Mary Ellen Schneider

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. Of 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 announcing 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 did not 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 question.

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. Of 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 announcing 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 did not 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 question.

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. Of 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 announcing 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 did not 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 question.

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.

Teen Births Up, Reversing Trend

The teenage birth rate increased by 3% in 2006, rising for the first time since 1991, according to preliminary data from the Centers for Disease Control and Prevention. Between 2005 and 2006, live births among teens aged 15–19 years rose from 40.5 per 1,000 to 41.9 per 1,000. This increase comes after 14 years of declines in the teen birth rate, which peaked in 1991 at 61.8 live births per 1,000 females. “It's way too early to know if this is the start of a new trend,” Stephanie Ventura, head of the reproductive statistics branch at the CDC, said in a statement. “But given the long-term progress we've witnessed, this change is notable.” Some abortion rights advocates point to the news as a sign that the federal government's push for abstinence-only education is backfiring with teens. “Congress and President Bush need to face the facts: Refusing to teach teens about birth control only leads to higher birth rates and rising rates of sexually transmitted infections,” Dr. Suzanne T. Poppema, board chair of Physicians for Reproductive Choice and Health, said in a statement. The full CDC report is available online at

www.cdc.gov/nchs

ACOG Defines 'Conscience' Policy

There are limits to when it is appropriate for physicians to refuse to provide reproductive health care on moral grounds, according to a new committee opinion from the American College of Obstetricians and Gynecologists. Physicians have a responsibility to refer patients to other providers in a timely manner if they cannot perform reproductive services in good conscience, according to the opinion issued by ACOG's Committee on Ethics. The committee also cautioned that physicians working in resource-poor areas should ensure that referral processes are in place so patients can continue to access services. ACOG's policy was viewed as an attack on “pro-life” physicians by the Christian Medical Association (CMA). In a letter to ACOG president Dr. Douglas W. Laube, the CMA and a number of other faith-based organizations called for the withdrawal of the committee opinion. “ACOG's misguided and uninformed public statement on conscience limits is bound to have the effect, whether unintended or actually intended, of discouraging persons of faith from practicing or choosing obstetrics and gynecology as a profession,” CMA wrote in the letter. ACOG officials had no comment on the letter.

Covance Makes iPledge Changes

Covance, the company that developed and manages the iPLEDGE risk management program for the acne drug isotretinoin, has formally incorporated changes to the program that have been finalized by the Food and Drug Administration. The most important change was an elimination of the 23-day lockout period for women of child-bearing potential. At that time, the FDA also said the program would now start the 7-day window for the initial prescription for women of child-bearing potential from the date of pregnancy testing, instead of the date of the office visit. To see all the latest changes, please visit

www.ipledgeprogram.com

Education May Delay Teen Sex

Adolescents who received formal sexual education before having sex for the first time were more likely to have delayed sex until at least age 15 years, according to an analysis from researchers at the CDC. Among adolescent girls aged 15–19 years who had received formal sex education before first sex, only 9% reported engaging in sex before age 15, compared with 22% of those who did not receive sex education before first sex. The study, which was published in the January issue of the Journal of Adolescent Health, found similar results among male adolescents. Only 10% of boys who received sex education before their first time having sex engaged in intercourse before age 15, compared with 32% of boys who had not had formal sex education. The analysis is based on the results of the 2002 Survey of Family Growth, a nationally representative survey with information on sexual activity, use of contraception, and births. The researchers analyzed data from 2,019 individuals aged 15–19.

FDA Sets User Fees for DTC Ads

The FDA is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency last December. Last September, Congress authorized FDA to create a user fee program for the advisory review of DTC prescription drug television advertisements. The program is voluntary and drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenue during the first year of the program.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face numerous challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could save $4 billion annually off the total U.S. health care bill.

Teen Births Up, Reversing Trend

The teenage birth rate increased by 3% in 2006, rising for the first time since 1991, according to preliminary data from the Centers for Disease Control and Prevention. Between 2005 and 2006, live births among teens aged 15–19 years rose from 40.5 per 1,000 to 41.9 per 1,000. This increase comes after 14 years of declines in the teen birth rate, which peaked in 1991 at 61.8 live births per 1,000 females. “It's way too early to know if this is the start of a new trend,” Stephanie Ventura, head of the reproductive statistics branch at the CDC, said in a statement. “But given the long-term progress we've witnessed, this change is notable.” Some abortion rights advocates point to the news as a sign that the federal government's push for abstinence-only education is backfiring with teens. “Congress and President Bush need to face the facts: Refusing to teach teens about birth control only leads to higher birth rates and rising rates of sexually transmitted infections,” Dr. Suzanne T. Poppema, board chair of Physicians for Reproductive Choice and Health, said in a statement. The full CDC report is available online at

www.cdc.gov/nchs

ACOG Defines 'Conscience' Policy

There are limits to when it is appropriate for physicians to refuse to provide reproductive health care on moral grounds, according to a new committee opinion from the American College of Obstetricians and Gynecologists. Physicians have a responsibility to refer patients to other providers in a timely manner if they cannot perform reproductive services in good conscience, according to the opinion issued by ACOG's Committee on Ethics. The committee also cautioned that physicians working in resource-poor areas should ensure that referral processes are in place so patients can continue to access services. ACOG's policy was viewed as an attack on “pro-life” physicians by the Christian Medical Association (CMA). In a letter to ACOG president Dr. Douglas W. Laube, the CMA and a number of other faith-based organizations called for the withdrawal of the committee opinion. “ACOG's misguided and uninformed public statement on conscience limits is bound to have the effect, whether unintended or actually intended, of discouraging persons of faith from practicing or choosing obstetrics and gynecology as a profession,” CMA wrote in the letter. ACOG officials had no comment on the letter.

Covance Makes iPledge Changes

Covance, the company that developed and manages the iPLEDGE risk management program for the acne drug isotretinoin, has formally incorporated changes to the program that have been finalized by the Food and Drug Administration. The most important change was an elimination of the 23-day lockout period for women of child-bearing potential. At that time, the FDA also said the program would now start the 7-day window for the initial prescription for women of child-bearing potential from the date of pregnancy testing, instead of the date of the office visit. To see all the latest changes, please visit

www.ipledgeprogram.com

Education May Delay Teen Sex

Adolescents who received formal sexual education before having sex for the first time were more likely to have delayed sex until at least age 15 years, according to an analysis from researchers at the CDC. Among adolescent girls aged 15–19 years who had received formal sex education before first sex, only 9% reported engaging in sex before age 15, compared with 22% of those who did not receive sex education before first sex. The study, which was published in the January issue of the Journal of Adolescent Health, found similar results among male adolescents. Only 10% of boys who received sex education before their first time having sex engaged in intercourse before age 15, compared with 32% of boys who had not had formal sex education. The analysis is based on the results of the 2002 Survey of Family Growth, a nationally representative survey with information on sexual activity, use of contraception, and births. The researchers analyzed data from 2,019 individuals aged 15–19.

FDA Sets User Fees for DTC Ads

The FDA is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency last December. Last September, Congress authorized FDA to create a user fee program for the advisory review of DTC prescription drug television advertisements. The program is voluntary and drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenue during the first year of the program.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face numerous challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could save $4 billion annually off the total U.S. health care bill.

Teen Births Up, Reversing Trend

The teenage birth rate increased by 3% in 2006, rising for the first time since 1991, according to preliminary data from the Centers for Disease Control and Prevention. Between 2005 and 2006, live births among teens aged 15–19 years rose from 40.5 per 1,000 to 41.9 per 1,000. This increase comes after 14 years of declines in the teen birth rate, which peaked in 1991 at 61.8 live births per 1,000 females. “It's way too early to know if this is the start of a new trend,” Stephanie Ventura, head of the reproductive statistics branch at the CDC, said in a statement. “But given the long-term progress we've witnessed, this change is notable.” Some abortion rights advocates point to the news as a sign that the federal government's push for abstinence-only education is backfiring with teens. “Congress and President Bush need to face the facts: Refusing to teach teens about birth control only leads to higher birth rates and rising rates of sexually transmitted infections,” Dr. Suzanne T. Poppema, board chair of Physicians for Reproductive Choice and Health, said in a statement. The full CDC report is available online at

www.cdc.gov/nchs

ACOG Defines 'Conscience' Policy

There are limits to when it is appropriate for physicians to refuse to provide reproductive health care on moral grounds, according to a new committee opinion from the American College of Obstetricians and Gynecologists. Physicians have a responsibility to refer patients to other providers in a timely manner if they cannot perform reproductive services in good conscience, according to the opinion issued by ACOG's Committee on Ethics. The committee also cautioned that physicians working in resource-poor areas should ensure that referral processes are in place so patients can continue to access services. ACOG's policy was viewed as an attack on “pro-life” physicians by the Christian Medical Association (CMA). In a letter to ACOG president Dr. Douglas W. Laube, the CMA and a number of other faith-based organizations called for the withdrawal of the committee opinion. “ACOG's misguided and uninformed public statement on conscience limits is bound to have the effect, whether unintended or actually intended, of discouraging persons of faith from practicing or choosing obstetrics and gynecology as a profession,” CMA wrote in the letter. ACOG officials had no comment on the letter.

