Mary Ellen Schneider

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events.

The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations. Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error.

Aetna is the first health plan to endorse the Leapfrog policy. “The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he added. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS).

One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked. “It's hard to know how it's going to be operationalized,” she added.

When used properly, the NQF never events list protects patients, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But, he cautioned, if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events.

The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations. Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error.

Aetna is the first health plan to endorse the Leapfrog policy. “The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he added. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS).

One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked. “It's hard to know how it's going to be operationalized,” she added.

When used properly, the NQF never events list protects patients, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But, he cautioned, if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events.

The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations. Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error.

Aetna is the first health plan to endorse the Leapfrog policy. “The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he added. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS).

One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked. “It's hard to know how it's going to be operationalized,” she added.

When used properly, the NQF never events list protects patients, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But, he cautioned, if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

ACOG Revisits Cord Blood Banking

If a patient requests information on umbilical cord blood banking, physicians should provide “balanced and accurate” information that explains the pros and cons of public versus private banking, according to the American College of Obstetricians and Gynecologists. In a recent opinion from ACOG's Committee on Obstetric Practice and the Committee on Genetics, ACOG also urges physicians to disclose any financial interests they may have when recruiting pregnant women for a for-profit cord blood bank. The committee opinion, which replaces an earlier opinion from 1997, advises physicians that there is no accurate estimate of the likelihood of using an autologous unit of umbilical cord blood. Some estimates put the chances at 1 in 2,700, while others say the rate could be lower. “Patients need to be aware that the chances are remote that the stem cells from their baby's banked cord blood will be used to treat that same child—or another family member—in the future,” Dr. Anthony R. Gregg, chair of ACOG's Committee on Genetics, said in a statement.

Abortion Rate on the Decline

Both the number and rate of abortions in the United States fell between 2000 and 2005, according to an analysis from the Guttmacher Institute. The number of abortions declined from 1.31 million in 2000 to 1.21 million in 2005, a drop of about 8%. And abortion rate dropped from 21 per 1,000 women aged 15–44 to 19.4 per 1,000 women, the lowest rate since 1974. The analysis, which will be published in the March issue of Perspective on Sexual and Reproductive Health, is based on the Guttmacher Institute's 14th survey of all known abortion providers in the United State. The Guttmacher Institute researchers cited a range of factors contributing to the decline in abortions including better contraceptive use, lower levels of unintended pregnancy, more women carrying unintended pregnancies to term, and difficulty accessing abortion services in some areas of the country. The National Right to Life Committee, however, credited women's right-to-know laws, parental consent laws, and so-called partial birth abortion bans with the decrease in abortions.

Prisoners' Abortion Rights Upheld

A federal appeals court in Missouri recently upheld the right of female prisoners in the state to be transported off-site to access abortions. In Roe v. Crawford et al., lawyers for the American Civil Liberties Union argued that pregnant women who are incarcerated do not lose their constitutional rights to obtain an abortion. The case first arose in 2005 when the ACLU went to court on behalf of a pregnant Missouri prisoner who wanted to obtain an abortion. At the time, the court ruled that the prison must transport the woman to a local health care facility to receive the abortion. Following that court victory, the ACLU had the case certified as a class action on behalf of all pregnant prisoners in Missouri. The U.S. District Court for the Western District of Missouri ruled in favor of the ACLU in July 2006, and last month the 8th U.S. Circuit Court of Appeals upheld that ruling.

Gender Plays Role in Depression Dx

Male and female physicians may have slightly different beliefs about when women are at greatest risk for depression, according to a survey of primary care physicians commissioned by the Society for Women's Health Research. While male and female physicians largely agree on the risks of depression, women doctors were more likely than men to say that women are at risk for depression during puberty and perimenopause. About 68% of female physicians cited puberty as a time when women with especially vulnerable to depression, compared with 48% of male physicians. The difference was more pronounced in perimenopause, where 93% of female physicians cited an increased risk, versus 68% of male physicians. The telephone survey included 417 male and 83 female physicians. The physician surveyed included family physicians, general practitioners, and internists. The survey, which was conducted by International Communications Research, was funded through an educational grant from Novartis.

Blue Cross/Blue Shield Sets Campaign

The Blue Cross and Blue Shield Association last month unveiled a 5-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured.

ACOG Revisits Cord Blood Banking

If a patient requests information on umbilical cord blood banking, physicians should provide “balanced and accurate” information that explains the pros and cons of public versus private banking, according to the American College of Obstetricians and Gynecologists. In a recent opinion from ACOG's Committee on Obstetric Practice and the Committee on Genetics, ACOG also urges physicians to disclose any financial interests they may have when recruiting pregnant women for a for-profit cord blood bank. The committee opinion, which replaces an earlier opinion from 1997, advises physicians that there is no accurate estimate of the likelihood of using an autologous unit of umbilical cord blood. Some estimates put the chances at 1 in 2,700, while others say the rate could be lower. “Patients need to be aware that the chances are remote that the stem cells from their baby's banked cord blood will be used to treat that same child—or another family member—in the future,” Dr. Anthony R. Gregg, chair of ACOG's Committee on Genetics, said in a statement.

Abortion Rate on the Decline

Both the number and rate of abortions in the United States fell between 2000 and 2005, according to an analysis from the Guttmacher Institute. The number of abortions declined from 1.31 million in 2000 to 1.21 million in 2005, a drop of about 8%. And abortion rate dropped from 21 per 1,000 women aged 15–44 to 19.4 per 1,000 women, the lowest rate since 1974. The analysis, which will be published in the March issue of Perspective on Sexual and Reproductive Health, is based on the Guttmacher Institute's 14th survey of all known abortion providers in the United State. The Guttmacher Institute researchers cited a range of factors contributing to the decline in abortions including better contraceptive use, lower levels of unintended pregnancy, more women carrying unintended pregnancies to term, and difficulty accessing abortion services in some areas of the country. The National Right to Life Committee, however, credited women's right-to-know laws, parental consent laws, and so-called partial birth abortion bans with the decrease in abortions.

Prisoners' Abortion Rights Upheld

A federal appeals court in Missouri recently upheld the right of female prisoners in the state to be transported off-site to access abortions. In Roe v. Crawford et al., lawyers for the American Civil Liberties Union argued that pregnant women who are incarcerated do not lose their constitutional rights to obtain an abortion. The case first arose in 2005 when the ACLU went to court on behalf of a pregnant Missouri prisoner who wanted to obtain an abortion. At the time, the court ruled that the prison must transport the woman to a local health care facility to receive the abortion. Following that court victory, the ACLU had the case certified as a class action on behalf of all pregnant prisoners in Missouri. The U.S. District Court for the Western District of Missouri ruled in favor of the ACLU in July 2006, and last month the 8th U.S. Circuit Court of Appeals upheld that ruling.

Gender Plays Role in Depression Dx

Male and female physicians may have slightly different beliefs about when women are at greatest risk for depression, according to a survey of primary care physicians commissioned by the Society for Women's Health Research. While male and female physicians largely agree on the risks of depression, women doctors were more likely than men to say that women are at risk for depression during puberty and perimenopause. About 68% of female physicians cited puberty as a time when women with especially vulnerable to depression, compared with 48% of male physicians. The difference was more pronounced in perimenopause, where 93% of female physicians cited an increased risk, versus 68% of male physicians. The telephone survey included 417 male and 83 female physicians. The physician surveyed included family physicians, general practitioners, and internists. The survey, which was conducted by International Communications Research, was funded through an educational grant from Novartis.

