Jennifer Lubell

WASHINGTON — The medical home, a model for financing and delivering care that has long been endorsed by the American Academy of Family Physicians, is a key part of the American College of Physicians' action plan to reform Medicare payment policies.

Medicare should pilot test the “advanced medical home,” where physicians would receive reimbursement for coordinating care in a practice environment that centers on a patient's individual needs, the ACP recommended in a policy paper.

The ACP urged Congress and the Bush administration to apply this model, along with other financial and organizational changes, to counter declining interest in primary care among medical students and practicing physicians.

Medicare's payment system is one of the main reasons that doctors are abandoning primary care, Robert B. Doherty, ACP's senior vice president of governmental affairs and public policy, said at a press briefing to release the ACP plan.

Medicare pays too little for the time that primary care physicians spend with their patients—and discourages them from organizing their practices to achieve optimal results, by failing to reimburse for things such as e-mail consultations, care coordination, or health information technology, he said.

“And despite all of the talk about pay for performance, Medicare continues to pay doctors for doing more, rather than doing better,” Mr. Doherty added.

Reconfiguring the payment system and encouraging use of the advanced medical home “would change the way that primary care is delivered and financed by Medicare and other payers,” ACP President Dr. C. Anderson Hedberg said.

Primary care physicians who apply the medical home model would partner with patients to ensure optimal management and coordination of care, using evidence-based clinical decision support tools at the point of care, Dr. Hedberg said. For example, an internist might partner with a patient in managing a chronic disease such as diabetes, and the patient would have access to medical advice through telephone and e-mail consultations.

Practices also would have arrangements with a team of health care professionals to provide “a full spectrum” of patient-centered services, Dr. Hedberg said.

Despite its emphasis on coordination of care, the advanced medical home is not the same as a disease management program, the ACP noted in its policy paper. In disease management, the emphasis is on the relationship between the patient and a case manager, with only periodic input from the physician. “In the advanced medical home model, the care and coordination of that care continually resides with the patient's personal physician and his/her health care team,” the paper indicated.

Successful use of the advanced medical home would rely on health information technology. Practices would be expected to issue regular reports on quality, efficiency, and patient experience measures, and use “innovative” scheduling systems to minimize appointment delays, Dr. Hedberg said.

Such innovations would require financing, however, which means that the advanced medical home cannot be implemented as an unfunded mandate, Mr. Doherty said. The Centers for Medicare and Medicaid Services (CMS) “will need to change the way it pays physicians who practice in an advanced medical home.” As the ACP envisions it, physicians who use the medical home model would receive an additional care management fee to cover the physician work involved in managing and coordinating care that falls outside of the usual face-to-face visit.

Physicians also would receive pay-for-performance bonuses and share in systemwide savings achieved by keeping patients with chronic conditions out of the hospital, he said.

A pilot test would help refine the model and demonstrate its potential to improve quality while lowering costs, Mr. Doherty said. The goal is to start implementing the advanced medical home as policy as early as 2007, “with widespread implementation within a few years.”

The advanced medical home “brings additional energy and ideas to the ongoing effort to bring improved and more efficient care to Medicare beneficiaries,” CMS spokesman Peter Ashkenaz said in an interview. He did not elaborate on whether the agency would pilot test such a system, but said that it was consistent with existing CMS initiatives such as the Medicare Health Support Program, “which works to provide more coordinated and effective care for those with chronic conditions. And it is consistent with our effort to adopt evidenced-based quality measures, which will lead us toward a pay-for-performance program,” he said.

The ACP's proposed “advanced medical home” builds on a concept that has been around for decades. In 1967, the medical home was described by the American Academy of Pediatrics' Council on Pediatric Practice as an effective model for caring for children with special needs, the ACP noted in its policy paper. The concept is also a central element of the American Academy of Family Physicians' Future of Family Medicine project.

The ACP added some enhancements to the AAFP's medical home concept, Mr. Doherty explained. For example, “we have a clear qualification process,” where practices would be certified as advanced medical homes and required to meet certain standards in order to qualify for additional payments.

AAFP President Dr. Larry Fields declined to comment specifically on the ACP proposal, but said the academy is working to convince Congress and the private sector that the medical home concept is worthwhile “and therefore worth paying for.”

An adequate workforce of family physicians providing patients with their own medical home “is the way to bring the promise of quality, affordable, accessible health care for everyone to fruition,” Dr. Fields said in an interview. The AAFP “will continue to try and convince those who still need convincing of the validity of our position.”

Congress and the private sector should also partner with the AAFP in providing funds for electronic health records, he said.

Although the advanced medical home is geared toward primary care, it wouldn't be limited to generalists, Mr. Doherty said. In most cases, a general internist or family physician would be the principal physician coordinating a patient's care in an advanced medical home. Yet “there may be instances when a patient might select a subspecialist within the medical home as his or her personal physician,” he said.

In such cases, the subspecialist is responsible for managing and coordinating care and provides the full range of required primary care services, he noted.

WASHINGTON — The medical home, a model for financing and delivering care that has long been endorsed by the American Academy of Family Physicians, is a key part of the American College of Physicians' action plan to reform Medicare payment policies.

Medicare should pilot test the “advanced medical home,” where physicians would receive reimbursement for coordinating care in a practice environment that centers on a patient's individual needs, the ACP recommended in a policy paper.

The ACP urged Congress and the Bush administration to apply this model, along with other financial and organizational changes, to counter declining interest in primary care among medical students and practicing physicians.

Medicare's payment system is one of the main reasons that doctors are abandoning primary care, Robert B. Doherty, ACP's senior vice president of governmental affairs and public policy, said at a press briefing to release the ACP plan.

Medicare pays too little for the time that primary care physicians spend with their patients—and discourages them from organizing their practices to achieve optimal results, by failing to reimburse for things such as e-mail consultations, care coordination, or health information technology, he said.

“And despite all of the talk about pay for performance, Medicare continues to pay doctors for doing more, rather than doing better,” Mr. Doherty added.

Reconfiguring the payment system and encouraging use of the advanced medical home “would change the way that primary care is delivered and financed by Medicare and other payers,” ACP President Dr. C. Anderson Hedberg said.

Primary care physicians who apply the medical home model would partner with patients to ensure optimal management and coordination of care, using evidence-based clinical decision support tools at the point of care, Dr. Hedberg said. For example, an internist might partner with a patient in managing a chronic disease such as diabetes, and the patient would have access to medical advice through telephone and e-mail consultations.

Practices also would have arrangements with a team of health care professionals to provide “a full spectrum” of patient-centered services, Dr. Hedberg said.

Despite its emphasis on coordination of care, the advanced medical home is not the same as a disease management program, the ACP noted in its policy paper. In disease management, the emphasis is on the relationship between the patient and a case manager, with only periodic input from the physician. “In the advanced medical home model, the care and coordination of that care continually resides with the patient's personal physician and his/her health care team,” the paper indicated.

Successful use of the advanced medical home would rely on health information technology. Practices would be expected to issue regular reports on quality, efficiency, and patient experience measures, and use “innovative” scheduling systems to minimize appointment delays, Dr. Hedberg said.

Such innovations would require financing, however, which means that the advanced medical home cannot be implemented as an unfunded mandate, Mr. Doherty said. The Centers for Medicare and Medicaid Services (CMS) “will need to change the way it pays physicians who practice in an advanced medical home.” As the ACP envisions it, physicians who use the medical home model would receive an additional care management fee to cover the physician work involved in managing and coordinating care that falls outside of the usual face-to-face visit.

Physicians also would receive pay-for-performance bonuses and share in systemwide savings achieved by keeping patients with chronic conditions out of the hospital, he said.

A pilot test would help refine the model and demonstrate its potential to improve quality while lowering costs, Mr. Doherty said. The goal is to start implementing the advanced medical home as policy as early as 2007, “with widespread implementation within a few years.”

The advanced medical home “brings additional energy and ideas to the ongoing effort to bring improved and more efficient care to Medicare beneficiaries,” CMS spokesman Peter Ashkenaz said in an interview. He did not elaborate on whether the agency would pilot test such a system, but said that it was consistent with existing CMS initiatives such as the Medicare Health Support Program, “which works to provide more coordinated and effective care for those with chronic conditions. And it is consistent with our effort to adopt evidenced-based quality measures, which will lead us toward a pay-for-performance program,” he said.

The ACP's proposed “advanced medical home” builds on a concept that has been around for decades. In 1967, the medical home was described by the American Academy of Pediatrics' Council on Pediatric Practice as an effective model for caring for children with special needs, the ACP noted in its policy paper. The concept is also a central element of the American Academy of Family Physicians' Future of Family Medicine project.

The ACP added some enhancements to the AAFP's medical home concept, Mr. Doherty explained. For example, “we have a clear qualification process,” where practices would be certified as advanced medical homes and required to meet certain standards in order to qualify for additional payments.

AAFP President Dr. Larry Fields declined to comment specifically on the ACP proposal, but said the academy is working to convince Congress and the private sector that the medical home concept is worthwhile “and therefore worth paying for.”

An adequate workforce of family physicians providing patients with their own medical home “is the way to bring the promise of quality, affordable, accessible health care for everyone to fruition,” Dr. Fields said in an interview. The AAFP “will continue to try and convince those who still need convincing of the validity of our position.”

Congress and the private sector should also partner with the AAFP in providing funds for electronic health records, he said.

Although the advanced medical home is geared toward primary care, it wouldn't be limited to generalists, Mr. Doherty said. In most cases, a general internist or family physician would be the principal physician coordinating a patient's care in an advanced medical home. Yet “there may be instances when a patient might select a subspecialist within the medical home as his or her personal physician,” he said.

In such cases, the subspecialist is responsible for managing and coordinating care and provides the full range of required primary care services, he noted.

WASHINGTON — The medical home, a model for financing and delivering care that has long been endorsed by the American Academy of Family Physicians, is a key part of the American College of Physicians' action plan to reform Medicare payment policies.

Medicare should pilot test the “advanced medical home,” where physicians would receive reimbursement for coordinating care in a practice environment that centers on a patient's individual needs, the ACP recommended in a policy paper.

The ACP urged Congress and the Bush administration to apply this model, along with other financial and organizational changes, to counter declining interest in primary care among medical students and practicing physicians.

Medicare's payment system is one of the main reasons that doctors are abandoning primary care, Robert B. Doherty, ACP's senior vice president of governmental affairs and public policy, said at a press briefing to release the ACP plan.

Medicare pays too little for the time that primary care physicians spend with their patients—and discourages them from organizing their practices to achieve optimal results, by failing to reimburse for things such as e-mail consultations, care coordination, or health information technology, he said.

“And despite all of the talk about pay for performance, Medicare continues to pay doctors for doing more, rather than doing better,” Mr. Doherty added.

Reconfiguring the payment system and encouraging use of the advanced medical home “would change the way that primary care is delivered and financed by Medicare and other payers,” ACP President Dr. C. Anderson Hedberg said.

Primary care physicians who apply the medical home model would partner with patients to ensure optimal management and coordination of care, using evidence-based clinical decision support tools at the point of care, Dr. Hedberg said. For example, an internist might partner with a patient in managing a chronic disease such as diabetes, and the patient would have access to medical advice through telephone and e-mail consultations.

Practices also would have arrangements with a team of health care professionals to provide “a full spectrum” of patient-centered services, Dr. Hedberg said.

Despite its emphasis on coordination of care, the advanced medical home is not the same as a disease management program, the ACP noted in its policy paper. In disease management, the emphasis is on the relationship between the patient and a case manager, with only periodic input from the physician. “In the advanced medical home model, the care and coordination of that care continually resides with the patient's personal physician and his/her health care team,” the paper indicated.

Successful use of the advanced medical home would rely on health information technology. Practices would be expected to issue regular reports on quality, efficiency, and patient experience measures, and use “innovative” scheduling systems to minimize appointment delays, Dr. Hedberg said.

Such innovations would require financing, however, which means that the advanced medical home cannot be implemented as an unfunded mandate, Mr. Doherty said. The Centers for Medicare and Medicaid Services (CMS) “will need to change the way it pays physicians who practice in an advanced medical home.” As the ACP envisions it, physicians who use the medical home model would receive an additional care management fee to cover the physician work involved in managing and coordinating care that falls outside of the usual face-to-face visit.

Physicians also would receive pay-for-performance bonuses and share in systemwide savings achieved by keeping patients with chronic conditions out of the hospital, he said.

A pilot test would help refine the model and demonstrate its potential to improve quality while lowering costs, Mr. Doherty said. The goal is to start implementing the advanced medical home as policy as early as 2007, “with widespread implementation within a few years.”

