Mary Ellen Schneider

NEW YORK. — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off, with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be enssured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. Some people will not get their partners treated, such as those with more than one sex partner or a partner they are unikely to have sex with again, men who have sex with men, and those who say outright they won't notify their partners.

So King County health officials developed a case report form that allows the diagnosing physician to check a box indicating that the health department should assume responsibility for partner notification, such as drawing on the services of a disease intervention specialist. Through the program, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the form has yielded encouraging results. A random sample of patients diagnosed with gonorrhea or chlamydia shows about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

If the results continue, the researchers estimate there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time. A community-level, randomized controlled trial is being conducted throughout the state to establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level.

NEW YORK. — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off, with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be enssured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. Some people will not get their partners treated, such as those with more than one sex partner or a partner they are unikely to have sex with again, men who have sex with men, and those who say outright they won't notify their partners.

So King County health officials developed a case report form that allows the diagnosing physician to check a box indicating that the health department should assume responsibility for partner notification, such as drawing on the services of a disease intervention specialist. Through the program, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the form has yielded encouraging results. A random sample of patients diagnosed with gonorrhea or chlamydia shows about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

If the results continue, the researchers estimate there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time. A community-level, randomized controlled trial is being conducted throughout the state to establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level.

NEW YORK. — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off, with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be enssured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. Some people will not get their partners treated, such as those with more than one sex partner or a partner they are unikely to have sex with again, men who have sex with men, and those who say outright they won't notify their partners.

So King County health officials developed a case report form that allows the diagnosing physician to check a box indicating that the health department should assume responsibility for partner notification, such as drawing on the services of a disease intervention specialist. Through the program, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the form has yielded encouraging results. A random sample of patients diagnosed with gonorrhea or chlamydia shows about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

If the results continue, the researchers estimate there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time. A community-level, randomized controlled trial is being conducted throughout the state to establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level.

PHILADELPHIA — The jury is still out on whether aromatase inhibitors could offer an alternative to clomiphene in the treatment of infertility associated with polycystic ovary syndrome, said endocrinologist Andrea D. Coviello of Boston University.

Aromatase inhibitors have been approved for use in breast cancer but are still experimental for ovulation induction, Dr. Coviello said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.

Instead of blocking the receptors centrally in the hypothalamus and the pituitary, aromatase inhibitors block estradiol production. Like clomiphene, aromatase inhibitors are used during the follicular phase.

The rationale for moving to aromatase inhibitors is that this class of drugs is thought to have fewer antiestrogenic side effects, including a lower risk of ovarian hyperstimulation syndrome and a lower risk of multiple gestation. But there are also significant concerns about fetal development problems in the babies conceived using aromatase inhibitors, she said. A definitive study to help physicians assess how aromatase inhibitors stack up to clomiphene has yet to be done. Current data are from small studies, said Dr. Coviello, who said she has no commercial support to disclose.

In a prospective, randomized trial of 74 patients, there was no significant difference in pregnancy rates between those receiving clomiphene and those receiving the aromatase inhibitor, letrozole (Fertil. Steril. 2006;86:1447-51). But estrogen levels were significantly lower in the letrozole group on the day of human chorionic gonadotropin administration, indicating potential for a better side-effect profile with letrozole.

INTERNAL MEDICINE NEWS, FAMILY PRACTICE NEWS, and this newspaper are published by the International Medical News Group, a division of Elsevier.

PHILADELPHIA — The jury is still out on whether aromatase inhibitors could offer an alternative to clomiphene in the treatment of infertility associated with polycystic ovary syndrome, said endocrinologist Andrea D. Coviello of Boston University.

Aromatase inhibitors have been approved for use in breast cancer but are still experimental for ovulation induction, Dr. Coviello said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.

Instead of blocking the receptors centrally in the hypothalamus and the pituitary, aromatase inhibitors block estradiol production. Like clomiphene, aromatase inhibitors are used during the follicular phase.

The rationale for moving to aromatase inhibitors is that this class of drugs is thought to have fewer antiestrogenic side effects, including a lower risk of ovarian hyperstimulation syndrome and a lower risk of multiple gestation. But there are also significant concerns about fetal development problems in the babies conceived using aromatase inhibitors, she said. A definitive study to help physicians assess how aromatase inhibitors stack up to clomiphene has yet to be done. Current data are from small studies, said Dr. Coviello, who said she has no commercial support to disclose.

In a prospective, randomized trial of 74 patients, there was no significant difference in pregnancy rates between those receiving clomiphene and those receiving the aromatase inhibitor, letrozole (Fertil. Steril. 2006;86:1447-51). But estrogen levels were significantly lower in the letrozole group on the day of human chorionic gonadotropin administration, indicating potential for a better side-effect profile with letrozole.

INTERNAL MEDICINE NEWS, FAMILY PRACTICE NEWS, and this newspaper are published by the International Medical News Group, a division of Elsevier.

PHILADELPHIA — The jury is still out on whether aromatase inhibitors could offer an alternative to clomiphene in the treatment of infertility associated with polycystic ovary syndrome, said endocrinologist Andrea D. Coviello of Boston University.

Aromatase inhibitors have been approved for use in breast cancer but are still experimental for ovulation induction, Dr. Coviello said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.

Instead of blocking the receptors centrally in the hypothalamus and the pituitary, aromatase inhibitors block estradiol production. Like clomiphene, aromatase inhibitors are used during the follicular phase.

The rationale for moving to aromatase inhibitors is that this class of drugs is thought to have fewer antiestrogenic side effects, including a lower risk of ovarian hyperstimulation syndrome and a lower risk of multiple gestation. But there are also significant concerns about fetal development problems in the babies conceived using aromatase inhibitors, she said. A definitive study to help physicians assess how aromatase inhibitors stack up to clomiphene has yet to be done. Current data are from small studies, said Dr. Coviello, who said she has no commercial support to disclose.

In a prospective, randomized trial of 74 patients, there was no significant difference in pregnancy rates between those receiving clomiphene and those receiving the aromatase inhibitor, letrozole (Fertil. Steril. 2006;86:1447-51). But estrogen levels were significantly lower in the letrozole group on the day of human chorionic gonadotropin administration, indicating potential for a better side-effect profile with letrozole.

INTERNAL MEDICINE NEWS, FAMILY PRACTICE NEWS, and this newspaper are published by the International Medical News Group, a division of Elsevier.

PHILADELPHIA — Lowering blood pressure might be more effective than lowering blood sugar alone for reducing the risk of cardiovascular events in type 2 diabetes patients, according to Dr. George J. Philippides, director of the coronary care unit at Boston Medical Center.

Reducing blood pressure in patients with type 2 diabetes can result in “profound” reductions in the risk of cardiovascular events, Dr. Philippides said at Endocrinology in the News sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.

