Frances Correa

A plan to finally replace Medicare’s much-maligned sustainable growth rate (SGR) payment formula could be unveiled by this summer, federal lawmakers said at a committee hearing. “Here’s the bottom line: If we get to December and we’re doing an extension, that’s a failure on our part,” Rep. Michael Burgess (R– Tex) said at the hearing. “We need a permanent solution that’s predictable, updatable, and reasonable for this year—and nothing else will do.”

“Whatever virtues the SGR had when it was created 14 years ago…, it’s clear that they have vanished,” added Rep. Henry A. Waxman (D– Calif). He noted that in the past 2 years, Congress has had to pass legislation six times, blocking fee cuts of up to 21% or more.

About 30 medical associations, including the American Society of Clinical Oncology (ASCO), responded to the House subcommittee’s request for suggestions and proposals in developing a new system. On May 5, 2011, House subcommittee members met with a five-person panel of experts from medical associations and health policy organizations to consider alternatives to the current SGR formula, which some participants labeled as anything but sustainable.

One size won’t fit all

Although the details of ASCO’s plan and others vary, they also show a consensus on several fronts: repealing the SGR, moving away from the traditional fee-for-services payment model, and providing a 4- to 5-year transition period during which providers can experiment with a variety of payment systems.

In a letter accompanying the ASCO recommendations, the president, Dr. George Sledge, and CEO, Dr. Allen Lichter, stressed that SGR reforms in general should be linked to existing “robust” systems that promote evidence-based medicine. For oncology in particular, that effort should leverage the Quality Oncology Practice Initiative (QOPI), a comprehensive, field-tested program that more than one-quarter of outpatient oncology practices in the United States already participate in. More than 80% of oncology care is provided in that setting.

“The current SGR system has created an uncertain and unstable environment— a situation that threatens the viability of practices and access to care for thousands of cancer patients,” they concluded.

In its recommendations, ASCO asserted that evidence-based medicine is “both warranted and necessary” because:

• Medicare beneficiaries account for more than half of all new cancer diagnoses in the United States, and treatment and prevention of the disease comprise almost 10% of costs under fee-for-service Medicare;
• The care is complex, treatment can span many specialties, and treatment strategies change rapidly to keep pace with scientific advances; and
• These complexities would not be adequately addressed if a multispecialty system (such as the Physician Quality Reporting System) were to be applied in the oncology setting.

The recommendations also detailed why the QOPI should be incorporated as the primary quality measurement program: 25%−30% of a range of practices—urban, rural, community, and academic—participate in it; it is free; some private insurers have adopted incentives for participation in the program; the performance measures are field-tested and up-to-date; and participation promotes high-quality, high-value care and can help identify and address discrepancies in oncology care.

Moreover, QOPI “protects the best interests of patients, reduces exposure to unnecessary treatments and tests, minimizes the use of suboptimal treatment options, promotes the coordination of care, and protects the Medicare program from costs associated with poor-quality care,” ASCO asserted in the recommendation.

Members of the expert panel also stressed the importance of avoiding a “one-size-fits-all” solution. “We should [be mindful] that what will work in one part of the country will not work in another part of the country, and that’s why we have continued to talk about a variety of options,” said Dr. Cecil Wilson, president of the American Medical Association (AMA). “There is a temptation to feel that we ought to figure out one rule …that solves it all.”

Dr. Wilson pointed to the provisions in the Affordable Care Act that allow for a variety of models of accountable care organizations, embodying the concept of options in the medical system. In that spirit, he said that the AMA has formed a physician leadership group to evaluate the effectiveness of alternative payment methods.

Dr. Roland A. Goertz, president of the American Academy of Family Physicians (AAFP), noted in written testimony to the committee that “the evidence shows that to achieve the savings Congress is looking for, and to improve the quality of health care delivered to millions of patients in the country, reform must include investment in primary care.”

