Jennifer Lubell

Efforts are underway in Pennsylvania to set up physician tracking systems, self-management programs, and centers to help patients better manage diabetes.

“In Pennsylvania there's a significant lack of knowledge regarding diabetes health,” said Dr. Andrew Behnke, an endocrinologist and a member of the Pennsylvania Medical Society. While the society isn't specifically involved in this initiative, “we're supportive of any effort to educate physicians and patients and help patients achieve their health goals.”

The University of Pittsburgh Diabetes Institute (UPDI) will spearhead these efforts in partnership with communities throughout western Pennsylvania with an $8 million grant from the Department of Defense.

“Diabetes has emerged as one of the most serious health problems in Pennsylvania, particularly in rural areas,” Rep. John Murtha (D-Pa.) said in announcing the initiative. Overall, 8% of Pennsylvanians (1.1 million people [720,500 diagnosed and 379,500 undiagnosed]) have diabetes, according to data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Diabetes accounts for $7.7 billion in total health care costs and 11,500 deaths every year in Pennsylvania.

The expectation is the programs will serve as models that can be replicated throughout the United States and applied to the military, Rep. Murtha said. A similar initiative is underway in New York City, where clinical laboratories are sending the results of all hemoglobin A_1c tests to the city's health department, with a goal of providing information to physicians on their patients with diabetes—and informing those patients whose results indicate poor glycemic control.

Some of the DOD funds will build upon the University of Pittsburgh Medical Center's efforts to track diabetes information. Diabetes tracking systems and programs will be offered through Memorial Medical Center, Uniontown Hospital, Highlands Hospital, and Indiana (Pa.) Regional Medical Center. Specifically, the programs will monitor hemoglobin A_1c tests, blood pressure, cholesterol levels, and foot and eye exams, said Linda Siminerio, Ph.D., director of the UPDI. Project leaders hope to use the data to coordinate intervention programs, where they would work with doctors to get patients better care.

As part of the tracking initiative, Delphi Health Systems Inc. will partner with UPDI and the community hospitals by providing diabetes management software to be used at the point of care.

The project has been working with leaders of hospitals in outlying communities that have their own physician practices, Dr. Siminerio said in an interview. “We've been asking those leaders who have done needs assessments in their communities what their physicians are interested in.”

In another partnership, the Diabetes Institute and the Conemaugh Health System's Memorial Medical Center will establish a Diabetes Wellness Center at Memorial's downtown campus in Johnstown. The Center plans comprehensive screening for the prevention of diabetes complications such as retinopathy, nephropathy, neuropathy, cardiovascular disease, and lower-extremity arterial disease.

Nationally, diabetes is the fifth leading cause of death, according to the American Diabetes Association. One out of every 10 health care dollars is spent on diabetes and its complications.

Efforts are underway in Pennsylvania to set up physician tracking systems, self-management programs, and centers to help patients better manage diabetes.

“In Pennsylvania there's a significant lack of knowledge regarding diabetes health,” said Dr. Andrew Behnke, an endocrinologist and a member of the Pennsylvania Medical Society. While the society isn't specifically involved in this initiative, “we're supportive of any effort to educate physicians and patients and help patients achieve their health goals.”

The University of Pittsburgh Diabetes Institute (UPDI) will spearhead these efforts in partnership with communities throughout western Pennsylvania with an $8 million grant from the Department of Defense.

“Diabetes has emerged as one of the most serious health problems in Pennsylvania, particularly in rural areas,” Rep. John Murtha (D-Pa.) said in announcing the initiative. Overall, 8% of Pennsylvanians (1.1 million people [720,500 diagnosed and 379,500 undiagnosed]) have diabetes, according to data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Diabetes accounts for $7.7 billion in total health care costs and 11,500 deaths every year in Pennsylvania.

The expectation is the programs will serve as models that can be replicated throughout the United States and applied to the military, Rep. Murtha said. A similar initiative is underway in New York City, where clinical laboratories are sending the results of all hemoglobin A_1c tests to the city's health department, with a goal of providing information to physicians on their patients with diabetes—and informing those patients whose results indicate poor glycemic control.