The advanced medical home “brings additional energy and ideas to the ongoing effort to bring improved and more efficient care to Medicare beneficiaries,” CMS spokesman Peter Ashkenaz said in an interview. He did not elaborate on whether the agency would pilot test such a system, but said that it was consistent with existing CMS initiatives such as the Medicare Health Support Program, “which works to provide more coordinated and effective care for those with chronic conditions. And it is consistent with our effort to adopt evidenced-based quality measures, which will lead us toward a pay-for-performance program,” he said.

The ACP's proposed “advanced medical home” builds on a concept that has been around for decades. In 1967, the medical home was described by the American Academy of Pediatrics' Council on Pediatric Practice as an effective model for caring for children with special needs, the ACP noted in its policy paper. The concept is also a central element of the American Academy of Family Physicians' Future of Family Medicine project.

The ACP added some enhancements to the AAFP's medical home concept, Mr. Doherty explained. For example, “we have a clear qualification process,” where practices would be certified as advanced medical homes and required to meet certain standards in order to qualify for additional payments.

AAFP President Dr. Larry Fields declined to comment specifically on the ACP proposal, but said the academy is working to convince Congress and the private sector that the medical home concept is worthwhile “and therefore worth paying for.”

An adequate workforce of family physicians providing patients with their own medical home “is the way to bring the promise of quality, affordable, accessible health care for everyone to fruition,” Dr. Fields said in an interview. The AAFP “will continue to try and convince those who still need convincing of the validity of our position.”

Congress and the private sector should also partner with the AAFP in providing funds for electronic health records, he said.

Although the advanced medical home is geared toward primary care, it wouldn't be limited to generalists, Mr. Doherty said. In most cases, a general internist or family physician would be the principal physician coordinating a patient's care in an advanced medical home. Yet “there may be instances when a patient might select a subspecialist within the medical home as his or her personal physician,” he said.

In such cases, the subspecialist is responsible for managing and coordinating care and provides the full range of required primary care services, he noted.

Medicare has expanded its coverage of bariatric surgery to its beneficiaries of all ages—provided that those patients seek care in facilities certified by the American College of Surgeons or the American Society for Bariatric Surgery.

The Centers for Medicare and Medicaid Services had originally proposed to exclude patients aged 65 years and older from coverage for bariatric surgery, based on the significant surgical risks seen in studies of this population.

But in reviewing new data and analyses, the agency determined that similar outcomes could be obtained in patients of all ages—provided that the surgery be performed in facilities capable of handling large numbers of these procedures and that it be performed only by highly qualified surgeons.

In its national coverage decision, CMS said it had evaluated the certification programs of the American College of Surgeons and the American Society for Bariatric Surgery and determined that facilities deemed Centers of Excellence by either organization would be able to produce the best surgical results.

The ACS devised its standards “for anybody performing this surgery in adults of any age,” Dr. R. Scott Jones, the ACS's director of the division of research and optimal patient care, said in an interview. “We've got a big problem with obesity, so it's important for the public to know that they can go to a hospital that meets standards that are subject to scrutiny.”

In announcing the national coverage decision, CMS Administrator Dr. Mark B. McClellan said, “Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons, it is an important option for some of our beneficiaries.

“While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries.”

CMS's original proposal, issued late last year, would have excluded coverage for patients older than 65 years, except in clinical trials.

Evidence regarding the benefits of the surgery is more limited for the over-65 population, Cynthia A. Brown, director of advocacy and health policy at ACS, said in an interview.

Nevertheless, she noted “the procedure is valuable, and ought to be covered as part of the process that includes data collection and quality monitoring. And that's what CMS is doing.”

The College started its certification program “because of concerns on what happens when new technology gets disseminated into the community and used in specialized facilities,” Ms. Brown said.

“Our certification program addresses those issues, as well as data collection, to monitor outcomes.”

The national coverage decision also expands the types of bariatric procedures Medicare covers for its beneficiaries. Previously, only gastric bypass surgery was covered; now the list also includes open or laparoscopic Roux-en-Y bypass, laparoscopic adjustable gastric banding, and open or laparoscopic biliopancreatic diversion with duodenal switch.

Although Medicare's bariatric coverage has expanded regarding patient age and types of procedures, limitations do remain. Coverage is still restricted to obese patients who have one or more comorbidities, such as hypertension, type 2 diabetes, osteoarthritis, or coronary heart disease, according to CMS.

More information on the American College of Surgeons' bariatric surgery certification program is available at www.facs.org/cqi/bscn/index.htmlwww.cms.hhs.gov/center/coverage.asp

Medicare has expanded its coverage of bariatric surgery to its beneficiaries of all ages—provided that those patients seek care in facilities certified by the American College of Surgeons or the American Society for Bariatric Surgery.

The Centers for Medicare and Medicaid Services had originally proposed to exclude patients aged 65 years and older from coverage for bariatric surgery, based on the significant surgical risks seen in studies of this population.

But in reviewing new data and analyses, the agency determined that similar outcomes could be obtained in patients of all ages—provided that the surgery be performed in facilities capable of handling large numbers of these procedures and that it be performed only by highly qualified surgeons.

In its national coverage decision, CMS said it had evaluated the certification programs of the American College of Surgeons and the American Society for Bariatric Surgery and determined that facilities deemed Centers of Excellence by either organization would be able to produce the best surgical results.

The ACS devised its standards “for anybody performing this surgery in adults of any age,” Dr. R. Scott Jones, the ACS's director of the division of research and optimal patient care, said in an interview. “We've got a big problem with obesity, so it's important for the public to know that they can go to a hospital that meets standards that are subject to scrutiny.”

In announcing the national coverage decision, CMS Administrator Dr. Mark B. McClellan said, “Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons, it is an important option for some of our beneficiaries.

“While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries.”

CMS's original proposal, issued late last year, would have excluded coverage for patients older than 65 years, except in clinical trials.

Evidence regarding the benefits of the surgery is more limited for the over-65 population, Cynthia A. Brown, director of advocacy and health policy at ACS, said in an interview.

Nevertheless, she noted “the procedure is valuable, and ought to be covered as part of the process that includes data collection and quality monitoring. And that's what CMS is doing.”

The College started its certification program “because of concerns on what happens when new technology gets disseminated into the community and used in specialized facilities,” Ms. Brown said.

“Our certification program addresses those issues, as well as data collection, to monitor outcomes.”

The national coverage decision also expands the types of bariatric procedures Medicare covers for its beneficiaries. Previously, only gastric bypass surgery was covered; now the list also includes open or laparoscopic Roux-en-Y bypass, laparoscopic adjustable gastric banding, and open or laparoscopic biliopancreatic diversion with duodenal switch.

Although Medicare's bariatric coverage has expanded regarding patient age and types of procedures, limitations do remain. Coverage is still restricted to obese patients who have one or more comorbidities, such as hypertension, type 2 diabetes, osteoarthritis, or coronary heart disease, according to CMS.

More information on the American College of Surgeons' bariatric surgery certification program is available at www.facs.org/cqi/bscn/index.htmlwww.cms.hhs.gov/center/coverage.asp

Medicare has expanded its coverage of bariatric surgery to its beneficiaries of all ages—provided that those patients seek care in facilities certified by the American College of Surgeons or the American Society for Bariatric Surgery.

The Centers for Medicare and Medicaid Services had originally proposed to exclude patients aged 65 years and older from coverage for bariatric surgery, based on the significant surgical risks seen in studies of this population.

But in reviewing new data and analyses, the agency determined that similar outcomes could be obtained in patients of all ages—provided that the surgery be performed in facilities capable of handling large numbers of these procedures and that it be performed only by highly qualified surgeons.

In its national coverage decision, CMS said it had evaluated the certification programs of the American College of Surgeons and the American Society for Bariatric Surgery and determined that facilities deemed Centers of Excellence by either organization would be able to produce the best surgical results.

The ACS devised its standards “for anybody performing this surgery in adults of any age,” Dr. R. Scott Jones, the ACS's director of the division of research and optimal patient care, said in an interview. “We've got a big problem with obesity, so it's important for the public to know that they can go to a hospital that meets standards that are subject to scrutiny.”

In announcing the national coverage decision, CMS Administrator Dr. Mark B. McClellan said, “Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons, it is an important option for some of our beneficiaries.

“While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries.”

CMS's original proposal, issued late last year, would have excluded coverage for patients older than 65 years, except in clinical trials.

Evidence regarding the benefits of the surgery is more limited for the over-65 population, Cynthia A. Brown, director of advocacy and health policy at ACS, said in an interview.

Nevertheless, she noted “the procedure is valuable, and ought to be covered as part of the process that includes data collection and quality monitoring. And that's what CMS is doing.”

The College started its certification program “because of concerns on what happens when new technology gets disseminated into the community and used in specialized facilities,” Ms. Brown said.

“Our certification program addresses those issues, as well as data collection, to monitor outcomes.”

The national coverage decision also expands the types of bariatric procedures Medicare covers for its beneficiaries. Previously, only gastric bypass surgery was covered; now the list also includes open or laparoscopic Roux-en-Y bypass, laparoscopic adjustable gastric banding, and open or laparoscopic biliopancreatic diversion with duodenal switch.

Although Medicare's bariatric coverage has expanded regarding patient age and types of procedures, limitations do remain. Coverage is still restricted to obese patients who have one or more comorbidities, such as hypertension, type 2 diabetes, osteoarthritis, or coronary heart disease, according to CMS.

More information on the American College of Surgeons' bariatric surgery certification program is available at www.facs.org/cqi/bscn/index.htmlwww.cms.hhs.gov/center/coverage.asp

Medicare's national coverage decision on bariatric surgery expands the population for which the program will cover the procedure, but specifies that the procedure must be done at a highly qualified center.

The Centers for Medicare and Medicaid Services originally proposed to exclude patients aged 65 years and older from coverage, based on the significant surgical risks seen in studies of this population. But in reviewing new data and analyses, the agency determined that similar outcomes could be obtained in patients of all ages, provided that the surgery was done in facilities capable of handling large numbers of these procedures and was performed by highly qualified surgeons.

This means that patients must seek care in facilities certified by certain medical organizations, the agency said.

In its national coverage decision, CMS said it had evaluated the certification programs of the American College of Surgeons (ACS) and the American Society for Bariatric Surgery and determined that facilities deemed Centers of Excellence by either organization would be able to produce the best surgical results.

In announcing the national coverage decision, Dr. Mark B. McClellan, CMS administrator, said that bariatric surgery “is not the first option for obesity treatment, but when performed by expert surgeons, it is an important option for some of our beneficiaries. While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries,” Dr. McClellan added.

The ACS devised its standards “for anybody performing this surgery in adults of any age,” Dr. R. Scott Jones, the ACS's director of the division of research and optimal patient care, said in an interview.

“We've got a big problem with obesity, so it's important for the public to know that they can go to a hospital that meets standards that are subject to scrutiny.”

Evidence regarding the benefits of the surgery is more limited for the over-65 population, Cynthia A. Brown, director of advocacy and health policy at ACS, said in an interview.

Nevertheless, she said, “the procedure is valuable, and ought to be covered as part of the process that includes data collection and quality monitoring. And that's what CMS is doing.”

The college started its certification program, “because of concerns on what happens when new technology gets disseminated into the community and used in specialized facilities,” Ms. Brown said. “Our certification program addresses those issues, as well as data collection, to monitor outcomes.”

The national coverage decision also expands the types of procedures Medicare covers for its beneficiaries. Previously, only gastric bypass was covered; now the list also includes open or laparoscopic Roux-en-Y bypass, laparoscopic adjustable gastric banding, and open or laparoscopic biliopancreatic diversion with duodenal switch.

Further, coverage is limited to obese patients with one or more comorbidities, such as hypertension, type 2 diabetes, osteoarthritis, or coronary heart disease, according to CMS.

More information on the ACS's bariatric surgery certification program is available at www.facs.org/cqi/bscn/index.htmlwww.cms.hhs.gov/center/coverage.asp

Medicare's national coverage decision on bariatric surgery expands the population for which the program will cover the procedure, but specifies that the procedure must be done at a highly qualified center.

The Centers for Medicare and Medicaid Services originally proposed to exclude patients aged 65 years and older from coverage, based on the significant surgical risks seen in studies of this population. But in reviewing new data and analyses, the agency determined that similar outcomes could be obtained in patients of all ages, provided that the surgery was done in facilities capable of handling large numbers of these procedures and was performed by highly qualified surgeons.

This means that patients must seek care in facilities certified by certain medical organizations, the agency said.

In its national coverage decision, CMS said it had evaluated the certification programs of the American College of Surgeons (ACS) and the American Society for Bariatric Surgery and determined that facilities deemed Centers of Excellence by either organization would be able to produce the best surgical results.