To strengthen primary care’s role in Medicare, the AAFP backs payment reforms that would boost primary care reimbursement and support the concept of the patient-centered medical home (PCMH). The AAFP’s proposal would create a blended reimbursement system for primary care delivered within a PCMH: fee-forservice payments and pay for performance, plus care management fees for PCMH-related activities that do not involve direct patient care.

To prepare for that new payment system, the AAFP has proposed a 5-year transition period with mandated pay increases for primary care physicians, an increase in the Primary Care Incentive Care payment from 10% to 20%, and a rule that Medicaid payments to primary care physicians will always be at least equal to Medicare payments.

Dr. David Hoyt, executive director of the American College of Surgeons, said the College is analyzing the use of bundled payments for surgery. Dr. M. Todd Williamson, of the Coalition of State Medical and National Specialty Societies, introduced the option of private contracting, in which patients would be free to apply their benefits to a doctor of their choice, who would be free to opt out on a per-patient basis.

“Private contracting is a key principle of American freedom and liberty,” Dr. Williamson said. “[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries.”

Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.

Rep. Burgess, who is also a physician, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.

Is the IPAB the new SGR?

Rep. Fred Upton (R–Mich) raised concerns about the Independent Payment Advisory Board (IPAB), crecreated by the Affordable Care Act. The Board sets expenditure targets on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. “Sounds a lot like the SGR, which we’re trying to get rid of,” Mr. Upton said. “Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform.”

Some panelists agreed. “It’s not impossible that [the IPAB] could serve a function,” Dr. Wilson said, “but as presently constituted, we see it [as] basically another target for physicians to meet, potential double jeopardy, with an SGR as well as the pronouncements from this body.”

The panelists also asserted their belief that whatever plan chosen should be physician led, with financial support of the government. “It would be very helpful if physicians could get better financial support in their own payment system to enable them to lead all of those efforts,” said Dr. Mark B. McClellan, director of the Engelberg Center for Health Care Reform and former administrator of the Centers for Medicare and Medicaid Services. “Right now, with fee-for-service staying the way it is, they’re staying behind.” Dr. McClellan added that physicians can be the best sources for innovative and costsaving mechanisms.

A plan to finally replace Medicare’s much-maligned sustainable growth rate (SGR) payment formula could be unveiled by this summer, federal lawmakers said at a committee hearing. “Here’s the bottom line: If we get to December and we’re doing an extension, that’s a failure on our part,” Rep. Michael Burgess (R– Tex) said at the hearing. “We need a permanent solution that’s predictable, updatable, and reasonable for this year—and nothing else will do.”

“Whatever virtues the SGR had when it was created 14 years ago…, it’s clear that they have vanished,” added Rep. Henry A. Waxman (D– Calif). He noted that in the past 2 years, Congress has had to pass legislation six times, blocking fee cuts of up to 21% or more.

About 30 medical associations, including the American Society of Clinical Oncology (ASCO), responded to the House subcommittee’s request for suggestions and proposals in developing a new system. On May 5, 2011, House subcommittee members met with a five-person panel of experts from medical associations and health policy organizations to consider alternatives to the current SGR formula, which some participants labeled as anything but sustainable.

One size won’t fit all

Although the details of ASCO’s plan and others vary, they also show a consensus on several fronts: repealing the SGR, moving away from the traditional fee-for-services payment model, and providing a 4- to 5-year transition period during which providers can experiment with a variety of payment systems.

In a letter accompanying the ASCO recommendations, the president, Dr. George Sledge, and CEO, Dr. Allen Lichter, stressed that SGR reforms in general should be linked to existing “robust” systems that promote evidence-based medicine. For oncology in particular, that effort should leverage the Quality Oncology Practice Initiative (QOPI), a comprehensive, field-tested program that more than one-quarter of outpatient oncology practices in the United States already participate in. More than 80% of oncology care is provided in that setting.

“The current SGR system has created an uncertain and unstable environment— a situation that threatens the viability of practices and access to care for thousands of cancer patients,” they concluded.