Covance Makes iPledge Changes

Covance, the company that developed and manages the iPLEDGE risk management program for the acne drug isotretinoin, has formally incorporated changes to the program that have been finalized by the Food and Drug Administration. The most important change was an elimination of the 23-day lockout period for women of child-bearing potential. At that time, the FDA also said the program would now start the 7-day window for the initial prescription for women of child-bearing potential from the date of pregnancy testing, instead of the date of the office visit. To see all the latest changes, please visit

www.ipledgeprogram.com

Education May Delay Teen Sex

Adolescents who received formal sexual education before having sex for the first time were more likely to have delayed sex until at least age 15 years, according to an analysis from researchers at the CDC. Among adolescent girls aged 15–19 years who had received formal sex education before first sex, only 9% reported engaging in sex before age 15, compared with 22% of those who did not receive sex education before first sex. The study, which was published in the January issue of the Journal of Adolescent Health, found similar results among male adolescents. Only 10% of boys who received sex education before their first time having sex engaged in intercourse before age 15, compared with 32% of boys who had not had formal sex education. The analysis is based on the results of the 2002 Survey of Family Growth, a nationally representative survey with information on sexual activity, use of contraception, and births. The researchers analyzed data from 2,019 individuals aged 15–19.

FDA Sets User Fees for DTC Ads

The FDA is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency last December. Last September, Congress authorized FDA to create a user fee program for the advisory review of DTC prescription drug television advertisements. The program is voluntary and drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenue during the first year of the program.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face numerous challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could save $4 billion annually off the total U.S. health care bill.

Medicare may soon begin providing coverage for continuous positive airway pressure devices for beneficiaries who have been diagnosed with obstructive sleep apnea using unattended home monitoring.

The coverage proposal is an expansion of Medicare's current policy, which provides coverage for CPAP only when a diagnosis of obstructive sleep apnea (OSA) has been confirmed using polysomnography in a sleep laboratory.

“Our proposed policy to extend coverage for continuous positive airway pressure provides more options for Medicare beneficiaries and their treating physicians,” Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said in a statement.

CMS plans to issue a final national coverage determination in March 2008. Medicare officials estimate that as many as 4 million Medicare beneficiaries have OSA.

The CMS proposal would extend coverage in cases where the diagnosis was made with a combination of a clinical evaluation and unattended home sleep monitoring. Medicare also is proposing to cover CPAP when the diagnosis of OSA is made through a clinical evaluation or another type of diagnostic test, as long as the patient is participating in a research study that meets CMS standards for clinical trial policy.

The current proposal “as is” is likely to result in a “wasteful use of resources” and could hurt patients, said Dr. Robert Thomas of Beth Israel Deaconess Medical Center in Boston. Single-channel sleep monitoring devices have many problems, including false-negative results, said Dr. Thomas, who holds patents for technology to estimate sleep quality from an ECG and for CO2 use in mixed sleep apnea treatment.

However, Dr. Thomas said, the CMS final policy is likely to be more sensible. “I do believe that doing all studies in the lab is not cost, time, or effort efficient,” he said. “So there is much merit in a sensible, best-science driven portable recording policy.”

The CMS also plans to limit coverage for the CPAP devices to an initial 12-week period to gauge whether the patient will respond to the treatment. Medicare will continue to cover use of the CPAP in those patients who respond to the treatment.

In addition, the CMS is planning to eliminate the requirement for a minimum 2 hours of continuous recorded sleep during testing, because patients with severe OSA may not be able to meet the requirement. Dr. Thomas praised this aspect of the proposal, because some patients with severe disease and badly fragmented sleep never reach the sleep threshold quickly enough to conduct an air pressure titration on the same night.

The CMS based its decision on advice from the Medicare Evidence Development and Coverage Advisory Committee, external technology assessments from the Agency for Healthcare Research and Quality, a review of individual clinical studies, and public comments. Agency officials concluded that the evidence was sufficient to allow for coverage based on diagnosis with type II, III, and IV home sleep testing monitors in appropriately selected patients.

Medicare may soon begin providing coverage for continuous positive airway pressure devices for beneficiaries who have been diagnosed with obstructive sleep apnea using unattended home monitoring.

The coverage proposal is an expansion of Medicare's current policy, which provides coverage for CPAP only when a diagnosis of obstructive sleep apnea (OSA) has been confirmed using polysomnography in a sleep laboratory.

“Our proposed policy to extend coverage for continuous positive airway pressure provides more options for Medicare beneficiaries and their treating physicians,” Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said in a statement.

CMS plans to issue a final national coverage determination in March 2008. Medicare officials estimate that as many as 4 million Medicare beneficiaries have OSA.

The CMS proposal would extend coverage in cases where the diagnosis was made with a combination of a clinical evaluation and unattended home sleep monitoring. Medicare also is proposing to cover CPAP when the diagnosis of OSA is made through a clinical evaluation or another type of diagnostic test, as long as the patient is participating in a research study that meets CMS standards for clinical trial policy.

The current proposal “as is” is likely to result in a “wasteful use of resources” and could hurt patients, said Dr. Robert Thomas of Beth Israel Deaconess Medical Center in Boston. Single-channel sleep monitoring devices have many problems, including false-negative results, said Dr. Thomas, who holds patents for technology to estimate sleep quality from an ECG and for CO2 use in mixed sleep apnea treatment.

However, Dr. Thomas said, the CMS final policy is likely to be more sensible. “I do believe that doing all studies in the lab is not cost, time, or effort efficient,” he said. “So there is much merit in a sensible, best-science driven portable recording policy.”

The CMS also plans to limit coverage for the CPAP devices to an initial 12-week period to gauge whether the patient will respond to the treatment. Medicare will continue to cover use of the CPAP in those patients who respond to the treatment.

In addition, the CMS is planning to eliminate the requirement for a minimum 2 hours of continuous recorded sleep during testing, because patients with severe OSA may not be able to meet the requirement. Dr. Thomas praised this aspect of the proposal, because some patients with severe disease and badly fragmented sleep never reach the sleep threshold quickly enough to conduct an air pressure titration on the same night.

The CMS based its decision on advice from the Medicare Evidence Development and Coverage Advisory Committee, external technology assessments from the Agency for Healthcare Research and Quality, a review of individual clinical studies, and public comments. Agency officials concluded that the evidence was sufficient to allow for coverage based on diagnosis with type II, III, and IV home sleep testing monitors in appropriately selected patients.

Medicare may soon begin providing coverage for continuous positive airway pressure devices for beneficiaries who have been diagnosed with obstructive sleep apnea using unattended home monitoring.

The coverage proposal is an expansion of Medicare's current policy, which provides coverage for CPAP only when a diagnosis of obstructive sleep apnea (OSA) has been confirmed using polysomnography in a sleep laboratory.

“Our proposed policy to extend coverage for continuous positive airway pressure provides more options for Medicare beneficiaries and their treating physicians,” Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said in a statement.

CMS plans to issue a final national coverage determination in March 2008. Medicare officials estimate that as many as 4 million Medicare beneficiaries have OSA.

The CMS proposal would extend coverage in cases where the diagnosis was made with a combination of a clinical evaluation and unattended home sleep monitoring. Medicare also is proposing to cover CPAP when the diagnosis of OSA is made through a clinical evaluation or another type of diagnostic test, as long as the patient is participating in a research study that meets CMS standards for clinical trial policy.

The current proposal “as is” is likely to result in a “wasteful use of resources” and could hurt patients, said Dr. Robert Thomas of Beth Israel Deaconess Medical Center in Boston. Single-channel sleep monitoring devices have many problems, including false-negative results, said Dr. Thomas, who holds patents for technology to estimate sleep quality from an ECG and for CO2 use in mixed sleep apnea treatment.

However, Dr. Thomas said, the CMS final policy is likely to be more sensible. “I do believe that doing all studies in the lab is not cost, time, or effort efficient,” he said. “So there is much merit in a sensible, best-science driven portable recording policy.”

The CMS also plans to limit coverage for the CPAP devices to an initial 12-week period to gauge whether the patient will respond to the treatment. Medicare will continue to cover use of the CPAP in those patients who respond to the treatment.

In addition, the CMS is planning to eliminate the requirement for a minimum 2 hours of continuous recorded sleep during testing, because patients with severe OSA may not be able to meet the requirement. Dr. Thomas praised this aspect of the proposal, because some patients with severe disease and badly fragmented sleep never reach the sleep threshold quickly enough to conduct an air pressure titration on the same night.

The CMS based its decision on advice from the Medicare Evidence Development and Coverage Advisory Committee, external technology assessments from the Agency for Healthcare Research and Quality, a review of individual clinical studies, and public comments. Agency officials concluded that the evidence was sufficient to allow for coverage based on diagnosis with type II, III, and IV home sleep testing monitors in appropriately selected patients.

