defense Base Realignment and Closure Commission. The commission sent its final report to President Bush on Sept. 8. If the president agrees with the recommendations, he will send the entire list to Congress for a vote. Congress must accept or reject the list in full, but cannot amend it. Not included in the closure plan is the National Museum of Health and Medicine, which is on the hospital grounds and houses a neuroanatomic collection with more than 35,000 specimens. If the closure is approved, most of the staff and services from the army hospital will be combined with services at the National Naval Medical Center in Bethesda, Md., and renamed the Walter Reed National Military Medical Center. Other services will be moved to Fort Belvoir, Va.

The recent disaster along the Gulf Coast may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have protected some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

“Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that—and our supplies and equipment—will be unsalvageable,” he said in an interview shortly following the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus,” (outside computer services) assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not.”

Fully integrated electronic medical records might not have been safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. “And, it does not have to be a vendor you bought your software from; there are tons of vendors out there providing remote access.”

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information, off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

Dr. Ellis could reach his practice associate in Birmingham via e-mail. “Two of my staff communicated that they are in upper Mississippi,” he said. Other physicians e-mailed from Houston and Baton Rouge to let him know their whereabouts.

Mail was something he wasn't able to receive. “No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors.”

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

“We are trying not to confuse the situation by coming up with our own information. Simplicity is best at times like these. Things in this regard change from minute to minute, and I am sure that even more information will become available to us and to our physicians as the days go by,” Ms. Shirley said.

Consider FEMA's Flood-Proofing Tips

Although hurricane season should be winding down by this time of year, it is always prudent to plan ahead for whatever severe wet weather next year holds in store. With that in mind, here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

▸ Ask your local emergency management office if your facility is located in a flood plain. Find out the history of flooding in your area. Determine the elevation of your facility in relation to streams, rivers, and dams.

▸ Learn about community evacuation plans from your local emergency management office.

▸ Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

▸ Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

▸ Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

▸ Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

▸ Remove outdoor hanging signs.

▸ Bring inside or secure any objects that might become airborne and cause damage in strong winds.

▸ Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

▸ Move equipment that cannot be stored away from glass and cover it with tarpaulins or heavy plastic.

▸ Place sandbags in spaces where water could enter.

▸ Move papers from lower drawers to cabinet tops.

The recent disaster along the Gulf Coast may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have protected some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

“Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that—and our supplies and equipment—will be unsalvageable,” he said in an interview shortly following the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus,” (outside computer services) assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not.”

Fully integrated electronic medical records might not have been safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. “And, it does not have to be a vendor you bought your software from; there are tons of vendors out there providing remote access.”

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information, off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

Dr. Ellis could reach his practice associate in Birmingham via e-mail. “Two of my staff communicated that they are in upper Mississippi,” he said. Other physicians e-mailed from Houston and Baton Rouge to let him know their whereabouts.

Mail was something he wasn't able to receive. “No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors.”

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

“We are trying not to confuse the situation by coming up with our own information. Simplicity is best at times like these. Things in this regard change from minute to minute, and I am sure that even more information will become available to us and to our physicians as the days go by,” Ms. Shirley said.

Consider FEMA's Flood-Proofing Tips

Although hurricane season should be winding down by this time of year, it is always prudent to plan ahead for whatever severe wet weather next year holds in store. With that in mind, here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

▸ Ask your local emergency management office if your facility is located in a flood plain. Find out the history of flooding in your area. Determine the elevation of your facility in relation to streams, rivers, and dams.

▸ Learn about community evacuation plans from your local emergency management office.

▸ Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

▸ Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

▸ Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

▸ Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

▸ Remove outdoor hanging signs.

▸ Bring inside or secure any objects that might become airborne and cause damage in strong winds.

▸ Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

▸ Move equipment that cannot be stored away from glass and cover it with tarpaulins or heavy plastic.

▸ Place sandbags in spaces where water could enter.

▸ Move papers from lower drawers to cabinet tops.

The recent disaster along the Gulf Coast may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have protected some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

“Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that—and our supplies and equipment—will be unsalvageable,” he said in an interview shortly following the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus,” (outside computer services) assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not.”

Fully integrated electronic medical records might not have been safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. “And, it does not have to be a vendor you bought your software from; there are tons of vendors out there providing remote access.”

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information, off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

Dr. Ellis could reach his practice associate in Birmingham via e-mail. “Two of my staff communicated that they are in upper Mississippi,” he said. Other physicians e-mailed from Houston and Baton Rouge to let him know their whereabouts.

Mail was something he wasn't able to receive. “No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors.”

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

“We are trying not to confuse the situation by coming up with our own information. Simplicity is best at times like these. Things in this regard change from minute to minute, and I am sure that even more information will become available to us and to our physicians as the days go by,” Ms. Shirley said.

Consider FEMA's Flood-Proofing Tips

Although hurricane season should be winding down by this time of year, it is always prudent to plan ahead for whatever severe wet weather next year holds in store. With that in mind, here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

▸ Ask your local emergency management office if your facility is located in a flood plain. Find out the history of flooding in your area. Determine the elevation of your facility in relation to streams, rivers, and dams.

▸ Learn about community evacuation plans from your local emergency management office.

▸ Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

▸ Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

▸ Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

▸ Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

▸ Remove outdoor hanging signs.

▸ Bring inside or secure any objects that might become airborne and cause damage in strong winds.

▸ Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

▸ Move equipment that cannot be stored away from glass and cover it with tarpaulins or heavy plastic.

▸ Place sandbags in spaces where water could enter.

▸ Move papers from lower drawers to cabinet tops.

The recent disaster in the Gulf Coast may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus” (outside computer services), assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site.” However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said.

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system, physicians should consider storing their administrative records off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will reopen on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

Medical Schools Find Interim Quarters

Medical schools affected by Hurricane Katrina and its aftermath scrambled to find alternative locations and resources, to ensure that their students and residents would be able to continue practicing medicine.