In its recommendations, ASCO asserted that evidence-based medicine is “both warranted and necessary” because:

• Medicare beneficiaries account for more than half of all new cancer diagnoses in the United States, and treatment and prevention of the disease comprise almost 10% of costs under fee-for-service Medicare;
• The care is complex, treatment can span many specialties, and treatment strategies change rapidly to keep pace with scientific advances; and
• These complexities would not be adequately addressed if a multispecialty system (such as the Physician Quality Reporting System) were to be applied in the oncology setting.

The recommendations also detailed why the QOPI should be incorporated as the primary quality measurement program: 25%−30% of a range of practices—urban, rural, community, and academic—participate in it; it is free; some private insurers have adopted incentives for participation in the program; the performance measures are field-tested and up-to-date; and participation promotes high-quality, high-value care and can help identify and address discrepancies in oncology care.

Moreover, QOPI “protects the best interests of patients, reduces exposure to unnecessary treatments and tests, minimizes the use of suboptimal treatment options, promotes the coordination of care, and protects the Medicare program from costs associated with poor-quality care,” ASCO asserted in the recommendation.

Members of the expert panel also stressed the importance of avoiding a “one-size-fits-all” solution. “We should [be mindful] that what will work in one part of the country will not work in another part of the country, and that’s why we have continued to talk about a variety of options,” said Dr. Cecil Wilson, president of the American Medical Association (AMA). “There is a temptation to feel that we ought to figure out one rule …that solves it all.”

Dr. Wilson pointed to the provisions in the Affordable Care Act that allow for a variety of models of accountable care organizations, embodying the concept of options in the medical system. In that spirit, he said that the AMA has formed a physician leadership group to evaluate the effectiveness of alternative payment methods.

Dr. Roland A. Goertz, president of the American Academy of Family Physicians (AAFP), noted in written testimony to the committee that “the evidence shows that to achieve the savings Congress is looking for, and to improve the quality of health care delivered to millions of patients in the country, reform must include investment in primary care.”

To strengthen primary care’s role in Medicare, the AAFP backs payment reforms that would boost primary care reimbursement and support the concept of the patient-centered medical home (PCMH). The AAFP’s proposal would create a blended reimbursement system for primary care delivered within a PCMH: fee-forservice payments and pay for performance, plus care management fees for PCMH-related activities that do not involve direct patient care.

To prepare for that new payment system, the AAFP has proposed a 5-year transition period with mandated pay increases for primary care physicians, an increase in the Primary Care Incentive Care payment from 10% to 20%, and a rule that Medicaid payments to primary care physicians will always be at least equal to Medicare payments.

Dr. David Hoyt, executive director of the American College of Surgeons, said the College is analyzing the use of bundled payments for surgery. Dr. M. Todd Williamson, of the Coalition of State Medical and National Specialty Societies, introduced the option of private contracting, in which patients would be free to apply their benefits to a doctor of their choice, who would be free to opt out on a per-patient basis.

“Private contracting is a key principle of American freedom and liberty,” Dr. Williamson said. “[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries.”

Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.

Rep. Burgess, who is also a physician, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.

Is the IPAB the new SGR?

Rep. Fred Upton (R–Mich) raised concerns about the Independent Payment Advisory Board (IPAB), crecreated by the Affordable Care Act. The Board sets expenditure targets on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. “Sounds a lot like the SGR, which we’re trying to get rid of,” Mr. Upton said. “Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform.”

Some panelists agreed. “It’s not impossible that [the IPAB] could serve a function,” Dr. Wilson said, “but as presently constituted, we see it [as] basically another target for physicians to meet, potential double jeopardy, with an SGR as well as the pronouncements from this body.”