Blue Cross/Blue Shield Sets Campaign

The Blue Cross and Blue Shield Association last month unveiled a 5-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured.

ACOG Revisits Cord Blood Banking

If a patient requests information on umbilical cord blood banking, physicians should provide “balanced and accurate” information that explains the pros and cons of public versus private banking, according to the American College of Obstetricians and Gynecologists. In a recent opinion from ACOG's Committee on Obstetric Practice and the Committee on Genetics, ACOG also urges physicians to disclose any financial interests they may have when recruiting pregnant women for a for-profit cord blood bank. The committee opinion, which replaces an earlier opinion from 1997, advises physicians that there is no accurate estimate of the likelihood of using an autologous unit of umbilical cord blood. Some estimates put the chances at 1 in 2,700, while others say the rate could be lower. “Patients need to be aware that the chances are remote that the stem cells from their baby's banked cord blood will be used to treat that same child—or another family member—in the future,” Dr. Anthony R. Gregg, chair of ACOG's Committee on Genetics, said in a statement.

Abortion Rate on the Decline

Both the number and rate of abortions in the United States fell between 2000 and 2005, according to an analysis from the Guttmacher Institute. The number of abortions declined from 1.31 million in 2000 to 1.21 million in 2005, a drop of about 8%. And abortion rate dropped from 21 per 1,000 women aged 15–44 to 19.4 per 1,000 women, the lowest rate since 1974. The analysis, which will be published in the March issue of Perspective on Sexual and Reproductive Health, is based on the Guttmacher Institute's 14th survey of all known abortion providers in the United State. The Guttmacher Institute researchers cited a range of factors contributing to the decline in abortions including better contraceptive use, lower levels of unintended pregnancy, more women carrying unintended pregnancies to term, and difficulty accessing abortion services in some areas of the country. The National Right to Life Committee, however, credited women's right-to-know laws, parental consent laws, and so-called partial birth abortion bans with the decrease in abortions.

Prisoners' Abortion Rights Upheld

A federal appeals court in Missouri recently upheld the right of female prisoners in the state to be transported off-site to access abortions. In Roe v. Crawford et al., lawyers for the American Civil Liberties Union argued that pregnant women who are incarcerated do not lose their constitutional rights to obtain an abortion. The case first arose in 2005 when the ACLU went to court on behalf of a pregnant Missouri prisoner who wanted to obtain an abortion. At the time, the court ruled that the prison must transport the woman to a local health care facility to receive the abortion. Following that court victory, the ACLU had the case certified as a class action on behalf of all pregnant prisoners in Missouri. The U.S. District Court for the Western District of Missouri ruled in favor of the ACLU in July 2006, and last month the 8th U.S. Circuit Court of Appeals upheld that ruling.

Gender Plays Role in Depression Dx

Male and female physicians may have slightly different beliefs about when women are at greatest risk for depression, according to a survey of primary care physicians commissioned by the Society for Women's Health Research. While male and female physicians largely agree on the risks of depression, women doctors were more likely than men to say that women are at risk for depression during puberty and perimenopause. About 68% of female physicians cited puberty as a time when women with especially vulnerable to depression, compared with 48% of male physicians. The difference was more pronounced in perimenopause, where 93% of female physicians cited an increased risk, versus 68% of male physicians. The telephone survey included 417 male and 83 female physicians. The physician surveyed included family physicians, general practitioners, and internists. The survey, which was conducted by International Communications Research, was funded through an educational grant from Novartis.

Blue Cross/Blue Shield Sets Campaign

The Blue Cross and Blue Shield Association last month unveiled a 5-point plan for building on the current employer-based health insurance system to improve quality, rein in costs, and provide universal coverage. The plan would create an independent institute to support research comparing the relative effectiveness of different medical treatments; change incentives so that providers are rewarded for delivering high-quality, coordinated care, especially for those with chronic illnesses; empower consumers and providers with personal health records and cost data on medical services; promote healthy lifestyles to prevent and manage chronic illness; and foster public-private solutions to cover the uninsured.

In the final budget proposal of his presidency, President Bush is proposing substantial cuts to hospitals, skilled nursing facilities, and graduate medical education.

Leaders in the Democrat-controlled Congress instantly declared the proposal dead on arrival.

Under the plan, the Bush administration has put forth legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years, largely from hospital and other provider payments. The idea is to slow down the growth rate of the program from 7.2% to 5% over 5 years. But critics say the cuts would harm hospitals that care for low-income patients and train physicians.

The FY 2009 budget proposal calls for freezing payments to inpatient hospitals, long-term care hospitals, skilled nursing facilities, hospices, outpatient hospitals, and ambulance services from 2009 through 2011. Payments would then drop 0.65% annually under the proposal.

The proposal also outlines a payment freeze for inpatient rehabilitation facilities and ambulatory surgical centers in 2010 and 2011, followed by annual cuts. And home health agencies would also see a 0% update from 2009 through 2013 followed by annual payment cuts.

The proposal would reduce indirect medical education add-on payments from 5.5% to 2.2% over the next 3 years, and would eliminate the duplicate hospital indirect medical education payment for Medicare Advantage beneficiaries.

Hospitals would also face additional cuts under the plan. For example, the proposed budget would reduce hospital capital payments by 5% in 2009, and hospital disproportionate share payments would drop 30% over the next 2 years.

The FY 2009 budget plan also includes proposed legislative and administrative changes aimed at cutting nearly $18 billion from Medicaid over the next 5 years.

The administration's budget would reauthorize the State Children's Health Insurance Program (SCHIP) through 2013. The plan calls for a $19.7 billion increase to the program over 5 years, including $450 million in outreach grants to states and other organizations to help enroll uninsured children in the program.

The budget proposal does not address the 10.6% physician pay cut scheduled for July.

The American College of Cardiology said in a statement that the administration's budget “falls short” by not including a proposal to fix the Medicare physician payment formula. “Physicians are willing to do their part, but quality cannot be achieved under a zero-sum scenario. Continued deep payment cuts make it impossible for physicians to continue to invest in a health care infrastructure that facilitates data collection and quality improvement while ensuring that patients have access to high quality care.”

In total, the administration is requesting $711.2 billion for the Centers for Medicare and Medicaid Services to cover mandatory and discretionary outlays for the Medicare, Medicaid, and SCHIP programs. The request is a $32.7 billion increase over the FY 2008 funding level.

Federal research agencies are also facing funding cuts or freezes under the proposal.

The administration is proposing no increase for the National Institutes of Health, keeping the agency's budget at about $29.5 billion. Health advocates say the failure to expand NIH funding will hurt research efforts in several critical areas. For example, the National Institute of Diabetes and Digestive and Kidney Diseases would receive an increase under the administration's proposal, but the $2.6 million bump amounts to a 0.15% increase over FY 2008.

The American Diabetes Association is urging Congress to disregard the president's proposal and provide $112.5 million in additional funding, a 6.6% increase.

“We cannot afford not to invest in diabetes research, treatment, and prevention–the consequences for our health care system and our society will be too severe,” Dr. John B. Buse, president of medicine and science for the American Diabetes Association, said in a statement. “The [association] calls on Congress to align their priorities and provide funds to remedy this growing health crisis.”

The administration's budget proposal also calls for $8.8 billion in funding for the Centers for Disease Control and Prevention, a $412 million drop from FY 2008. The Agency for Healthcare Research and Quality would also face a cut under the proposal. The president is calling for $326 million in funding for the agency, a $9 million decrease from FY 2008.