At press time, most of the students from Tulane University in New Orleans were being housed 180 miles away at Jackson State University in Jackson, Miss. Tulane leadership had set up temporary headquarters in Jackson with the assistance of the University of Mississippi Medical Center.

Paul K. Whelton, M.D., senior vice president for health sciences at Tulane, said the university would establish a more permanent “interim leadership headquarters” in Houston.

“Senior administrative staff are in discussion with their counterparts at Houston-area medical schools about these schools assisting Tulane in continuing to provide medical education for Tulane students in all 4 years of medical education,” the Association of American Medical Colleges reported. A similar plan was being developed for Tulane residents.

In the meantime, the School of Medicine at Louisiana State University, New Orleans, made arrangements to hold classes in Baton Rouge until its facilities were once again suitable for occupation.

Charity Hospital in New Orleans will be out of service for an extended period of time, as the city begins a major clean up effort, he said. “We will be expending our bed capacity at Earl K. Long Medical Center [in Baton Rouge], and at University Medical Center in Lafayette … and reassigning our residency staff to those hospitals as well as to some other private hospitals.”

The recent disaster in the Gulf Coast may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus” (outside computer services), assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site.” However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said.

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system, physicians should consider storing their administrative records off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will reopen on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

Medical Schools Find Interim Quarters

Medical schools affected by Hurricane Katrina and its aftermath scrambled to find alternative locations and resources, to ensure that their students and residents would be able to continue practicing medicine.

At press time, most of the students from Tulane University in New Orleans were being housed 180 miles away at Jackson State University in Jackson, Miss. Tulane leadership had set up temporary headquarters in Jackson with the assistance of the University of Mississippi Medical Center.

Paul K. Whelton, M.D., senior vice president for health sciences at Tulane, said the university would establish a more permanent “interim leadership headquarters” in Houston.

“Senior administrative staff are in discussion with their counterparts at Houston-area medical schools about these schools assisting Tulane in continuing to provide medical education for Tulane students in all 4 years of medical education,” the Association of American Medical Colleges reported. A similar plan was being developed for Tulane residents.

In the meantime, the School of Medicine at Louisiana State University, New Orleans, made arrangements to hold classes in Baton Rouge until its facilities were once again suitable for occupation.

Charity Hospital in New Orleans will be out of service for an extended period of time, as the city begins a major clean up effort, he said. “We will be expending our bed capacity at Earl K. Long Medical Center [in Baton Rouge], and at University Medical Center in Lafayette … and reassigning our residency staff to those hospitals as well as to some other private hospitals.”

The recent disaster in the Gulf Coast may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus” (outside computer services), assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site.” However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said.

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system, physicians should consider storing their administrative records off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will reopen on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

At press time, the Louisiana State Medical Society was working with the state's Department of Health and Hospitals, the Office of Emergency Preparedness, the Department of Homeland Security, and the Federal Emergency Management Agency to contact physicians.

Medical Schools Find Interim Quarters

Medical schools affected by Hurricane Katrina and its aftermath scrambled to find alternative locations and resources, to ensure that their students and residents would be able to continue practicing medicine.

At press time, most of the students from Tulane University in New Orleans were being housed 180 miles away at Jackson State University in Jackson, Miss. Tulane leadership had set up temporary headquarters in Jackson with the assistance of the University of Mississippi Medical Center.

Paul K. Whelton, M.D., senior vice president for health sciences at Tulane, said the university would establish a more permanent “interim leadership headquarters” in Houston.

“Senior administrative staff are in discussion with their counterparts at Houston-area medical schools about these schools assisting Tulane in continuing to provide medical education for Tulane students in all 4 years of medical education,” the Association of American Medical Colleges reported. A similar plan was being developed for Tulane residents.

In the meantime, the School of Medicine at Louisiana State University, New Orleans, made arrangements to hold classes in Baton Rouge until its facilities were once again suitable for occupation.

Charity Hospital in New Orleans will be out of service for an extended period of time, as the city begins a major clean up effort, he said. “We will be expending our bed capacity at Earl K. Long Medical Center [in Baton Rouge], and at University Medical Center in Lafayette … and reassigning our residency staff to those hospitals as well as to some other private hospitals.”

WASHINGTON — Hurricane Katrina has put many things on hold, including the fate of $10 billion in cuts to the Medicaid program that were proposed by a federally appointed commission.

The Medicaid Commission, which was called for by the fiscal year 2006 federal budget agreement and chartered in May by Health and Human Services Secretary Mike Leavitt, included 13 voting members and 15 nonvoting members representing a variety of interests. It was given a deadline of September 1 to come up with ways to cut the money from the Medicaid budget.

After only two meetings, the commission announced its list of ways to achieve the cuts: changing the reimbursement formula for prescription drugs, tightening rules for asset transfers prior to receiving nursing home care, and allowing states to increase copayments for nonpreferred drugs. But after the list of cuts was announced, Hurricane Katrina left hundreds of thousands of people homeless and without a regular source of medical care, and Congress decided the need to reduce the Medicaid budget wasn't so urgent after all.

“There's no doubt that Hurricane Katrina has made it necessary to provide additional resources for the Medicaid program, and we're going to do that apart from reconciliation in the Katrina relief package that's being put together,” Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, said in announcing an indefinite delay. However, he added that the changes would be voted on eventually.

With regard to the recommendation to reform the long-term care program under Medicaid, Ray Sheppach, executive director of the National Governors Association said at the August meeting that there is a “fairly sophisticated group of lawyers now who are helping people move their assets or income streams to their children or other people so they can [qualify for] Medicaid.”

To prevent people from taking advantage of some of the loopholes in the law, Mr. Sheppach said the NGA favored increasing the “lookback” period—the period during which any assets transferred would still be counted as assets for the beneficiary in determining Medicaid eligibility—from 3 to 5 years. “We also think the type of asset should be expanded so we can look at most assets, including trusts and annuities. And although it will be somewhat controversial, we believe that housing—which is an increasingly valuable asset—should also be put on the table.”