TBI Bill Passes Senate

The reauthorization of the Traumatic Brain Injury Act moved one step closer to becoming law last month when the Senate approved the legislation. The bill now awaits action in the House. The legislation (S. 793) would authorize continued funding for a number of federal traumatic brain injury programs and would provide grants to states for community-based services. The legislation also mandates several new studies to determine the incidence and prevalence of traumatic brain injury, identify therapeutic interventions, and develop guidelines for rehabilitation. In addition, the Senate bill calls on the Government Accountability Office to determine what challenges soldiers who have sustained a traumatic brain injury face when returning to their communities. As of December 2007, more than 30,000 soldiers have been wounded in Iraq, and brain injuries account for approximately two-thirds of those injuries, according to Sen. Orrin Hatch (R-Utah), who sponsored the bill.

Migraine Research Funding

Migraine research got an infusion of funding recently when the Migraine Research Foundation announced plans to spend at least $500,000 this year to fund grants to investigate the causes of and cures for migraines. And the organization committed to awarding more money each year for migraine research. “Migraine is underresearched by the scientific community, undertreated by physicians, and underappreciated by society,” Dr. Joel Saper of Michigan State University, chair of the foundation's medical advisory board, said in a statement. “The Migraine Research Foundation is about more than just the research that it will fund directly—it is about stimulating others to join us in addressing a critical gap in medical research.” The Migraine Research Foundation is a nonprofit group founded by Stephen Semlitz and Cathy Glaser, whose family has struggled with migraines. The organization's funding comes from private donors, including individuals, foundations, and corporations.

Autism Network Triples in Size

Autism Speaks, an autism advocacy organization, is planning to significantly expand its Autism Treatment Network from 5 to 15 sites at hospitals and medical centers across the United States and Canada. The idea behind the network is to encourage collaboration among different medical specialists and ultimately to develop common clinical standards for individuals with an autism spectrum disorder. The Autism Treatment Network sites also offer families the option of participating in a data registry used to track children with the disorders. “Developing common standards of medical care across 15 sites will allow us to get answers to the questions parents ask about their children's care much more quickly,” Dr. James Perrin, director of the clinical coordinating center for the Autism Treatment Network, said in a statement. Autism Speaks began the network effort in 2005 at five sites, which provide services to about 2,000 new cases of autism spectrum disorders each year.

FDA Can't Fulfill Its Mission

The Food and Drug Administration “suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities,” according to a report by three members of the agency's Science Board. The FDA has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources, they said. “FDA's inability to keep up with scientific advances means that American lives are at risk,” wrote the panelists, adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, Jefferson Pilot Corp. Professor of Neurobiology and Genetics at Duke University, Durham, N.C.; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School, Boston.

TBI Bill Passes Senate

The reauthorization of the Traumatic Brain Injury Act moved one step closer to becoming law last month when the Senate approved the legislation. The bill now awaits action in the House. The legislation (S. 793) would authorize continued funding for a number of federal traumatic brain injury programs and would provide grants to states for community-based services. The legislation also mandates several new studies to determine the incidence and prevalence of traumatic brain injury, identify therapeutic interventions, and develop guidelines for rehabilitation. In addition, the Senate bill calls on the Government Accountability Office to determine what challenges soldiers who have sustained a traumatic brain injury face when returning to their communities. As of December 2007, more than 30,000 soldiers have been wounded in Iraq, and brain injuries account for approximately two-thirds of those injuries, according to Sen. Orrin Hatch (R-Utah), who sponsored the bill.

Migraine Research Funding

Migraine research got an infusion of funding recently when the Migraine Research Foundation announced plans to spend at least $500,000 this year to fund grants to investigate the causes of and cures for migraines. And the organization committed to awarding more money each year for migraine research. “Migraine is underresearched by the scientific community, undertreated by physicians, and underappreciated by society,” Dr. Joel Saper of Michigan State University, chair of the foundation's medical advisory board, said in a statement. “The Migraine Research Foundation is about more than just the research that it will fund directly—it is about stimulating others to join us in addressing a critical gap in medical research.” The Migraine Research Foundation is a nonprofit group founded by Stephen Semlitz and Cathy Glaser, whose family has struggled with migraines. The organization's funding comes from private donors, including individuals, foundations, and corporations.

Autism Network Triples in Size

Autism Speaks, an autism advocacy organization, is planning to significantly expand its Autism Treatment Network from 5 to 15 sites at hospitals and medical centers across the United States and Canada. The idea behind the network is to encourage collaboration among different medical specialists and ultimately to develop common clinical standards for individuals with an autism spectrum disorder. The Autism Treatment Network sites also offer families the option of participating in a data registry used to track children with the disorders. “Developing common standards of medical care across 15 sites will allow us to get answers to the questions parents ask about their children's care much more quickly,” Dr. James Perrin, director of the clinical coordinating center for the Autism Treatment Network, said in a statement. Autism Speaks began the network effort in 2005 at five sites, which provide services to about 2,000 new cases of autism spectrum disorders each year.

FDA Can't Fulfill Its Mission

The Food and Drug Administration “suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities,” according to a report by three members of the agency's Science Board. The FDA has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources, they said. “FDA's inability to keep up with scientific advances means that American lives are at risk,” wrote the panelists, adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, Jefferson Pilot Corp. Professor of Neurobiology and Genetics at Duke University, Durham, N.C.; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School, Boston.

TBI Bill Passes Senate

The reauthorization of the Traumatic Brain Injury Act moved one step closer to becoming law last month when the Senate approved the legislation. The bill now awaits action in the House. The legislation (S. 793) would authorize continued funding for a number of federal traumatic brain injury programs and would provide grants to states for community-based services. The legislation also mandates several new studies to determine the incidence and prevalence of traumatic brain injury, identify therapeutic interventions, and develop guidelines for rehabilitation. In addition, the Senate bill calls on the Government Accountability Office to determine what challenges soldiers who have sustained a traumatic brain injury face when returning to their communities. As of December 2007, more than 30,000 soldiers have been wounded in Iraq, and brain injuries account for approximately two-thirds of those injuries, according to Sen. Orrin Hatch (R-Utah), who sponsored the bill.

Migraine Research Funding

Migraine research got an infusion of funding recently when the Migraine Research Foundation announced plans to spend at least $500,000 this year to fund grants to investigate the causes of and cures for migraines. And the organization committed to awarding more money each year for migraine research. “Migraine is underresearched by the scientific community, undertreated by physicians, and underappreciated by society,” Dr. Joel Saper of Michigan State University, chair of the foundation's medical advisory board, said in a statement. “The Migraine Research Foundation is about more than just the research that it will fund directly—it is about stimulating others to join us in addressing a critical gap in medical research.” The Migraine Research Foundation is a nonprofit group founded by Stephen Semlitz and Cathy Glaser, whose family has struggled with migraines. The organization's funding comes from private donors, including individuals, foundations, and corporations.

Autism Network Triples in Size

Autism Speaks, an autism advocacy organization, is planning to significantly expand its Autism Treatment Network from 5 to 15 sites at hospitals and medical centers across the United States and Canada. The idea behind the network is to encourage collaboration among different medical specialists and ultimately to develop common clinical standards for individuals with an autism spectrum disorder. The Autism Treatment Network sites also offer families the option of participating in a data registry used to track children with the disorders. “Developing common standards of medical care across 15 sites will allow us to get answers to the questions parents ask about their children's care much more quickly,” Dr. James Perrin, director of the clinical coordinating center for the Autism Treatment Network, said in a statement. Autism Speaks began the network effort in 2005 at five sites, which provide services to about 2,000 new cases of autism spectrum disorders each year.

FDA Can't Fulfill Its Mission

The Food and Drug Administration “suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities,” according to a report by three members of the agency's Science Board. The FDA has become weak and unable to fulfill its mission because of the increasing number of demands and an inability to respond because of a lack of resources, they said. “FDA's inability to keep up with scientific advances means that American lives are at risk,” wrote the panelists, adding that the agency can't fulfill its mission “without substantial and sustained additional appropriations.” The report was written by Gail Cassell, Ph.D., vice president of scientific affairs at Eli Lilly & Co.; Dr. Allen D. Roses, Jefferson Pilot Corp. Professor of Neurobiology and Genetics at Duke University, Durham, N.C.; and Dr. Barbara J. McNeil, head of the health care policy department at Harvard Medical School, Boston.

In what has become a year-end tradition, last-minute congressional action has staved off deep cuts to the Medicare physician fee schedule.

The 2007 version means physicians won't feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, the legislation was expected to be signed by President Bush.

But unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear.

Dr. Sharad Lakhanpal, chair of the government affairs committee at the American College of Rheumatology, called the situation a “major fiasco.”

“The ACR is going to make a sincere effort to try and get a permanent fix. February 25 and 26 are the ACR's advocates days in Washington, D.C. We're trying to bring as many rheumatologists and patients who could be good spokespersons,” he said. The board of directors will also plan another lobbying day in May, in advance of the July 1 fee cut. “I hope other medical organizations will do that too.”