The Food and Drug Administration would receive a $130 million increase over FY 2008, bringing its total funding to $2.4 billion in FY 2009. Its budget proposal includes $389.5 million for drug safety activities, an increase of about $36 million.

In the final budget proposal of his presidency, President Bush is proposing substantial cuts to hospitals, skilled nursing facilities, and graduate medical education.

Leaders in the Democrat-controlled Congress instantly declared the proposal dead on arrival.

Under the plan, the Bush administration has put forth legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years, largely from hospital and other provider payments. The idea is to slow down the growth rate of the program from 7.2% to 5% over 5 years. But critics say the cuts would harm hospitals that care for low-income patients and train physicians.

The FY 2009 budget proposal calls for freezing payments to inpatient hospitals, long-term care hospitals, skilled nursing facilities, hospices, outpatient hospitals, and ambulance services from 2009 through 2011. Payments would then drop 0.65% annually under the proposal.

The proposal also outlines a payment freeze for inpatient rehabilitation facilities and ambulatory surgical centers in 2010 and 2011, followed by annual cuts. And home health agencies would also see a 0% update from 2009 through 2013 followed by annual payment cuts.

The proposal would reduce indirect medical education add-on payments from 5.5% to 2.2% over the next 3 years, and would eliminate the duplicate hospital indirect medical education payment for Medicare Advantage beneficiaries.

Hospitals would also face additional cuts under the plan. For example, the proposed budget would reduce hospital capital payments by 5% in 2009, and hospital disproportionate share payments would drop 30% over the next 2 years.

The FY 2009 budget plan also includes proposed legislative and administrative changes aimed at cutting nearly $18 billion from Medicaid over the next 5 years.

The administration's budget would reauthorize the State Children's Health Insurance Program (SCHIP) through 2013. The plan calls for a $19.7 billion increase to the program over 5 years, including $450 million in outreach grants to states and other organizations to help enroll uninsured children in the program.

The budget proposal does not address the 10.6% physician pay cut scheduled for July.

The American College of Cardiology said in a statement that the administration's budget “falls short” by not including a proposal to fix the Medicare physician payment formula. “Physicians are willing to do their part, but quality cannot be achieved under a zero-sum scenario. Continued deep payment cuts make it impossible for physicians to continue to invest in a health care infrastructure that facilitates data collection and quality improvement while ensuring that patients have access to high quality care.”

In total, the administration is requesting $711.2 billion for the Centers for Medicare and Medicaid Services to cover mandatory and discretionary outlays for the Medicare, Medicaid, and SCHIP programs. The request is a $32.7 billion increase over the FY 2008 funding level.

Federal research agencies are also facing funding cuts or freezes under the proposal.

The administration is proposing no increase for the National Institutes of Health, keeping the agency's budget at about $29.5 billion. Health advocates say the failure to expand NIH funding will hurt research efforts in several critical areas. For example, the National Institute of Diabetes and Digestive and Kidney Diseases would receive an increase under the administration's proposal, but the $2.6 million bump amounts to a 0.15% increase over FY 2008.

The American Diabetes Association is urging Congress to disregard the president's proposal and provide $112.5 million in additional funding, a 6.6% increase.

“We cannot afford not to invest in diabetes research, treatment, and prevention–the consequences for our health care system and our society will be too severe,” Dr. John B. Buse, president of medicine and science for the American Diabetes Association, said in a statement. “The [association] calls on Congress to align their priorities and provide funds to remedy this growing health crisis.”

The administration's budget proposal also calls for $8.8 billion in funding for the Centers for Disease Control and Prevention, a $412 million drop from FY 2008. The Agency for Healthcare Research and Quality would also face a cut under the proposal. The president is calling for $326 million in funding for the agency, a $9 million decrease from FY 2008.

The Food and Drug Administration would receive a $130 million increase over FY 2008, bringing its total funding to $2.4 billion in FY 2009. Its budget proposal includes $389.5 million for drug safety activities, an increase of about $36 million.

In the final budget proposal of his presidency, President Bush is proposing substantial cuts to hospitals, skilled nursing facilities, and graduate medical education.

Leaders in the Democrat-controlled Congress instantly declared the proposal dead on arrival.

Under the plan, the Bush administration has put forth legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years, largely from hospital and other provider payments. The idea is to slow down the growth rate of the program from 7.2% to 5% over 5 years. But critics say the cuts would harm hospitals that care for low-income patients and train physicians.

The FY 2009 budget proposal calls for freezing payments to inpatient hospitals, long-term care hospitals, skilled nursing facilities, hospices, outpatient hospitals, and ambulance services from 2009 through 2011. Payments would then drop 0.65% annually under the proposal.

The proposal also outlines a payment freeze for inpatient rehabilitation facilities and ambulatory surgical centers in 2010 and 2011, followed by annual cuts. And home health agencies would also see a 0% update from 2009 through 2013 followed by annual payment cuts.

The proposal would reduce indirect medical education add-on payments from 5.5% to 2.2% over the next 3 years, and would eliminate the duplicate hospital indirect medical education payment for Medicare Advantage beneficiaries.

Hospitals would also face additional cuts under the plan. For example, the proposed budget would reduce hospital capital payments by 5% in 2009, and hospital disproportionate share payments would drop 30% over the next 2 years.

The FY 2009 budget plan also includes proposed legislative and administrative changes aimed at cutting nearly $18 billion from Medicaid over the next 5 years.

The administration's budget would reauthorize the State Children's Health Insurance Program (SCHIP) through 2013. The plan calls for a $19.7 billion increase to the program over 5 years, including $450 million in outreach grants to states and other organizations to help enroll uninsured children in the program.

The budget proposal does not address the 10.6% physician pay cut scheduled for July.

The American College of Cardiology said in a statement that the administration's budget “falls short” by not including a proposal to fix the Medicare physician payment formula. “Physicians are willing to do their part, but quality cannot be achieved under a zero-sum scenario. Continued deep payment cuts make it impossible for physicians to continue to invest in a health care infrastructure that facilitates data collection and quality improvement while ensuring that patients have access to high quality care.”

In total, the administration is requesting $711.2 billion for the Centers for Medicare and Medicaid Services to cover mandatory and discretionary outlays for the Medicare, Medicaid, and SCHIP programs. The request is a $32.7 billion increase over the FY 2008 funding level.

Federal research agencies are also facing funding cuts or freezes under the proposal.

The administration is proposing no increase for the National Institutes of Health, keeping the agency's budget at about $29.5 billion. Health advocates say the failure to expand NIH funding will hurt research efforts in several critical areas. For example, the National Institute of Diabetes and Digestive and Kidney Diseases would receive an increase under the administration's proposal, but the $2.6 million bump amounts to a 0.15% increase over FY 2008.

The American Diabetes Association is urging Congress to disregard the president's proposal and provide $112.5 million in additional funding, a 6.6% increase.

“We cannot afford not to invest in diabetes research, treatment, and prevention–the consequences for our health care system and our society will be too severe,” Dr. John B. Buse, president of medicine and science for the American Diabetes Association, said in a statement. “The [association] calls on Congress to align their priorities and provide funds to remedy this growing health crisis.”

The administration's budget proposal also calls for $8.8 billion in funding for the Centers for Disease Control and Prevention, a $412 million drop from FY 2008. The Agency for Healthcare Research and Quality would also face a cut under the proposal. The president is calling for $326 million in funding for the agency, a $9 million decrease from FY 2008.