The “tiered copayments” proposal, which would allow states to implement higher copayments for nonpreferred drugs, also raised a lot of interest.

John Monahan, president of state-sponsored business at WellPoint, the for-profit California Blue Shield plan, said that he favored increased use of generic drugs. “Getting [people to increase] utilization of generics by even 5% would be an incredible savings.”

John Rugge, M.D., CEO of the Hudson Headwaters Health Network, in Glens Falls, N.Y., added that “with the psychotropic medications, there's a huge danger in [substituting] one antidepressant for another, one atypical antipsychotic for another; they clearly have to be tailored to the individual. And these are people in most need of service.”

Commission vice-chair Angus King, former governor of Maine (I), said he thought the issue could be dealt with because of the ability of the physician to override any preferred drug if it was clinically necessary to do so. He noted that in Maine, such override requests are usually filled within 72 hours.

Commission member Carol Berkowitz, M.D., president of the American Academy of Pediatrics, said she was concerned about how well such an override system would work. Dr. Berkowitz, who practices in Los Angeles, said that “in my experience it's 30–45 days before it gets approved.”

At its next meeting, which is scheduled for late October, the commission is expected to begin the second phase of its work: making recommendations for long-term restructuring of the Medicaid system.

Information about the Medicaid Commission is available online at www.cms.hhs.gov/faca/mc/details.asp

WASHINGTON — Hurricane Katrina has put many things on hold, including the fate of $10 billion in cuts to the Medicaid program that were proposed by a federally appointed commission.

The Medicaid Commission, which was called for by the fiscal year 2006 federal budget agreement and chartered in May by Health and Human Services Secretary Mike Leavitt, included 13 voting members and 15 nonvoting members representing a variety of interests. It was given a deadline of September 1 to come up with ways to cut the money from the Medicaid budget.

After only two meetings, the commission announced its list of ways to achieve the cuts: changing the reimbursement formula for prescription drugs, tightening rules for asset transfers prior to receiving nursing home care, and allowing states to increase copayments for nonpreferred drugs. But after the list of cuts was announced, Hurricane Katrina left hundreds of thousands of people homeless and without a regular source of medical care, and Congress decided the need to reduce the Medicaid budget wasn't so urgent after all.

“There's no doubt that Hurricane Katrina has made it necessary to provide additional resources for the Medicaid program, and we're going to do that apart from reconciliation in the Katrina relief package that's being put together,” Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, said in announcing an indefinite delay. However, he added that the changes would be voted on eventually.

With regard to the recommendation to reform the long-term care program under Medicaid, Ray Sheppach, executive director of the National Governors Association said at the August meeting that there is a “fairly sophisticated group of lawyers now who are helping people move their assets or income streams to their children or other people so they can [qualify for] Medicaid.”

To prevent people from taking advantage of some of the loopholes in the law, Mr. Sheppach said the NGA favored increasing the “lookback” period—the period during which any assets transferred would still be counted as assets for the beneficiary in determining Medicaid eligibility—from 3 to 5 years. “We also think the type of asset should be expanded so we can look at most assets, including trusts and annuities. And although it will be somewhat controversial, we believe that housing—which is an increasingly valuable asset—should also be put on the table.”

The “tiered copayments” proposal, which would allow states to implement higher copayments for nonpreferred drugs, also raised a lot of interest.

John Monahan, president of state-sponsored business at WellPoint, the for-profit California Blue Shield plan, said that he favored increased use of generic drugs. “Getting [people to increase] utilization of generics by even 5% would be an incredible savings.”

John Rugge, M.D., CEO of the Hudson Headwaters Health Network, in Glens Falls, N.Y., added that “with the psychotropic medications, there's a huge danger in [substituting] one antidepressant for another, one atypical antipsychotic for another; they clearly have to be tailored to the individual. And these are people in most need of service.”

Commission vice-chair Angus King, former governor of Maine (I), said he thought the issue could be dealt with because of the ability of the physician to override any preferred drug if it was clinically necessary to do so. He noted that in Maine, such override requests are usually filled within 72 hours.

Commission member Carol Berkowitz, M.D., president of the American Academy of Pediatrics, said she was concerned about how well such an override system would work. Dr. Berkowitz, who practices in Los Angeles, said that “in my experience it's 30–45 days before it gets approved.”

At its next meeting, which is scheduled for late October, the commission is expected to begin the second phase of its work: making recommendations for long-term restructuring of the Medicaid system.

Information about the Medicaid Commission is available online at www.cms.hhs.gov/faca/mc/details.asp

WASHINGTON — Hurricane Katrina has put many things on hold, including the fate of $10 billion in cuts to the Medicaid program that were proposed by a federally appointed commission.

The Medicaid Commission, which was called for by the fiscal year 2006 federal budget agreement and chartered in May by Health and Human Services Secretary Mike Leavitt, included 13 voting members and 15 nonvoting members representing a variety of interests. It was given a deadline of September 1 to come up with ways to cut the money from the Medicaid budget.

After only two meetings, the commission announced its list of ways to achieve the cuts: changing the reimbursement formula for prescription drugs, tightening rules for asset transfers prior to receiving nursing home care, and allowing states to increase copayments for nonpreferred drugs. But after the list of cuts was announced, Hurricane Katrina left hundreds of thousands of people homeless and without a regular source of medical care, and Congress decided the need to reduce the Medicaid budget wasn't so urgent after all.

“There's no doubt that Hurricane Katrina has made it necessary to provide additional resources for the Medicaid program, and we're going to do that apart from reconciliation in the Katrina relief package that's being put together,” Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, said in announcing an indefinite delay. However, he added that the changes would be voted on eventually.