In announcing the national coverage decision, Dr. Mark B. McClellan, CMS administrator, said that bariatric surgery “is not the first option for obesity treatment, but when performed by expert surgeons, it is an important option for some of our beneficiaries. While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries,” Dr. McClellan added.

The ACS devised its standards “for anybody performing this surgery in adults of any age,” Dr. R. Scott Jones, the ACS's director of the division of research and optimal patient care, said in an interview.

“We've got a big problem with obesity, so it's important for the public to know that they can go to a hospital that meets standards that are subject to scrutiny.”

Evidence regarding the benefits of the surgery is more limited for the over-65 population, Cynthia A. Brown, director of advocacy and health policy at ACS, said in an interview.

Nevertheless, she said, “the procedure is valuable, and ought to be covered as part of the process that includes data collection and quality monitoring. And that's what CMS is doing.”

The college started its certification program, “because of concerns on what happens when new technology gets disseminated into the community and used in specialized facilities,” Ms. Brown said. “Our certification program addresses those issues, as well as data collection, to monitor outcomes.”

The national coverage decision also expands the types of procedures Medicare covers for its beneficiaries. Previously, only gastric bypass was covered; now the list also includes open or laparoscopic Roux-en-Y bypass, laparoscopic adjustable gastric banding, and open or laparoscopic biliopancreatic diversion with duodenal switch.

Further, coverage is limited to obese patients with one or more comorbidities, such as hypertension, type 2 diabetes, osteoarthritis, or coronary heart disease, according to CMS.

More information on the ACS's bariatric surgery certification program is available at www.facs.org/cqi/bscn/index.htmlwww.cms.hhs.gov/center/coverage.asp

Medicare's national coverage decision on bariatric surgery expands the population for which the program will cover the procedure, but specifies that the procedure must be done at a highly qualified center.

The Centers for Medicare and Medicaid Services originally proposed to exclude patients aged 65 years and older from coverage, based on the significant surgical risks seen in studies of this population. But in reviewing new data and analyses, the agency determined that similar outcomes could be obtained in patients of all ages, provided that the surgery was done in facilities capable of handling large numbers of these procedures and was performed by highly qualified surgeons.

This means that patients must seek care in facilities certified by certain medical organizations, the agency said.

In its national coverage decision, CMS said it had evaluated the certification programs of the American College of Surgeons (ACS) and the American Society for Bariatric Surgery and determined that facilities deemed Centers of Excellence by either organization would be able to produce the best surgical results.

In announcing the national coverage decision, Dr. Mark B. McClellan, CMS administrator, said that bariatric surgery “is not the first option for obesity treatment, but when performed by expert surgeons, it is an important option for some of our beneficiaries. While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates, and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries,” Dr. McClellan added.

The ACS devised its standards “for anybody performing this surgery in adults of any age,” Dr. R. Scott Jones, the ACS's director of the division of research and optimal patient care, said in an interview.

“We've got a big problem with obesity, so it's important for the public to know that they can go to a hospital that meets standards that are subject to scrutiny.”

Evidence regarding the benefits of the surgery is more limited for the over-65 population, Cynthia A. Brown, director of advocacy and health policy at ACS, said in an interview.

Nevertheless, she said, “the procedure is valuable, and ought to be covered as part of the process that includes data collection and quality monitoring. And that's what CMS is doing.”

The college started its certification program, “because of concerns on what happens when new technology gets disseminated into the community and used in specialized facilities,” Ms. Brown said. “Our certification program addresses those issues, as well as data collection, to monitor outcomes.”

The national coverage decision also expands the types of procedures Medicare covers for its beneficiaries. Previously, only gastric bypass was covered; now the list also includes open or laparoscopic Roux-en-Y bypass, laparoscopic adjustable gastric banding, and open or laparoscopic biliopancreatic diversion with duodenal switch.

Further, coverage is limited to obese patients with one or more comorbidities, such as hypertension, type 2 diabetes, osteoarthritis, or coronary heart disease, according to CMS.

More information on the ACS's bariatric surgery certification program is available at www.facs.org/cqi/bscn/index.htmlwww.cms.hhs.gov/center/coverage.asp

WASHINGTON — A permanent fix to the Medicare physician fee schedule “will be a difficult bill to pass through Congress,” Mark Hayes, a majority spokesman for the Senate Finance Committee, said at a conference sponsored by AcademyHealth.

“It's an expensive proposition in the current budget climate we're in,” Mr. Hayes said, voicing the concerns of other Republican staff members who participated in a discussion on the 2006 health care agenda. This year's midterm congressional election also will play a role in shaping progress on this issue, he said.

Driving the cuts in pay is the sustainable growth rate (SGR), a component of the Medicare payment formula that ties medical spending to the ups and downs of the national economy and determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002 and will continue to cause decreases until the process is changed.

In recent years, Congress has staved off additional reductions by providing small increases in pay. This year's Deficit Reduction Act provided another 1-year fix to the physician payment issue, a “0%” update, instead of a fee increase.

“Unfortunately, under the existing formula, physicians are expected to take another 4.4% reduction in 2007,” said Chuck Clapton, chief counsel for the House Energy and Commerce Committee's subcommittee on health.

“We have to make sure that beneficiaries continue to get access to physician services,” Mr. Clapton said. At some point, this will require yet another short-term fix for 2007, but for the long term, “it's my chairman's [Rep. Joe Barton (R-Tex.)] vote that we take more [systematic] steps to address some of the underlying problems that led to these recurring issues.”

Pay for performance should factor into this reform, Mr. Clapton said. “We should eventually move toward systems built on rewarding for high-quality services.”

Sen. Max Baucus (D-Mont.), ranking member of the Senate Finance Committee, agreed that the issue was complex and expensive. “We anticipate action on the issue this year,” said Carol Guthrie, an aide to the senator, in an interview. “Sen. Baucus feels that it's vital, given our country's limited pool of health care dollars, to recognize and encourage excellent provider care with pay-for-performance measures.”

Sen. Baucus will continue to work with Sen. Chuck Grassley (R-Iowa), chair of the Finance Committee, to approve the pay-for-performance legislation they wrote together, Ms. Guthrie said. “Sen. Baucus was very disappointed to see that most pay-for-performance provisions were stripped from the [Deficit Reduction Act].”

The panel also touched upon health savings accounts, with the Republican staffers supporting the approach as an affordable health care option that's already shown signs of success.

Congressional Democrats have historically criticized these plans for attracting only the young, healthy, and wealthy. This is what health care analysts call “adverse selection,” Sen. Baucus said in a recent statement. “Encouraging healthier Americans to choose these accounts and high-deductible plans will make health care more expensive for those who stay behind in traditional coverage,” he said. “These accounts will lead to a weaker health care system, not a stronger one.”

Other issues on the congressional health care agenda in 2006 include:

▸ Medicaid's waiver process. With the flexibility that the Deficit Reduction Act provided to the states, “we believe we will have a fresh look at [Medicaid's] 1115 waiver process,” Mr. Hayes said. The waivers give states the authority to make broad changes in eligibility, benefits, or cost-sharing in Medicaid, providing additional elbow room to test innovative coverage options.

Although it's been a necessary element for states to manage their Medicaid programs, it's still largely operating the way it did in 1965, he said. “We're looking for more transparency, more accountability between the states and the budget neutrality requirements, and also more examination about the lessons learned about those demonstrations, to really turn that program into the demonstration program it was intended to be.”

▸ State Children's Health Insurance Program. SCHIP is back on agenda this year, because a number of states are facing shortfalls in 2007 for the program, Mr. Hayes said. “We want to make sure that health coverage for children is protected.”

▸ Health information technology networks. The health care industry appears to be moving toward paperless systems, so it would be beneficial to come to some agreement on standards for an interoperable system, said Stephen J. Northrup, health policy staff director for the Senate Health, Education, Labor, and Pensions Committee.

▸ Affordable coverage for small businesses. The Senate Health, Education, Labor, and Pensions Committee is working on legislation to give small businesses newer and more affordable options to pool their resources, offering them more market value and relief from mandates, Mr. Northrup said.

WASHINGTON — A permanent fix to the Medicare physician fee schedule “will be a difficult bill to pass through Congress,” Mark Hayes, a majority spokesman for the Senate Finance Committee, said at a conference sponsored by AcademyHealth.

“It's an expensive proposition in the current budget climate we're in,” Mr. Hayes said, voicing the concerns of other Republican staff members who participated in a discussion on the 2006 health care agenda. This year's midterm congressional election also will play a role in shaping progress on this issue, he said.

Driving the cuts in pay is the sustainable growth rate (SGR), a component of the Medicare payment formula that ties medical spending to the ups and downs of the national economy and determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002 and will continue to cause decreases until the process is changed.

In recent years, Congress has staved off additional reductions by providing small increases in pay. This year's Deficit Reduction Act provided another 1-year fix to the physician payment issue, a “0%” update, instead of a fee increase.

“Unfortunately, under the existing formula, physicians are expected to take another 4.4% reduction in 2007,” said Chuck Clapton, chief counsel for the House Energy and Commerce Committee's subcommittee on health.

“We have to make sure that beneficiaries continue to get access to physician services,” Mr. Clapton said. At some point, this will require yet another short-term fix for 2007, but for the long term, “it's my chairman's [Rep. Joe Barton (R-Tex.)] vote that we take more [systematic] steps to address some of the underlying problems that led to these recurring issues.”

Pay for performance should factor into this reform, Mr. Clapton said. “We should eventually move toward systems built on rewarding for high-quality services.”

Sen. Max Baucus (D-Mont.), ranking member of the Senate Finance Committee, agreed that the issue was complex and expensive. “We anticipate action on the issue this year,” said Carol Guthrie, an aide to the senator, in an interview. “Sen. Baucus feels that it's vital, given our country's limited pool of health care dollars, to recognize and encourage excellent provider care with pay-for-performance measures.”

Sen. Baucus will continue to work with Sen. Chuck Grassley (R-Iowa), chair of the Finance Committee, to approve the pay-for-performance legislation they wrote together, Ms. Guthrie said. “Sen. Baucus was very disappointed to see that most pay-for-performance provisions were stripped from the [Deficit Reduction Act].”

The panel also touched upon health savings accounts, with the Republican staffers supporting the approach as an affordable health care option that's already shown signs of success.

Congressional Democrats have historically criticized these plans for attracting only the young, healthy, and wealthy. This is what health care analysts call “adverse selection,” Sen. Baucus said in a recent statement. “Encouraging healthier Americans to choose these accounts and high-deductible plans will make health care more expensive for those who stay behind in traditional coverage,” he said. “These accounts will lead to a weaker health care system, not a stronger one.”

Other issues on the congressional health care agenda in 2006 include:

▸ Medicaid's waiver process. With the flexibility that the Deficit Reduction Act provided to the states, “we believe we will have a fresh look at [Medicaid's] 1115 waiver process,” Mr. Hayes said. The waivers give states the authority to make broad changes in eligibility, benefits, or cost-sharing in Medicaid, providing additional elbow room to test innovative coverage options.

Although it's been a necessary element for states to manage their Medicaid programs, it's still largely operating the way it did in 1965, he said. “We're looking for more transparency, more accountability between the states and the budget neutrality requirements, and also more examination about the lessons learned about those demonstrations, to really turn that program into the demonstration program it was intended to be.”

▸ State Children's Health Insurance Program. SCHIP is back on agenda this year, because a number of states are facing shortfalls in 2007 for the program, Mr. Hayes said. “We want to make sure that health coverage for children is protected.”

▸ Health information technology networks. The health care industry appears to be moving toward paperless systems, so it would be beneficial to come to some agreement on standards for an interoperable system, said Stephen J. Northrup, health policy staff director for the Senate Health, Education, Labor, and Pensions Committee.

▸ Affordable coverage for small businesses. The Senate Health, Education, Labor, and Pensions Committee is working on legislation to give small businesses newer and more affordable options to pool their resources, offering them more market value and relief from mandates, Mr. Northrup said.

WASHINGTON — A permanent fix to the Medicare physician fee schedule “will be a difficult bill to pass through Congress,” Mark Hayes, a majority spokesman for the Senate Finance Committee, said at a conference sponsored by AcademyHealth.

“It's an expensive proposition in the current budget climate we're in,” Mr. Hayes said, voicing the concerns of other Republican staff members who participated in a discussion on the 2006 health care agenda. This year's midterm congressional election also will play a role in shaping progress on this issue, he said.

Driving the cuts in pay is the sustainable growth rate (SGR), a component of the Medicare payment formula that ties medical spending to the ups and downs of the national economy and determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002 and will continue to cause decreases until the process is changed.