He said that his practice of nine rheumatologists in Dallas had already considered refusing any new Medicare patients in advance of this most recent reprieve. And this 6-month “breathing room” period and the 0.5% pay increase hardly help. “Of course you always look for positives—the last few years [lawmakers] were just freezing it. But it's almost comical that they have given us a 0.5% increase…. The raise of 0.5% is even less than the rate of inflation,” he said.

Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians, agreed. Many practices are small businesses and it's difficult to make a business plan for the year when physicians can only calculate Medicare revenues for the first 6 months, he said.

And if Medicare payments make up 30%–40% of a practice's revenues, the impact can be substantial.

By law, officials at the Centers for Medicare and Medicaid Services must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payment based in part on the gross domestic product. Medical professional societies have been lobbying for years to eliminate the formula, which they argue does not adequately account for rising practice costs.

Since the legislation passed at year-end did not deal with the SGR, physicians will face even more significant pay cuts in July and again in January 2009 unless Congress acts over the next few months.

Members of the House worked to address the scheduled physician pay cut under Medicare and other health reforms last August. At that time, the House passed a bill that would have given physicians a 0.5% payment update for 2008 and 2009. In addition, the bill would have provided a new physician payment structure with a separate conversion factor for six service categories. That legislation could not gain traction in the Senate.

This time around, Congress passed a scaled-down package that could pass both chambers overwhelmingly and would not encounter a veto threat.

The House democratic leadership expressed disappointment that the bill did not address some of the issues included in the August bill, such as eliminating overpayments to Medicare Advantage plans. The leadership has pledged to continue negotiations on more comprehensive legislation this year.

In addition to halting the physician pay cut for 6 months, the recently passed legislation extends the Physician Quality Reporting Initiative program for 2008. The program, which launched in July 2007, allows physicians to earn up to 1.5% of their total allowed Medicare charges if they report on certain quality data. This program could be of more interest to physicians this time around, Mr. Doherty said, since it's an opportunity for them to increase their revenues from Medicare.

The bill also extends the Special Diabetes Program through Sept. 30, 2009. The program was established to fund type 1 diabetes research, and type 2 diabetes treatment and prevention for Native Americans and Alaska Natives.

The bill will also extend for 6 months provisions to aid physicians practicing in shortage areas.

In what has become a year-end tradition, last-minute congressional action has staved off deep cuts to the Medicare physician fee schedule.

The 2007 version means physicians won't feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, the legislation was expected to be signed by President Bush.

But unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear.

Dr. Sharad Lakhanpal, chair of the government affairs committee at the American College of Rheumatology, called the situation a “major fiasco.”

“The ACR is going to make a sincere effort to try and get a permanent fix. February 25 and 26 are the ACR's advocates days in Washington, D.C. We're trying to bring as many rheumatologists and patients who could be good spokespersons,” he said. The board of directors will also plan another lobbying day in May, in advance of the July 1 fee cut. “I hope other medical organizations will do that too.”

He said that his practice of nine rheumatologists in Dallas had already considered refusing any new Medicare patients in advance of this most recent reprieve. And this 6-month “breathing room” period and the 0.5% pay increase hardly help. “Of course you always look for positives—the last few years [lawmakers] were just freezing it. But it's almost comical that they have given us a 0.5% increase…. The raise of 0.5% is even less than the rate of inflation,” he said.

Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians, agreed. Many practices are small businesses and it's difficult to make a business plan for the year when physicians can only calculate Medicare revenues for the first 6 months, he said.

And if Medicare payments make up 30%–40% of a practice's revenues, the impact can be substantial.

By law, officials at the Centers for Medicare and Medicaid Services must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payment based in part on the gross domestic product. Medical professional societies have been lobbying for years to eliminate the formula, which they argue does not adequately account for rising practice costs.

Since the legislation passed at year-end did not deal with the SGR, physicians will face even more significant pay cuts in July and again in January 2009 unless Congress acts over the next few months.

Members of the House worked to address the scheduled physician pay cut under Medicare and other health reforms last August. At that time, the House passed a bill that would have given physicians a 0.5% payment update for 2008 and 2009. In addition, the bill would have provided a new physician payment structure with a separate conversion factor for six service categories. That legislation could not gain traction in the Senate.

This time around, Congress passed a scaled-down package that could pass both chambers overwhelmingly and would not encounter a veto threat.

The House democratic leadership expressed disappointment that the bill did not address some of the issues included in the August bill, such as eliminating overpayments to Medicare Advantage plans. The leadership has pledged to continue negotiations on more comprehensive legislation this year.

In addition to halting the physician pay cut for 6 months, the recently passed legislation extends the Physician Quality Reporting Initiative program for 2008. The program, which launched in July 2007, allows physicians to earn up to 1.5% of their total allowed Medicare charges if they report on certain quality data. This program could be of more interest to physicians this time around, Mr. Doherty said, since it's an opportunity for them to increase their revenues from Medicare.

The bill also extends the Special Diabetes Program through Sept. 30, 2009. The program was established to fund type 1 diabetes research, and type 2 diabetes treatment and prevention for Native Americans and Alaska Natives.

The bill will also extend for 6 months provisions to aid physicians practicing in shortage areas.

In what has become a year-end tradition, last-minute congressional action has staved off deep cuts to the Medicare physician fee schedule.

The 2007 version means physicians won't feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, the legislation was expected to be signed by President Bush.

But unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear.

Dr. Sharad Lakhanpal, chair of the government affairs committee at the American College of Rheumatology, called the situation a “major fiasco.”

“The ACR is going to make a sincere effort to try and get a permanent fix. February 25 and 26 are the ACR's advocates days in Washington, D.C. We're trying to bring as many rheumatologists and patients who could be good spokespersons,” he said. The board of directors will also plan another lobbying day in May, in advance of the July 1 fee cut. “I hope other medical organizations will do that too.”

He said that his practice of nine rheumatologists in Dallas had already considered refusing any new Medicare patients in advance of this most recent reprieve. And this 6-month “breathing room” period and the 0.5% pay increase hardly help. “Of course you always look for positives—the last few years [lawmakers] were just freezing it. But it's almost comical that they have given us a 0.5% increase…. The raise of 0.5% is even less than the rate of inflation,” he said.

Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians, agreed. Many practices are small businesses and it's difficult to make a business plan for the year when physicians can only calculate Medicare revenues for the first 6 months, he said.

And if Medicare payments make up 30%–40% of a practice's revenues, the impact can be substantial.

By law, officials at the Centers for Medicare and Medicaid Services must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payment based in part on the gross domestic product. Medical professional societies have been lobbying for years to eliminate the formula, which they argue does not adequately account for rising practice costs.

Since the legislation passed at year-end did not deal with the SGR, physicians will face even more significant pay cuts in July and again in January 2009 unless Congress acts over the next few months.

Members of the House worked to address the scheduled physician pay cut under Medicare and other health reforms last August. At that time, the House passed a bill that would have given physicians a 0.5% payment update for 2008 and 2009. In addition, the bill would have provided a new physician payment structure with a separate conversion factor for six service categories. That legislation could not gain traction in the Senate.

This time around, Congress passed a scaled-down package that could pass both chambers overwhelmingly and would not encounter a veto threat.

The House democratic leadership expressed disappointment that the bill did not address some of the issues included in the August bill, such as eliminating overpayments to Medicare Advantage plans. The leadership has pledged to continue negotiations on more comprehensive legislation this year.

In addition to halting the physician pay cut for 6 months, the recently passed legislation extends the Physician Quality Reporting Initiative program for 2008. The program, which launched in July 2007, allows physicians to earn up to 1.5% of their total allowed Medicare charges if they report on certain quality data. This program could be of more interest to physicians this time around, Mr. Doherty said, since it's an opportunity for them to increase their revenues from Medicare.

The bill also extends the Special Diabetes Program through Sept. 30, 2009. The program was established to fund type 1 diabetes research, and type 2 diabetes treatment and prevention for Native Americans and Alaska Natives.

The bill will also extend for 6 months provisions to aid physicians practicing in shortage areas.

As physicians struggle to decide if or when to incorporate electronic health records into their practices, personal health records are gaining popularity.

Personal health records (PHRs) allow patients to store and access their medical information electronically. Various versions are available through physicians, health systems, insurers, and employers, and are offered on a stand-alone, subscription basis. But with so many models, no two records are likely to be the same and each may present different challenges for the physician-patient relationship.

“We're really in a kind of Wild West situation with the PHR,” said Dr. Peter Basch, an internist and medical director for eHealth at MedStar Health, a seven-hospital system in Washington and Baltimore. Currently, two types of records are dominant—those that are linked to a physician's or health system's electronic health record, and free-standing records, Dr. Basch said.