For example, in the U.K. Prospective Diabetes Study, patients who achieved tight control of their blood pressure (mean blood pressure of 144/82 mm Hg) lowered their risk of stroke by 44%, compared with the group of patients with a mean blood pressure of 154/87 mm Hg. The group with tight blood pressure control also had a 34% risk reduction for macrovascular diseases, compared with the group with less tight control (BMJ 1998;317:703-13).

By comparison, the evidence is less clear about whether achieving tight glycemic control alone will lower the risk of cardiovascular events, Dr. Philippides said. Physicians should lower sugar levels for other reasons, such as the microvascular benefits, but the evidence so far fails to show that doing so lowers the risk for myocardial infarction, he said.

Dr. Philippides advised physicians to be aggressive in treating hypertension in diabetes patients because of the significant benefits seen with even small decreases in blood pressure. For many patients, that might mean using three agents, he said.

Dr. Philippides is on the speakers bureau for Bristol-Myers Squibb Co., is a consultant for Merck & Co., and receives research support from Sanofi Aventis.

PHILADELPHIA — Lowering blood pressure might be more effective than lowering blood sugar alone for reducing the risk of cardiovascular events in type 2 diabetes patients, according to Dr. George J. Philippides, director of the coronary care unit at Boston Medical Center.

Reducing blood pressure in patients with type 2 diabetes can result in “profound” reductions in the risk of cardiovascular events, Dr. Philippides said at Endocrinology in the News sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.

For example, in the U.K. Prospective Diabetes Study, patients who achieved tight control of their blood pressure (mean blood pressure of 144/82 mm Hg) lowered their risk of stroke by 44%, compared with the group of patients with a mean blood pressure of 154/87 mm Hg. The group with tight blood pressure control also had a 34% risk reduction for macrovascular diseases, compared with the group with less tight control (BMJ 1998;317:703-13).

By comparison, the evidence is less clear about whether achieving tight glycemic control alone will lower the risk of cardiovascular events, Dr. Philippides said. Physicians should lower sugar levels for other reasons, such as the microvascular benefits, but the evidence so far fails to show that doing so lowers the risk for myocardial infarction, he said.

Dr. Philippides advised physicians to be aggressive in treating hypertension in diabetes patients because of the significant benefits seen with even small decreases in blood pressure. For many patients, that might mean using three agents, he said.

Dr. Philippides is on the speakers bureau for Bristol-Myers Squibb Co., is a consultant for Merck & Co., and receives research support from Sanofi Aventis.

PHILADELPHIA — Lowering blood pressure might be more effective than lowering blood sugar alone for reducing the risk of cardiovascular events in type 2 diabetes patients, according to Dr. George J. Philippides, director of the coronary care unit at Boston Medical Center.

Reducing blood pressure in patients with type 2 diabetes can result in “profound” reductions in the risk of cardiovascular events, Dr. Philippides said at Endocrinology in the News sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.

For example, in the U.K. Prospective Diabetes Study, patients who achieved tight control of their blood pressure (mean blood pressure of 144/82 mm Hg) lowered their risk of stroke by 44%, compared with the group of patients with a mean blood pressure of 154/87 mm Hg. The group with tight blood pressure control also had a 34% risk reduction for macrovascular diseases, compared with the group with less tight control (BMJ 1998;317:703-13).

By comparison, the evidence is less clear about whether achieving tight glycemic control alone will lower the risk of cardiovascular events, Dr. Philippides said. Physicians should lower sugar levels for other reasons, such as the microvascular benefits, but the evidence so far fails to show that doing so lowers the risk for myocardial infarction, he said.

Dr. Philippides advised physicians to be aggressive in treating hypertension in diabetes patients because of the significant benefits seen with even small decreases in blood pressure. For many patients, that might mean using three agents, he said.

Dr. Philippides is on the speakers bureau for Bristol-Myers Squibb Co., is a consultant for Merck & Co., and receives research support from Sanofi Aventis.

While the Democrats continue to debate the need for individual mandates for health coverage, Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines. “Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a Tampa speech to announce details of his health care proposal. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign. The idea is to reform the marketplace and drive down costs overall.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to the purchase coverage in the individual market where coverage is expensive and difficult to obtain, said Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

And a $5,000 tax credit wouldn't be enough for family coverage, which the Kaiser Family Foundation estimates at nearly $12,000 on average, Mr. Hickey said.

While the Democrats continue to debate the need for individual mandates for health coverage, Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines. “Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a Tampa speech to announce details of his health care proposal. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign. The idea is to reform the marketplace and drive down costs overall.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to the purchase coverage in the individual market where coverage is expensive and difficult to obtain, said Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

And a $5,000 tax credit wouldn't be enough for family coverage, which the Kaiser Family Foundation estimates at nearly $12,000 on average, Mr. Hickey said.

While the Democrats continue to debate the need for individual mandates for health coverage, Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines. “Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a Tampa speech to announce details of his health care proposal. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign. The idea is to reform the marketplace and drive down costs overall.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to the purchase coverage in the individual market where coverage is expensive and difficult to obtain, said Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

And a $5,000 tax credit wouldn't be enough for family coverage, which the Kaiser Family Foundation estimates at nearly $12,000 on average, Mr. Hickey said.

More information about the different reporting options is available online at www.cms.hhs.gov/pqri

Physicians now have nine different options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.

The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half-year. Officials at the Centers for Medicare and Medicaid Services announced the changes last month.

Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.

“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” CMS Acting Administrator Kerry Weems said in a statement.

In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.

Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.

In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.

This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.

CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.

CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.

For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to quality for payment using measures groups, physicians have to submit data for each of the measures in the group.

Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS. Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.

Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.

It appears that the changes will make it easier to report data, said Dr. James King, president of the American Academy of Family Physicians. “We want to be able to get our data in.”

However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. The extent to which internists will be able to use registry-based reporting will be unclear until CMS releases the list of participating registries in late August, he said.

Submitting Data Under PQRI

The Centers for Medicare and Medicaid Services recently outlined nine options for reporting data to PQRI in 2008.

Three options facilitate claims-based reporting:

▸ Physicians can choose to report on individual measures for a full year from Jan. 1 to Dec. 31, 2008. Under this option, physicians with three or more applicable measures would report on at least three measures for at least 80% of their patients. Those with fewer than three applicable measures would report on all of those measures for at least 80% of their eligible patients.

▸ Physicians can also choose from two reporting approaches for the half-year reporting period from July 1 to Dec. 31. Physicians could report on all measures in a measures group for 15 consecutive patients with the relevant condition or 80% of eligible patients.

Six options are registry-based:

▸ CMS will allow three reporting options for a full-year reporting period. Those who chose to report on individual measures must report on 80% of applicable cases for a minimum of three measures. Physicians can also report on a measures group for 30 consecutive patients with the applicable condition or 80% of the applicable cases.