In recent years, Congress has staved off additional reductions by providing small increases in pay. This year's Deficit Reduction Act provided another 1-year fix to the physician payment issue, a “0%” update, instead of a fee increase.

“Unfortunately, under the existing formula, physicians are expected to take another 4.4% reduction in 2007,” said Chuck Clapton, chief counsel for the House Energy and Commerce Committee's subcommittee on health.

“We have to make sure that beneficiaries continue to get access to physician services,” Mr. Clapton said. At some point, this will require yet another short-term fix for 2007, but for the long term, “it's my chairman's [Rep. Joe Barton (R-Tex.)] vote that we take more [systematic] steps to address some of the underlying problems that led to these recurring issues.”

Pay for performance should factor into this reform, Mr. Clapton said. “We should eventually move toward systems built on rewarding for high-quality services.”

Sen. Max Baucus (D-Mont.), ranking member of the Senate Finance Committee, agreed that the issue was complex and expensive. “We anticipate action on the issue this year,” said Carol Guthrie, an aide to the senator, in an interview. “Sen. Baucus feels that it's vital, given our country's limited pool of health care dollars, to recognize and encourage excellent provider care with pay-for-performance measures.”

Sen. Baucus will continue to work with Sen. Chuck Grassley (R-Iowa), chair of the Finance Committee, to approve the pay-for-performance legislation they wrote together, Ms. Guthrie said. “Sen. Baucus was very disappointed to see that most pay-for-performance provisions were stripped from the [Deficit Reduction Act].”

The panel also touched upon health savings accounts, with the Republican staffers supporting the approach as an affordable health care option that's already shown signs of success.

Congressional Democrats have historically criticized these plans for attracting only the young, healthy, and wealthy. This is what health care analysts call “adverse selection,” Sen. Baucus said in a recent statement. “Encouraging healthier Americans to choose these accounts and high-deductible plans will make health care more expensive for those who stay behind in traditional coverage,” he said. “These accounts will lead to a weaker health care system, not a stronger one.”

Other issues on the congressional health care agenda in 2006 include:

▸ Medicaid's waiver process. With the flexibility that the Deficit Reduction Act provided to the states, “we believe we will have a fresh look at [Medicaid's] 1115 waiver process,” Mr. Hayes said. The waivers give states the authority to make broad changes in eligibility, benefits, or cost-sharing in Medicaid, providing additional elbow room to test innovative coverage options.

Although it's been a necessary element for states to manage their Medicaid programs, it's still largely operating the way it did in 1965, he said. “We're looking for more transparency, more accountability between the states and the budget neutrality requirements, and also more examination about the lessons learned about those demonstrations, to really turn that program into the demonstration program it was intended to be.”

▸ State Children's Health Insurance Program. SCHIP is back on agenda this year, because a number of states are facing shortfalls in 2007 for the program, Mr. Hayes said. “We want to make sure that health coverage for children is protected.”

▸ Health information technology networks. The health care industry appears to be moving toward paperless systems, so it would be beneficial to come to some agreement on standards for an interoperable system, said Stephen J. Northrup, health policy staff director for the Senate Health, Education, Labor, and Pensions Committee.

▸ Affordable coverage for small businesses. The Senate Health, Education, Labor, and Pensions Committee is working on legislation to give small businesses newer and more affordable options to pool their resources, offering them more market value and relief from mandates, Mr. Northrup said.

Health Care Growth

One dollar of every $5 will be spent on health care by 2015, with spending reaching more than $4 trillion, according to a study from the National Health Statistics Group at the Centers for Medicare and Medicaid Services. Forecasters predict that national health spending growth will consistently outpace the growth in the gross domestic product (GDP) over the next 10 years, with health spending expected to consume 20% of GDP, compared with 16% today. Growth in total physician spending is expected to decline from 9% in 2004 to 7.5% in 2005, or a total of $430 billion. It's likely that physician spending will approach $850 billion by 2015. This figure is probably an underestimate, however, “since it incorporates Medicare payment cuts for physicians from 2006 through 2013. In fact, Congress has already eliminated the cut planned for 2006,” according to a summary of the survey. In other findings, spending on prescription drugs is expected to reach $446 billion in 2015, up from $188 billion in 2004. Spending on hospital care is expected to reach $1.2 trillion in 2015, double the 2005 level. Implementation of the new Medicare Part D drug benefit, and the added burden of paying costs that had been absorbed by other sectors, will lead to a spike in Medicare growth of up to 25% in 2006. In the next 10 years, Medicare spending is projected to rise from $309 billion in 2004 to $792 billion by 2015.

Deciphering Drug Coverage

In an effort to answer some of the many questions physicians have about the new Medicare Part D prescription drug benefit, Medicare has posted a new fact sheet on its Web site. The fact sheet includes links to formulary information, requests for prescription information and change forms, and a chart on Part B versus Part D drug coverage. The fact sheet describes the prescribing physician's role in coverage determination, exceptions, and appeals processes and provides an outline of the deadlines for prescription drug plans to respond to physician requests. The fact sheet is available online at

www.cms.hhs.gov/MedlearnProducts/downloads/Part_D_Resource_Factsheet.pdf

www.cms.hhs.gov/center/provider.asp

Part D: Not Perfect

The Medicare drug benefit isn't without its flaws, Republican staff acknowledged at a conference sponsored by AcademyHealth. “We want to make sure the program continues on to a successful conclusion, to get prescription drugs for people. It's a big part of our agenda,” said Mark Hayes, a majority spokesman for the Senate Finance Committee. “Medicare prescription drug spending under this new benefit has already decreased by 20%,” said Chuck Clapton, majority chief counsel for the House Energy and Commerce Committee's Subcommittee on Health. “That's not to say the new benefit has been a complete and full success. There have been some problems—some populations have had some issues in getting the prescription drugs they need. Beneficiaries haven't been able to enroll seamlessly.” To clear up confusion over the drug benefit, Sen. Max Baucus (D-Mont.) in forthcoming legislation will propose standards for approval and classification of plan offerings so that “seniors can make apples-to-apples comparisons and reach informed decisions” about their prescription drugs, according to a statement from his office.

Medicare Formulary Guidance

The U.S. Pharmacopeia (USP) last month released its final model guidelines for use in developing Medicare prescription drug formularies in 2007. The model guidelines are used by the Centers for Medicare and Medicaid Services to evaluate the formularies created by private drug plans that participate in the Medicare Part D program. There are fewer unique categories and classes in the 2007 document—133, compared with 146 in the 2006 version. In addition, the number of formulary key drug types, which are used by CMS to test the comprehensiveness of the formulary, has been increased from 118 to 141. The final model guidelines also eliminate the distinction between nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors. The USP model guidelines are available online at

www.usp.org

Lester Crawford, Lobbyist

Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., has taken a position at Policy Directions Inc., a Washington-based lobbying and consulting firm. Mr. Crawford will be senior counsel to the organization, which counts pharmaceutical manufacturers and biotechnology and food companies among its clients. By law, he will be barred from directly lobbying Congress for at least a year. Policy Directions declined to make him available for an interview. Mr. Crawford resigned abruptly from his FDA post in September, just 2 months after he was confirmed by the Senate. In the 5 years of the Bush Administration, the FDA has had a permanent commissioner for only 18 months. (Mr. Crawford served in an acting capacity for 16 months without Senate confirmation.) In early February, Sen. Chuck Grassley (R-Iowa) wrote to White House Chief of Staff Andrew Card asking that a permanent commissioner be nominated, adding that the agency was adrift without such leadership. For now, Dr. Andrew von Eschenbach is the acting commissioner, but also continues to hold his previous job as head of the National Cancer Institute.

Health Care Growth

One dollar of every $5 will be spent on health care by 2015, with spending reaching more than $4 trillion, according to a study from the National Health Statistics Group at the Centers for Medicare and Medicaid Services. Forecasters predict that national health spending growth will consistently outpace the growth in the gross domestic product (GDP) over the next 10 years, with health spending expected to consume 20% of GDP, compared with 16% today. Growth in total physician spending is expected to decline from 9% in 2004 to 7.5% in 2005, or a total of $430 billion. It's likely that physician spending will approach $850 billion by 2015. This figure is probably an underestimate, however, “since it incorporates Medicare payment cuts for physicians from 2006 through 2013. In fact, Congress has already eliminated the cut planned for 2006,” according to a summary of the survey. In other findings, spending on prescription drugs is expected to reach $446 billion in 2015, up from $188 billion in 2004. Spending on hospital care is expected to reach $1.2 trillion in 2015, double the 2005 level. Implementation of the new Medicare Part D drug benefit, and the added burden of paying costs that had been absorbed by other sectors, will lead to a spike in Medicare growth of up to 25% in 2006. In the next 10 years, Medicare spending is projected to rise from $309 billion in 2004 to $792 billion by 2015.

Deciphering Drug Coverage

In an effort to answer some of the many questions physicians have about the new Medicare Part D prescription drug benefit, Medicare has posted a new fact sheet on its Web site. The fact sheet includes links to formulary information, requests for prescription information and change forms, and a chart on Part B versus Part D drug coverage. The fact sheet describes the prescribing physician's role in coverage determination, exceptions, and appeals processes and provides an outline of the deadlines for prescription drug plans to respond to physician requests. The fact sheet is available online at

www.cms.hhs.gov/MedlearnProducts/downloads/Part_D_Resource_Factsheet.pdf

www.cms.hhs.gov/center/provider.asp

Part D: Not Perfect

The Medicare drug benefit isn't without its flaws, Republican staff acknowledged at a conference sponsored by AcademyHealth. “We want to make sure the program continues on to a successful conclusion, to get prescription drugs for people. It's a big part of our agenda,” said Mark Hayes, a majority spokesman for the Senate Finance Committee. “Medicare prescription drug spending under this new benefit has already decreased by 20%,” said Chuck Clapton, majority chief counsel for the House Energy and Commerce Committee's Subcommittee on Health. “That's not to say the new benefit has been a complete and full success. There have been some problems—some populations have had some issues in getting the prescription drugs they need. Beneficiaries haven't been able to enroll seamlessly.” To clear up confusion over the drug benefit, Sen. Max Baucus (D-Mont.) in forthcoming legislation will propose standards for approval and classification of plan offerings so that “seniors can make apples-to-apples comparisons and reach informed decisions” about their prescription drugs, according to a statement from his office.

Medicare Formulary Guidance

The U.S. Pharmacopeia (USP) last month released its final model guidelines for use in developing Medicare prescription drug formularies in 2007. The model guidelines are used by the Centers for Medicare and Medicaid Services to evaluate the formularies created by private drug plans that participate in the Medicare Part D program. There are fewer unique categories and classes in the 2007 document—133, compared with 146 in the 2006 version. In addition, the number of formulary key drug types, which are used by CMS to test the comprehensiveness of the formulary, has been increased from 118 to 141. The final model guidelines also eliminate the distinction between nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors. The USP model guidelines are available online at

www.usp.org

Lester Crawford, Lobbyist

Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., has taken a position at Policy Directions Inc., a Washington-based lobbying and consulting firm. Mr. Crawford will be senior counsel to the organization, which counts pharmaceutical manufacturers and biotechnology and food companies among its clients. By law, he will be barred from directly lobbying Congress for at least a year. Policy Directions declined to make him available for an interview. Mr. Crawford resigned abruptly from his FDA post in September, just 2 months after he was confirmed by the Senate. In the 5 years of the Bush Administration, the FDA has had a permanent commissioner for only 18 months. (Mr. Crawford served in an acting capacity for 16 months without Senate confirmation.) In early February, Sen. Chuck Grassley (R-Iowa) wrote to White House Chief of Staff Andrew Card asking that a permanent commissioner be nominated, adding that the agency was adrift without such leadership. For now, Dr. Andrew von Eschenbach is the acting commissioner, but also continues to hold his previous job as head of the National Cancer Institute.

Health Care Growth

One dollar of every $5 will be spent on health care by 2015, with spending reaching more than $4 trillion, according to a study from the National Health Statistics Group at the Centers for Medicare and Medicaid Services. Forecasters predict that national health spending growth will consistently outpace the growth in the gross domestic product (GDP) over the next 10 years, with health spending expected to consume 20% of GDP, compared with 16% today. Growth in total physician spending is expected to decline from 9% in 2004 to 7.5% in 2005, or a total of $430 billion. It's likely that physician spending will approach $850 billion by 2015. This figure is probably an underestimate, however, “since it incorporates Medicare payment cuts for physicians from 2006 through 2013. In fact, Congress has already eliminated the cut planned for 2006,” according to a summary of the survey. In other findings, spending on prescription drugs is expected to reach $446 billion in 2015, up from $188 billion in 2004. Spending on hospital care is expected to reach $1.2 trillion in 2015, double the 2005 level. Implementation of the new Medicare Part D drug benefit, and the added burden of paying costs that had been absorbed by other sectors, will lead to a spike in Medicare growth of up to 25% in 2006. In the next 10 years, Medicare spending is projected to rise from $309 billion in 2004 to $792 billion by 2015.