With regard to the recommendation to reform the long-term care program under Medicaid, Ray Sheppach, executive director of the National Governors Association said at the August meeting that there is a “fairly sophisticated group of lawyers now who are helping people move their assets or income streams to their children or other people so they can [qualify for] Medicaid.”

To prevent people from taking advantage of some of the loopholes in the law, Mr. Sheppach said the NGA favored increasing the “lookback” period—the period during which any assets transferred would still be counted as assets for the beneficiary in determining Medicaid eligibility—from 3 to 5 years. “We also think the type of asset should be expanded so we can look at most assets, including trusts and annuities. And although it will be somewhat controversial, we believe that housing—which is an increasingly valuable asset—should also be put on the table.”

The “tiered copayments” proposal, which would allow states to implement higher copayments for nonpreferred drugs, also raised a lot of interest.

John Monahan, president of state-sponsored business at WellPoint, the for-profit California Blue Shield plan, said that he favored increased use of generic drugs. “Getting [people to increase] utilization of generics by even 5% would be an incredible savings.”

John Rugge, M.D., CEO of the Hudson Headwaters Health Network, in Glens Falls, N.Y., added that “with the psychotropic medications, there's a huge danger in [substituting] one antidepressant for another, one atypical antipsychotic for another; they clearly have to be tailored to the individual. And these are people in most need of service.”

Commission vice-chair Angus King, former governor of Maine (I), said he thought the issue could be dealt with because of the ability of the physician to override any preferred drug if it was clinically necessary to do so. He noted that in Maine, such override requests are usually filled within 72 hours.

Commission member Carol Berkowitz, M.D., president of the American Academy of Pediatrics, said she was concerned about how well such an override system would work. Dr. Berkowitz, who practices in Los Angeles, said that “in my experience it's 30–45 days before it gets approved.”

At its next meeting, which is scheduled for late October, the commission is expected to begin the second phase of its work: making recommendations for long-term restructuring of the Medicaid system.

Information about the Medicaid Commission is available online at www.cms.hhs.gov/faca/mc/details.asp

The recent disaster in New Orleans may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

“Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that—and our supplies and equipment—will be unsalvageable,” he said in an interview shortly following the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus” (outside computer services), assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site.”

However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. “And, it does not have to be a vendor you bought your software from; there are tons of vendors out there providing remote access.”

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information, off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

At press time, Dr. Ellis was able to communicate only by e-mail because all the phone prefixes in Louisiana and Mississippi were unreachable.

He could reach his practice associate in Birmingham via e-mail. “Two of my staff communicated that they are in upper Mississippi.”

Mail was something he wasn't able to receive. “No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors.”

Follow FEMA's Flood-Proof Tips

Here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

▸ Ask your local emergency management office whether your facility is located in a flood plain. Find out the history of flooding in your area. Determine the elevation of your facility in relation to streams, rivers, and dams.

▸ Learn about community evacuation plans from your local emergency management office.

▸ Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

▸ Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

▸ Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

▸ Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

▸ Remove outdoor hanging signs.

▸ Bring inside or secure any objects that might become airborne and cause damage in strong winds.

▸ Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

▸ Move equipment that cannot be stored away from glass and cover it with tarpaulins or heavy plastic.

▸ Place sandbags in spaces where water could enter.

▸ Remove papers from lower drawers of desks and file cabinets and place them in plastic bags or containers on top of the cabinets.

Medical Schools Are Making Do

Medical schools affected by Hurricane Katrina and its aftermath scrambled to find alternate locations and resources.

At press time, most students from Tulane University in New Orleans were being housed 180 miles away at Jackson State University in Jackson, Miss.

“Senior administrative staff are in discussion with their counterparts at Houston-area medical schools about these schools assisting Tulane in continuing to provide medical education for Tulane students in all 4 years of medical education,” the Association of American Medical Colleges reported. A similar plan was being developed for Tulane residents.

The Louisiana State University School of Medicine, New Orleans, will hold classes in Baton Rouge, Dean Larry Hollier, M.D., said in a statement. “We will be expanding our bed capacity at Earl K. Long Medical Center [in Baton Rouge] and at University Medical Center in Lafayette and reassigning our residency staff to those hospitals [and others].”

The University of South Alabama in Mobile reopened in September, the AAMC reported.

The recent disaster in New Orleans may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

“Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that—and our supplies and equipment—will be unsalvageable,” he said in an interview shortly following the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus” (outside computer services), assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site.”

However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. “And, it does not have to be a vendor you bought your software from; there are tons of vendors out there providing remote access.”

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information, off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

At press time, Dr. Ellis was able to communicate only by e-mail because all the phone prefixes in Louisiana and Mississippi were unreachable.

He could reach his practice associate in Birmingham via e-mail. “Two of my staff communicated that they are in upper Mississippi.”

Mail was something he wasn't able to receive. “No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors.”

Follow FEMA's Flood-Proof Tips

Here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

▸ Ask your local emergency management office whether your facility is located in a flood plain. Find out the history of flooding in your area. Determine the elevation of your facility in relation to streams, rivers, and dams.

▸ Learn about community evacuation plans from your local emergency management office.

▸ Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

▸ Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

▸ Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

▸ Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

▸ Remove outdoor hanging signs.

▸ Bring inside or secure any objects that might become airborne and cause damage in strong winds.

▸ Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

▸ Move equipment that cannot be stored away from glass and cover it with tarpaulins or heavy plastic.

▸ Place sandbags in spaces where water could enter.

▸ Remove papers from lower drawers of desks and file cabinets and place them in plastic bags or containers on top of the cabinets.

Medical Schools Are Making Do

Medical schools affected by Hurricane Katrina and its aftermath scrambled to find alternate locations and resources.

At press time, most students from Tulane University in New Orleans were being housed 180 miles away at Jackson State University in Jackson, Miss.