▸ CMS has also established three reporting options for reporting to a registry for a half-year from July 1 to Dec. 31. For example, physicians and other eligible professionals could report on individual measures for 80% of applicable cases for a minimum of three measures. Physicians could also report for a half-year using measures groups. For example, physicians can report on a measures group for 15 consecutive patients with the applicable condition or 80% of applicable cases.

More information about the different reporting options is available online at www.cms.hhs.gov/pqri

Physicians now have nine different options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.

The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half-year. Officials at the Centers for Medicare and Medicaid Services announced the changes last month.

Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.

“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” CMS Acting Administrator Kerry Weems said in a statement.

In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.

Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.

In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.

This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.

CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.

CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.

For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to quality for payment using measures groups, physicians have to submit data for each of the measures in the group.

Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS. Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.

Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.

It appears that the changes will make it easier to report data, said Dr. James King, president of the American Academy of Family Physicians. “We want to be able to get our data in.”

However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. The extent to which internists will be able to use registry-based reporting will be unclear until CMS releases the list of participating registries in late August, he said.

Submitting Data Under PQRI

The Centers for Medicare and Medicaid Services recently outlined nine options for reporting data to PQRI in 2008.

Three options facilitate claims-based reporting:

▸ Physicians can choose to report on individual measures for a full year from Jan. 1 to Dec. 31, 2008. Under this option, physicians with three or more applicable measures would report on at least three measures for at least 80% of their patients. Those with fewer than three applicable measures would report on all of those measures for at least 80% of their eligible patients.

▸ Physicians can also choose from two reporting approaches for the half-year reporting period from July 1 to Dec. 31. Physicians could report on all measures in a measures group for 15 consecutive patients with the relevant condition or 80% of eligible patients.

Six options are registry-based:

▸ CMS will allow three reporting options for a full-year reporting period. Those who chose to report on individual measures must report on 80% of applicable cases for a minimum of three measures. Physicians can also report on a measures group for 30 consecutive patients with the applicable condition or 80% of the applicable cases.

▸ CMS has also established three reporting options for reporting to a registry for a half-year from July 1 to Dec. 31. For example, physicians and other eligible professionals could report on individual measures for 80% of applicable cases for a minimum of three measures. Physicians could also report for a half-year using measures groups. For example, physicians can report on a measures group for 15 consecutive patients with the applicable condition or 80% of applicable cases.

More information about the different reporting options is available online at www.cms.hhs.gov/pqri

Physicians now have nine different options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.

The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half-year. Officials at the Centers for Medicare and Medicaid Services announced the changes last month.

Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.

“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” CMS Acting Administrator Kerry Weems said in a statement.

In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.

Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.

In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.

This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.

CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.

CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.

For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to quality for payment using measures groups, physicians have to submit data for each of the measures in the group.

Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS. Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.

Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.

It appears that the changes will make it easier to report data, said Dr. James King, president of the American Academy of Family Physicians. “We want to be able to get our data in.”

However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. The extent to which internists will be able to use registry-based reporting will be unclear until CMS releases the list of participating registries in late August, he said.

Submitting Data Under PQRI

The Centers for Medicare and Medicaid Services recently outlined nine options for reporting data to PQRI in 2008.

Three options facilitate claims-based reporting:

▸ Physicians can choose to report on individual measures for a full year from Jan. 1 to Dec. 31, 2008. Under this option, physicians with three or more applicable measures would report on at least three measures for at least 80% of their patients. Those with fewer than three applicable measures would report on all of those measures for at least 80% of their eligible patients.

▸ Physicians can also choose from two reporting approaches for the half-year reporting period from July 1 to Dec. 31. Physicians could report on all measures in a measures group for 15 consecutive patients with the relevant condition or 80% of eligible patients.

Six options are registry-based:

▸ CMS will allow three reporting options for a full-year reporting period. Those who chose to report on individual measures must report on 80% of applicable cases for a minimum of three measures. Physicians can also report on a measures group for 30 consecutive patients with the applicable condition or 80% of the applicable cases.

▸ CMS has also established three reporting options for reporting to a registry for a half-year from July 1 to Dec. 31. For example, physicians and other eligible professionals could report on individual measures for 80% of applicable cases for a minimum of three measures. Physicians could also report for a half-year using measures groups. For example, physicians can report on a measures group for 15 consecutive patients with the applicable condition or 80% of applicable cases.

The state by state figures are available online at www.familiesusa.org

In 2006, more than seven working-age people in the state of Texas died each day because of a lack of health insurance coverage, according to estimates from the consumer group Families USA.

Families USA released state-by-state estimates of deaths attributed to a lack of health insurance for individuals aged 25-64 years. The report builds on the work of the Institute of Medicine, which in 2002 released a report that found that approximately 18,000 individuals aged 25-64 years died in 2000 because they were uninsured. A more recent study from the Urban Institute found that approximately 22,000 people in that age bracket died in 2006 because they didn't have health insurance.

“Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don't have the same access to health care as their insured neighbors,” Ron Pollack, executive director of Families USA, said during a teleconference to release the report. “The conclusions are sadly clear—a lack of health coverage is a matter of life and death for many people.”

In general, the uninsured are less likely to have a usual source of care outside of the emergency department, they often go without screenings and preventive care, and they frequently forgo needed medical treatment, Mr. Pollack said. While this often results in poor health, in the extreme it also leads to death, he said.

For example, in Utah, where 19% of the 1.2 million working-age people in the state were uninsured in 2006, on average three people died each week because of a lack of health insurance coverage. Between 2000 and 2006, more than 800 people died because of a lack of health insurance, the group estimated.

In Massachusetts, about 12% of the 3.4 million people between the ages of 25 and 64 years were uninsured in 2006. Families USA estimates that more than six working-age individuals in the state died each week in 2006 because of a lack of insurance coverage. Between 2000 and 2006, more than 2,000 working-age adults died because they didn't have insurance coverage, the group estimated.

However, these numbers are likely to improve in the next couple of years as more people gain insurance coverage as a result of health reform legislation passed in that state, Mr. Pollack said.

The Families USA estimates are based on 2000-2005 state mortality and population data from the National Center for Health Statistics and the U.S. Census Bureau Current Population Survey data from 2000 to 2006.

The state by state figures are available online at www.familiesusa.org

In 2006, more than seven working-age people in the state of Texas died each day because of a lack of health insurance coverage, according to estimates from the consumer group Families USA.

Families USA released state-by-state estimates of deaths attributed to a lack of health insurance for individuals aged 25-64 years. The report builds on the work of the Institute of Medicine, which in 2002 released a report that found that approximately 18,000 individuals aged 25-64 years died in 2000 because they were uninsured. A more recent study from the Urban Institute found that approximately 22,000 people in that age bracket died in 2006 because they didn't have health insurance.

“Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don't have the same access to health care as their insured neighbors,” Ron Pollack, executive director of Families USA, said during a teleconference to release the report. “The conclusions are sadly clear—a lack of health coverage is a matter of life and death for many people.”

In general, the uninsured are less likely to have a usual source of care outside of the emergency department, they often go without screenings and preventive care, and they frequently forgo needed medical treatment, Mr. Pollack said. While this often results in poor health, in the extreme it also leads to death, he said.

For example, in Utah, where 19% of the 1.2 million working-age people in the state were uninsured in 2006, on average three people died each week because of a lack of health insurance coverage. Between 2000 and 2006, more than 800 people died because of a lack of health insurance, the group estimated.

In Massachusetts, about 12% of the 3.4 million people between the ages of 25 and 64 years were uninsured in 2006. Families USA estimates that more than six working-age individuals in the state died each week in 2006 because of a lack of insurance coverage. Between 2000 and 2006, more than 2,000 working-age adults died because they didn't have insurance coverage, the group estimated.

However, these numbers are likely to improve in the next couple of years as more people gain insurance coverage as a result of health reform legislation passed in that state, Mr. Pollack said.

The Families USA estimates are based on 2000-2005 state mortality and population data from the National Center for Health Statistics and the U.S. Census Bureau Current Population Survey data from 2000 to 2006.

The state by state figures are available online at www.familiesusa.org

In 2006, more than seven working-age people in the state of Texas died each day because of a lack of health insurance coverage, according to estimates from the consumer group Families USA.

Families USA released state-by-state estimates of deaths attributed to a lack of health insurance for individuals aged 25-64 years. The report builds on the work of the Institute of Medicine, which in 2002 released a report that found that approximately 18,000 individuals aged 25-64 years died in 2000 because they were uninsured. A more recent study from the Urban Institute found that approximately 22,000 people in that age bracket died in 2006 because they didn't have health insurance.

“Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don't have the same access to health care as their insured neighbors,” Ron Pollack, executive director of Families USA, said during a teleconference to release the report. “The conclusions are sadly clear—a lack of health coverage is a matter of life and death for many people.”

In general, the uninsured are less likely to have a usual source of care outside of the emergency department, they often go without screenings and preventive care, and they frequently forgo needed medical treatment, Mr. Pollack said. While this often results in poor health, in the extreme it also leads to death, he said.

For example, in Utah, where 19% of the 1.2 million working-age people in the state were uninsured in 2006, on average three people died each week because of a lack of health insurance coverage. Between 2000 and 2006, more than 800 people died because of a lack of health insurance, the group estimated.

In Massachusetts, about 12% of the 3.4 million people between the ages of 25 and 64 years were uninsured in 2006. Families USA estimates that more than six working-age individuals in the state died each week in 2006 because of a lack of insurance coverage. Between 2000 and 2006, more than 2,000 working-age adults died because they didn't have insurance coverage, the group estimated.

However, these numbers are likely to improve in the next couple of years as more people gain insurance coverage as a result of health reform legislation passed in that state, Mr. Pollack said.

The Families USA estimates are based on 2000-2005 state mortality and population data from the National Center for Health Statistics and the U.S. Census Bureau Current Population Survey data from 2000 to 2006.

Study Challenges Teen Oral Sex Myth

The belief that teens engage in oral sex so that they can be sexually active while remaining “virgins” is not supported by teen behavior, according to a study from the Guttmacher Institute. The analysis found that 55% of male and female adolescents aged 15-19 years have engaged in heterosexual oral sex, compared with 50% who have engaged in vaginal sex. But teens were nearly four times more likely to have had oral sex if they had engaged in vaginal sex, the study found. For example, 87% of adolescents who had ever had vaginal sex had also had oral sex, compared with only 23% of adolescents who had not had vaginal sex. “Our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth. There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners,” study author Laura Lindberg, Ph.D., of the Guttmacher Institute, said in a statement. The findings are based on data from the 2002 National Survey of Family Growth, which measured the prevalence of oral and anal sex among men and women. The survey includes responses from 1,505 females and 1,121 males aged 15-19 years. The study is available on the Journal of Adolescent Health's Web site (

http://journals.elsevierhealth.com/periodicals/jah

Initial Breast-Feeding Increases

The percentage of infants who have ever been breast-fed reached 77% for children born in 2005-2006, exceeding a public health target of 75%, according to an analysis by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention. The percentage of infants who have ever been breast-fed has been on the rise since 1993-1994, when initial rates of breast-feeding were around 60%. However, there has been no significant change in the percentage of women who continued to breast-feed at 6 months of age. The analysis also found that breast-feeding continues to vary by race/ethnicity. For example, the percentage of infants who were ever breast-fed was 79% among non-Hispanic white infants, compared with 65% among non-Hispanic black infants.

International Study Launched

Researchers recently launched a multinational osteoporosis trial of nearly 60,000 postmenopausal women that aims to provide a real-world look at how patients at risk for osteoporotic fractures are treated. The Global Longitudinal Registry of Osteoporosis in Women is an observational study that has enrolled women aged over 55 years who visited their primary care physicians during the 2 years prior to study enrollment; enrollment is not linked to an osteoporosis diagnosis. Participants were recruited through primary care physicians at 17 sites in North America, Europe, and Australia. Researchers will collect information on osteoporosis risk factors, treatments, patient and physician behavior, and fracture outcomes over a 5-year period. The study is being conducted by researchers at the Center for Outcomes Research at the University of Massachusetts, Worcester, and is supported by an unrestricted research grant from the Alliance for Better Bone Health, funded by Sanofi Aventis U.S. and Procter & Gamble Pharmaceuticals. More information is available at

www.outcomes.org/glow

FDA Pushes for Adverse Event Reports

Doctors who use Epocrates products have received a message on their personal digital assistants explaining how adverse event reporting works, as part of a Food and Drug Administration effort to increase the number of adverse event reports from doctors. “Physicians are on the front line when it comes to patient care, and working with Epocrates helps us remind them of safety and error reporting directly at the point of patient contact,” said Dr. Norman Marks, medical director of the FDA's MedWatch program.

Half of Insured Americans on Rx Drugs

Medco Health Solutions has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: Forty-eight percent of women aged 20-44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, while the top therapies overall were antihypertensives and cholesterol-cutters. Hormone therapy use by women aged 45-64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. “But there is a silver lining: It does show that people are receiving treatment which can prevent more serious health problems down the road.”