The Food and Drug Administration would receive a $130 million increase over FY 2008, bringing its total funding to $2.4 billion in FY 2009. Its budget proposal includes $389.5 million for drug safety activities, an increase of about $36 million.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never-events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations.

Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error. Aetna is the first health plan to endorse the Leapfrog policy.

“The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never-events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he said. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician, Ms. Brown said.

“If there's a problem with blood incompatibility, is it the surgeon's fault?” she asked. “It's hard to know how it's going to be operationalized.”

When used properly, the NQF never-events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. Cigna plans to have a national policy in place by October 2008, spokesman Mark Slitt said.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never-events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations.

Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error. Aetna is the first health plan to endorse the Leapfrog policy.

“The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never-events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he said. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician, Ms. Brown said.

“If there's a problem with blood incompatibility, is it the surgeon's fault?” she asked. “It's hard to know how it's going to be operationalized.”

When used properly, the NQF never-events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. Cigna plans to have a national policy in place by October 2008, spokesman Mark Slitt said.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never-events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations.

Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error. Aetna is the first health plan to endorse the Leapfrog policy.

“The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never-events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he said. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician, Ms. Brown said.

“If there's a problem with blood incompatibility, is it the surgeon's fault?” she asked. “It's hard to know how it's going to be operationalized.”

When used properly, the NQF never-events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. Cigna plans to have a national policy in place by October 2008, spokesman Mark Slitt said.

Most Americans favor a continuation of the employer-based health insurance system and say they believe health insurance costs should be shared among individuals, employers, and the government, according to a Commonwealth Fund survey.

More than two-thirds of surveyed Americans favor requiring individuals to obtain health insurance in an effort to provide universal health coverage.

These findings indicate that on certain health reform issues Americans' views may be more closely aligned with proposals put forth by Democratic candidates for president than those outlined by Republicans. For example, the leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage, while most of the Republican candidates propose changes to the tax code that could reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis.

Sen. Hillary Clinton (D-N.Y.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children. Of the Republican candidates, no one is proposing an individual insurance mandate, according to the Commonwealth Fund.

From June to October 2007, the Commonwealth Fund conducted a phone survey of 3,501 adults aged 19 years and older as part of its biennial health insurance survey.

Respondents expressed broad support for employer-based health insurance. About 81% said employers should provide health insurance or contribute to a fund to cover all Americans. Support for this idea among respondents was high regardless of political affiliation, race, gender, age, and income.

Support for an individual insurance mandate to ensure coverage for all was lower; 68% of respondents said they strongly or somewhat favor a requirement that all individuals obtain health insurance.

When respondents were asked who should pay for health insurance for all Americans, 66% favored a system in which costs would be shared by individuals, employers, and the government. About 15% said it should be financed mostly by government, 8% said by employers, and 6% by individuals. About 86% of the respondents said health care reform is very or somewhat important in determining their vote.

ELSEVIER GLOBAL MEDICAL NEWS

Most Americans favor a continuation of the employer-based health insurance system and say they believe health insurance costs should be shared among individuals, employers, and the government, according to a Commonwealth Fund survey.

More than two-thirds of surveyed Americans favor requiring individuals to obtain health insurance in an effort to provide universal health coverage.

These findings indicate that on certain health reform issues Americans' views may be more closely aligned with proposals put forth by Democratic candidates for president than those outlined by Republicans. For example, the leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage, while most of the Republican candidates propose changes to the tax code that could reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis.

Sen. Hillary Clinton (D-N.Y.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children. Of the Republican candidates, no one is proposing an individual insurance mandate, according to the Commonwealth Fund.

From June to October 2007, the Commonwealth Fund conducted a phone survey of 3,501 adults aged 19 years and older as part of its biennial health insurance survey.

Respondents expressed broad support for employer-based health insurance. About 81% said employers should provide health insurance or contribute to a fund to cover all Americans. Support for this idea among respondents was high regardless of political affiliation, race, gender, age, and income.

Support for an individual insurance mandate to ensure coverage for all was lower; 68% of respondents said they strongly or somewhat favor a requirement that all individuals obtain health insurance.

When respondents were asked who should pay for health insurance for all Americans, 66% favored a system in which costs would be shared by individuals, employers, and the government. About 15% said it should be financed mostly by government, 8% said by employers, and 6% by individuals. About 86% of the respondents said health care reform is very or somewhat important in determining their vote.

ELSEVIER GLOBAL MEDICAL NEWS

Most Americans favor a continuation of the employer-based health insurance system and say they believe health insurance costs should be shared among individuals, employers, and the government, according to a Commonwealth Fund survey.

More than two-thirds of surveyed Americans favor requiring individuals to obtain health insurance in an effort to provide universal health coverage.

These findings indicate that on certain health reform issues Americans' views may be more closely aligned with proposals put forth by Democratic candidates for president than those outlined by Republicans. For example, the leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage, while most of the Republican candidates propose changes to the tax code that could reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis.

Sen. Hillary Clinton (D-N.Y.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children. Of the Republican candidates, no one is proposing an individual insurance mandate, according to the Commonwealth Fund.

From June to October 2007, the Commonwealth Fund conducted a phone survey of 3,501 adults aged 19 years and older as part of its biennial health insurance survey.

Respondents expressed broad support for employer-based health insurance. About 81% said employers should provide health insurance or contribute to a fund to cover all Americans. Support for this idea among respondents was high regardless of political affiliation, race, gender, age, and income.

Support for an individual insurance mandate to ensure coverage for all was lower; 68% of respondents said they strongly or somewhat favor a requirement that all individuals obtain health insurance.

When respondents were asked who should pay for health insurance for all Americans, 66% favored a system in which costs would be shared by individuals, employers, and the government. About 15% said it should be financed mostly by government, 8% said by employers, and 6% by individuals. About 86% of the respondents said health care reform is very or somewhat important in determining their vote.

ELSEVIER GLOBAL MEDICAL NEWS

In the final budget proposal of his presidency, President Bush is proposing substantial cuts to hospitals, skilled nursing facilities, and graduate medical education.

Leaders in the Democrat-controlled Congress instantly declared the proposal dead on arrival.

Under the plan, the Bush administration has put forth legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years, largely from hospital and other provider payments.

The idea is to slow down the growth rate of the program from 7.2% to 5% over 5 years. But critics say that the cuts would harm hospitals that care for low-income patients and train physicians.

The FY 2009 budget proposal calls for freezing payments to inpatient hospitals, long-term care hospitals, skilled nursing facilities, hospices, outpatient hospitals, and ambulance services from 2009 through 2011. Payments would then drop 0.65% annually under the proposal.

The proposal also outlines a payment freeze for inpatient rehabilitation facilities and ambulatory surgical centers in 2010 and 2011, followed by annual cuts. And home health agencies would also see a 0% update from 2009 through 2013 followed by annual payment cuts.

The budget proposal also would reduce indirect medical education add-on payments from 5.5% to 2.2% over the next 3 years, and would eliminate the duplicate hospital indirect medical education payment for Medicare Advantage beneficiaries.

Hospitals would face additional cuts under the plan. For example, the proposed budget would reduce hospital capital payments by 5% in 2009, and hospital disproportionate share payments would drop 30% over the next 2 years.

The FY 2009 budget plan also includes proposed legislative and administrative changes that are designed to cut nearly $18 billion from Medicaid over the next 5 years.