The panelists also asserted their belief that whatever plan chosen should be physician led, with financial support of the government. “It would be very helpful if physicians could get better financial support in their own payment system to enable them to lead all of those efforts,” said Dr. Mark B. McClellan, director of the Engelberg Center for Health Care Reform and former administrator of the Centers for Medicare and Medicaid Services. “Right now, with fee-for-service staying the way it is, they’re staying behind.” Dr. McClellan added that physicians can be the best sources for innovative and costsaving mechanisms.

A plan to finally replace Medicare’s much-maligned sustainable growth rate (SGR) payment formula could be unveiled by this summer, federal lawmakers said at a committee hearing. “Here’s the bottom line: If we get to December and we’re doing an extension, that’s a failure on our part,” Rep. Michael Burgess (R– Tex) said at the hearing. “We need a permanent solution that’s predictable, updatable, and reasonable for this year—and nothing else will do.”

“Whatever virtues the SGR had when it was created 14 years ago…, it’s clear that they have vanished,” added Rep. Henry A. Waxman (D– Calif). He noted that in the past 2 years, Congress has had to pass legislation six times, blocking fee cuts of up to 21% or more.

About 30 medical associations, including the American Society of Clinical Oncology (ASCO), responded to the House subcommittee’s request for suggestions and proposals in developing a new system. On May 5, 2011, House subcommittee members met with a five-person panel of experts from medical associations and health policy organizations to consider alternatives to the current SGR formula, which some participants labeled as anything but sustainable.

One size won’t fit all

Although the details of ASCO’s plan and others vary, they also show a consensus on several fronts: repealing the SGR, moving away from the traditional fee-for-services payment model, and providing a 4- to 5-year transition period during which providers can experiment with a variety of payment systems.

In a letter accompanying the ASCO recommendations, the president, Dr. George Sledge, and CEO, Dr. Allen Lichter, stressed that SGR reforms in general should be linked to existing “robust” systems that promote evidence-based medicine. For oncology in particular, that effort should leverage the Quality Oncology Practice Initiative (QOPI), a comprehensive, field-tested program that more than one-quarter of outpatient oncology practices in the United States already participate in. More than 80% of oncology care is provided in that setting.

“The current SGR system has created an uncertain and unstable environment— a situation that threatens the viability of practices and access to care for thousands of cancer patients,” they concluded.

In its recommendations, ASCO asserted that evidence-based medicine is “both warranted and necessary” because:

• Medicare beneficiaries account for more than half of all new cancer diagnoses in the United States, and treatment and prevention of the disease comprise almost 10% of costs under fee-for-service Medicare;
• The care is complex, treatment can span many specialties, and treatment strategies change rapidly to keep pace with scientific advances; and
• These complexities would not be adequately addressed if a multispecialty system (such as the Physician Quality Reporting System) were to be applied in the oncology setting.

The recommendations also detailed why the QOPI should be incorporated as the primary quality measurement program: 25%−30% of a range of practices—urban, rural, community, and academic—participate in it; it is free; some private insurers have adopted incentives for participation in the program; the performance measures are field-tested and up-to-date; and participation promotes high-quality, high-value care and can help identify and address discrepancies in oncology care.

Moreover, QOPI “protects the best interests of patients, reduces exposure to unnecessary treatments and tests, minimizes the use of suboptimal treatment options, promotes the coordination of care, and protects the Medicare program from costs associated with poor-quality care,” ASCO asserted in the recommendation.

Members of the expert panel also stressed the importance of avoiding a “one-size-fits-all” solution. “We should [be mindful] that what will work in one part of the country will not work in another part of the country, and that’s why we have continued to talk about a variety of options,” said Dr. Cecil Wilson, president of the American Medical Association (AMA). “There is a temptation to feel that we ought to figure out one rule …that solves it all.”

Dr. Wilson pointed to the provisions in the Affordable Care Act that allow for a variety of models of accountable care organizations, embodying the concept of options in the medical system. In that spirit, he said that the AMA has formed a physician leadership group to evaluate the effectiveness of alternative payment methods.