Study Challenges Teen Oral Sex Myth

The belief that teens engage in oral sex so that they can be sexually active while remaining “virgins” is not supported by teen behavior, according to a study from the Guttmacher Institute. The analysis found that 55% of male and female adolescents aged 15-19 years have engaged in heterosexual oral sex, compared with 50% who have engaged in vaginal sex. But teens were nearly four times more likely to have had oral sex if they had engaged in vaginal sex, the study found. For example, 87% of adolescents who had ever had vaginal sex had also had oral sex, compared with only 23% of adolescents who had not had vaginal sex. “Our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth. There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners,” study author Laura Lindberg, Ph.D., of the Guttmacher Institute, said in a statement. The findings are based on data from the 2002 National Survey of Family Growth, which measured the prevalence of oral and anal sex among men and women. The survey includes responses from 1,505 females and 1,121 males aged 15-19 years. The study is available on the Journal of Adolescent Health's Web site (

http://journals.elsevierhealth.com/periodicals/jah

Initial Breast-Feeding Increases

The percentage of infants who have ever been breast-fed reached 77% for children born in 2005-2006, exceeding a public health target of 75%, according to an analysis by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention. The percentage of infants who have ever been breast-fed has been on the rise since 1993-1994, when initial rates of breast-feeding were around 60%. However, there has been no significant change in the percentage of women who continued to breast-feed at 6 months of age. The analysis also found that breast-feeding continues to vary by race/ethnicity. For example, the percentage of infants who were ever breast-fed was 79% among non-Hispanic white infants, compared with 65% among non-Hispanic black infants.

International Study Launched

Researchers recently launched a multinational osteoporosis trial of nearly 60,000 postmenopausal women that aims to provide a real-world look at how patients at risk for osteoporotic fractures are treated. The Global Longitudinal Registry of Osteoporosis in Women is an observational study that has enrolled women aged over 55 years who visited their primary care physicians during the 2 years prior to study enrollment; enrollment is not linked to an osteoporosis diagnosis. Participants were recruited through primary care physicians at 17 sites in North America, Europe, and Australia. Researchers will collect information on osteoporosis risk factors, treatments, patient and physician behavior, and fracture outcomes over a 5-year period. The study is being conducted by researchers at the Center for Outcomes Research at the University of Massachusetts, Worcester, and is supported by an unrestricted research grant from the Alliance for Better Bone Health, funded by Sanofi Aventis U.S. and Procter & Gamble Pharmaceuticals. More information is available at

www.outcomes.org/glow

FDA Pushes for Adverse Event Reports

Doctors who use Epocrates products have received a message on their personal digital assistants explaining how adverse event reporting works, as part of a Food and Drug Administration effort to increase the number of adverse event reports from doctors. “Physicians are on the front line when it comes to patient care, and working with Epocrates helps us remind them of safety and error reporting directly at the point of patient contact,” said Dr. Norman Marks, medical director of the FDA's MedWatch program.

Half of Insured Americans on Rx Drugs

Medco Health Solutions has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: Forty-eight percent of women aged 20-44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, while the top therapies overall were antihypertensives and cholesterol-cutters. Hormone therapy use by women aged 45-64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. “But there is a silver lining: It does show that people are receiving treatment which can prevent more serious health problems down the road.”

Study Challenges Teen Oral Sex Myth

The belief that teens engage in oral sex so that they can be sexually active while remaining “virgins” is not supported by teen behavior, according to a study from the Guttmacher Institute. The analysis found that 55% of male and female adolescents aged 15-19 years have engaged in heterosexual oral sex, compared with 50% who have engaged in vaginal sex. But teens were nearly four times more likely to have had oral sex if they had engaged in vaginal sex, the study found. For example, 87% of adolescents who had ever had vaginal sex had also had oral sex, compared with only 23% of adolescents who had not had vaginal sex. “Our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth. There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners,” study author Laura Lindberg, Ph.D., of the Guttmacher Institute, said in a statement. The findings are based on data from the 2002 National Survey of Family Growth, which measured the prevalence of oral and anal sex among men and women. The survey includes responses from 1,505 females and 1,121 males aged 15-19 years. The study is available on the Journal of Adolescent Health's Web site (

http://journals.elsevierhealth.com/periodicals/jah

Initial Breast-Feeding Increases

The percentage of infants who have ever been breast-fed reached 77% for children born in 2005-2006, exceeding a public health target of 75%, according to an analysis by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention. The percentage of infants who have ever been breast-fed has been on the rise since 1993-1994, when initial rates of breast-feeding were around 60%. However, there has been no significant change in the percentage of women who continued to breast-feed at 6 months of age. The analysis also found that breast-feeding continues to vary by race/ethnicity. For example, the percentage of infants who were ever breast-fed was 79% among non-Hispanic white infants, compared with 65% among non-Hispanic black infants.

International Study Launched

Researchers recently launched a multinational osteoporosis trial of nearly 60,000 postmenopausal women that aims to provide a real-world look at how patients at risk for osteoporotic fractures are treated. The Global Longitudinal Registry of Osteoporosis in Women is an observational study that has enrolled women aged over 55 years who visited their primary care physicians during the 2 years prior to study enrollment; enrollment is not linked to an osteoporosis diagnosis. Participants were recruited through primary care physicians at 17 sites in North America, Europe, and Australia. Researchers will collect information on osteoporosis risk factors, treatments, patient and physician behavior, and fracture outcomes over a 5-year period. The study is being conducted by researchers at the Center for Outcomes Research at the University of Massachusetts, Worcester, and is supported by an unrestricted research grant from the Alliance for Better Bone Health, funded by Sanofi Aventis U.S. and Procter & Gamble Pharmaceuticals. More information is available at

www.outcomes.org/glow

FDA Pushes for Adverse Event Reports

Doctors who use Epocrates products have received a message on their personal digital assistants explaining how adverse event reporting works, as part of a Food and Drug Administration effort to increase the number of adverse event reports from doctors. “Physicians are on the front line when it comes to patient care, and working with Epocrates helps us remind them of safety and error reporting directly at the point of patient contact,” said Dr. Norman Marks, medical director of the FDA's MedWatch program.

Half of Insured Americans on Rx Drugs

Medco Health Solutions has determined that 51% of insured Americans—children and adults—were taking prescription medications for at least one chronic condition in 2007. The pharmacy benefit management company analyzed a representative sample of 2.5 million people from its database. A surprise: Forty-eight percent of women aged 20-44 years are being treated for a chronic condition, compared with 33% of men their age. Antidepressants were the most common prescription for this age group, while the top therapies overall were antihypertensives and cholesterol-cutters. Hormone therapy use by women aged 45-64 years declined from 30% in 2001 to 15% in 2007. The data “paint a pretty unhealthy picture of America,” Dr. Robert Epstein, Medco's chief medical officer, said in a statement. “But there is a silver lining: It does show that people are receiving treatment which can prevent more serious health problems down the road.”