The administration's budget would reauthorize the State Children's Health Insurance Program (SCHIP) through 2013. The plan calls for a $19.7 billion increase to the program over 5 years, including $450 million in outreach grants to states and other organizations to support enrollment of uninsured children in the program.

One area that the administration's budget proposal does not address is the 10.6% physician pay cut that is scheduled to take place this July.

The administration's budget “falls short” by not including a proposal to fix the Medicare physician payment formula, the American College of Cardiology said in a statement.

“Physicians are willing to do their part, but quality cannot be achieved under a zero-sum scenario,” according to the ACP statement. “Continued deep payment cuts make it impossible for physicians to continue to invest in a health care infrastructure that facilitates data collection and quality improvement while ensuring that patients have access to high quality care.”

In total, the administration is requesting $711.2 billion for the Centers for Medicare and Medicaid Services to cover mandatory and discretionary outlays for the Medicare, Medicaid, and SCHIP programs. The request is a $32.7 billion increase over the FY 2008 funding level.

Federal research agencies also are facing funding cuts or freezes under the FY 2009 budget proposal. The administration is proposing no funding increase for the National Institutes of Health, keeping the agency's budget at approximately $29.5 billion. Health advocates contend that the failure to expand NIH funding will hurt research efforts in several critical areas.

For example, the National Institute of Diabetes and Digestive and Kidney Diseases would receive an increase under the administration's proposal, but the $2.6 million bump amounts to a 0.15% increase over FY 2008. The American Diabetes Association is urging Congress to disregard the president's proposal and provide $112.5 million in additional funding, a 6.6% increase.

“We cannot afford not to invest in diabetes research, treatment, and prevention—the consequences for our health care system and our society will be too severe,” Dr. John B. Buse, president of medicine and science for the American Diabetes Association, said in a statement. “The American Diabetes Association calls on Congress to align their priorities and provide funds to remedy this growing health crisis.”

The administration's budget proposal also calls for $8.8 billion in funding for the Centers for Disease Control and Prevention, a $412 million drop from FY 2008. The Agency for Healthcare Research and Quality would also face a cut under the proposal. The president is calling for $326 million in funding for the agency, a $9 million decrease from FY 2008.

The Food and Drug Administration would receive a $130 million increase over FY 2008, bringing its total funding to $2.4 billion in FY 2009. The FDA budget proposal includes $389.5 million for drug safety activities at the agency, an increase of about $36 million.

In the final budget proposal of his presidency, President Bush is proposing substantial cuts to hospitals, skilled nursing facilities, and graduate medical education.

Leaders in the Democrat-controlled Congress instantly declared the proposal dead on arrival.

Under the plan, the Bush administration has put forth legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years, largely from hospital and other provider payments.

The idea is to slow down the growth rate of the program from 7.2% to 5% over 5 years. But critics say that the cuts would harm hospitals that care for low-income patients and train physicians.

The FY 2009 budget proposal calls for freezing payments to inpatient hospitals, long-term care hospitals, skilled nursing facilities, hospices, outpatient hospitals, and ambulance services from 2009 through 2011. Payments would then drop 0.65% annually under the proposal.

The proposal also outlines a payment freeze for inpatient rehabilitation facilities and ambulatory surgical centers in 2010 and 2011, followed by annual cuts. And home health agencies would also see a 0% update from 2009 through 2013 followed by annual payment cuts.

The budget proposal also would reduce indirect medical education add-on payments from 5.5% to 2.2% over the next 3 years, and would eliminate the duplicate hospital indirect medical education payment for Medicare Advantage beneficiaries.

Hospitals would face additional cuts under the plan. For example, the proposed budget would reduce hospital capital payments by 5% in 2009, and hospital disproportionate share payments would drop 30% over the next 2 years.

The FY 2009 budget plan also includes proposed legislative and administrative changes that are designed to cut nearly $18 billion from Medicaid over the next 5 years.

The administration's budget would reauthorize the State Children's Health Insurance Program (SCHIP) through 2013. The plan calls for a $19.7 billion increase to the program over 5 years, including $450 million in outreach grants to states and other organizations to support enrollment of uninsured children in the program.

One area that the administration's budget proposal does not address is the 10.6% physician pay cut that is scheduled to take place this July.

The administration's budget “falls short” by not including a proposal to fix the Medicare physician payment formula, the American College of Cardiology said in a statement.

“Physicians are willing to do their part, but quality cannot be achieved under a zero-sum scenario,” according to the ACP statement. “Continued deep payment cuts make it impossible for physicians to continue to invest in a health care infrastructure that facilitates data collection and quality improvement while ensuring that patients have access to high quality care.”

In total, the administration is requesting $711.2 billion for the Centers for Medicare and Medicaid Services to cover mandatory and discretionary outlays for the Medicare, Medicaid, and SCHIP programs. The request is a $32.7 billion increase over the FY 2008 funding level.

Federal research agencies also are facing funding cuts or freezes under the FY 2009 budget proposal. The administration is proposing no funding increase for the National Institutes of Health, keeping the agency's budget at approximately $29.5 billion. Health advocates contend that the failure to expand NIH funding will hurt research efforts in several critical areas.

For example, the National Institute of Diabetes and Digestive and Kidney Diseases would receive an increase under the administration's proposal, but the $2.6 million bump amounts to a 0.15% increase over FY 2008. The American Diabetes Association is urging Congress to disregard the president's proposal and provide $112.5 million in additional funding, a 6.6% increase.

“We cannot afford not to invest in diabetes research, treatment, and prevention—the consequences for our health care system and our society will be too severe,” Dr. John B. Buse, president of medicine and science for the American Diabetes Association, said in a statement. “The American Diabetes Association calls on Congress to align their priorities and provide funds to remedy this growing health crisis.”

The administration's budget proposal also calls for $8.8 billion in funding for the Centers for Disease Control and Prevention, a $412 million drop from FY 2008. The Agency for Healthcare Research and Quality would also face a cut under the proposal. The president is calling for $326 million in funding for the agency, a $9 million decrease from FY 2008.

The Food and Drug Administration would receive a $130 million increase over FY 2008, bringing its total funding to $2.4 billion in FY 2009. The FDA budget proposal includes $389.5 million for drug safety activities at the agency, an increase of about $36 million.

In the final budget proposal of his presidency, President Bush is proposing substantial cuts to hospitals, skilled nursing facilities, and graduate medical education.

Leaders in the Democrat-controlled Congress instantly declared the proposal dead on arrival.

Under the plan, the Bush administration has put forth legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years, largely from hospital and other provider payments.

The idea is to slow down the growth rate of the program from 7.2% to 5% over 5 years. But critics say that the cuts would harm hospitals that care for low-income patients and train physicians.

The FY 2009 budget proposal calls for freezing payments to inpatient hospitals, long-term care hospitals, skilled nursing facilities, hospices, outpatient hospitals, and ambulance services from 2009 through 2011. Payments would then drop 0.65% annually under the proposal.

The proposal also outlines a payment freeze for inpatient rehabilitation facilities and ambulatory surgical centers in 2010 and 2011, followed by annual cuts. And home health agencies would also see a 0% update from 2009 through 2013 followed by annual payment cuts.

The budget proposal also would reduce indirect medical education add-on payments from 5.5% to 2.2% over the next 3 years, and would eliminate the duplicate hospital indirect medical education payment for Medicare Advantage beneficiaries.