With connected PHRs, patients can usually access subsets of their medical data and communicate with their physicians' offices on selected matters such as scheduling appointments. With a free-standing PHR, patients generally have greater control of the data that are entered, and of who can access the data. The market is more mature now in terms of connected PHRs, especially those that are linked to large medical groups and large health systems, Dr. Basch said.

In an effort to tame some of the variability in the market, Health Level Seven Inc. (HL7), a national organization that sets health information technology standards, has released a proposed personal health record standard. In August, HL7 unveiled its Personal Health Record System Functional Model, and sought public comments on it. The HL7 general model can be customized so that it can be used with each of the various PHR models available.

Another possible way to accelerate the development of the personal health record market is through the Certification Commission for Healthcare Information Technology (CCHIT), a body that already certifies ambulatory and inpatient electronic health record systems.

The CCHIT is looking at the area of personal health records, according to its chairman, Dr. Mark Leavitt. However, any certification of PHR products would be at least a year off, since the CCHIT has not developed certification criteria in that area. Although the PHR industry is still in its early stages, it is not necessary to wait for the industry to fully mature before developing certification criteria. In fact, setting standards early can be helpful, Dr. Leavitt said.

Through its electronic health record certification process, the CCHIT is requiring that records have the capability to send patient summary information, which would be helpful in populating a patient's PHR.

Many factors are driving the growth of PHRs. Employer groups, frustrated with escalating health costs, represent one faction pushing for PHR development. While the evidence is not yet in, the theory is that PHRs would allow patients to be better consumers, potentially saving employers money, Dr. Basch said.

Health insurers also are getting into the act. For example, Aetna recently announced that starting this month, federal enrollees in any of the company's medical plans will have access to a password-protected online PHR. The record would include claims information on physician office visits, labs, diagnoses, treatment, and prescriptions. Even Medicare is testing the PHR field. In June, Medicare launched a pilot program to allow certain beneficiaries to access a PHR through participating Medicare Advantage and Part D drug plans.

There also are some patients who care deeply about having PHRs because they are managing chronic conditions for themselves or family members, Dr. Basch said.

Even if most consumers are not clamoring for PHRs, when surveyed, they do favor the concept. For example, in a November 2006 survey commissioned by the Markle Foundation, nearly two-thirds of the 1,003 adults polled said they would like to access their medical information electronically. Interest was even higher among younger Americans, with 72% of those under age 40 saying they would like to access their health information online.

But consumers who were surveyed also had significant concerns about the privacy and security of their records. For example, 80% said they were very concerned about identity theft, and 77% said they were very concerned about their medical information being used for marketing purposes.

Concerns about security and privacy are shared by physicians. With a free-standing PHR, physicians could receive requests from patients to populate their data, but they might be reluctant to send such sensitive data in an unsecured way or in a way that could compromise the security of their own electronic systems, Dr. Basch said.

But an even more complicated question for physicians is what to do with information they receive from a PHR that may be entered or edited by the patient.

The use of PHRs does change the dynamic with the physician and the patient, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. With paper records, even though the information belongs to the patient, it is strictly controlled in the physician office. Having an electronic record that is potentially much more open to the patient could change how the physician documents information in the chart, he said.

One of the barriers to greater physician acceptance of PHRs is the payment structure, Dr. Kellerman said. Services such as phone calls and coordination of care are not reimbursed, and most physicians do not have the capital to invest in electronic health records that could be linked to PHRs or that could feature patient portals, he said.

As physicians struggle to decide if or when to incorporate electronic health records into their practices, personal health records are gaining popularity.

Personal health records (PHRs) allow patients to store and access their medical information electronically. Various versions are available through physicians, health systems, insurers, and employers, and are offered on a stand-alone, subscription basis. But with so many models, no two records are likely to be the same and each may present different challenges for the physician-patient relationship.

“We're really in a kind of Wild West situation with the PHR,” said Dr. Peter Basch, an internist and medical director for eHealth at MedStar Health, a seven-hospital system in Washington and Baltimore. Currently, two types of records are dominant—those that are linked to a physician's or health system's electronic health record, and free-standing records, Dr. Basch said.

With connected PHRs, patients can usually access subsets of their medical data and communicate with their physicians' offices on selected matters such as scheduling appointments. With a free-standing PHR, patients generally have greater control of the data that are entered, and of who can access the data. The market is more mature now in terms of connected PHRs, especially those that are linked to large medical groups and large health systems, Dr. Basch said.

In an effort to tame some of the variability in the market, Health Level Seven Inc. (HL7), a national organization that sets health information technology standards, has released a proposed personal health record standard. In August, HL7 unveiled its Personal Health Record System Functional Model, and sought public comments on it. The HL7 general model can be customized so that it can be used with each of the various PHR models available.

Another possible way to accelerate the development of the personal health record market is through the Certification Commission for Healthcare Information Technology (CCHIT), a body that already certifies ambulatory and inpatient electronic health record systems.

The CCHIT is looking at the area of personal health records, according to its chairman, Dr. Mark Leavitt. However, any certification of PHR products would be at least a year off, since the CCHIT has not developed certification criteria in that area. Although the PHR industry is still in its early stages, it is not necessary to wait for the industry to fully mature before developing certification criteria. In fact, setting standards early can be helpful, Dr. Leavitt said.

Through its electronic health record certification process, the CCHIT is requiring that records have the capability to send patient summary information, which would be helpful in populating a patient's PHR.

Many factors are driving the growth of PHRs. Employer groups, frustrated with escalating health costs, represent one faction pushing for PHR development. While the evidence is not yet in, the theory is that PHRs would allow patients to be better consumers, potentially saving employers money, Dr. Basch said.

Health insurers also are getting into the act. For example, Aetna recently announced that starting this month, federal enrollees in any of the company's medical plans will have access to a password-protected online PHR. The record would include claims information on physician office visits, labs, diagnoses, treatment, and prescriptions. Even Medicare is testing the PHR field. In June, Medicare launched a pilot program to allow certain beneficiaries to access a PHR through participating Medicare Advantage and Part D drug plans.

There also are some patients who care deeply about having PHRs because they are managing chronic conditions for themselves or family members, Dr. Basch said.

Even if most consumers are not clamoring for PHRs, when surveyed, they do favor the concept. For example, in a November 2006 survey commissioned by the Markle Foundation, nearly two-thirds of the 1,003 adults polled said they would like to access their medical information electronically. Interest was even higher among younger Americans, with 72% of those under age 40 saying they would like to access their health information online.

But consumers who were surveyed also had significant concerns about the privacy and security of their records. For example, 80% said they were very concerned about identity theft, and 77% said they were very concerned about their medical information being used for marketing purposes.

Concerns about security and privacy are shared by physicians. With a free-standing PHR, physicians could receive requests from patients to populate their data, but they might be reluctant to send such sensitive data in an unsecured way or in a way that could compromise the security of their own electronic systems, Dr. Basch said.

But an even more complicated question for physicians is what to do with information they receive from a PHR that may be entered or edited by the patient.

The use of PHRs does change the dynamic with the physician and the patient, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. With paper records, even though the information belongs to the patient, it is strictly controlled in the physician office. Having an electronic record that is potentially much more open to the patient could change how the physician documents information in the chart, he said.

One of the barriers to greater physician acceptance of PHRs is the payment structure, Dr. Kellerman said. Services such as phone calls and coordination of care are not reimbursed, and most physicians do not have the capital to invest in electronic health records that could be linked to PHRs or that could feature patient portals, he said.

As physicians struggle to decide if or when to incorporate electronic health records into their practices, personal health records are gaining popularity.

Personal health records (PHRs) allow patients to store and access their medical information electronically. Various versions are available through physicians, health systems, insurers, and employers, and are offered on a stand-alone, subscription basis. But with so many models, no two records are likely to be the same and each may present different challenges for the physician-patient relationship.

“We're really in a kind of Wild West situation with the PHR,” said Dr. Peter Basch, an internist and medical director for eHealth at MedStar Health, a seven-hospital system in Washington and Baltimore. Currently, two types of records are dominant—those that are linked to a physician's or health system's electronic health record, and free-standing records, Dr. Basch said.

With connected PHRs, patients can usually access subsets of their medical data and communicate with their physicians' offices on selected matters such as scheduling appointments. With a free-standing PHR, patients generally have greater control of the data that are entered, and of who can access the data. The market is more mature now in terms of connected PHRs, especially those that are linked to large medical groups and large health systems, Dr. Basch said.

In an effort to tame some of the variability in the market, Health Level Seven Inc. (HL7), a national organization that sets health information technology standards, has released a proposed personal health record standard. In August, HL7 unveiled its Personal Health Record System Functional Model, and sought public comments on it. The HL7 general model can be customized so that it can be used with each of the various PHR models available.

Another possible way to accelerate the development of the personal health record market is through the Certification Commission for Healthcare Information Technology (CCHIT), a body that already certifies ambulatory and inpatient electronic health record systems.