“Senior administrative staff are in discussion with their counterparts at Houston-area medical schools about these schools assisting Tulane in continuing to provide medical education for Tulane students in all 4 years of medical education,” the Association of American Medical Colleges reported. A similar plan was being developed for Tulane residents.

The Louisiana State University School of Medicine, New Orleans, will hold classes in Baton Rouge, Dean Larry Hollier, M.D., said in a statement. “We will be expanding our bed capacity at Earl K. Long Medical Center [in Baton Rouge] and at University Medical Center in Lafayette and reassigning our residency staff to those hospitals [and others].”

The University of South Alabama in Mobile reopened in September, the AAMC reported.

The recent disaster in New Orleans may be a wake-up call for all physicians to establish some kind of emergency backup system for their businesses.

“Physicians don't always think of themselves as running a business, but they're going to think of it now,” Rosemarie Nelson, a Syracuse, N.Y.-based consultant with the Medical Group Management Association, said in an interview.

Otolaryngologist Michael Ellis, M.D., is hoping that technology might have retained some of his records. His practice in Chalmette, La., south of New Orleans, is in an area flooded to the rooftops in the aftermath of Hurricane Katrina and the subsequent breakdown of New Orleans' levees.

“Like most physicians, I have billing electronic records, but my office clinical records are paper. I assume all that—and our supplies and equipment—will be unsalvageable,” he said in an interview shortly following the flood.

Dr. Ellis said that he had backups in place for his billing records, both hard copy and “off campus” (outside computer services), assuming that certain computers weren't damaged or backed up during the flood.

As Ms. Nelson noted, “there is just no way to secure paper records. They're there or they're not. You're not going to copy and store them off-site.”

However, a fully integrated electronic medical record might not have been completely safe for stricken medical communities, either.

Anne L. Shirley, a spokeswoman with the Louisiana State Medical Society, said an undetermined number of records have been destroyed.

Some electronic records weren't able to be accessed as most computer servers have been destroyed, Ms. Shirley said. The Louisiana State Board of Medical Examiners is located in a hard-hit flood area in New Orleans, and the society's Web site and database were inoperable, even from remote locations, Ms. Shirley said. “This, as you can imagine, poses a problem with license verification and credentialing for displaced physicians.”

One way to solve backup problems such as these is to have electronic medical records stored in a secure, remote site by a vendor, Ms. Nelson said. “And, it does not have to be a vendor you bought your software from; there are tons of vendors out there providing remote access.”

Such vendors also can offer Internet-based backups, which “add a whole new sense of security,” she noted. “When something happens in an area or region, that [backup disk] you took home is as insecure as your records.”

Even if they don't use an electronic medical record system (and only about 15% of doctors have them), physicians should consider storing their administrative records, such as financial and scheduling information, off-site, Ms. Nelson said.

“You need to think about using off-site backup for your financial applications, scheduling, patient list, and some receivables. You still have insurance receivables there, and you're going to need that cash inflow because you're going to have to buy new equipment. So securing your financial records is equally as important.”

The patient list will be essential when you need to inform patients that you've set up your practice in a new location or will be reopening on a particular date, she added.

An advantage of backing up financial information is that it also includes some clinical information, Ms. Nelson said. “That's because you need to have a diagnosis code to bill the insurance company.”

At press time, Dr. Ellis was able to communicate only by e-mail because all the phone prefixes in Louisiana and Mississippi were unreachable.

He could reach his practice associate in Birmingham via e-mail. “Two of my staff communicated that they are in upper Mississippi.”

Mail was something he wasn't able to receive. “No one has said what is happening to it, or how we can contact insurers, Medicare, etc., to change our address. I don't know what patients are doing about getting their prescriptions filled since they can't reach doctors.”

Follow FEMA's Flood-Proof Tips

Here are some general tips from the Federal Emergency Management Agency on flood and hurricane preparation for businesses:

▸ Ask your local emergency management office whether your facility is located in a flood plain. Find out the history of flooding in your area. Determine the elevation of your facility in relation to streams, rivers, and dams.

▸ Learn about community evacuation plans from your local emergency management office.

▸ Establish facility shutdown procedures. Make plans for assisting employees who may need transportation.

▸ Purchase a National Oceanic and Atmospheric Administration weather radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.

▸ Get information about flood insurance from your insurance carrier. Regular property and casualty insurance does not cover flooding.

If a hurricane or other major weather event is being forecast, consider taking these actions ahead of time:

▸ Clear out areas with extensive glass frontage as much as possible. If you have shutters, use them; otherwise, use precut plywood to board up doors and windows.

▸ Remove outdoor hanging signs.

▸ Bring inside or secure any objects that might become airborne and cause damage in strong winds.

▸ Store as much equipment as high as possible off the floor, especially goods that could be in short supply after the storm.

▸ Move equipment that cannot be stored away from glass and cover it with tarpaulins or heavy plastic.

▸ Place sandbags in spaces where water could enter.

▸ Remove papers from lower drawers of desks and file cabinets and place them in plastic bags or containers on top of the cabinets.

Medical Schools Are Making Do

Medical schools affected by Hurricane Katrina and its aftermath scrambled to find alternate locations and resources.

At press time, most students from Tulane University in New Orleans were being housed 180 miles away at Jackson State University in Jackson, Miss.

“Senior administrative staff are in discussion with their counterparts at Houston-area medical schools about these schools assisting Tulane in continuing to provide medical education for Tulane students in all 4 years of medical education,” the Association of American Medical Colleges reported. A similar plan was being developed for Tulane residents.

The Louisiana State University School of Medicine, New Orleans, will hold classes in Baton Rouge, Dean Larry Hollier, M.D., said in a statement. “We will be expanding our bed capacity at Earl K. Long Medical Center [in Baton Rouge] and at University Medical Center in Lafayette and reassigning our residency staff to those hospitals [and others].”