Hospitals would face additional cuts under the plan. For example, the proposed budget would reduce hospital capital payments by 5% in 2009, and hospital disproportionate share payments would drop 30% over the next 2 years.

The FY 2009 budget plan also includes proposed legislative and administrative changes that are designed to cut nearly $18 billion from Medicaid over the next 5 years.

The administration's budget would reauthorize the State Children's Health Insurance Program (SCHIP) through 2013. The plan calls for a $19.7 billion increase to the program over 5 years, including $450 million in outreach grants to states and other organizations to support enrollment of uninsured children in the program.

One area that the administration's budget proposal does not address is the 10.6% physician pay cut that is scheduled to take place this July.

The administration's budget “falls short” by not including a proposal to fix the Medicare physician payment formula, the American College of Cardiology said in a statement.

“Physicians are willing to do their part, but quality cannot be achieved under a zero-sum scenario,” according to the ACP statement. “Continued deep payment cuts make it impossible for physicians to continue to invest in a health care infrastructure that facilitates data collection and quality improvement while ensuring that patients have access to high quality care.”

In total, the administration is requesting $711.2 billion for the Centers for Medicare and Medicaid Services to cover mandatory and discretionary outlays for the Medicare, Medicaid, and SCHIP programs. The request is a $32.7 billion increase over the FY 2008 funding level.

Federal research agencies also are facing funding cuts or freezes under the FY 2009 budget proposal. The administration is proposing no funding increase for the National Institutes of Health, keeping the agency's budget at approximately $29.5 billion. Health advocates contend that the failure to expand NIH funding will hurt research efforts in several critical areas.

For example, the National Institute of Diabetes and Digestive and Kidney Diseases would receive an increase under the administration's proposal, but the $2.6 million bump amounts to a 0.15% increase over FY 2008. The American Diabetes Association is urging Congress to disregard the president's proposal and provide $112.5 million in additional funding, a 6.6% increase.

“We cannot afford not to invest in diabetes research, treatment, and prevention—the consequences for our health care system and our society will be too severe,” Dr. John B. Buse, president of medicine and science for the American Diabetes Association, said in a statement. “The American Diabetes Association calls on Congress to align their priorities and provide funds to remedy this growing health crisis.”

The administration's budget proposal also calls for $8.8 billion in funding for the Centers for Disease Control and Prevention, a $412 million drop from FY 2008. The Agency for Healthcare Research and Quality would also face a cut under the proposal. The president is calling for $326 million in funding for the agency, a $9 million decrease from FY 2008.

The Food and Drug Administration would receive a $130 million increase over FY 2008, bringing its total funding to $2.4 billion in FY 2009. The FDA budget proposal includes $389.5 million for drug safety activities at the agency, an increase of about $36 million.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations.

Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error.

Aetna is the first health plan to endorse the Leapfrog policy. “The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he said. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked.

When used properly, the NQF never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations.

Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error.

Aetna is the first health plan to endorse the Leapfrog policy. “The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he said. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked.

When used properly, the NQF never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations.

Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error.

Aetna is the first health plan to endorse the Leapfrog policy. “The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals about quality, he said. “The intent here is not to be punitive.”

But the Aetna announcement has encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked.

When used properly, the NQF never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care. “If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

Most Americans favor a continuation of the employer-based health insurance system and say that they believe health insurance costs should be shared among individuals, employers, and the government, according to the results of a survey conducted by the Commonwealth Fund.

More than two-thirds of Americans who took part would favor a mandate for individuals to obtain health insurance in an effort to provide universal health coverage.

These findings indicate that on certain health reform issues Americans' views may be more closely aligned with the proposals put forth by Democratic candidates for president than those outlined by Republicans.

For example, the leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage, while most of the Republican candidates are proposing changes to the tax code that could potentially reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis.

Sen. Hillary Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children.

Among all the Republican candidates, no one is proposing an individual insurance mandate, according to the Commonwealth Fund.

From June to October 2007, the Commonwealth Fund conducted a telephone survey of 3,501 adults aged 19 years and older as part of its biennial health insurance survey. The group released the results from four health reform queries before they announced the other findings, which are scheduled to be released in March.

The survey respondents expressed broad support for an employer-based system of health insurance coverage. About 81% of respondents said that employers should either provide health insurance or contribute to a fund in order to cover all Americans. Support for this idea among respondents was high regardless of political affiliation, race, gender, age, and income.

The support for an individual insurance mandate to ensure coverage for all was lower; 68% of the respondents said that they strongly or somewhat favor a requirement that all individuals obtain health insurance. About 25% said they strongly or somewhat opposed the idea. About 7% said they didn't know, or refused to answer.

When respondents were asked who should pay for health insurance for all Americans, 66% favored a system in which costs would be shared by individuals, employers, and the government. About 15% said it should be mostly government financed, 8% said it should be paid for mostly by employers, and 6% favored having individuals pick up the tab. Another 5% said they didn't know, or refused to answer.

The survey also indicated that the candidates' views on health care reform will be important in determining votes. About 86% of the respondents said that health care reform is very or somewhat important in determining their vote.

Most Americans favor a continuation of the employer-based health insurance system and say that they believe health insurance costs should be shared among individuals, employers, and the government, according to the results of a survey conducted by the Commonwealth Fund.

More than two-thirds of Americans who took part would favor a mandate for individuals to obtain health insurance in an effort to provide universal health coverage.

These findings indicate that on certain health reform issues Americans' views may be more closely aligned with the proposals put forth by Democratic candidates for president than those outlined by Republicans.

For example, the leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage, while most of the Republican candidates are proposing changes to the tax code that could potentially reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis.

Sen. Hillary Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children.

Among all the Republican candidates, no one is proposing an individual insurance mandate, according to the Commonwealth Fund.

From June to October 2007, the Commonwealth Fund conducted a telephone survey of 3,501 adults aged 19 years and older as part of its biennial health insurance survey. The group released the results from four health reform queries before they announced the other findings, which are scheduled to be released in March.

The survey respondents expressed broad support for an employer-based system of health insurance coverage. About 81% of respondents said that employers should either provide health insurance or contribute to a fund in order to cover all Americans. Support for this idea among respondents was high regardless of political affiliation, race, gender, age, and income.

The support for an individual insurance mandate to ensure coverage for all was lower; 68% of the respondents said that they strongly or somewhat favor a requirement that all individuals obtain health insurance. About 25% said they strongly or somewhat opposed the idea. About 7% said they didn't know, or refused to answer.

When respondents were asked who should pay for health insurance for all Americans, 66% favored a system in which costs would be shared by individuals, employers, and the government. About 15% said it should be mostly government financed, 8% said it should be paid for mostly by employers, and 6% favored having individuals pick up the tab. Another 5% said they didn't know, or refused to answer.

The survey also indicated that the candidates' views on health care reform will be important in determining votes. About 86% of the respondents said that health care reform is very or somewhat important in determining their vote.

Most Americans favor a continuation of the employer-based health insurance system and say that they believe health insurance costs should be shared among individuals, employers, and the government, according to the results of a survey conducted by the Commonwealth Fund.

More than two-thirds of Americans who took part would favor a mandate for individuals to obtain health insurance in an effort to provide universal health coverage.

These findings indicate that on certain health reform issues Americans' views may be more closely aligned with the proposals put forth by Democratic candidates for president than those outlined by Republicans.

For example, the leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage, while most of the Republican candidates are proposing changes to the tax code that could potentially reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis.

Sen. Hillary Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children.