Deciphering Drug Coverage

In an effort to answer some of the many questions physicians have about the new Medicare Part D prescription drug benefit, Medicare has posted a new fact sheet on its Web site. The fact sheet includes links to formulary information, requests for prescription information and change forms, and a chart on Part B versus Part D drug coverage. The fact sheet describes the prescribing physician's role in coverage determination, exceptions, and appeals processes and provides an outline of the deadlines for prescription drug plans to respond to physician requests. The fact sheet is available online at

www.cms.hhs.gov/MedlearnProducts/downloads/Part_D_Resource_Factsheet.pdf

www.cms.hhs.gov/center/provider.asp

Part D: Not Perfect

The Medicare drug benefit isn't without its flaws, Republican staff acknowledged at a conference sponsored by AcademyHealth. “We want to make sure the program continues on to a successful conclusion, to get prescription drugs for people. It's a big part of our agenda,” said Mark Hayes, a majority spokesman for the Senate Finance Committee. “Medicare prescription drug spending under this new benefit has already decreased by 20%,” said Chuck Clapton, majority chief counsel for the House Energy and Commerce Committee's Subcommittee on Health. “That's not to say the new benefit has been a complete and full success. There have been some problems—some populations have had some issues in getting the prescription drugs they need. Beneficiaries haven't been able to enroll seamlessly.” To clear up confusion over the drug benefit, Sen. Max Baucus (D-Mont.) in forthcoming legislation will propose standards for approval and classification of plan offerings so that “seniors can make apples-to-apples comparisons and reach informed decisions” about their prescription drugs, according to a statement from his office.

Medicare Formulary Guidance

The U.S. Pharmacopeia (USP) last month released its final model guidelines for use in developing Medicare prescription drug formularies in 2007. The model guidelines are used by the Centers for Medicare and Medicaid Services to evaluate the formularies created by private drug plans that participate in the Medicare Part D program. There are fewer unique categories and classes in the 2007 document—133, compared with 146 in the 2006 version. In addition, the number of formulary key drug types, which are used by CMS to test the comprehensiveness of the formulary, has been increased from 118 to 141. The final model guidelines also eliminate the distinction between nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors. The USP model guidelines are available online at

www.usp.org

Lester Crawford, Lobbyist

Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., has taken a position at Policy Directions Inc., a Washington-based lobbying and consulting firm. Mr. Crawford will be senior counsel to the organization, which counts pharmaceutical manufacturers and biotechnology and food companies among its clients. By law, he will be barred from directly lobbying Congress for at least a year. Policy Directions declined to make him available for an interview. Mr. Crawford resigned abruptly from his FDA post in September, just 2 months after he was confirmed by the Senate. In the 5 years of the Bush Administration, the FDA has had a permanent commissioner for only 18 months. (Mr. Crawford served in an acting capacity for 16 months without Senate confirmation.) In early February, Sen. Chuck Grassley (R-Iowa) wrote to White House Chief of Staff Andrew Card asking that a permanent commissioner be nominated, adding that the agency was adrift without such leadership. For now, Dr. Andrew von Eschenbach is the acting commissioner, but also continues to hold his previous job as head of the National Cancer Institute.

WASHINGTON — A permanent fix to the Medicare physician fee schedule “will be a difficult bill to pass through Congress,” Mark Hayes, a majority spokesman for the Senate Finance Committee, said at a conference sponsored by AcademyHealth.

“It's an expensive proposition in the current budget climate we're in,” Mr. Hayes said, voicing the concerns of other Republican staff members who participated in a discussion on the 2006 health care agenda. This year's midterm congressional election also will play a role in shaping progress on this issue, he said.

Driving the cuts in pay is the sustainable growth rate (SGR), a component of the Medicare payment formula that ties medical spending to the ups and downs of the national economy and determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002 and will continue to cause decreases until the process is changed.

In recent years, Congress has staved off additional reductions by providing small increases in pay. This year's Deficit Reduction Act provided another 1-year fix to the physician payment issue, a “0%” update, instead of a fee increase.

“Unfortunately, under the existing formula, physicians are expected to take another 4.4% reduction in 2007,” said Chuck Clapton, chief counsel for the House Energy and Commerce Committee's subcommittee on health.

“We have to make sure that beneficiaries continue to get access to physician services,” Mr. Clapton said. At some point, this will require yet another short-term fix for 2007, but for the long term, “it's my chairman's [Rep. Joe Barton (R-Tex.)] vote that we take more [systematic] steps to address some of the underlying problems that led to these recurring issues.”

Pay for performance should factor into this reform, Mr. Clapton said.

Sen. Max Baucus (D-Mont.), ranking member of the Senate Finance Committee, agreed that the issue was complex and expensive. “We certainly anticipate action on the issue this year,” Carol Guthrie, an aide to the senator, said in an interview. “Sen. Baucus feels that it's vital, given our country's limited pool of health care dollars, to recognize and encourage excellent provider care with pay-for-performance measures.”

Sen. Baucus will continue to work with Sen. Chuck Grassley (R-Iowa), chair of the Finance Committee, to approve the pay-for-performance legislation they wrote together, Ms. Guthrie said. The panel also touched upon health savings accounts, with the Republican staffers supporting the approach as an affordable health care option that's already shown signs of success.

Congressional Democrats have historically criticized these plans for attracting only the young, healthy, and wealthy. This is what health care analysts call “adverse selection,” Sen. Baucus said in a statement.

Other issues on the congressional health care agenda in 2006 include:

▸ Medicaid's waiver process. With the flexibility that the Deficit Reduction Act provided to the states, “we believe we will have a fresh look at [Medicaid's] 1115 waiver process,” Mr. Hayes said. The waivers give states the authority to make broad changes in eligibility, benefits, or cost-sharing in Medicaid.

▸ State Children's Health Insurance Program. SCHIP is back on agenda, because a number of states are facing shortfalls in 2007 for the program, Mr. Hayes said.

▸ Health information technology. The health care industry appears to be moving toward paperless systems, so it would be beneficial to come to some agreement on standards for an interoperable system, said Stephen J. Northrup, health policy staff director for the Senate Health, Education, Labor, and Pensions Committee.

▸ Affordable coverage for small businesses. The Senate Health, Education, Labor, and Pensions Committee is working on legislation to give small businesses newer and more affordable options to pool their resources, Mr. Northrup said.

WASHINGTON — A permanent fix to the Medicare physician fee schedule “will be a difficult bill to pass through Congress,” Mark Hayes, a majority spokesman for the Senate Finance Committee, said at a conference sponsored by AcademyHealth.

“It's an expensive proposition in the current budget climate we're in,” Mr. Hayes said, voicing the concerns of other Republican staff members who participated in a discussion on the 2006 health care agenda. This year's midterm congressional election also will play a role in shaping progress on this issue, he said.

Driving the cuts in pay is the sustainable growth rate (SGR), a component of the Medicare payment formula that ties medical spending to the ups and downs of the national economy and determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002 and will continue to cause decreases until the process is changed.

In recent years, Congress has staved off additional reductions by providing small increases in pay. This year's Deficit Reduction Act provided another 1-year fix to the physician payment issue, a “0%” update, instead of a fee increase.

“Unfortunately, under the existing formula, physicians are expected to take another 4.4% reduction in 2007,” said Chuck Clapton, chief counsel for the House Energy and Commerce Committee's subcommittee on health.

“We have to make sure that beneficiaries continue to get access to physician services,” Mr. Clapton said. At some point, this will require yet another short-term fix for 2007, but for the long term, “it's my chairman's [Rep. Joe Barton (R-Tex.)] vote that we take more [systematic] steps to address some of the underlying problems that led to these recurring issues.”

Pay for performance should factor into this reform, Mr. Clapton said.

Sen. Max Baucus (D-Mont.), ranking member of the Senate Finance Committee, agreed that the issue was complex and expensive. “We certainly anticipate action on the issue this year,” Carol Guthrie, an aide to the senator, said in an interview. “Sen. Baucus feels that it's vital, given our country's limited pool of health care dollars, to recognize and encourage excellent provider care with pay-for-performance measures.”

Sen. Baucus will continue to work with Sen. Chuck Grassley (R-Iowa), chair of the Finance Committee, to approve the pay-for-performance legislation they wrote together, Ms. Guthrie said. The panel also touched upon health savings accounts, with the Republican staffers supporting the approach as an affordable health care option that's already shown signs of success.

Congressional Democrats have historically criticized these plans for attracting only the young, healthy, and wealthy. This is what health care analysts call “adverse selection,” Sen. Baucus said in a statement.

Other issues on the congressional health care agenda in 2006 include:

▸ Medicaid's waiver process. With the flexibility that the Deficit Reduction Act provided to the states, “we believe we will have a fresh look at [Medicaid's] 1115 waiver process,” Mr. Hayes said. The waivers give states the authority to make broad changes in eligibility, benefits, or cost-sharing in Medicaid.

▸ State Children's Health Insurance Program. SCHIP is back on agenda, because a number of states are facing shortfalls in 2007 for the program, Mr. Hayes said.

▸ Health information technology. The health care industry appears to be moving toward paperless systems, so it would be beneficial to come to some agreement on standards for an interoperable system, said Stephen J. Northrup, health policy staff director for the Senate Health, Education, Labor, and Pensions Committee.

▸ Affordable coverage for small businesses. The Senate Health, Education, Labor, and Pensions Committee is working on legislation to give small businesses newer and more affordable options to pool their resources, Mr. Northrup said.

WASHINGTON — A permanent fix to the Medicare physician fee schedule “will be a difficult bill to pass through Congress,” Mark Hayes, a majority spokesman for the Senate Finance Committee, said at a conference sponsored by AcademyHealth.

“It's an expensive proposition in the current budget climate we're in,” Mr. Hayes said, voicing the concerns of other Republican staff members who participated in a discussion on the 2006 health care agenda. This year's midterm congressional election also will play a role in shaping progress on this issue, he said.

Driving the cuts in pay is the sustainable growth rate (SGR), a component of the Medicare payment formula that ties medical spending to the ups and downs of the national economy and determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002 and will continue to cause decreases until the process is changed.

In recent years, Congress has staved off additional reductions by providing small increases in pay. This year's Deficit Reduction Act provided another 1-year fix to the physician payment issue, a “0%” update, instead of a fee increase.

“Unfortunately, under the existing formula, physicians are expected to take another 4.4% reduction in 2007,” said Chuck Clapton, chief counsel for the House Energy and Commerce Committee's subcommittee on health.

“We have to make sure that beneficiaries continue to get access to physician services,” Mr. Clapton said. At some point, this will require yet another short-term fix for 2007, but for the long term, “it's my chairman's [Rep. Joe Barton (R-Tex.)] vote that we take more [systematic] steps to address some of the underlying problems that led to these recurring issues.”

Pay for performance should factor into this reform, Mr. Clapton said.

Sen. Max Baucus (D-Mont.), ranking member of the Senate Finance Committee, agreed that the issue was complex and expensive. “We certainly anticipate action on the issue this year,” Carol Guthrie, an aide to the senator, said in an interview. “Sen. Baucus feels that it's vital, given our country's limited pool of health care dollars, to recognize and encourage excellent provider care with pay-for-performance measures.”

Sen. Baucus will continue to work with Sen. Chuck Grassley (R-Iowa), chair of the Finance Committee, to approve the pay-for-performance legislation they wrote together, Ms. Guthrie said. The panel also touched upon health savings accounts, with the Republican staffers supporting the approach as an affordable health care option that's already shown signs of success.

Congressional Democrats have historically criticized these plans for attracting only the young, healthy, and wealthy. This is what health care analysts call “adverse selection,” Sen. Baucus said in a statement.

Other issues on the congressional health care agenda in 2006 include:

▸ Medicaid's waiver process. With the flexibility that the Deficit Reduction Act provided to the states, “we believe we will have a fresh look at [Medicaid's] 1115 waiver process,” Mr. Hayes said. The waivers give states the authority to make broad changes in eligibility, benefits, or cost-sharing in Medicaid.

▸ State Children's Health Insurance Program. SCHIP is back on agenda, because a number of states are facing shortfalls in 2007 for the program, Mr. Hayes said.

▸ Health information technology. The health care industry appears to be moving toward paperless systems, so it would be beneficial to come to some agreement on standards for an interoperable system, said Stephen J. Northrup, health policy staff director for the Senate Health, Education, Labor, and Pensions Committee.