The University of South Alabama in Mobile reopened in September, the AAMC reported.

WASHINGTON — The Centers for Medicare and Medicaid Services has revised its rules and regulations governing reimbursement for power wheelchairs and scooters.

“This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility,” CMS Administrator Mark McClellan, M.D., said in a statement.

The rule change “is part of a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending.”

Physicians, as well as other providers, criticized the old reimbursement criteria as too burdensome, inasmuch as they required physicians to provide a certificate of medical necessity before a scooter or wheelchair could be covered for reimbursement.

However, CMS officials were wary of loosening coverage requirements because of a recent rash of fraudulent wheelchair and scooter claims. The fraud reached such a high level that CMS launched its “Operator Wheeler Dealer” campaign to stop it.

Under the new regulations, the medical necessity certificate has been eliminated, but in its place, the agency is requiring certain clinical documentation items from the patient's medical record, along with a written prescription—given within 30 days of the evaluation—issued to the supplier. And the rules keep the requirement that physicians must conduct a face-to-face examination of the patient before prescribing a mobility device.

Medicare already pays for this evaluation visit. However, because of the additional documentation required under the new rules, Medicare is authorizing an additional payment to physicians for preparing the paperwork.

Physicians must include a special billing code on the office visit claim in order to receive this extra payment.

The agency also is removing the requirement that only certain specialists—physiatrists, orthopedic surgeons, neurologists, and rheumatologists—be authorized to prescribe power scooters. Instead, all physicians and treating practitioners will be able to prescribe scooters and power wheelchairs.

The Power Mobility Coalition (PMC), a group of mobility-device manufacturers, organizations expressed concern that the new rules would make it tougher for physicians to comply.

“The PMC agrees with CMS that the treating physician is in the best position to assess the need for power mobility devices, but is concerned that, in order to fully succeed, CMS and its contractors will have to conduct a comprehensive review of the benefit for physicians,” the organization said in a statement.

“Physicians may not be fully aware of the analytical standard that will be applied to claims, let alone which of the 49 new product codes most appropriately meets beneficiary needs.

“The PMC also has concerns over the 30-day time frame for submission of a [mobility device] claim after a physician face-to-face visit,” the group's statement continued.

“Given the extensive documentation requirement, suppliers, especially those in rural areas, may find the 30-day time frame too tight to obtain and submit all relevant parts of the medical record, as well as the necessary supporting documentation,” the statement said.

The new rules, which were published in the Aug. 26 Federal Register, will take effect Oct. 25.

CMS will accept comments on the rules until Nov. 25, and a final rule will be published “at a later date,” according to the agency.

The interim final rule and accompanying fact sheet can be found online at www.cms.hhs.gov/coverage/wheelchairs.asp

WASHINGTON — The Centers for Medicare and Medicaid Services has revised its rules and regulations governing reimbursement for power wheelchairs and scooters.

“This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility,” CMS Administrator Mark McClellan, M.D., said in a statement.

The rule change “is part of a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending.”

Physicians, as well as other providers, criticized the old reimbursement criteria as too burdensome, inasmuch as they required physicians to provide a certificate of medical necessity before a scooter or wheelchair could be covered for reimbursement.

However, CMS officials were wary of loosening coverage requirements because of a recent rash of fraudulent wheelchair and scooter claims. The fraud reached such a high level that CMS launched its “Operator Wheeler Dealer” campaign to stop it.

Under the new regulations, the medical necessity certificate has been eliminated, but in its place, the agency is requiring certain clinical documentation items from the patient's medical record, along with a written prescription—given within 30 days of the evaluation—issued to the supplier. And the rules keep the requirement that physicians must conduct a face-to-face examination of the patient before prescribing a mobility device.

Medicare already pays for this evaluation visit. However, because of the additional documentation required under the new rules, Medicare is authorizing an additional payment to physicians for preparing the paperwork.

Physicians must include a special billing code on the office visit claim in order to receive this extra payment.

The agency also is removing the requirement that only certain specialists—physiatrists, orthopedic surgeons, neurologists, and rheumatologists—be authorized to prescribe power scooters. Instead, all physicians and treating practitioners will be able to prescribe scooters and power wheelchairs.

The Power Mobility Coalition (PMC), a group of mobility-device manufacturers, organizations expressed concern that the new rules would make it tougher for physicians to comply.

“The PMC agrees with CMS that the treating physician is in the best position to assess the need for power mobility devices, but is concerned that, in order to fully succeed, CMS and its contractors will have to conduct a comprehensive review of the benefit for physicians,” the organization said in a statement.

“Physicians may not be fully aware of the analytical standard that will be applied to claims, let alone which of the 49 new product codes most appropriately meets beneficiary needs.

“The PMC also has concerns over the 30-day time frame for submission of a [mobility device] claim after a physician face-to-face visit,” the group's statement continued.

“Given the extensive documentation requirement, suppliers, especially those in rural areas, may find the 30-day time frame too tight to obtain and submit all relevant parts of the medical record, as well as the necessary supporting documentation,” the statement said.

The new rules, which were published in the Aug. 26 Federal Register, will take effect Oct. 25.

CMS will accept comments on the rules until Nov. 25, and a final rule will be published “at a later date,” according to the agency.

The interim final rule and accompanying fact sheet can be found online at www.cms.hhs.gov/coverage/wheelchairs.asp

WASHINGTON — The Centers for Medicare and Medicaid Services has revised its rules and regulations governing reimbursement for power wheelchairs and scooters.

“This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility,” CMS Administrator Mark McClellan, M.D., said in a statement.

The rule change “is part of a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending.”

Physicians, as well as other providers, criticized the old reimbursement criteria as too burdensome, inasmuch as they required physicians to provide a certificate of medical necessity before a scooter or wheelchair could be covered for reimbursement.