Among all the Republican candidates, no one is proposing an individual insurance mandate, according to the Commonwealth Fund.

From June to October 2007, the Commonwealth Fund conducted a telephone survey of 3,501 adults aged 19 years and older as part of its biennial health insurance survey. The group released the results from four health reform queries before they announced the other findings, which are scheduled to be released in March.

The survey respondents expressed broad support for an employer-based system of health insurance coverage. About 81% of respondents said that employers should either provide health insurance or contribute to a fund in order to cover all Americans. Support for this idea among respondents was high regardless of political affiliation, race, gender, age, and income.

The support for an individual insurance mandate to ensure coverage for all was lower; 68% of the respondents said that they strongly or somewhat favor a requirement that all individuals obtain health insurance. About 25% said they strongly or somewhat opposed the idea. About 7% said they didn't know, or refused to answer.

When respondents were asked who should pay for health insurance for all Americans, 66% favored a system in which costs would be shared by individuals, employers, and the government. About 15% said it should be mostly government financed, 8% said it should be paid for mostly by employers, and 6% favored having individuals pick up the tab. Another 5% said they didn't know, or refused to answer.

The survey also indicated that the candidates' views on health care reform will be important in determining votes. About 86% of the respondents said that health care reform is very or somewhat important in determining their vote.

Look for the Folic Acid Seal

Not nearly enough women of childbearing age are consuming the recommended amount of folic acid each day, but the March of Dimes and the Grain Foods Foundation are hoping that a new folic acid seal will help change that. The two organizations teamed up to create a seal that reads “Folic Acid for a Healthy Pregnancy” that will appear on select grain products that have been fortified with folic acid. The seal may also help correct some misconceptions about which foods contain folic acid. For example, a recent survey of 600 women sponsored by the Grain Foods Foundation found that only 12% of women thought enriched white bread had high levels of folic acid, even though it actually has twice as much folic acid as does whole grain or whole wheat bread. The March of Dimes recommends that women of childbearing age consume 400 mcg of folic acid daily before pregnancy and continuing into the early months of pregnancy. “The Folic Acid for a Healthy Pregnancy seal will make it easier for women to choose foods that are healthy for them and their babies,” Jennifer L. Howse, president of the March of Dimes, said in a statement. “Folic acid is the most important vitamin women can take to help prevent serious birth defects of the brain and spine, and it's most important that they start taking it before they get pregnant and continue it after.”

Family Planning Funding Gets Boost

Title X family planning programs fared well in the 2008 omnibus budget bill signed by President Bush at the end of last year. Under the legislation, Title X family planning funding increased by $16.8 million, bringing total funding for the programs to nearly $300 million. This is the largest increase in Title X funding since 2000, according to Planned Parenthood Federation of America. In addition, the legislation eliminated new funding for the Community-Based Abstinence Education program. Reproductive health groups praised the two moves as common sense. “The best way to prevent unintended pregnancies and promote healthy families is to invest in family planning programs like Title X, and ensure more women and families have access to reproductive health care and comprehensive sex education programs,” Cecile Richards, Planned Parenthood president, said in a statement.

Mandatory HIV Testing in New Jersey

New Jersey recently became the first state in the nation to require universal opt-out HIV testing for pregnant women. Under the new law, which was signed by then-Acting Gov. Richard J. Codey in December, health care providers must test all pregnant women for HIV early in their pregnancies and again during the third trimester unless the patient chooses not to be tested. The law also requires all birthing facilities in the state to test newborns at the time of delivery if the mother's HIV status is either positive or unknown. Previously, women had to opt in for testing. Women will also receive information about HIV, AIDS, and the benefits of being tested.

New York Funds Stem Cell Research

Officials in New York recently awarded the first grants as part of a $600 million stem cell research program. In this first round, the state announced a total of $14.5 million in 1-year development grants to support stem cell research and training at 25 institutions. The funding can be used for direct stem cell research, stem cell research equipment and infrastructure, or training of researchers. More grants are expected to be announced later in the year. In the next round, grant awards will focus on encouraging collaboration among scientists in the state, supporting innovative investigator-initiated research, and investigating pluripotent stem cells and other approaches to deriving these stem cells. “These grants will bring New York's entire health care community closer to realizing the vast medical breakthroughs that stem cell research offers,” Kenneth E. Raske, president of the Greater New York Hospital Association, said in a statement.

Judge Overturns Maine's Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law, intended to address high health care and prescription drug costs, had been challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyze, and sell such data to pharmaceutical manufacturers.

Look for the Folic Acid Seal

Not nearly enough women of childbearing age are consuming the recommended amount of folic acid each day, but the March of Dimes and the Grain Foods Foundation are hoping that a new folic acid seal will help change that. The two organizations teamed up to create a seal that reads “Folic Acid for a Healthy Pregnancy” that will appear on select grain products that have been fortified with folic acid. The seal may also help correct some misconceptions about which foods contain folic acid. For example, a recent survey of 600 women sponsored by the Grain Foods Foundation found that only 12% of women thought enriched white bread had high levels of folic acid, even though it actually has twice as much folic acid as does whole grain or whole wheat bread. The March of Dimes recommends that women of childbearing age consume 400 mcg of folic acid daily before pregnancy and continuing into the early months of pregnancy. “The Folic Acid for a Healthy Pregnancy seal will make it easier for women to choose foods that are healthy for them and their babies,” Jennifer L. Howse, president of the March of Dimes, said in a statement. “Folic acid is the most important vitamin women can take to help prevent serious birth defects of the brain and spine, and it's most important that they start taking it before they get pregnant and continue it after.”

Family Planning Funding Gets Boost

Title X family planning programs fared well in the 2008 omnibus budget bill signed by President Bush at the end of last year. Under the legislation, Title X family planning funding increased by $16.8 million, bringing total funding for the programs to nearly $300 million. This is the largest increase in Title X funding since 2000, according to Planned Parenthood Federation of America. In addition, the legislation eliminated new funding for the Community-Based Abstinence Education program. Reproductive health groups praised the two moves as common sense. “The best way to prevent unintended pregnancies and promote healthy families is to invest in family planning programs like Title X, and ensure more women and families have access to reproductive health care and comprehensive sex education programs,” Cecile Richards, Planned Parenthood president, said in a statement.

Mandatory HIV Testing in New Jersey

New Jersey recently became the first state in the nation to require universal opt-out HIV testing for pregnant women. Under the new law, which was signed by then-Acting Gov. Richard J. Codey in December, health care providers must test all pregnant women for HIV early in their pregnancies and again during the third trimester unless the patient chooses not to be tested. The law also requires all birthing facilities in the state to test newborns at the time of delivery if the mother's HIV status is either positive or unknown. Previously, women had to opt in for testing. Women will also receive information about HIV, AIDS, and the benefits of being tested.

New York Funds Stem Cell Research

Officials in New York recently awarded the first grants as part of a $600 million stem cell research program. In this first round, the state announced a total of $14.5 million in 1-year development grants to support stem cell research and training at 25 institutions. The funding can be used for direct stem cell research, stem cell research equipment and infrastructure, or training of researchers. More grants are expected to be announced later in the year. In the next round, grant awards will focus on encouraging collaboration among scientists in the state, supporting innovative investigator-initiated research, and investigating pluripotent stem cells and other approaches to deriving these stem cells. “These grants will bring New York's entire health care community closer to realizing the vast medical breakthroughs that stem cell research offers,” Kenneth E. Raske, president of the Greater New York Hospital Association, said in a statement.