Mo. Gets Stroke Care System

The Missouri General Assembly recently passed legislation aimed at strengthening its emergency response to stroke and heart attack. The bill, HB 1790, establishes a “time critical diagnosis system” for stroke and ST-elevation myocardial infarction (STEMI) and requires the state health department to establish protocols for transporting patients to the nearest designated stroke and STEMI centers. The legislation, which was passed in May, is expected to be signed by the governor. “This lifesaving legislation provides the framework to create a new designation of stroke and heart attack centers in Missouri,” Republican Gov. Matt Blunt said in a statement. “These centers will focus on giving patients the right care in the right place in the right amount of time.” The state health department is already preparing to implement such a system, the governor said.

Grant to Study Parkinson's Tx

Officials at the National Institutes of Health recently awarded a $1.33 million grant to support research into the side effects of Parkinson's treatment. Christopher Bishop, Ph.D., of Binghamton (N.Y.) University, along with colleagues at Wayne State University in Detroit and the Veterans Administration hospital in Chicago, are researching ways to reduce dyskinesia and suppress the involuntary movements associated with prolonged treatment on L-dopa. “We are beginning to believe that dyskinesia is actually the inability to suppress motor memories as a result of the drug's stimulation,” Dr. Bishop said in a statement. One focus of their work is to look at serotonin compounds that reduce glutamate following L-dopa treatment. The research is also being supported by the American Parkinson's Disease Association.

MDs Don't Promote Research

Nearly 95% of Americans in a recent survey said that their physicians have never spoken to them about participating in a medical research study. The survey results, released by the Society for Women's Health Research, also found that less than 10% of respondents had ever participated in such a study. Further, women were less likely than were men to know that research opportunities were available. About 73% of women were aware of research opportunities, compared with 83% of men who were surveyed. Women were also more likely to say that they were too old or too sick to participate in research, according to the study. For example, 7.2% of women said that their age made them hesitant to participate in clinical research, compared with 2.4% of men. “Women 65 and older are among the fastest growing segments of our population, and we have very little health research data on them,” Sherry Marts, Ph.D., vice president of scientific affairs for the Society for Women's Health Research, said in a statement. “This lack of information is an area of great need and growing concern.” The telephone survey included responses from 2,028 U.S. adults.

CBO Casts Doubt on IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a report from the Congressional Budget Office. However, the adoption of health IT alone will not produce significant savings, the report concludes. For example, institutions that have successfully used health IT to lower costs are generally integrated health care systems such as Kaiser Permanente. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO report said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. Those estimates are derived by assuming certain changes to the health care system intended to incentivize physicians. CBO analysts found that a subsidy to providers could increase adoption but would be costly to the government. The full report is available online at

www.cbo.gov

Mo. Gets Stroke Care System

The Missouri General Assembly recently passed legislation aimed at strengthening its emergency response to stroke and heart attack. The bill, HB 1790, establishes a “time critical diagnosis system” for stroke and ST-elevation myocardial infarction (STEMI) and requires the state health department to establish protocols for transporting patients to the nearest designated stroke and STEMI centers. The legislation, which was passed in May, is expected to be signed by the governor. “This lifesaving legislation provides the framework to create a new designation of stroke and heart attack centers in Missouri,” Republican Gov. Matt Blunt said in a statement. “These centers will focus on giving patients the right care in the right place in the right amount of time.” The state health department is already preparing to implement such a system, the governor said.

Grant to Study Parkinson's Tx

Officials at the National Institutes of Health recently awarded a $1.33 million grant to support research into the side effects of Parkinson's treatment. Christopher Bishop, Ph.D., of Binghamton (N.Y.) University, along with colleagues at Wayne State University in Detroit and the Veterans Administration hospital in Chicago, are researching ways to reduce dyskinesia and suppress the involuntary movements associated with prolonged treatment on L-dopa. “We are beginning to believe that dyskinesia is actually the inability to suppress motor memories as a result of the drug's stimulation,” Dr. Bishop said in a statement. One focus of their work is to look at serotonin compounds that reduce glutamate following L-dopa treatment. The research is also being supported by the American Parkinson's Disease Association.

MDs Don't Promote Research

Nearly 95% of Americans in a recent survey said that their physicians have never spoken to them about participating in a medical research study. The survey results, released by the Society for Women's Health Research, also found that less than 10% of respondents had ever participated in such a study. Further, women were less likely than were men to know that research opportunities were available. About 73% of women were aware of research opportunities, compared with 83% of men who were surveyed. Women were also more likely to say that they were too old or too sick to participate in research, according to the study. For example, 7.2% of women said that their age made them hesitant to participate in clinical research, compared with 2.4% of men. “Women 65 and older are among the fastest growing segments of our population, and we have very little health research data on them,” Sherry Marts, Ph.D., vice president of scientific affairs for the Society for Women's Health Research, said in a statement. “This lack of information is an area of great need and growing concern.” The telephone survey included responses from 2,028 U.S. adults.

CBO Casts Doubt on IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a report from the Congressional Budget Office. However, the adoption of health IT alone will not produce significant savings, the report concludes. For example, institutions that have successfully used health IT to lower costs are generally integrated health care systems such as Kaiser Permanente. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO report said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. Those estimates are derived by assuming certain changes to the health care system intended to incentivize physicians. CBO analysts found that a subsidy to providers could increase adoption but would be costly to the government. The full report is available online at

www.cbo.gov

Mo. Gets Stroke Care System

The Missouri General Assembly recently passed legislation aimed at strengthening its emergency response to stroke and heart attack. The bill, HB 1790, establishes a “time critical diagnosis system” for stroke and ST-elevation myocardial infarction (STEMI) and requires the state health department to establish protocols for transporting patients to the nearest designated stroke and STEMI centers. The legislation, which was passed in May, is expected to be signed by the governor. “This lifesaving legislation provides the framework to create a new designation of stroke and heart attack centers in Missouri,” Republican Gov. Matt Blunt said in a statement. “These centers will focus on giving patients the right care in the right place in the right amount of time.” The state health department is already preparing to implement such a system, the governor said.

Grant to Study Parkinson's Tx

Officials at the National Institutes of Health recently awarded a $1.33 million grant to support research into the side effects of Parkinson's treatment. Christopher Bishop, Ph.D., of Binghamton (N.Y.) University, along with colleagues at Wayne State University in Detroit and the Veterans Administration hospital in Chicago, are researching ways to reduce dyskinesia and suppress the involuntary movements associated with prolonged treatment on L-dopa. “We are beginning to believe that dyskinesia is actually the inability to suppress motor memories as a result of the drug's stimulation,” Dr. Bishop said in a statement. One focus of their work is to look at serotonin compounds that reduce glutamate following L-dopa treatment. The research is also being supported by the American Parkinson's Disease Association.