However, CMS officials were wary of loosening coverage requirements because of a recent rash of fraudulent wheelchair and scooter claims. The fraud reached such a high level that CMS launched its “Operator Wheeler Dealer” campaign to stop it.

Under the new regulations, the medical necessity certificate has been eliminated, but in its place, the agency is requiring certain clinical documentation items from the patient's medical record, along with a written prescription—given within 30 days of the evaluation—issued to the supplier. And the rules keep the requirement that physicians must conduct a face-to-face examination of the patient before prescribing a mobility device.

Medicare already pays for this evaluation visit. However, because of the additional documentation required under the new rules, Medicare is authorizing an additional payment to physicians for preparing the paperwork.

Physicians must include a special billing code on the office visit claim in order to receive this extra payment.

The agency also is removing the requirement that only certain specialists—physiatrists, orthopedic surgeons, neurologists, and rheumatologists—be authorized to prescribe power scooters. Instead, all physicians and treating practitioners will be able to prescribe scooters and power wheelchairs.

The Power Mobility Coalition (PMC), a group of mobility-device manufacturers, organizations expressed concern that the new rules would make it tougher for physicians to comply.

“The PMC agrees with CMS that the treating physician is in the best position to assess the need for power mobility devices, but is concerned that, in order to fully succeed, CMS and its contractors will have to conduct a comprehensive review of the benefit for physicians,” the organization said in a statement.

“Physicians may not be fully aware of the analytical standard that will be applied to claims, let alone which of the 49 new product codes most appropriately meets beneficiary needs.

“The PMC also has concerns over the 30-day time frame for submission of a [mobility device] claim after a physician face-to-face visit,” the group's statement continued.

“Given the extensive documentation requirement, suppliers, especially those in rural areas, may find the 30-day time frame too tight to obtain and submit all relevant parts of the medical record, as well as the necessary supporting documentation,” the statement said.

The new rules, which were published in the Aug. 26 Federal Register, will take effect Oct. 25.

CMS will accept comments on the rules until Nov. 25, and a final rule will be published “at a later date,” according to the agency.

The interim final rule and accompanying fact sheet can be found online at www.cms.hhs.gov/coverage/wheelchairs.asp

WASHINGTON – Among the many things put on hold by Hurricane Katrina is the fate of $10 billion in cuts to the Medicaid program that were proposed by a federally appointed commission.

The Medicaid Commission, which was called for by the fiscal year 2006 federal budget agreement and chartered in May by Health and Human Services Secretary Mike Leavitt, included 13 voting members and 15 nonvoting members representing a variety of interests. It was given a deadline of Sept. 1 to come up with ways to cut the money from the Medicaid budget.

After only two meetings, the commission announced its list of ways to achieve the cuts: changing the reimbursement formula for prescription drugs, tightening rules for asset transfers prior to receiving nursing home care, and allowing states to increase copayments for nonpreferred drugs. But then Hurricane Katrina left hundreds of thousands of people homeless and without a regular source of medical care, and Congress decided the need to reduce the Medicaid budget wasn't so urgent after all.

“There's no doubt that Hurricane Katrina has made it necessary to provide additional resources for the Medicaid program, and we're going to do that apart from reconciliation in the Katrina relief package that's being put together,” Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, said in announcing an indefinite delay. However, he added that the changes would be voted on eventually.

With regard to the recommendation to reform the long-term care program under Medicaid, Ray Sheppach, executive director of the National Governors Association said at the August meeting that there is a “fairly sophisticated group of lawyers now who are helping people move their assets or income streams to their children or other people so they can [qualify for] Medicaid.”

To prevent people from taking advantage of some of the loopholes in the law, Mr. Sheppach said the NGA favored increasing the “lookback” period–the period during which any assets transferred would still be counted as assets for the beneficiary in determining Medicaid eligibility–from 3 to 5 years.

“We also think the type of asset should be expanded so we can look at most assets, including trusts and annuities. And although it will be somewhat controversial, we believe that housing–which is an increasingly valuable asset–should also be put on the table,” Mr. Sheppach explained.

The “tiered copayments” proposal, which would allow states to implement higher copayments for nonpreferred drugs, also raised a lot of interest.

John Monahan, president of state-sponsored business at WellPoint, the for-profit California Blue Shield plan, said that he favored increased use of generic drugs. “Getting [people to increase] utilization of generic up by even 5% would be an incredible savings.”

John Rugge, M.D., CEO of the Hudson Headwaters Health Network, in Glens Falls, N.Y., added that “with the psychotropic medications, there's a huge danger in [substituting] one antidepressant for another, one atypical antipsychotic for another; they clearly have to be tailored to the individual. And these are people in most need of service.”

Commission vice-chair Angus King, former governor of Maine (I), said he thought the issue could be dealt with because of the ability of the physician to override any preferred drug if it was clinically necessary to do so. He noted that in Maine, such override requests are usually filled within 72 hours.

Commission member Carol Berkowitz, M.D., president of the American Academy of Pediatrics, said she was concerned about how well such an override system would work.

Dr. Berkowitz, who practices in Los Angeles, said that “in my experience it's 30–45 days before it gets approved.”

At its next meeting, which was scheduled for late October, the commission was expected to begin the second phase of its work: making recommendations for long-term restructuring of Medicaid.

Information about the Medicaid Commission is available online at www.cms.hhs.gov/faca/mc/details.asp

WASHINGTON – Among the many things put on hold by Hurricane Katrina is the fate of $10 billion in cuts to the Medicaid program that were proposed by a federally appointed commission.

The Medicaid Commission, which was called for by the fiscal year 2006 federal budget agreement and chartered in May by Health and Human Services Secretary Mike Leavitt, included 13 voting members and 15 nonvoting members representing a variety of interests. It was given a deadline of Sept. 1 to come up with ways to cut the money from the Medicaid budget.