The CCHIT is looking at the area of personal health records, according to its chairman, Dr. Mark Leavitt. However, any certification of PHR products would be at least a year off, since the CCHIT has not developed certification criteria in that area. Although the PHR industry is still in its early stages, it is not necessary to wait for the industry to fully mature before developing certification criteria. In fact, setting standards early can be helpful, Dr. Leavitt said.

Through its electronic health record certification process, the CCHIT is requiring that records have the capability to send patient summary information, which would be helpful in populating a patient's PHR.

Many factors are driving the growth of PHRs. Employer groups, frustrated with escalating health costs, represent one faction pushing for PHR development. While the evidence is not yet in, the theory is that PHRs would allow patients to be better consumers, potentially saving employers money, Dr. Basch said.

Health insurers also are getting into the act. For example, Aetna recently announced that starting this month, federal enrollees in any of the company's medical plans will have access to a password-protected online PHR. The record would include claims information on physician office visits, labs, diagnoses, treatment, and prescriptions. Even Medicare is testing the PHR field. In June, Medicare launched a pilot program to allow certain beneficiaries to access a PHR through participating Medicare Advantage and Part D drug plans.

There also are some patients who care deeply about having PHRs because they are managing chronic conditions for themselves or family members, Dr. Basch said.

Even if most consumers are not clamoring for PHRs, when surveyed, they do favor the concept. For example, in a November 2006 survey commissioned by the Markle Foundation, nearly two-thirds of the 1,003 adults polled said they would like to access their medical information electronically. Interest was even higher among younger Americans, with 72% of those under age 40 saying they would like to access their health information online.

But consumers who were surveyed also had significant concerns about the privacy and security of their records. For example, 80% said they were very concerned about identity theft, and 77% said they were very concerned about their medical information being used for marketing purposes.

Concerns about security and privacy are shared by physicians. With a free-standing PHR, physicians could receive requests from patients to populate their data, but they might be reluctant to send such sensitive data in an unsecured way or in a way that could compromise the security of their own electronic systems, Dr. Basch said.

But an even more complicated question for physicians is what to do with information they receive from a PHR that may be entered or edited by the patient.

The use of PHRs does change the dynamic with the physician and the patient, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. With paper records, even though the information belongs to the patient, it is strictly controlled in the physician office. Having an electronic record that is potentially much more open to the patient could change how the physician documents information in the chart, he said.

One of the barriers to greater physician acceptance of PHRs is the payment structure, Dr. Kellerman said. Services such as phone calls and coordination of care are not reimbursed, and most physicians do not have the capital to invest in electronic health records that could be linked to PHRs or that could feature patient portals, he said.

In what has become a year-end tradition, last-minute congressional action has staved off deep cuts to the Medicare physician fee schedule.

The 2007 version means physicians won't feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, the legislation was expected to be signed by President Bush.

Unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear.

“It creates a tremendous degree of instability in the system,” said Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.

Many physician practices are small businesses, and it's difficult for physicians to make a business plan for the year when they can only calculate Medicare revenues for the first 6 months. Mr. Doherty said, adding that if Medicare payments make up 30%–40% of a practice's revenues, the impact can be substantial.

Officials at the American Medical Association also expressed disappointment with the legislation.

“We strongly urge Congress to break the tradition of short-term interventions that are not funded and fail to chart a course for replacing a flawed payment formula that is a barrier to improving quality and access to care for seniors,” Dr. Edward Langston, AMA board chair, said in a statement.

By law, officials at the Centers for Medicare and Medicaid Services must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payment based in part on the gross domestic product. Medical professional societies have been lobbying for years to eliminate the formula, which they argue does not adequately account for rising practice costs.

Since the legislation passed at year-end did not deal with the SGR, physicians will face even more significant pay cuts in July and again in January 2009 unless Congress acts over the next few months.

Members of the House worked to address the scheduled physician pay cut under Medicare and other health reforms last August. At that time, the House passed a bill that would have given physicians a 0.5% payment update for 2008 and 2009. In addition, the bill would have provided a new physician payment structure with a separate conversion factor for six service categories. That legislation could not gain traction in the Senate.

This time around, however, Congress passed a scaled-down package that could pass both chambers overwhelmingly and would not encounter a veto threat from President Bush.

The House Democratic leadership expressed disappointment that the bill did not address some of the issues included in the August bill, such as eliminating overpayments to Medicare Advantage plans. The leadership has pledged to continue negotiations on more comprehensive legislation this year.

Medical professional societies will spend the next few months working with members of Congress to try to avert the scheduled cut from taking effect in July. For its part, ACP is planning a new grassroots campaign to let members of Congress know what physicians are doing now as a result of the unpredictable Medicare payment situation. These anecdotes won't be hypothetical, Mr. Doherty explained, but will describe what physicians are doing today.

In addition to halting the physician pay cut for 6 months, the recently passed legislation extends the Physician Quality Reporting Initiative program for 2008. The program, which launched in July 2007, allows physicians to earn up to 1.5% of their total allowed Medicare charges if they report on certain quality data. This program could be of more interest to physicians this time around, Mr. Doherty said, since it's an opportunity for them to increase their revenues from Medicare.

The bill also extends the Special Diabetes Program through Sept. 30, 2009. The program was established to fund type 1 diabetes research, and type 2 diabetes treatment and prevention for Native Americans and Alaska Natives.

The bill also will extend for 6 months provisions to aid physicians practicing in shortage areas.

In what has become a year-end tradition, last-minute congressional action has staved off deep cuts to the Medicare physician fee schedule.

The 2007 version means physicians won't feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, the legislation was expected to be signed by President Bush.

Unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear.

“It creates a tremendous degree of instability in the system,” said Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.

Many physician practices are small businesses, and it's difficult for physicians to make a business plan for the year when they can only calculate Medicare revenues for the first 6 months. Mr. Doherty said, adding that if Medicare payments make up 30%–40% of a practice's revenues, the impact can be substantial.

Officials at the American Medical Association also expressed disappointment with the legislation.

“We strongly urge Congress to break the tradition of short-term interventions that are not funded and fail to chart a course for replacing a flawed payment formula that is a barrier to improving quality and access to care for seniors,” Dr. Edward Langston, AMA board chair, said in a statement.

By law, officials at the Centers for Medicare and Medicaid Services must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payment based in part on the gross domestic product. Medical professional societies have been lobbying for years to eliminate the formula, which they argue does not adequately account for rising practice costs.

Since the legislation passed at year-end did not deal with the SGR, physicians will face even more significant pay cuts in July and again in January 2009 unless Congress acts over the next few months.

Members of the House worked to address the scheduled physician pay cut under Medicare and other health reforms last August. At that time, the House passed a bill that would have given physicians a 0.5% payment update for 2008 and 2009. In addition, the bill would have provided a new physician payment structure with a separate conversion factor for six service categories. That legislation could not gain traction in the Senate.

This time around, however, Congress passed a scaled-down package that could pass both chambers overwhelmingly and would not encounter a veto threat from President Bush.

The House Democratic leadership expressed disappointment that the bill did not address some of the issues included in the August bill, such as eliminating overpayments to Medicare Advantage plans. The leadership has pledged to continue negotiations on more comprehensive legislation this year.

Medical professional societies will spend the next few months working with members of Congress to try to avert the scheduled cut from taking effect in July. For its part, ACP is planning a new grassroots campaign to let members of Congress know what physicians are doing now as a result of the unpredictable Medicare payment situation. These anecdotes won't be hypothetical, Mr. Doherty explained, but will describe what physicians are doing today.

In addition to halting the physician pay cut for 6 months, the recently passed legislation extends the Physician Quality Reporting Initiative program for 2008. The program, which launched in July 2007, allows physicians to earn up to 1.5% of their total allowed Medicare charges if they report on certain quality data. This program could be of more interest to physicians this time around, Mr. Doherty said, since it's an opportunity for them to increase their revenues from Medicare.

The bill also extends the Special Diabetes Program through Sept. 30, 2009. The program was established to fund type 1 diabetes research, and type 2 diabetes treatment and prevention for Native Americans and Alaska Natives.

The bill also will extend for 6 months provisions to aid physicians practicing in shortage areas.

In what has become a year-end tradition, last-minute congressional action has staved off deep cuts to the Medicare physician fee schedule.

The 2007 version means physicians won't feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, the legislation was expected to be signed by President Bush.

Unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear.

“It creates a tremendous degree of instability in the system,” said Robert Doherty, senior vice president for governmental affairs and public policy at the American College of Physicians.

Many physician practices are small businesses, and it's difficult for physicians to make a business plan for the year when they can only calculate Medicare revenues for the first 6 months. Mr. Doherty said, adding that if Medicare payments make up 30%–40% of a practice's revenues, the impact can be substantial.

Officials at the American Medical Association also expressed disappointment with the legislation.

“We strongly urge Congress to break the tradition of short-term interventions that are not funded and fail to chart a course for replacing a flawed payment formula that is a barrier to improving quality and access to care for seniors,” Dr. Edward Langston, AMA board chair, said in a statement.

By law, officials at the Centers for Medicare and Medicaid Services must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payment based in part on the gross domestic product. Medical professional societies have been lobbying for years to eliminate the formula, which they argue does not adequately account for rising practice costs.