Dr. Roland A. Goertz, president of the American Academy of Family Physicians (AAFP), noted in written testimony to the committee that “the evidence shows that to achieve the savings Congress is looking for, and to improve the quality of health care delivered to millions of patients in the country, reform must include investment in primary care.”

To strengthen primary care’s role in Medicare, the AAFP backs payment reforms that would boost primary care reimbursement and support the concept of the patient-centered medical home (PCMH). The AAFP’s proposal would create a blended reimbursement system for primary care delivered within a PCMH: fee-forservice payments and pay for performance, plus care management fees for PCMH-related activities that do not involve direct patient care.

To prepare for that new payment system, the AAFP has proposed a 5-year transition period with mandated pay increases for primary care physicians, an increase in the Primary Care Incentive Care payment from 10% to 20%, and a rule that Medicaid payments to primary care physicians will always be at least equal to Medicare payments.

Dr. David Hoyt, executive director of the American College of Surgeons, said the College is analyzing the use of bundled payments for surgery. Dr. M. Todd Williamson, of the Coalition of State Medical and National Specialty Societies, introduced the option of private contracting, in which patients would be free to apply their benefits to a doctor of their choice, who would be free to opt out on a per-patient basis.

“Private contracting is a key principle of American freedom and liberty,” Dr. Williamson said. “[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries.”

Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.

Rep. Burgess, who is also a physician, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.

Is the IPAB the new SGR?

Rep. Fred Upton (R–Mich) raised concerns about the Independent Payment Advisory Board (IPAB), crecreated by the Affordable Care Act. The Board sets expenditure targets on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. “Sounds a lot like the SGR, which we’re trying to get rid of,” Mr. Upton said. “Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform.”

Some panelists agreed. “It’s not impossible that [the IPAB] could serve a function,” Dr. Wilson said, “but as presently constituted, we see it [as] basically another target for physicians to meet, potential double jeopardy, with an SGR as well as the pronouncements from this body.”

The panelists also asserted their belief that whatever plan chosen should be physician led, with financial support of the government. “It would be very helpful if physicians could get better financial support in their own payment system to enable them to lead all of those efforts,” said Dr. Mark B. McClellan, director of the Engelberg Center for Health Care Reform and former administrator of the Centers for Medicare and Medicaid Services. “Right now, with fee-for-service staying the way it is, they’re staying behind.” Dr. McClellan added that physicians can be the best sources for innovative and costsaving mechanisms.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Up to 10.5% of the 32 million uninsured Americans who will receive coverage under the Affordable Care Act have preexisting mental health or substance use conditions, Ron Manderscheid, Ph.D., said in a teleconference sponsored by the Substance Abuse and Mental Health Services Administration.

The expanded coverage these consumers will receive is sure to have ripple effects throughout the health care system -- ultimately saving lives, said Dr. Manderscheid, executive director of the National Association of County and Behavioral Health and Developmental Disability Directors. He added that under the current health system, public mental health clients die 25 years sooner than the average American because of a lack of access to primary care.

Carol McDaid said there is much to be gained from the new law. "As recovery advocates, we are going to continue to make sure that the law is implemented and enforced according to congressional intent," said Ms. McDaid, cofounder and principal of Capitol Decisions, a nonprofit advocacy organization. She added that providers who choose to participate with the state-based health insurance exchanges will be required to offer mental health and addiction services.

Many aspects of the health care reform law will not go into effect until 2014, but consumers already can benefit from restrictions against insurers limiting annual and lifetime coverage, coverage for young adults who are on their parents’ plan (through age 26), coverage regardless of preexisting conditions, and an external review process for denied claims, Ms. McDaid said.

This access to essential health benefits, including treatment and rehabilitation for mental health and substance use disorders, is a first for behavioral health, said Alice Dembner, deputy police director for Community Catalyst, a nonprofit advocacy organization. The health exchanges, one of the offerings that will go into effect in a few years, will include premium and cost-sharing subsidies for low- and moderate-income people. This will provide assistance to thousands of mental health patients, Ms. Dembner said.