MDs Don't Promote Research

Nearly 95% of Americans in a recent survey said that their physicians have never spoken to them about participating in a medical research study. The survey results, released by the Society for Women's Health Research, also found that less than 10% of respondents had ever participated in such a study. Further, women were less likely than were men to know that research opportunities were available. About 73% of women were aware of research opportunities, compared with 83% of men who were surveyed. Women were also more likely to say that they were too old or too sick to participate in research, according to the study. For example, 7.2% of women said that their age made them hesitant to participate in clinical research, compared with 2.4% of men. “Women 65 and older are among the fastest growing segments of our population, and we have very little health research data on them,” Sherry Marts, Ph.D., vice president of scientific affairs for the Society for Women's Health Research, said in a statement. “This lack of information is an area of great need and growing concern.” The telephone survey included responses from 2,028 U.S. adults.

CBO Casts Doubt on IT Savings

Health information technology, when coupled with other reforms, can help reduce health spending in certain settings, according to a report from the Congressional Budget Office. However, the adoption of health IT alone will not produce significant savings, the report concludes. For example, institutions that have successfully used health IT to lower costs are generally integrated health care systems such as Kaiser Permanente. “Office-based physicians in particular may see no benefit if they purchase [an electronic health record]—and may even suffer financial harm,” the CBO report said. Recent studies by the RAND Corporation and the Center for Information Technology Leadership estimate savings from health IT at around $80 billion annually. Those estimates are derived by assuming certain changes to the health care system intended to incentivize physicians. CBO analysts found that a subsidy to providers could increase adoption but would be costly to the government. The full report is available online at

www.cbo.gov

The presidential candidates aren't the only ones with proposals to reform the American health care system.

While the designs are different, more and more players in the health care arena are unveiling their own detailed plans to provide health care coverage for all or most Americans.

For instance, the Commonwealth Fund recently outlined a proposal called “Building Blocks” that seeks to cover 44 million of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature both private plans and a “Medicare Extra” option. The Medicare Extra plan would offer premiums of $259 a month for individuals and $702 a month for families, 30% lower than the average premium charged to employers today, according to the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan (SCHIP) to cover all adults and children below 150% of the federal poverty level. And the plan would include both individual and employer mandates for health coverage.

With the use of modeling from the Lewin Group, officials at the Commonwealth Fund estimate that the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But the plan could actually save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health, according to the Commonwealth Fund.

“This approach builds on group insurance coverage and the national reach of Medicare and at the same time addresses the high administrative and premium costs for individuals and small groups,” Karen Davis, Commonwealth Fund president, said.

In the meantime, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has brought forward its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” the proposal calls for subsidies and tax breaks to help individuals afford coverage, improving health care quality through health information technology and care coordination, and realigning the financial incentives in the health care system to pay for value.

For example, the plan calls on the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums. The plan also calls for applying the same tax breaks to individually purchased health insurance as apply to employer-sponsored coverage. However, the group did not endorse the idea of individual mandates for health insurance.

The plan also calls for moving away from a payment system that rewards physicians and hospitals for the volume of services they provide and instead paying for evidence-based care and prevention. The current model rewards inefficiency and pays better when patients are sicker, Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, said during a press briefing to release the plan.

“We really are suggesting we turn that upside down,” he said.

The presidential candidates aren't the only ones with proposals to reform the American health care system.

While the designs are different, more and more players in the health care arena are unveiling their own detailed plans to provide health care coverage for all or most Americans.

For instance, the Commonwealth Fund recently outlined a proposal called “Building Blocks” that seeks to cover 44 million of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature both private plans and a “Medicare Extra” option. The Medicare Extra plan would offer premiums of $259 a month for individuals and $702 a month for families, 30% lower than the average premium charged to employers today, according to the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan (SCHIP) to cover all adults and children below 150% of the federal poverty level. And the plan would include both individual and employer mandates for health coverage.

With the use of modeling from the Lewin Group, officials at the Commonwealth Fund estimate that the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But the plan could actually save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health, according to the Commonwealth Fund.

“This approach builds on group insurance coverage and the national reach of Medicare and at the same time addresses the high administrative and premium costs for individuals and small groups,” Karen Davis, Commonwealth Fund president, said.

In the meantime, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has brought forward its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” the proposal calls for subsidies and tax breaks to help individuals afford coverage, improving health care quality through health information technology and care coordination, and realigning the financial incentives in the health care system to pay for value.

For example, the plan calls on the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums. The plan also calls for applying the same tax breaks to individually purchased health insurance as apply to employer-sponsored coverage. However, the group did not endorse the idea of individual mandates for health insurance.

The plan also calls for moving away from a payment system that rewards physicians and hospitals for the volume of services they provide and instead paying for evidence-based care and prevention. The current model rewards inefficiency and pays better when patients are sicker, Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, said during a press briefing to release the plan.

“We really are suggesting we turn that upside down,” he said.

The presidential candidates aren't the only ones with proposals to reform the American health care system.

While the designs are different, more and more players in the health care arena are unveiling their own detailed plans to provide health care coverage for all or most Americans.

For instance, the Commonwealth Fund recently outlined a proposal called “Building Blocks” that seeks to cover 44 million of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature both private plans and a “Medicare Extra” option. The Medicare Extra plan would offer premiums of $259 a month for individuals and $702 a month for families, 30% lower than the average premium charged to employers today, according to the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan (SCHIP) to cover all adults and children below 150% of the federal poverty level. And the plan would include both individual and employer mandates for health coverage.

With the use of modeling from the Lewin Group, officials at the Commonwealth Fund estimate that the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But the plan could actually save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health, according to the Commonwealth Fund.

“This approach builds on group insurance coverage and the national reach of Medicare and at the same time addresses the high administrative and premium costs for individuals and small groups,” Karen Davis, Commonwealth Fund president, said.

In the meantime, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has brought forward its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” the proposal calls for subsidies and tax breaks to help individuals afford coverage, improving health care quality through health information technology and care coordination, and realigning the financial incentives in the health care system to pay for value.

For example, the plan calls on the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums. The plan also calls for applying the same tax breaks to individually purchased health insurance as apply to employer-sponsored coverage. However, the group did not endorse the idea of individual mandates for health insurance.

The plan also calls for moving away from a payment system that rewards physicians and hospitals for the volume of services they provide and instead paying for evidence-based care and prevention. The current model rewards inefficiency and pays better when patients are sicker, Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, said during a press briefing to release the plan.

“We really are suggesting we turn that upside down,” he said.

While the Democrats continue to debate the need for individual mandates for health coverage, presumptive Republican presidential nominee Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a recent Tampa speech to announce details of his health care proposal.

“It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost,” he said.

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan, or GAP. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign.

The idea is to reform the marketplace and drive down costs overall.

Grace-Marie Turner, a McCain campaign adviser and president of the Galen Institute, which favors free-market approaches to health care, said that Sen. McCain recognizes that the first step to expanding coverage is to make health care more affordable.

The cornerstones of that approach include giving consumers more coverage options, paying for wellness and prevention, and getting rid of waste in the system.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States.