▸ Affordable coverage for small businesses. The Senate Health, Education, Labor, and Pensions Committee is working on legislation to give small businesses newer and more affordable options to pool their resources, Mr. Northrup said.

Medicare's new prescription drug benefit offers meager savings on drug prices, according to a Families USA survey.

For 19 out of the top 20 drugs prescribed to seniors in 2004 in several regions of the country, Families USA found that Medicare's prices were much higher than those negotiated by the Department of Veterans Affairs (VA). “For half of the top 20 drugs prescribed to seniors, the lowest price offered by any Medicare prescription drug plan was at least 48.2% higher than the lowest price available through the VA,” the survey indicated.

“The huge prices paid by seniors and taxpayers could have been avoided if Congress and the president had not caved in to the pressure of the drug lobby,” said Ron Pollack, executive director of Families USA. “They prohibited Medicare from bargaining for cheaper prices and, to ensure that this would never change, they delegated the administration of the benefit to private plans, which have far less bargaining clout.”

According to Peter Ashkenaz, deputy director of the Office of Public Affairs for the Centers for Medicare and Medicaid Services, Families USA just rehashed the old argument that there should be government price controls and a one-size-fits-all benefit.

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview.

The survey also compared the annual difference between the lowest VA prices and lowest Medicare drug plan prices among the top seven drugs prescribed for seniors. Huge differences were noted in a few of these drugs (see chart).

The total percentage difference between VA and Medicare plan prices may be even higher than 48%, however, since no single Medicare plan offers the lowest price for all 20 drugs compared with its plan competitors, the survey noted.

VA prices are lower for both generic and brand-name drugs, Families USA noted. Eighteen of the 20 most-prescribed medicines for seniors are brand-name drugs. For the two generic drugs, the median difference between the lowest Medicare drug plan and the lowest VA price was 95%.

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, agreed with CMS that it was unfair to compare Medicare's new drug plan to a government-mandated price control system such as the VA.

“The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Even so, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.”

A report from the nonpartisan Congressional Budget Office said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

ELSEVIER GLOBAL MEDICAL NEWS

Medicare's new prescription drug benefit offers meager savings on drug prices, according to a Families USA survey.

For 19 out of the top 20 drugs prescribed to seniors in 2004 in several regions of the country, Families USA found that Medicare's prices were much higher than those negotiated by the Department of Veterans Affairs (VA). “For half of the top 20 drugs prescribed to seniors, the lowest price offered by any Medicare prescription drug plan was at least 48.2% higher than the lowest price available through the VA,” the survey indicated.

“The huge prices paid by seniors and taxpayers could have been avoided if Congress and the president had not caved in to the pressure of the drug lobby,” said Ron Pollack, executive director of Families USA. “They prohibited Medicare from bargaining for cheaper prices and, to ensure that this would never change, they delegated the administration of the benefit to private plans, which have far less bargaining clout.”

According to Peter Ashkenaz, deputy director of the Office of Public Affairs for the Centers for Medicare and Medicaid Services, Families USA just rehashed the old argument that there should be government price controls and a one-size-fits-all benefit.

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview.

The survey also compared the annual difference between the lowest VA prices and lowest Medicare drug plan prices among the top seven drugs prescribed for seniors. Huge differences were noted in a few of these drugs (see chart).

The total percentage difference between VA and Medicare plan prices may be even higher than 48%, however, since no single Medicare plan offers the lowest price for all 20 drugs compared with its plan competitors, the survey noted.

VA prices are lower for both generic and brand-name drugs, Families USA noted. Eighteen of the 20 most-prescribed medicines for seniors are brand-name drugs. For the two generic drugs, the median difference between the lowest Medicare drug plan and the lowest VA price was 95%.

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, agreed with CMS that it was unfair to compare Medicare's new drug plan to a government-mandated price control system such as the VA.

“The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Even so, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.”

A report from the nonpartisan Congressional Budget Office said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

ELSEVIER GLOBAL MEDICAL NEWS

Medicare's new prescription drug benefit offers meager savings on drug prices, according to a Families USA survey.

For 19 out of the top 20 drugs prescribed to seniors in 2004 in several regions of the country, Families USA found that Medicare's prices were much higher than those negotiated by the Department of Veterans Affairs (VA). “For half of the top 20 drugs prescribed to seniors, the lowest price offered by any Medicare prescription drug plan was at least 48.2% higher than the lowest price available through the VA,” the survey indicated.

“The huge prices paid by seniors and taxpayers could have been avoided if Congress and the president had not caved in to the pressure of the drug lobby,” said Ron Pollack, executive director of Families USA. “They prohibited Medicare from bargaining for cheaper prices and, to ensure that this would never change, they delegated the administration of the benefit to private plans, which have far less bargaining clout.”

According to Peter Ashkenaz, deputy director of the Office of Public Affairs for the Centers for Medicare and Medicaid Services, Families USA just rehashed the old argument that there should be government price controls and a one-size-fits-all benefit.

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview.

The survey also compared the annual difference between the lowest VA prices and lowest Medicare drug plan prices among the top seven drugs prescribed for seniors. Huge differences were noted in a few of these drugs (see chart).

The total percentage difference between VA and Medicare plan prices may be even higher than 48%, however, since no single Medicare plan offers the lowest price for all 20 drugs compared with its plan competitors, the survey noted.

VA prices are lower for both generic and brand-name drugs, Families USA noted. Eighteen of the 20 most-prescribed medicines for seniors are brand-name drugs. For the two generic drugs, the median difference between the lowest Medicare drug plan and the lowest VA price was 95%.

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, agreed with CMS that it was unfair to compare Medicare's new drug plan to a government-mandated price control system such as the VA.

“The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Even so, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.”

A report from the nonpartisan Congressional Budget Office said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — The United States has underinvested in health information technologies that could help improve the lives of elderly people, Craig Barrett, chairman of the board of the Intel Corporation, said at the 2005 White House Conference on Aging.

Companies have been actively investigating these technologies—“just not here in the U.S.,” he said. “Many other countries are ahead of us. They have rules and regulations promoting the development of these technologies.”

In Korea, for example, user-friendly devices such as cell phones that double as glucose monitors are being tested.

Bringing such technology to market requires reseach and development funding, but licensing hurdles, regulatory issues, reimbursement issues, and liability concerns slow the process in the United States. Physicians, for example, don't use e-mail to communicate with patients because they are not reimbursed for giving advice over the Internet, Mr. Barrett said.

If the United States were to coordinate companies' efforts to tap research and development funding for such technologies, elderly patients could live better quality lives in their homes, rather than in hospitals and clinics, he argued.

Those efforts also would help lower the medical costs of caring for elderly patients, who make up 15% of all patients, but who account for 85% of medical costs, Mr. Barrett said.

Various devices capable of monitoring information about diseases could be made available to patients, caretakers, and physicians, he said. “You could turn the health care system around so that all sorts of technology could be used by individuals at home to ward off having to go to the hospital,” he said.

You could detect disease onset with monitors and sensors. By placing these technologies in the home, “you could sense if individuals are walking around, opening refrigerators, if they're taking their medication, what they're doing on a daily basis.” The sensors would be monitored remotely so that caregivers and family could check up on their parents or elders at any time.

Sensors could be used to help monitor chronic disease, tracking variables such as mobility, sleep quality, heartbeat, and breathing regularity, he said.

Such technology could also be used to improve lifestyles of older patients, he said. “People who have memory problems often don't want to answer the phone because they're afraid they're not going to know who's on the other end. They don't want to answer the door because they're afraid they might not recognize [the person].”

A possible solution is to give such patients a simple, enhanced call monitoring system that shows them the picture of a person, their relationship, and when the two last talked.

Wireless broadband offers a communication channel between patient, physician and caregiver, Mr. Barrett said. “As the country gets more broadband, the connectivity between homes, offices, and individuals, becomes easier and more useful.”

To improve access and quality of care for older patients, White House Conference on Aging delegates approved several implementation plans to advance health information technology, such as:

▸ Updating Medicare to place greater emphasis on establishing cost-effective linkages to home- and community-based options through the Aging Network, to promote chronic disease management and increase health promotion and disease prevention measures.

▸ Establishing a new title under the Older Americans Act to create aging and disability resource centers as a single point of entry in each region across the country.

▸ Including in the Older Americans Act provisions to foster development of a virtual electronic database that is shared between providers.

▸ Amending the Health Insurance Portability and Accountability Act and other “restrictive” regulations to allow communication between health providers and the aging network regarding client care.

WASHINGTON — The United States has underinvested in health information technologies that could help improve the lives of elderly people, Craig Barrett, chairman of the board of the Intel Corporation, said at the 2005 White House Conference on Aging.

Companies have been actively investigating these technologies—“just not here in the U.S.,” he said. “Many other countries are ahead of us. They have rules and regulations promoting the development of these technologies.”

In Korea, for example, user-friendly devices such as cell phones that double as glucose monitors are being tested.

Bringing such technology to market requires reseach and development funding, but licensing hurdles, regulatory issues, reimbursement issues, and liability concerns slow the process in the United States. Physicians, for example, don't use e-mail to communicate with patients because they are not reimbursed for giving advice over the Internet, Mr. Barrett said.

If the United States were to coordinate companies' efforts to tap research and development funding for such technologies, elderly patients could live better quality lives in their homes, rather than in hospitals and clinics, he argued.

Those efforts also would help lower the medical costs of caring for elderly patients, who make up 15% of all patients, but who account for 85% of medical costs, Mr. Barrett said.

Various devices capable of monitoring information about diseases could be made available to patients, caretakers, and physicians, he said. “You could turn the health care system around so that all sorts of technology could be used by individuals at home to ward off having to go to the hospital,” he said.

You could detect disease onset with monitors and sensors. By placing these technologies in the home, “you could sense if individuals are walking around, opening refrigerators, if they're taking their medication, what they're doing on a daily basis.” The sensors would be monitored remotely so that caregivers and family could check up on their parents or elders at any time.

Sensors could be used to help monitor chronic disease, tracking variables such as mobility, sleep quality, heartbeat, and breathing regularity, he said.

Such technology could also be used to improve lifestyles of older patients, he said. “People who have memory problems often don't want to answer the phone because they're afraid they're not going to know who's on the other end. They don't want to answer the door because they're afraid they might not recognize [the person].”

A possible solution is to give such patients a simple, enhanced call monitoring system that shows them the picture of a person, their relationship, and when the two last talked.

Wireless broadband offers a communication channel between patient, physician and caregiver, Mr. Barrett said. “As the country gets more broadband, the connectivity between homes, offices, and individuals, becomes easier and more useful.”

To improve access and quality of care for older patients, White House Conference on Aging delegates approved several implementation plans to advance health information technology, such as:

▸ Updating Medicare to place greater emphasis on establishing cost-effective linkages to home- and community-based options through the Aging Network, to promote chronic disease management and increase health promotion and disease prevention measures.

▸ Establishing a new title under the Older Americans Act to create aging and disability resource centers as a single point of entry in each region across the country.

▸ Including in the Older Americans Act provisions to foster development of a virtual electronic database that is shared between providers.

▸ Amending the Health Insurance Portability and Accountability Act and other “restrictive” regulations to allow communication between health providers and the aging network regarding client care.

WASHINGTON — The United States has underinvested in health information technologies that could help improve the lives of elderly people, Craig Barrett, chairman of the board of the Intel Corporation, said at the 2005 White House Conference on Aging.

Companies have been actively investigating these technologies—“just not here in the U.S.,” he said. “Many other countries are ahead of us. They have rules and regulations promoting the development of these technologies.”

In Korea, for example, user-friendly devices such as cell phones that double as glucose monitors are being tested.

Bringing such technology to market requires reseach and development funding, but licensing hurdles, regulatory issues, reimbursement issues, and liability concerns slow the process in the United States. Physicians, for example, don't use e-mail to communicate with patients because they are not reimbursed for giving advice over the Internet, Mr. Barrett said.

If the United States were to coordinate companies' efforts to tap research and development funding for such technologies, elderly patients could live better quality lives in their homes, rather than in hospitals and clinics, he argued.

Those efforts also would help lower the medical costs of caring for elderly patients, who make up 15% of all patients, but who account for 85% of medical costs, Mr. Barrett said.

Various devices capable of monitoring information about diseases could be made available to patients, caretakers, and physicians, he said. “You could turn the health care system around so that all sorts of technology could be used by individuals at home to ward off having to go to the hospital,” he said.

You could detect disease onset with monitors and sensors. By placing these technologies in the home, “you could sense if individuals are walking around, opening refrigerators, if they're taking their medication, what they're doing on a daily basis.” The sensors would be monitored remotely so that caregivers and family could check up on their parents or elders at any time.