Despite the Affordable Care Act’s potential benefits to those with mental illness, the new law could be undermined by several factors, Ms. Dembner said. Those factors include the federal debt ceiling, which limits the government’s ability to borrow money to fund spending; state court cases challenging the law’s constitutionality; and the 2012 electoral campaign, in which candidates vying for the Republican nomination will campaign against the law.

Most of the Affordable Care Act’s provisions will roll out in the future, a factor that seems to be working to the advantage of its opponents. "So there is a long time lag there for the potential for erosion of political will, and there’s still limited public understanding of the law and what it will mean," Ms. Dembner said, adding that public awareness and support are critical to preserving the law.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20-22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO’s need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Mr. Blum said the CMS is nonetheless devising a model that will greatly improve care. "We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care, and so we’re very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model."

The comment period on ACO regulation will close on June 6.

Greater use of electronic health records would cut greenhouse gas emissions, energy use, waste and toxic chemical production, and water consumption, according to a study by Marianne C. Turley, Ph.D., and her associates at Kaiser Permanente.

Even after factoring in the additional energy consumption from the increased use of personal computers, the overall net effect on the environment would be favorable, the researchers concluded based on an analysis of the impact of the Kaiser Permanente EHR system, which covers 8.7 million beneficiaries.

(c) Sean McBride/iStockphoto.com

Annually, the use of the Kaiser EHR system eliminated the use of 1,373 tons of paper by discontinuing the use of paper medical charts, x-ray jackets, and administrative forms. The system also decreased annual gas consumption by an estimated 3.3-10 million gallons by cutting the number of visits by 4-13 million. Patients who were registered online could correspond with their providers about nonemergency concerns through secure e-mail messages, the investigators reported (Health Aff. 2011;30:938-46).

Switching from desktop to laptop computers saved 89,300 megawatt hours and digitizing x-rays eliminated the waste of 203 tons of plastic and 79 tons of toxic chemicals. Using the Environmental Protection Agency’s greenhouse gas equivalencies calculator, Dr. Turley and her associates estimated that Kaiser’s efforts reduced greenhouse gas emissions by 9,200 tons.

Results were based on data from regional operational reports, paper-purchasing records, and internal pharmaceutical reports. Travel distance was estimated by calculating the distance from patient addresses to Kaiser-participating primary care buildings and aggregating them by region.

With a growing emphasis on health technology, the Kaiser study showed that "the use of electronic health records can both change the face of health care and help reduce its environmental footprint," the researchers wrote.

Despite these findings, Dr. Turley and her associates said that the environmental impact of switching to electronic health records will vary from system to system. As the Affordable Care Act calls for implementation of electronic systems, they said further analysis is necessary to determine the impacts of widespread implementation.

Although 51% of office-based physicians are currently using an electronic system, only 10% of practices reported their systems as being fully functioning, according to the most recent evaluation from the Centers for Disease Control and Prevention. Regardless, implementation of electronic systems will probably increase as provisions in the American Recovery and Reinvestment Act of 2009 create incentives for providers who invest in electronic systems. Public and private investment in these systems is expected to reach $40 billion in the next several years, according to the investigators.

Greater use of electronic health records would cut greenhouse gas emissions, energy use, waste and toxic chemical production, and water consumption, according to a study by Marianne C. Turley, Ph.D., and her associates at Kaiser Permanente.

Even after factoring in the additional energy consumption from the increased use of personal computers, the overall net effect on the environment would be favorable, the researchers concluded based on an analysis of the impact of the Kaiser Permanente EHR system, which covers 8.7 million beneficiaries.

(c) Sean McBride/iStockphoto.com

Annually, the use of the Kaiser EHR system eliminated the use of 1,373 tons of paper by discontinuing the use of paper medical charts, x-ray jackets, and administrative forms. The system also decreased annual gas consumption by an estimated 3.3-10 million gallons by cutting the number of visits by 4-13 million. Patients who were registered online could correspond with their providers about nonemergency concerns through secure e-mail messages, the investigators reported (Health Aff. 2011;30:938-46).