Since the legislation passed at year-end did not deal with the SGR, physicians will face even more significant pay cuts in July and again in January 2009 unless Congress acts over the next few months.

Members of the House worked to address the scheduled physician pay cut under Medicare and other health reforms last August. At that time, the House passed a bill that would have given physicians a 0.5% payment update for 2008 and 2009. In addition, the bill would have provided a new physician payment structure with a separate conversion factor for six service categories. That legislation could not gain traction in the Senate.

This time around, however, Congress passed a scaled-down package that could pass both chambers overwhelmingly and would not encounter a veto threat from President Bush.

The House Democratic leadership expressed disappointment that the bill did not address some of the issues included in the August bill, such as eliminating overpayments to Medicare Advantage plans. The leadership has pledged to continue negotiations on more comprehensive legislation this year.

Medical professional societies will spend the next few months working with members of Congress to try to avert the scheduled cut from taking effect in July. For its part, ACP is planning a new grassroots campaign to let members of Congress know what physicians are doing now as a result of the unpredictable Medicare payment situation. These anecdotes won't be hypothetical, Mr. Doherty explained, but will describe what physicians are doing today.

In addition to halting the physician pay cut for 6 months, the recently passed legislation extends the Physician Quality Reporting Initiative program for 2008. The program, which launched in July 2007, allows physicians to earn up to 1.5% of their total allowed Medicare charges if they report on certain quality data. This program could be of more interest to physicians this time around, Mr. Doherty said, since it's an opportunity for them to increase their revenues from Medicare.

The bill also extends the Special Diabetes Program through Sept. 30, 2009. The program was established to fund type 1 diabetes research, and type 2 diabetes treatment and prevention for Native Americans and Alaska Natives.

The bill also will extend for 6 months provisions to aid physicians practicing in shortage areas.

As physicians struggle to decide if or when to incorporate electronic health records into their practices, personal health records are gaining popularity.

Personal health records (PHRs) allow patients to store and access their medical information electronically. Various versions are available through physicians, health systems, insurers, and employers, and are offered on a stand-alone, subscription basis. But with so many models, no two records are likely to be the same, and each may present different challenges for the physician-patient relationship.

"We're really in a kind of Wild West situation with the PHR," said Dr. Peter Basch, an internist and medical director for eHealth at MedStar Health, a seven-hospital system in Washington and Baltimore.

Currently, two types of records are dominant—those that are linked to a physician's or health system's electronic health record, and free-standing records, Dr. Basch said.

With connected PHRs, patients can usually access subsets of their medical data and communicate with their physicians' offices on selected matters such as scheduling appointments. With a free-standing PHR, patients generally have greater control of the data that are entered, and of who can access the data. The market is more mature now in terms of connected PHRs, especially those that are linked to large medical groups and large health systems, Dr. Basch said.

In an effort to tame some of the variability in the market, Health Level Seven Inc. (HL7), a national organization that sets health information technology standards, has released a proposed personal health record standard. In August, HL7 unveiled its Personal Health Record System Functional Model, and sought public comments on it. The HL7 general model can be customized so that it can be used with each of the various PHR models available in the marketplace.

Another possible way to accelerate the development of the personal health record market is through the Certification Commission for Healthcare Information Technology (CCHIT), a body that already certifies ambulatory and inpatient electronic health record systems.

The CCHIT is looking at the area of personal health records, according to its chairman, Dr. Mark Leavitt. However, any certification of PHR products would be at least a year off, since the CCHIT has not developed certification criteria in that area. Although the PHR industry is still in its early stages, it is not necessary to wait for the industry to fully mature before developing certification criteria. In fact, setting standards early can be helpful, Dr. Leavitt said.

The PHR marketplace also may get a boost from the CCHIT long before a PHR certification process gets off the ground, Dr. Leavitt added. Through its electronic health record certification process, the CCHIT is requiring that records have the capability to send patient summary information, which would be helpful in populating a patient's PHR.

Many factors are driving the growth of PHRs. Employer groups, frustrated with escalating health costs, represent one faction pushing for PHR development.

Health insurers also are getting into the act. For example, Aetna recently announced that, starting this month, federal enrollees in any of the company's medical plans will have access to a password-protected online PHR. Even Medicare is testing the PHR field. Even if most consumers are not clamoring for PHRs, when surveyed, they do favor the concept. For example, in a November 2006 survey commissioned by the Markle Foundation, nearly two-thirds of the 1,003 adults polled said they would like to access their medical information electronically.

But consumers who were surveyed also had significant concerns about the privacy and security of their records. For example, 80% said they were very concerned about identity theft, and 77% said they were very concerned about their medical information being used for marketing purposes.

Concerns about security and privacy are shared by physicians. With a free-standing PHR, physicians could receive requests from patients to populate their data, but they might be reluctant to send such sensitive data in an unsecured way or in a way that could compromise the security of their own electronic systems, Dr. Basch said.

As physicians struggle to decide if or when to incorporate electronic health records into their practices, personal health records are gaining popularity.

Personal health records (PHRs) allow patients to store and access their medical information electronically. Various versions are available through physicians, health systems, insurers, and employers, and are offered on a stand-alone, subscription basis. But with so many models, no two records are likely to be the same, and each may present different challenges for the physician-patient relationship.

"We're really in a kind of Wild West situation with the PHR," said Dr. Peter Basch, an internist and medical director for eHealth at MedStar Health, a seven-hospital system in Washington and Baltimore.

Currently, two types of records are dominant—those that are linked to a physician's or health system's electronic health record, and free-standing records, Dr. Basch said.

With connected PHRs, patients can usually access subsets of their medical data and communicate with their physicians' offices on selected matters such as scheduling appointments. With a free-standing PHR, patients generally have greater control of the data that are entered, and of who can access the data. The market is more mature now in terms of connected PHRs, especially those that are linked to large medical groups and large health systems, Dr. Basch said.

In an effort to tame some of the variability in the market, Health Level Seven Inc. (HL7), a national organization that sets health information technology standards, has released a proposed personal health record standard. In August, HL7 unveiled its Personal Health Record System Functional Model, and sought public comments on it. The HL7 general model can be customized so that it can be used with each of the various PHR models available in the marketplace.

Another possible way to accelerate the development of the personal health record market is through the Certification Commission for Healthcare Information Technology (CCHIT), a body that already certifies ambulatory and inpatient electronic health record systems.

The CCHIT is looking at the area of personal health records, according to its chairman, Dr. Mark Leavitt. However, any certification of PHR products would be at least a year off, since the CCHIT has not developed certification criteria in that area. Although the PHR industry is still in its early stages, it is not necessary to wait for the industry to fully mature before developing certification criteria. In fact, setting standards early can be helpful, Dr. Leavitt said.

The PHR marketplace also may get a boost from the CCHIT long before a PHR certification process gets off the ground, Dr. Leavitt added. Through its electronic health record certification process, the CCHIT is requiring that records have the capability to send patient summary information, which would be helpful in populating a patient's PHR.

Many factors are driving the growth of PHRs. Employer groups, frustrated with escalating health costs, represent one faction pushing for PHR development.

Health insurers also are getting into the act. For example, Aetna recently announced that, starting this month, federal enrollees in any of the company's medical plans will have access to a password-protected online PHR. Even Medicare is testing the PHR field. Even if most consumers are not clamoring for PHRs, when surveyed, they do favor the concept. For example, in a November 2006 survey commissioned by the Markle Foundation, nearly two-thirds of the 1,003 adults polled said they would like to access their medical information electronically.

But consumers who were surveyed also had significant concerns about the privacy and security of their records. For example, 80% said they were very concerned about identity theft, and 77% said they were very concerned about their medical information being used for marketing purposes.

Concerns about security and privacy are shared by physicians. With a free-standing PHR, physicians could receive requests from patients to populate their data, but they might be reluctant to send such sensitive data in an unsecured way or in a way that could compromise the security of their own electronic systems, Dr. Basch said.

As physicians struggle to decide if or when to incorporate electronic health records into their practices, personal health records are gaining popularity.

Personal health records (PHRs) allow patients to store and access their medical information electronically. Various versions are available through physicians, health systems, insurers, and employers, and are offered on a stand-alone, subscription basis. But with so many models, no two records are likely to be the same, and each may present different challenges for the physician-patient relationship.

"We're really in a kind of Wild West situation with the PHR," said Dr. Peter Basch, an internist and medical director for eHealth at MedStar Health, a seven-hospital system in Washington and Baltimore.

Currently, two types of records are dominant—those that are linked to a physician's or health system's electronic health record, and free-standing records, Dr. Basch said.

With connected PHRs, patients can usually access subsets of their medical data and communicate with their physicians' offices on selected matters such as scheduling appointments. With a free-standing PHR, patients generally have greater control of the data that are entered, and of who can access the data. The market is more mature now in terms of connected PHRs, especially those that are linked to large medical groups and large health systems, Dr. Basch said.