“We are pretty amazed at how extreme a plan Mr. McCain has staked out,” commented Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to the purchase coverage in the individual market where coverage is expensive and difficult to obtain.

“Our prediction is a race to the bottom,” he said.

And a $5,000 tax credit wouldn't be enough to cover the cost of family coverage, which the Kaiser Family Foundation estimates costs on average nearly $12,000, he commented.

It's hard to predict exactly what will happen with employer-based coverage under this proposal, said Sara R. Collins, Ph.D., assistant vice president for the Program on the Future of Health Insurance at the Commonwealth Fund. The question is whether individuals who currently have comprehensive coverage through their employer would end up underinsured after moving into the individual market.

The proposal is raising some concerns among physicians. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal, saying that taking away the employee tax exclusion would “undoubtedly” cause a shift to individual coverage and force many people into government health care programs.

The focus should be on expanding coverage to the uninsured, not destabilizing the current system of coverage, he said.

But Dr. Lewin praised the direction of Sen. McCain's quality of care proposals, which include plans aimed at increasing the adoption of health information technology and paying physicians for prevention and chronic disease management.

In the areas of health information technology and medical research funding, Sen. McCain's proposal is actually similar to the plans put forth by the Democratic candidates Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.), said Naomi Senkeeto, a health policy analyst at the American College of Physicians.

For example, Sen. McCain plans to dedicate federal research dollars on the basis of “sound science” and a put a greater emphasis on chronic disease care and management.

The American College of Physicians does not endorse any candidates but has performed an analysis of how the presidential candidates compare with one another on guaranteeing access to affordable coverage, providing everyone with a primary care physician, increasing investment in health information technology, reducing administrative expenses, and increasing funding for research. The side-by-side comparison is available online at the ACP Web site, www.acponline.org/advocacy/where_we_stand/election/

Sen. John McCain is in favor of allowing Americans to buy health insurance coverage across state lines. JOHN McCain

While the Democrats continue to debate the need for individual mandates for health coverage, presumptive Republican presidential nominee Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a recent Tampa speech to announce details of his health care proposal.

“It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost,” he said.

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan, or GAP. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign.

The idea is to reform the marketplace and drive down costs overall.

Grace-Marie Turner, a McCain campaign adviser and president of the Galen Institute, which favors free-market approaches to health care, said that Sen. McCain recognizes that the first step to expanding coverage is to make health care more affordable.

The cornerstones of that approach include giving consumers more coverage options, paying for wellness and prevention, and getting rid of waste in the system.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States.

“We are pretty amazed at how extreme a plan Mr. McCain has staked out,” commented Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to the purchase coverage in the individual market where coverage is expensive and difficult to obtain.

“Our prediction is a race to the bottom,” he said.

And a $5,000 tax credit wouldn't be enough to cover the cost of family coverage, which the Kaiser Family Foundation estimates costs on average nearly $12,000, he commented.

It's hard to predict exactly what will happen with employer-based coverage under this proposal, said Sara R. Collins, Ph.D., assistant vice president for the Program on the Future of Health Insurance at the Commonwealth Fund. The question is whether individuals who currently have comprehensive coverage through their employer would end up underinsured after moving into the individual market.

The proposal is raising some concerns among physicians. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal, saying that taking away the employee tax exclusion would “undoubtedly” cause a shift to individual coverage and force many people into government health care programs.

The focus should be on expanding coverage to the uninsured, not destabilizing the current system of coverage, he said.

But Dr. Lewin praised the direction of Sen. McCain's quality of care proposals, which include plans aimed at increasing the adoption of health information technology and paying physicians for prevention and chronic disease management.

In the areas of health information technology and medical research funding, Sen. McCain's proposal is actually similar to the plans put forth by the Democratic candidates Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.), said Naomi Senkeeto, a health policy analyst at the American College of Physicians.

For example, Sen. McCain plans to dedicate federal research dollars on the basis of “sound science” and a put a greater emphasis on chronic disease care and management.

The American College of Physicians does not endorse any candidates but has performed an analysis of how the presidential candidates compare with one another on guaranteeing access to affordable coverage, providing everyone with a primary care physician, increasing investment in health information technology, reducing administrative expenses, and increasing funding for research. The side-by-side comparison is available online at the ACP Web site, www.acponline.org/advocacy/where_we_stand/election/

Sen. John McCain is in favor of allowing Americans to buy health insurance coverage across state lines. JOHN McCain

While the Democrats continue to debate the need for individual mandates for health coverage, presumptive Republican presidential nominee Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a recent Tampa speech to announce details of his health care proposal.

“It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost,” he said.

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan, or GAP. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign.

The idea is to reform the marketplace and drive down costs overall.

Grace-Marie Turner, a McCain campaign adviser and president of the Galen Institute, which favors free-market approaches to health care, said that Sen. McCain recognizes that the first step to expanding coverage is to make health care more affordable.

The cornerstones of that approach include giving consumers more coverage options, paying for wellness and prevention, and getting rid of waste in the system.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States.

“We are pretty amazed at how extreme a plan Mr. McCain has staked out,” commented Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to the purchase coverage in the individual market where coverage is expensive and difficult to obtain.

“Our prediction is a race to the bottom,” he said.

And a $5,000 tax credit wouldn't be enough to cover the cost of family coverage, which the Kaiser Family Foundation estimates costs on average nearly $12,000, he commented.

It's hard to predict exactly what will happen with employer-based coverage under this proposal, said Sara R. Collins, Ph.D., assistant vice president for the Program on the Future of Health Insurance at the Commonwealth Fund. The question is whether individuals who currently have comprehensive coverage through their employer would end up underinsured after moving into the individual market.

The proposal is raising some concerns among physicians. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal, saying that taking away the employee tax exclusion would “undoubtedly” cause a shift to individual coverage and force many people into government health care programs.

The focus should be on expanding coverage to the uninsured, not destabilizing the current system of coverage, he said.

But Dr. Lewin praised the direction of Sen. McCain's quality of care proposals, which include plans aimed at increasing the adoption of health information technology and paying physicians for prevention and chronic disease management.

In the areas of health information technology and medical research funding, Sen. McCain's proposal is actually similar to the plans put forth by the Democratic candidates Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.), said Naomi Senkeeto, a health policy analyst at the American College of Physicians.

For example, Sen. McCain plans to dedicate federal research dollars on the basis of “sound science” and a put a greater emphasis on chronic disease care and management.

The American College of Physicians does not endorse any candidates but has performed an analysis of how the presidential candidates compare with one another on guaranteeing access to affordable coverage, providing everyone with a primary care physician, increasing investment in health information technology, reducing administrative expenses, and increasing funding for research. The side-by-side comparison is available online at the ACP Web site, www.acponline.org/advocacy/where_we_stand/election/

Sen. John McCain is in favor of allowing Americans to buy health insurance coverage across state lines. JOHN McCain