Sensors could be used to help monitor chronic disease, tracking variables such as mobility, sleep quality, heartbeat, and breathing regularity, he said.

Such technology could also be used to improve lifestyles of older patients, he said. “People who have memory problems often don't want to answer the phone because they're afraid they're not going to know who's on the other end. They don't want to answer the door because they're afraid they might not recognize [the person].”

A possible solution is to give such patients a simple, enhanced call monitoring system that shows them the picture of a person, their relationship, and when the two last talked.

Wireless broadband offers a communication channel between patient, physician and caregiver, Mr. Barrett said. “As the country gets more broadband, the connectivity between homes, offices, and individuals, becomes easier and more useful.”

To improve access and quality of care for older patients, White House Conference on Aging delegates approved several implementation plans to advance health information technology, such as:

▸ Updating Medicare to place greater emphasis on establishing cost-effective linkages to home- and community-based options through the Aging Network, to promote chronic disease management and increase health promotion and disease prevention measures.

▸ Establishing a new title under the Older Americans Act to create aging and disability resource centers as a single point of entry in each region across the country.

▸ Including in the Older Americans Act provisions to foster development of a virtual electronic database that is shared between providers.

▸ Amending the Health Insurance Portability and Accountability Act and other “restrictive” regulations to allow communication between health providers and the aging network regarding client care.

2007 Budget:Mostly Cuts for Kids

More cuts are slated for Medicaid and the State Children's Health Insurance Program under the president's fiscal year 2007 budget request. In an effort to reduce the deficit, the administration has proposed changes that would result in $13.5 billion in cuts over 5 years to Medicaid/SCHIP. One legislative proposal that would get increased funding is Cover the Kids, a grant program that would promote enrollment of eligible children in Medicaid and SCHIP. The president called for a $69 million increase for the program in 2007, and $330 million over 5 years. Cuts for children's programs are slated in other areas of the budget: The request for the Health Resources and Services Administration, for example, contains no money for emergency medical services for children, which in the past has been funded at $20 million.

Suit Alleges Junk-Food Brainwashing

Consumer groups and parents are suing Nickelodeon and Kellogg Co. in an attempt to stop the companies from marketing junk food to children. The announcement follows an Institute of Medicine report which found that food advertising aimed at children encourages them to request high-calorie, low-nutrient foods. “Nickelodeon and Kellogg engage in business practices that literally sicken our children,” said Michael F. Jacobson, executive director of the Center for Science in the Public Interest, one of the plaintiffs. “Their marketing tactics are designed to convince kids that everything they hear from their parents about food is wrong. It's a multimedia brainwashing and reeducation campaign—and a disease-promoting one at that.” Other plaintiffs in the suit include the Campaign for a Commercial-Free Childhood and parents Sherri Carlson of Wakefield, Mass., and Andrew Leong of Brookline, Mass. Kellogg is not commenting at this point, said Jill Saletta, Kellogg's director for communications.

Neighborhood Weight Watch?

It pays to know your neighbors: A recent study published in the journal, Social Science & Medicine found that children who grew up in close-knit neighborhoods were less likely to be obese. Researchers surveyed 807 adolescents in 684 households in 65 neighborhoods in Los Angeles County, Calif., and sampled 3,000 adult respondents. They found a significant relationship between collective efficacy or the “willingness of community members to look out for each other and intervene when trouble arises,” and body mass index, being at risk of overweight, and overweight status. “Future interventions to control weight by addressing the social environment at the community level may be promising,” the researchers concluded.

Steroid Abuse Prevention Award

Oregon Health and Science University in Portland is the recipient of the first annual $1 million SI Champion Award from Sports Illustrated magazine for its work on preventing steroid abuse by high school athletes. “Based on the Center for Disease Control and Prevention's latest information (2003), approximately 850,000 high school students have admitted using steroids,” Sports Illustrated noted in a statement. “Since 1993, steroid use among this age group has increased from one in every 45 to one in 16.” To help combat the problem, the university created two programs: ATLAS (Athletes Training and Learning to Avoid Steroids) for high school males and ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) for high school females. Both programs focus on healthy nutrition and exercise as alternatives to harmful behaviors, and both have been shown to reduce the use of steroids as well as other drugs and alcohol. The university will receive cash and public service announcements in the magazine totaling $1 million to create a network of schools that will serve as national models for the two programs.

Depression Prevails in Teens

Earlier interventions are needed to address childhood onset of mental health disorders, Missy Fleming, Ph.D., program director for child and adolescent health for the American Medical Association, said at a meeting of the National Institute for Health Care Management Foundation. “We need to develop a stronger infrastructure and policies to promote and support healthy psychological development,” she said. This involves increasing access to interventions that are likely to reduce the burdens of untreated mental disorders; linking assessment services to prevention and treatment, especially those that are sensitive to cultural needs; and enlisting primary care physicians, schools, and community resources to meet adolescent and young adult mental health needs. Major depressive disorder is common during childhood with an estimated prevalence of 2%–5% for adolescents aged 13–18 years. This problem increases through young adulthood, she said.

2007 Budget:Mostly Cuts for Kids

More cuts are slated for Medicaid and the State Children's Health Insurance Program under the president's fiscal year 2007 budget request. In an effort to reduce the deficit, the administration has proposed changes that would result in $13.5 billion in cuts over 5 years to Medicaid/SCHIP. One legislative proposal that would get increased funding is Cover the Kids, a grant program that would promote enrollment of eligible children in Medicaid and SCHIP. The president called for a $69 million increase for the program in 2007, and $330 million over 5 years. Cuts for children's programs are slated in other areas of the budget: The request for the Health Resources and Services Administration, for example, contains no money for emergency medical services for children, which in the past has been funded at $20 million.

Suit Alleges Junk-Food Brainwashing

Consumer groups and parents are suing Nickelodeon and Kellogg Co. in an attempt to stop the companies from marketing junk food to children. The announcement follows an Institute of Medicine report which found that food advertising aimed at children encourages them to request high-calorie, low-nutrient foods. “Nickelodeon and Kellogg engage in business practices that literally sicken our children,” said Michael F. Jacobson, executive director of the Center for Science in the Public Interest, one of the plaintiffs. “Their marketing tactics are designed to convince kids that everything they hear from their parents about food is wrong. It's a multimedia brainwashing and reeducation campaign—and a disease-promoting one at that.” Other plaintiffs in the suit include the Campaign for a Commercial-Free Childhood and parents Sherri Carlson of Wakefield, Mass., and Andrew Leong of Brookline, Mass. Kellogg is not commenting at this point, said Jill Saletta, Kellogg's director for communications.

Neighborhood Weight Watch?

It pays to know your neighbors: A recent study published in the journal, Social Science & Medicine found that children who grew up in close-knit neighborhoods were less likely to be obese. Researchers surveyed 807 adolescents in 684 households in 65 neighborhoods in Los Angeles County, Calif., and sampled 3,000 adult respondents. They found a significant relationship between collective efficacy or the “willingness of community members to look out for each other and intervene when trouble arises,” and body mass index, being at risk of overweight, and overweight status. “Future interventions to control weight by addressing the social environment at the community level may be promising,” the researchers concluded.

Steroid Abuse Prevention Award

Oregon Health and Science University in Portland is the recipient of the first annual $1 million SI Champion Award from Sports Illustrated magazine for its work on preventing steroid abuse by high school athletes. “Based on the Center for Disease Control and Prevention's latest information (2003), approximately 850,000 high school students have admitted using steroids,” Sports Illustrated noted in a statement. “Since 1993, steroid use among this age group has increased from one in every 45 to one in 16.” To help combat the problem, the university created two programs: ATLAS (Athletes Training and Learning to Avoid Steroids) for high school males and ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) for high school females. Both programs focus on healthy nutrition and exercise as alternatives to harmful behaviors, and both have been shown to reduce the use of steroids as well as other drugs and alcohol. The university will receive cash and public service announcements in the magazine totaling $1 million to create a network of schools that will serve as national models for the two programs.

Depression Prevails in Teens

Earlier interventions are needed to address childhood onset of mental health disorders, Missy Fleming, Ph.D., program director for child and adolescent health for the American Medical Association, said at a meeting of the National Institute for Health Care Management Foundation. “We need to develop a stronger infrastructure and policies to promote and support healthy psychological development,” she said. This involves increasing access to interventions that are likely to reduce the burdens of untreated mental disorders; linking assessment services to prevention and treatment, especially those that are sensitive to cultural needs; and enlisting primary care physicians, schools, and community resources to meet adolescent and young adult mental health needs. Major depressive disorder is common during childhood with an estimated prevalence of 2%–5% for adolescents aged 13–18 years. This problem increases through young adulthood, she said.

2007 Budget:Mostly Cuts for Kids

More cuts are slated for Medicaid and the State Children's Health Insurance Program under the president's fiscal year 2007 budget request. In an effort to reduce the deficit, the administration has proposed changes that would result in $13.5 billion in cuts over 5 years to Medicaid/SCHIP. One legislative proposal that would get increased funding is Cover the Kids, a grant program that would promote enrollment of eligible children in Medicaid and SCHIP. The president called for a $69 million increase for the program in 2007, and $330 million over 5 years. Cuts for children's programs are slated in other areas of the budget: The request for the Health Resources and Services Administration, for example, contains no money for emergency medical services for children, which in the past has been funded at $20 million.

Suit Alleges Junk-Food Brainwashing

Consumer groups and parents are suing Nickelodeon and Kellogg Co. in an attempt to stop the companies from marketing junk food to children. The announcement follows an Institute of Medicine report which found that food advertising aimed at children encourages them to request high-calorie, low-nutrient foods. “Nickelodeon and Kellogg engage in business practices that literally sicken our children,” said Michael F. Jacobson, executive director of the Center for Science in the Public Interest, one of the plaintiffs. “Their marketing tactics are designed to convince kids that everything they hear from their parents about food is wrong. It's a multimedia brainwashing and reeducation campaign—and a disease-promoting one at that.” Other plaintiffs in the suit include the Campaign for a Commercial-Free Childhood and parents Sherri Carlson of Wakefield, Mass., and Andrew Leong of Brookline, Mass. Kellogg is not commenting at this point, said Jill Saletta, Kellogg's director for communications.

Neighborhood Weight Watch?

It pays to know your neighbors: A recent study published in the journal, Social Science & Medicine found that children who grew up in close-knit neighborhoods were less likely to be obese. Researchers surveyed 807 adolescents in 684 households in 65 neighborhoods in Los Angeles County, Calif., and sampled 3,000 adult respondents. They found a significant relationship between collective efficacy or the “willingness of community members to look out for each other and intervene when trouble arises,” and body mass index, being at risk of overweight, and overweight status. “Future interventions to control weight by addressing the social environment at the community level may be promising,” the researchers concluded.

Steroid Abuse Prevention Award

Oregon Health and Science University in Portland is the recipient of the first annual $1 million SI Champion Award from Sports Illustrated magazine for its work on preventing steroid abuse by high school athletes. “Based on the Center for Disease Control and Prevention's latest information (2003), approximately 850,000 high school students have admitted using steroids,” Sports Illustrated noted in a statement. “Since 1993, steroid use among this age group has increased from one in every 45 to one in 16.” To help combat the problem, the university created two programs: ATLAS (Athletes Training and Learning to Avoid Steroids) for high school males and ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) for high school females. Both programs focus on healthy nutrition and exercise as alternatives to harmful behaviors, and both have been shown to reduce the use of steroids as well as other drugs and alcohol. The university will receive cash and public service announcements in the magazine totaling $1 million to create a network of schools that will serve as national models for the two programs.

Depression Prevails in Teens

Earlier interventions are needed to address childhood onset of mental health disorders, Missy Fleming, Ph.D., program director for child and adolescent health for the American Medical Association, said at a meeting of the National Institute for Health Care Management Foundation. “We need to develop a stronger infrastructure and policies to promote and support healthy psychological development,” she said. This involves increasing access to interventions that are likely to reduce the burdens of untreated mental disorders; linking assessment services to prevention and treatment, especially those that are sensitive to cultural needs; and enlisting primary care physicians, schools, and community resources to meet adolescent and young adult mental health needs. Major depressive disorder is common during childhood with an estimated prevalence of 2%–5% for adolescents aged 13–18 years. This problem increases through young adulthood, she said.