Switching from desktop to laptop computers saved 89,300 megawatt hours and digitizing x-rays eliminated the waste of 203 tons of plastic and 79 tons of toxic chemicals. Using the Environmental Protection Agency’s greenhouse gas equivalencies calculator, Dr. Turley and her associates estimated that Kaiser’s efforts reduced greenhouse gas emissions by 9,200 tons.

Results were based on data from regional operational reports, paper-purchasing records, and internal pharmaceutical reports. Travel distance was estimated by calculating the distance from patient addresses to Kaiser-participating primary care buildings and aggregating them by region.

With a growing emphasis on health technology, the Kaiser study showed that "the use of electronic health records can both change the face of health care and help reduce its environmental footprint," the researchers wrote.

Despite these findings, Dr. Turley and her associates said that the environmental impact of switching to electronic health records will vary from system to system. As the Affordable Care Act calls for implementation of electronic systems, they said further analysis is necessary to determine the impacts of widespread implementation.

Although 51% of office-based physicians are currently using an electronic system, only 10% of practices reported their systems as being fully functioning, according to the most recent evaluation from the Centers for Disease Control and Prevention. Regardless, implementation of electronic systems will probably increase as provisions in the American Recovery and Reinvestment Act of 2009 create incentives for providers who invest in electronic systems. Public and private investment in these systems is expected to reach $40 billion in the next several years, according to the investigators.

Greater use of electronic health records would cut greenhouse gas emissions, energy use, waste and toxic chemical production, and water consumption, according to a study by Marianne C. Turley, Ph.D., and her associates at Kaiser Permanente.

Even after factoring in the additional energy consumption from the increased use of personal computers, the overall net effect on the environment would be favorable, the researchers concluded based on an analysis of the impact of the Kaiser Permanente EHR system, which covers 8.7 million beneficiaries.

(c) Sean McBride/iStockphoto.com

Annually, the use of the Kaiser EHR system eliminated the use of 1,373 tons of paper by discontinuing the use of paper medical charts, x-ray jackets, and administrative forms. The system also decreased annual gas consumption by an estimated 3.3-10 million gallons by cutting the number of visits by 4-13 million. Patients who were registered online could correspond with their providers about nonemergency concerns through secure e-mail messages, the investigators reported (Health Aff. 2011;30:938-46).

Switching from desktop to laptop computers saved 89,300 megawatt hours and digitizing x-rays eliminated the waste of 203 tons of plastic and 79 tons of toxic chemicals. Using the Environmental Protection Agency’s greenhouse gas equivalencies calculator, Dr. Turley and her associates estimated that Kaiser’s efforts reduced greenhouse gas emissions by 9,200 tons.

Results were based on data from regional operational reports, paper-purchasing records, and internal pharmaceutical reports. Travel distance was estimated by calculating the distance from patient addresses to Kaiser-participating primary care buildings and aggregating them by region.

With a growing emphasis on health technology, the Kaiser study showed that "the use of electronic health records can both change the face of health care and help reduce its environmental footprint," the researchers wrote.

Despite these findings, Dr. Turley and her associates said that the environmental impact of switching to electronic health records will vary from system to system. As the Affordable Care Act calls for implementation of electronic systems, they said further analysis is necessary to determine the impacts of widespread implementation.

Although 51% of office-based physicians are currently using an electronic system, only 10% of practices reported their systems as being fully functioning, according to the most recent evaluation from the Centers for Disease Control and Prevention. Regardless, implementation of electronic systems will probably increase as provisions in the American Recovery and Reinvestment Act of 2009 create incentives for providers who invest in electronic systems. Public and private investment in these systems is expected to reach $40 billion in the next several years, according to the investigators.