After only two meetings, the commission announced its list of ways to achieve the cuts: changing the reimbursement formula for prescription drugs, tightening rules for asset transfers prior to receiving nursing home care, and allowing states to increase copayments for nonpreferred drugs. But then Hurricane Katrina left hundreds of thousands of people homeless and without a regular source of medical care, and Congress decided the need to reduce the Medicaid budget wasn't so urgent after all.

“There's no doubt that Hurricane Katrina has made it necessary to provide additional resources for the Medicaid program, and we're going to do that apart from reconciliation in the Katrina relief package that's being put together,” Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, said in announcing an indefinite delay. However, he added that the changes would be voted on eventually.

With regard to the recommendation to reform the long-term care program under Medicaid, Ray Sheppach, executive director of the National Governors Association said at the August meeting that there is a “fairly sophisticated group of lawyers now who are helping people move their assets or income streams to their children or other people so they can [qualify for] Medicaid.”

To prevent people from taking advantage of some of the loopholes in the law, Mr. Sheppach said the NGA favored increasing the “lookback” period–the period during which any assets transferred would still be counted as assets for the beneficiary in determining Medicaid eligibility–from 3 to 5 years.

“We also think the type of asset should be expanded so we can look at most assets, including trusts and annuities. And although it will be somewhat controversial, we believe that housing–which is an increasingly valuable asset–should also be put on the table,” Mr. Sheppach explained.

The “tiered copayments” proposal, which would allow states to implement higher copayments for nonpreferred drugs, also raised a lot of interest.

John Monahan, president of state-sponsored business at WellPoint, the for-profit California Blue Shield plan, said that he favored increased use of generic drugs. “Getting [people to increase] utilization of generic up by even 5% would be an incredible savings.”

John Rugge, M.D., CEO of the Hudson Headwaters Health Network, in Glens Falls, N.Y., added that “with the psychotropic medications, there's a huge danger in [substituting] one antidepressant for another, one atypical antipsychotic for another; they clearly have to be tailored to the individual. And these are people in most need of service.”

Commission vice-chair Angus King, former governor of Maine (I), said he thought the issue could be dealt with because of the ability of the physician to override any preferred drug if it was clinically necessary to do so. He noted that in Maine, such override requests are usually filled within 72 hours.

Commission member Carol Berkowitz, M.D., president of the American Academy of Pediatrics, said she was concerned about how well such an override system would work.

Dr. Berkowitz, who practices in Los Angeles, said that “in my experience it's 30–45 days before it gets approved.”

At its next meeting, which was scheduled for late October, the commission was expected to begin the second phase of its work: making recommendations for long-term restructuring of Medicaid.

Information about the Medicaid Commission is available online at www.cms.hhs.gov/faca/mc/details.asp

WASHINGTON – Among the many things put on hold by Hurricane Katrina is the fate of $10 billion in cuts to the Medicaid program that were proposed by a federally appointed commission.

The Medicaid Commission, which was called for by the fiscal year 2006 federal budget agreement and chartered in May by Health and Human Services Secretary Mike Leavitt, included 13 voting members and 15 nonvoting members representing a variety of interests. It was given a deadline of Sept. 1 to come up with ways to cut the money from the Medicaid budget.

After only two meetings, the commission announced its list of ways to achieve the cuts: changing the reimbursement formula for prescription drugs, tightening rules for asset transfers prior to receiving nursing home care, and allowing states to increase copayments for nonpreferred drugs. But then Hurricane Katrina left hundreds of thousands of people homeless and without a regular source of medical care, and Congress decided the need to reduce the Medicaid budget wasn't so urgent after all.

“There's no doubt that Hurricane Katrina has made it necessary to provide additional resources for the Medicaid program, and we're going to do that apart from reconciliation in the Katrina relief package that's being put together,” Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, said in announcing an indefinite delay. However, he added that the changes would be voted on eventually.

With regard to the recommendation to reform the long-term care program under Medicaid, Ray Sheppach, executive director of the National Governors Association said at the August meeting that there is a “fairly sophisticated group of lawyers now who are helping people move their assets or income streams to their children or other people so they can [qualify for] Medicaid.”

To prevent people from taking advantage of some of the loopholes in the law, Mr. Sheppach said the NGA favored increasing the “lookback” period–the period during which any assets transferred would still be counted as assets for the beneficiary in determining Medicaid eligibility–from 3 to 5 years.

“We also think the type of asset should be expanded so we can look at most assets, including trusts and annuities. And although it will be somewhat controversial, we believe that housing–which is an increasingly valuable asset–should also be put on the table,” Mr. Sheppach explained.

The “tiered copayments” proposal, which would allow states to implement higher copayments for nonpreferred drugs, also raised a lot of interest.

John Monahan, president of state-sponsored business at WellPoint, the for-profit California Blue Shield plan, said that he favored increased use of generic drugs. “Getting [people to increase] utilization of generic up by even 5% would be an incredible savings.”

John Rugge, M.D., CEO of the Hudson Headwaters Health Network, in Glens Falls, N.Y., added that “with the psychotropic medications, there's a huge danger in [substituting] one antidepressant for another, one atypical antipsychotic for another; they clearly have to be tailored to the individual. And these are people in most need of service.”

Commission vice-chair Angus King, former governor of Maine (I), said he thought the issue could be dealt with because of the ability of the physician to override any preferred drug if it was clinically necessary to do so. He noted that in Maine, such override requests are usually filled within 72 hours.

Commission member Carol Berkowitz, M.D., president of the American Academy of Pediatrics, said she was concerned about how well such an override system would work.

Dr. Berkowitz, who practices in Los Angeles, said that “in my experience it's 30–45 days before it gets approved.”

At its next meeting, which was scheduled for late October, the commission was expected to begin the second phase of its work: making recommendations for long-term restructuring of Medicaid.

Information about the Medicaid Commission is available online at www.cms.hhs.gov/faca/mc/details.asp