Bill Halts 4.4% Cut

Congress' long-awaited passage of the budget reconciliation package (also called the Deficit Reduction Act) put a freeze on a 4.4% Medicare pay cut that physicians experienced in the month of January. The congressional action stopped any further reductions but did not increase Medicare physician pay for 2006. The Centers for Medicare and Medicaid Services will reimburse physicians retroactively for the January reductions, and has instructed its contractors to automatically reprocess claims. But work on this issue is far from over, Dr. J. Edward Hill, president of the American Medical Association, said in a statement. “With 6 years of cuts still scheduled to come as practice costs continue to rise—we fear more physicians will make difficult practice decisions about treating Medicare patients. … We must build on the momentum and awareness raised in 2005 to make 2006 the year Congress permanently repeals the broken Medicare physician payment formula.” President Bush's fiscal year 2007 budget request to Congress briefly mentioned the impending cuts, but it also expounded on CMS's efforts to expand pay-for-performance initiatives to “achieve better outcomes at a lower overall cost.”

And on to the 2007 Budget

The President's 2007 budget request for the Department of Health and Human Services—$698 billion—is a $58 billion increase from 2006, but contains cost containment measures that would whittle down or eliminate certain programs. Medicare initiatives to “encourage efficient and appropriate payment for services; foster competition; and promote beneficiary involvement in their health care decisions” would save nearly $36 billion from 2007 to 2011, according to an HHS statement. But Part A hospital payments would incur $22 billion of these cuts— “the wrong policy at the wrong time,” as hospitals have been losing money caring for Medicare beneficiaries since 2003, said Chip Kahn, president of the Federation of American Hospitals. Aiming to meet the president's goal of cutting the federal deficit in half by 2009, the budget request proposes other targeted reductions or elimination of certain programs whose performance ratings were low or whose purposes are being covered by other HHS programs. These cuts include $133 million to rural health programs run by the Health Resources and Services Administration, and elimination of the $630 million Community Services Block Grant program. Several organizations decried the proposed cuts to National Institutes of Health research programs. The National Institute of Diabetes and Digestive and Kidney Diseases would be funded at $11 million less than in 2006, according to the American Diabetes Association. Also, the Centers for Disease Control and Prevention would receive only $819 million for chronic disease programs, a $20 million reduction from last year, the ADA reported. Some programs took special priority in the request—the president, for example, asked for $4.4 billion for bioterrorism-related spending in 2007, a $178 million increase over 2006. To achieve the president's goal for most Americans to have secure personal electronic health records by 2014, $169 million was requested for 2007 ($59 million more than in 2006) for health information technology. The Food and Drug Administration's 2007 budget request totaled $1.95 billion, a 3.8% increase over 2006. Much of these additional FDA funds would be used for pandemic prevention, promotion of molecular medicine, and protection of the food supply from bioterrorism.

Not So Sure on Quarantines

Americans are in favor of quarantines as a protection against infectious diseases—but when it comes to the enforcement and monitoring of quarantines, they're not as receptive as people in other countries, according to a Web-exclusive Health Affairs study titled “Attitudes toward the Use of Quarantine in a Public Health Emergency in Four Countries.” Residents of the United States, Hong Kong, Singapore, and Taiwan were polled for the study. Certain enforcement measures received wide support in the Asian nations, but only 53% of Americans said they would favor a requirement for everyone to wear masks in public in the event of disease outbreak. Only 44% supported screening for illness by taking people's temperature before they entered public places. Americans were also less supportive of quarantine compliance measures such as guards, electronic ankle bracelets, and periodic video surveillance, compared with residents of the Asian nations. The use of arrest to maintain quarantine had limited support in all of the countries. Only 42% of the U.S. respondents supported a compulsory quarantine where noncompliant individuals could be arrested, the study indicated.

CVD Awareness Rises

More women are aware of cardiovascular disease, and that knowledge is causing them to take positive preventive health steps for themselves and family members, according to a recent study published in the journal Circulation. A survey of more than 1,000 women aged 25 and older found that awareness has nearly doubled since 1997. Among the women who completed the full survey in July 2005, 55% said that heart disease/heart attack is the leading cause of death. This is up from 30% in 1997. In addition, about 54% of women who reported seeing a health care professional on a regular basis said they had discussed their risk of heart disease within the past 6 months. The top reason women cited for not speaking to a physician or other health care professional about heart disease in the last year was that the provider did not bring it up.

Bill Halts 4.4% Cut

Congress' long-awaited passage of the budget reconciliation package (also called the Deficit Reduction Act) put a freeze on a 4.4% Medicare pay cut that physicians experienced in the month of January. The congressional action stopped any further reductions but did not increase Medicare physician pay for 2006. The Centers for Medicare and Medicaid Services will reimburse physicians retroactively for the January reductions, and has instructed its contractors to automatically reprocess claims. But work on this issue is far from over, Dr. J. Edward Hill, president of the American Medical Association, said in a statement. “With 6 years of cuts still scheduled to come as practice costs continue to rise—we fear more physicians will make difficult practice decisions about treating Medicare patients. … We must build on the momentum and awareness raised in 2005 to make 2006 the year Congress permanently repeals the broken Medicare physician payment formula.” President Bush's fiscal year 2007 budget request to Congress briefly mentioned the impending cuts, but it also expounded on CMS's efforts to expand pay-for-performance initiatives to “achieve better outcomes at a lower overall cost.”

And on to the 2007 Budget

The President's 2007 budget request for the Department of Health and Human Services—$698 billion—is a $58 billion increase from 2006, but contains cost containment measures that would whittle down or eliminate certain programs. Medicare initiatives to “encourage efficient and appropriate payment for services; foster competition; and promote beneficiary involvement in their health care decisions” would save nearly $36 billion from 2007 to 2011, according to an HHS statement. But Part A hospital payments would incur $22 billion of these cuts— “the wrong policy at the wrong time,” as hospitals have been losing money caring for Medicare beneficiaries since 2003, said Chip Kahn, president of the Federation of American Hospitals. Aiming to meet the president's goal of cutting the federal deficit in half by 2009, the budget request proposes other targeted reductions or elimination of certain programs whose performance ratings were low or whose purposes are being covered by other HHS programs. These cuts include $133 million to rural health programs run by the Health Resources and Services Administration, and elimination of the $630 million Community Services Block Grant program. Several organizations decried the proposed cuts to National Institutes of Health research programs. The National Institute of Diabetes and Digestive and Kidney Diseases would be funded at $11 million less than in 2006, according to the American Diabetes Association. Also, the Centers for Disease Control and Prevention would receive only $819 million for chronic disease programs, a $20 million reduction from last year, the ADA reported. Some programs took special priority in the request—the president, for example, asked for $4.4 billion for bioterrorism-related spending in 2007, a $178 million increase over 2006. To achieve the president's goal for most Americans to have secure personal electronic health records by 2014, $169 million was requested for 2007 ($59 million more than in 2006) for health information technology. The Food and Drug Administration's 2007 budget request totaled $1.95 billion, a 3.8% increase over 2006. Much of these additional FDA funds would be used for pandemic prevention, promotion of molecular medicine, and protection of the food supply from bioterrorism.

Not So Sure on Quarantines

Americans are in favor of quarantines as a protection against infectious diseases—but when it comes to the enforcement and monitoring of quarantines, they're not as receptive as people in other countries, according to a Web-exclusive Health Affairs study titled “Attitudes toward the Use of Quarantine in a Public Health Emergency in Four Countries.” Residents of the United States, Hong Kong, Singapore, and Taiwan were polled for the study. Certain enforcement measures received wide support in the Asian nations, but only 53% of Americans said they would favor a requirement for everyone to wear masks in public in the event of disease outbreak. Only 44% supported screening for illness by taking people's temperature before they entered public places. Americans were also less supportive of quarantine compliance measures such as guards, electronic ankle bracelets, and periodic video surveillance, compared with residents of the Asian nations. The use of arrest to maintain quarantine had limited support in all of the countries. Only 42% of the U.S. respondents supported a compulsory quarantine where noncompliant individuals could be arrested, the study indicated.

CVD Awareness Rises

More women are aware of cardiovascular disease, and that knowledge is causing them to take positive preventive health steps for themselves and family members, according to a recent study published in the journal Circulation. A survey of more than 1,000 women aged 25 and older found that awareness has nearly doubled since 1997. Among the women who completed the full survey in July 2005, 55% said that heart disease/heart attack is the leading cause of death. This is up from 30% in 1997. In addition, about 54% of women who reported seeing a health care professional on a regular basis said they had discussed their risk of heart disease within the past 6 months. The top reason women cited for not speaking to a physician or other health care professional about heart disease in the last year was that the provider did not bring it up.

Bill Halts 4.4% Cut

Congress' long-awaited passage of the budget reconciliation package (also called the Deficit Reduction Act) put a freeze on a 4.4% Medicare pay cut that physicians experienced in the month of January. The congressional action stopped any further reductions but did not increase Medicare physician pay for 2006. The Centers for Medicare and Medicaid Services will reimburse physicians retroactively for the January reductions, and has instructed its contractors to automatically reprocess claims. But work on this issue is far from over, Dr. J. Edward Hill, president of the American Medical Association, said in a statement. “With 6 years of cuts still scheduled to come as practice costs continue to rise—we fear more physicians will make difficult practice decisions about treating Medicare patients. … We must build on the momentum and awareness raised in 2005 to make 2006 the year Congress permanently repeals the broken Medicare physician payment formula.” President Bush's fiscal year 2007 budget request to Congress briefly mentioned the impending cuts, but it also expounded on CMS's efforts to expand pay-for-performance initiatives to “achieve better outcomes at a lower overall cost.”

And on to the 2007 Budget

The President's 2007 budget request for the Department of Health and Human Services—$698 billion—is a $58 billion increase from 2006, but contains cost containment measures that would whittle down or eliminate certain programs. Medicare initiatives to “encourage efficient and appropriate payment for services; foster competition; and promote beneficiary involvement in their health care decisions” would save nearly $36 billion from 2007 to 2011, according to an HHS statement. But Part A hospital payments would incur $22 billion of these cuts— “the wrong policy at the wrong time,” as hospitals have been losing money caring for Medicare beneficiaries since 2003, said Chip Kahn, president of the Federation of American Hospitals. Aiming to meet the president's goal of cutting the federal deficit in half by 2009, the budget request proposes other targeted reductions or elimination of certain programs whose performance ratings were low or whose purposes are being covered by other HHS programs. These cuts include $133 million to rural health programs run by the Health Resources and Services Administration, and elimination of the $630 million Community Services Block Grant program. Several organizations decried the proposed cuts to National Institutes of Health research programs. The National Institute of Diabetes and Digestive and Kidney Diseases would be funded at $11 million less than in 2006, according to the American Diabetes Association. Also, the Centers for Disease Control and Prevention would receive only $819 million for chronic disease programs, a $20 million reduction from last year, the ADA reported. Some programs took special priority in the request—the president, for example, asked for $4.4 billion for bioterrorism-related spending in 2007, a $178 million increase over 2006. To achieve the president's goal for most Americans to have secure personal electronic health records by 2014, $169 million was requested for 2007 ($59 million more than in 2006) for health information technology. The Food and Drug Administration's 2007 budget request totaled $1.95 billion, a 3.8% increase over 2006. Much of these additional FDA funds would be used for pandemic prevention, promotion of molecular medicine, and protection of the food supply from bioterrorism.

Not So Sure on Quarantines

Americans are in favor of quarantines as a protection against infectious diseases—but when it comes to the enforcement and monitoring of quarantines, they're not as receptive as people in other countries, according to a Web-exclusive Health Affairs study titled “Attitudes toward the Use of Quarantine in a Public Health Emergency in Four Countries.” Residents of the United States, Hong Kong, Singapore, and Taiwan were polled for the study. Certain enforcement measures received wide support in the Asian nations, but only 53% of Americans said they would favor a requirement for everyone to wear masks in public in the event of disease outbreak. Only 44% supported screening for illness by taking people's temperature before they entered public places. Americans were also less supportive of quarantine compliance measures such as guards, electronic ankle bracelets, and periodic video surveillance, compared with residents of the Asian nations. The use of arrest to maintain quarantine had limited support in all of the countries. Only 42% of the U.S. respondents supported a compulsory quarantine where noncompliant individuals could be arrested, the study indicated.

CVD Awareness Rises

More women are aware of cardiovascular disease, and that knowledge is causing them to take positive preventive health steps for themselves and family members, according to a recent study published in the journal Circulation. A survey of more than 1,000 women aged 25 and older found that awareness has nearly doubled since 1997. Among the women who completed the full survey in July 2005, 55% said that heart disease/heart attack is the leading cause of death. This is up from 30% in 1997. In addition, about 54% of women who reported seeing a health care professional on a regular basis said they had discussed their risk of heart disease within the past 6 months. The top reason women cited for not speaking to a physician or other health care professional about heart disease in the last year was that the provider did not bring it up.