Judge Overturns Maine's Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law, intended to address high health care and prescription drug costs, had been challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyze, and sell such data to pharmaceutical manufacturers.

Look for the Folic Acid Seal

Not nearly enough women of childbearing age are consuming the recommended amount of folic acid each day, but the March of Dimes and the Grain Foods Foundation are hoping that a new folic acid seal will help change that. The two organizations teamed up to create a seal that reads “Folic Acid for a Healthy Pregnancy” that will appear on select grain products that have been fortified with folic acid. The seal may also help correct some misconceptions about which foods contain folic acid. For example, a recent survey of 600 women sponsored by the Grain Foods Foundation found that only 12% of women thought enriched white bread had high levels of folic acid, even though it actually has twice as much folic acid as does whole grain or whole wheat bread. The March of Dimes recommends that women of childbearing age consume 400 mcg of folic acid daily before pregnancy and continuing into the early months of pregnancy. “The Folic Acid for a Healthy Pregnancy seal will make it easier for women to choose foods that are healthy for them and their babies,” Jennifer L. Howse, president of the March of Dimes, said in a statement. “Folic acid is the most important vitamin women can take to help prevent serious birth defects of the brain and spine, and it's most important that they start taking it before they get pregnant and continue it after.”

Family Planning Funding Gets Boost

Title X family planning programs fared well in the 2008 omnibus budget bill signed by President Bush at the end of last year. Under the legislation, Title X family planning funding increased by $16.8 million, bringing total funding for the programs to nearly $300 million. This is the largest increase in Title X funding since 2000, according to Planned Parenthood Federation of America. In addition, the legislation eliminated new funding for the Community-Based Abstinence Education program. Reproductive health groups praised the two moves as common sense. “The best way to prevent unintended pregnancies and promote healthy families is to invest in family planning programs like Title X, and ensure more women and families have access to reproductive health care and comprehensive sex education programs,” Cecile Richards, Planned Parenthood president, said in a statement.

Mandatory HIV Testing in New Jersey

New Jersey recently became the first state in the nation to require universal opt-out HIV testing for pregnant women. Under the new law, which was signed by then-Acting Gov. Richard J. Codey in December, health care providers must test all pregnant women for HIV early in their pregnancies and again during the third trimester unless the patient chooses not to be tested. The law also requires all birthing facilities in the state to test newborns at the time of delivery if the mother's HIV status is either positive or unknown. Previously, women had to opt in for testing. Women will also receive information about HIV, AIDS, and the benefits of being tested.

New York Funds Stem Cell Research

Officials in New York recently awarded the first grants as part of a $600 million stem cell research program. In this first round, the state announced a total of $14.5 million in 1-year development grants to support stem cell research and training at 25 institutions. The funding can be used for direct stem cell research, stem cell research equipment and infrastructure, or training of researchers. More grants are expected to be announced later in the year. In the next round, grant awards will focus on encouraging collaboration among scientists in the state, supporting innovative investigator-initiated research, and investigating pluripotent stem cells and other approaches to deriving these stem cells. “These grants will bring New York's entire health care community closer to realizing the vast medical breakthroughs that stem cell research offers,” Kenneth E. Raske, president of the Greater New York Hospital Association, said in a statement.

Judge Overturns Maine's Rx Info Law

A federal judge has overturned a Maine law that would have restricted medical data companies' access to physician prescribing information. In a decision that relied heavily on a previous ruling in New Hampshire, U.S. District Judge John Woodcock said that the law would prohibit “the transfer of truthful commercial information” and would violate the free speech guarantee of the First Amendment. The Maine law, intended to address high health care and prescription drug costs, had been challenged on constitutional grounds by IMS Health, Wolters Kluwer Health, and Verispan, all medical data companies that collect, analyze, and sell such data to pharmaceutical manufacturers.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna, Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur.

The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission for Accreditation of Healthcare Organizations, state reporting programs, or patient safety organizations. Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error. Aetna is the first health plan to endorse the Leapfrog policy.

“The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals ad health care providers about quality, he said.

“The intent here is not to be punitive,” Dr. Cutler added.

However, the Aetna announcement has nevertheless encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS).

One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked.

“It's hard to know how it's going to be operationalized,” she added.

When used properly, the National Quality Forum's never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, who is the chair of the American College of Surgeons Committee on Patient Safety and Quality Improvement.

However, he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care.

“If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, who also serves as the vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna, Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur.

The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission for Accreditation of Healthcare Organizations, state reporting programs, or patient safety organizations. Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error. Aetna is the first health plan to endorse the Leapfrog policy.

“The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals ad health care providers about quality, he said.

“The intent here is not to be punitive,” Dr. Cutler added.

However, the Aetna announcement has nevertheless encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS).

One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked.

“It's hard to know how it's going to be operationalized,” she added.

When used properly, the National Quality Forum's never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, who is the chair of the American College of Surgeons Committee on Patient Safety and Quality Improvement.

However, he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care.

“If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, who also serves as the vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.

In a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors.

The announcement follows a policy shift by the Centers for Medicare and Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008.

Aetna, Inc. has incorporated language into its hospital contracts that calls for waiving all costs related to a number of serious reportable events. The language comes from the Leapfrog Group's “never events” policy, which includes a list of 28 events considered so harmful that they should never occur.

The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery performed on the wrong body part or on the wrong patient, to stage III or IV pressure ulcers acquired after admission to a health care facility.

The policy instructs hospitals to report errors within 10 days to the Joint Commission for Accreditation of Healthcare Organizations, state reporting programs, or patient safety organizations. Hospitals also are asked to take action to prevent future events and to apologize to the patient or family affected by the error. Aetna is the first health plan to endorse the Leapfrog policy.

“The major goal here is to get hospitals to focus on having the systems in place to prevent these events from happening,” said Dr. Charles Cutler, Aetna's national medical director.

Adopting the Leapfrog Group's never events policy is not about saving money, Dr. Cutler said. In fact, many of the never events carry no additional cost. Instead, Aetna is seeking to send a consistent message to hospitals ad health care providers about quality, he said.

“The intent here is not to be punitive,” Dr. Cutler added.

However, the Aetna announcement has nevertheless encountered some skepticism from the physician community.

The NQF list of never events is much broader than the eight preventable events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS).

One reason that many of those events were not included on Medicare's list is that they are difficult to measure with the current coding system, she said.

Another problem with the Aetna approach is that it's hard to affix blame to a hospital or a particular physician. “If there's a problem with blood incompatibility, is it the surgeon's fault?” Ms. Brown asked.

“It's hard to know how it's going to be operationalized,” she added.

When used properly, the National Quality Forum's never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, who is the chair of the American College of Surgeons Committee on Patient Safety and Quality Improvement.

However, he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and overreporting could create unintended consequences.

For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said.

Dr. Opelka also questioned whether hospitals would continue to report these types of serious preventable errors if they aren't being paid for the care.

“If the reports are generated from a hospital claims system and the payer no longer recognizes the events as payable, isn't the message to stop reporting rather than to prevent the never events?” asked Dr. Opelka, who also serves as the vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans.

The policy is likely to affect all of Aetna's network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said.

Since Medicare announced its policy shift last summer, other insurers have considered changes to their policies. Officials at Cigna, for example, are evaluating how to implement a similar policy within their hospital network. The insurer plans to have a national policy in place by October 2008, said Cigna spokesman Mark Slitt.