In an effort to tame some of the variability in the market, Health Level Seven Inc. (HL7), a national organization that sets health information technology standards, has released a proposed personal health record standard. In August, HL7 unveiled its Personal Health Record System Functional Model, and sought public comments on it. The HL7 general model can be customized so that it can be used with each of the various PHR models available in the marketplace.

Another possible way to accelerate the development of the personal health record market is through the Certification Commission for Healthcare Information Technology (CCHIT), a body that already certifies ambulatory and inpatient electronic health record systems.

The CCHIT is looking at the area of personal health records, according to its chairman, Dr. Mark Leavitt. However, any certification of PHR products would be at least a year off, since the CCHIT has not developed certification criteria in that area. Although the PHR industry is still in its early stages, it is not necessary to wait for the industry to fully mature before developing certification criteria. In fact, setting standards early can be helpful, Dr. Leavitt said.

The PHR marketplace also may get a boost from the CCHIT long before a PHR certification process gets off the ground, Dr. Leavitt added. Through its electronic health record certification process, the CCHIT is requiring that records have the capability to send patient summary information, which would be helpful in populating a patient's PHR.

Many factors are driving the growth of PHRs. Employer groups, frustrated with escalating health costs, represent one faction pushing for PHR development.

Health insurers also are getting into the act. For example, Aetna recently announced that, starting this month, federal enrollees in any of the company's medical plans will have access to a password-protected online PHR. Even Medicare is testing the PHR field. Even if most consumers are not clamoring for PHRs, when surveyed, they do favor the concept. For example, in a November 2006 survey commissioned by the Markle Foundation, nearly two-thirds of the 1,003 adults polled said they would like to access their medical information electronically.

But consumers who were surveyed also had significant concerns about the privacy and security of their records. For example, 80% said they were very concerned about identity theft, and 77% said they were very concerned about their medical information being used for marketing purposes.

Concerns about security and privacy are shared by physicians. With a free-standing PHR, physicians could receive requests from patients to populate their data, but they might be reluctant to send such sensitive data in an unsecured way or in a way that could compromise the security of their own electronic systems, Dr. Basch said.

Adoption of health information technology varies significantly among physicians in different specialties, according to a new study from the Center for Studying Health System Change.

Only 12% of physicians overall have adopted comprehensive electronic medical records, but physician uptake of specific health IT functions, such as obtaining guidelines or writing prescriptions, varies depending on specialty. For example, 74% of emergency physicians have health IT systems that can access patient notes, compared with just 36% of psychiatrists.

The findings are based on the Health System Change (HSC) 2004–2005 Community Tracking Study Physician Survey, a nationally representative telephone poll that included responses from 6,628 physicians.

As part of the survey, physicians were asked about practice-based availability of information technology across several clinical areas, including–retrieving patient notes or problem lists; writing prescriptions; exchanging clinical data and images with other physicians; and exchanging clinical data and images with hospitals.

The full report is available at www.hschange.com/CONTENT/945.

Adoption of health information technology varies significantly among physicians in different specialties, according to a new study from the Center for Studying Health System Change.

Only 12% of physicians overall have adopted comprehensive electronic medical records, but physician uptake of specific health IT functions, such as obtaining guidelines or writing prescriptions, varies depending on specialty. For example, 74% of emergency physicians have health IT systems that can access patient notes, compared with just 36% of psychiatrists.

The findings are based on the Health System Change (HSC) 2004–2005 Community Tracking Study Physician Survey, a nationally representative telephone poll that included responses from 6,628 physicians.

As part of the survey, physicians were asked about practice-based availability of information technology across several clinical areas, including–retrieving patient notes or problem lists; writing prescriptions; exchanging clinical data and images with other physicians; and exchanging clinical data and images with hospitals.

The full report is available at www.hschange.com/CONTENT/945.

Adoption of health information technology varies significantly among physicians in different specialties, according to a new study from the Center for Studying Health System Change.

Only 12% of physicians overall have adopted comprehensive electronic medical records, but physician uptake of specific health IT functions, such as obtaining guidelines or writing prescriptions, varies depending on specialty. For example, 74% of emergency physicians have health IT systems that can access patient notes, compared with just 36% of psychiatrists.

The findings are based on the Health System Change (HSC) 2004–2005 Community Tracking Study Physician Survey, a nationally representative telephone poll that included responses from 6,628 physicians.

As part of the survey, physicians were asked about practice-based availability of information technology across several clinical areas, including–retrieving patient notes or problem lists; writing prescriptions; exchanging clinical data and images with other physicians; and exchanging clinical data and images with hospitals.

The full report is available at www.hschange.com/CONTENT/945.

Cost containment strategies, such as tiered drug plans, reduce overall prescription drug utilization and increase the use of generics, according to an analysis of prescription drug use by Medicare-eligible retirees.

But even with decreased utilization, individuals enrolled in three-tiered drug plans, which charge higher copayments for certain medications, spent more money out of pocket than did individuals enrolled in single-tiered plans.

The study, conducted by researchers at Mathematica Policy Research Inc. and RTI International, included 352,760 Medicare beneficiaries with employer-sponsored drug coverage and dependent spouses aged 65 or older (Health Serv. Res. 2007 Sept. 11 [Epub doi:10.1111/j.1475-6773.2007.00774.x]).

The study is further confirmation that the retiree population is sensitive to price, “but we don't know what that means in terms of health outcomes,” Boyd H. Gilman, Ph.D., a senior researcher at the Cambridge, Mass., office of Mathematica, said in an interview.

On average, individuals in single-tiered plans filled 46 prescriptions a year, compared with 38 prescriptions among those enrolled in three-tiered plans. But enrollees in singled-tiered plans used fewer generics, the researchers found. Nearly 39% of the drugs purchased under single-tier plans were generics, compared with nearly 44% in three-tiered plans.

Drug plans spent about $1,943 per individual in single-tiered plans, versus $1,354 in three-tiered plans. Individuals who were enrolled in single-tier plans spent about $245 a year, compared with $469 spent by individuals enrolled in multitiered plans.

The study was funded by an internal grant from RTI International.

Cost containment strategies, such as tiered drug plans, reduce overall prescription drug utilization and increase the use of generics, according to an analysis of prescription drug use by Medicare-eligible retirees.

But even with decreased utilization, individuals enrolled in three-tiered drug plans, which charge higher copayments for certain medications, spent more money out of pocket than did individuals enrolled in single-tiered plans.

The study, conducted by researchers at Mathematica Policy Research Inc. and RTI International, included 352,760 Medicare beneficiaries with employer-sponsored drug coverage and dependent spouses aged 65 or older (Health Serv. Res. 2007 Sept. 11 [Epub doi:10.1111/j.1475-6773.2007.00774.x]).

The study is further confirmation that the retiree population is sensitive to price, “but we don't know what that means in terms of health outcomes,” Boyd H. Gilman, Ph.D., a senior researcher at the Cambridge, Mass., office of Mathematica, said in an interview.

On average, individuals in single-tiered plans filled 46 prescriptions a year, compared with 38 prescriptions among those enrolled in three-tiered plans. But enrollees in singled-tiered plans used fewer generics, the researchers found. Nearly 39% of the drugs purchased under single-tier plans were generics, compared with nearly 44% in three-tiered plans.

Drug plans spent about $1,943 per individual in single-tiered plans, versus $1,354 in three-tiered plans. Individuals who were enrolled in single-tier plans spent about $245 a year, compared with $469 spent by individuals enrolled in multitiered plans.

The study was funded by an internal grant from RTI International.

Cost containment strategies, such as tiered drug plans, reduce overall prescription drug utilization and increase the use of generics, according to an analysis of prescription drug use by Medicare-eligible retirees.

But even with decreased utilization, individuals enrolled in three-tiered drug plans, which charge higher copayments for certain medications, spent more money out of pocket than did individuals enrolled in single-tiered plans.

The study, conducted by researchers at Mathematica Policy Research Inc. and RTI International, included 352,760 Medicare beneficiaries with employer-sponsored drug coverage and dependent spouses aged 65 or older (Health Serv. Res. 2007 Sept. 11 [Epub doi:10.1111/j.1475-6773.2007.00774.x]).

The study is further confirmation that the retiree population is sensitive to price, “but we don't know what that means in terms of health outcomes,” Boyd H. Gilman, Ph.D., a senior researcher at the Cambridge, Mass., office of Mathematica, said in an interview.

On average, individuals in single-tiered plans filled 46 prescriptions a year, compared with 38 prescriptions among those enrolled in three-tiered plans. But enrollees in singled-tiered plans used fewer generics, the researchers found. Nearly 39% of the drugs purchased under single-tier plans were generics, compared with nearly 44% in three-tiered plans.

Drug plans spent about $1,943 per individual in single-tiered plans, versus $1,354 in three-tiered plans. Individuals who were enrolled in single-tier plans spent about $245 a year, compared with $469 spent by individuals enrolled in multitiered plans.

The study was funded by an internal grant from RTI International.