Some of the DOD funds will build upon the University of Pittsburgh Medical Center's efforts to track diabetes information. Diabetes tracking systems and programs will be offered through Memorial Medical Center, Uniontown Hospital, Highlands Hospital, and Indiana (Pa.) Regional Medical Center. Specifically, the programs will monitor hemoglobin A_1c tests, blood pressure, cholesterol levels, and foot and eye exams, said Linda Siminerio, Ph.D., director of the UPDI. Project leaders hope to use the data to coordinate intervention programs, where they would work with doctors to get patients better care.

As part of the tracking initiative, Delphi Health Systems Inc. will partner with UPDI and the community hospitals by providing diabetes management software to be used at the point of care.

The project has been working with leaders of hospitals in outlying communities that have their own physician practices, Dr. Siminerio said in an interview. “We've been asking those leaders who have done needs assessments in their communities what their physicians are interested in.”

In another partnership, the Diabetes Institute and the Conemaugh Health System's Memorial Medical Center will establish a Diabetes Wellness Center at Memorial's downtown campus in Johnstown. The Center plans comprehensive screening for the prevention of diabetes complications such as retinopathy, nephropathy, neuropathy, cardiovascular disease, and lower-extremity arterial disease.

Nationally, diabetes is the fifth leading cause of death, according to the American Diabetes Association. One out of every 10 health care dollars is spent on diabetes and its complications.

Efforts are underway in Pennsylvania to set up physician tracking systems, self-management programs, and centers to help patients better manage diabetes.

“In Pennsylvania there's a significant lack of knowledge regarding diabetes health,” said Dr. Andrew Behnke, an endocrinologist and a member of the Pennsylvania Medical Society. While the society isn't specifically involved in this initiative, “we're supportive of any effort to educate physicians and patients and help patients achieve their health goals.”

The University of Pittsburgh Diabetes Institute (UPDI) will spearhead these efforts in partnership with communities throughout western Pennsylvania with an $8 million grant from the Department of Defense.

“Diabetes has emerged as one of the most serious health problems in Pennsylvania, particularly in rural areas,” Rep. John Murtha (D-Pa.) said in announcing the initiative. Overall, 8% of Pennsylvanians (1.1 million people [720,500 diagnosed and 379,500 undiagnosed]) have diabetes, according to data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Diabetes accounts for $7.7 billion in total health care costs and 11,500 deaths every year in Pennsylvania.

The expectation is the programs will serve as models that can be replicated throughout the United States and applied to the military, Rep. Murtha said. A similar initiative is underway in New York City, where clinical laboratories are sending the results of all hemoglobin A_1c tests to the city's health department, with a goal of providing information to physicians on their patients with diabetes—and informing those patients whose results indicate poor glycemic control.

Some of the DOD funds will build upon the University of Pittsburgh Medical Center's efforts to track diabetes information. Diabetes tracking systems and programs will be offered through Memorial Medical Center, Uniontown Hospital, Highlands Hospital, and Indiana (Pa.) Regional Medical Center. Specifically, the programs will monitor hemoglobin A_1c tests, blood pressure, cholesterol levels, and foot and eye exams, said Linda Siminerio, Ph.D., director of the UPDI. Project leaders hope to use the data to coordinate intervention programs, where they would work with doctors to get patients better care.

As part of the tracking initiative, Delphi Health Systems Inc. will partner with UPDI and the community hospitals by providing diabetes management software to be used at the point of care.

The project has been working with leaders of hospitals in outlying communities that have their own physician practices, Dr. Siminerio said in an interview. “We've been asking those leaders who have done needs assessments in their communities what their physicians are interested in.”

In another partnership, the Diabetes Institute and the Conemaugh Health System's Memorial Medical Center will establish a Diabetes Wellness Center at Memorial's downtown campus in Johnstown. The Center plans comprehensive screening for the prevention of diabetes complications such as retinopathy, nephropathy, neuropathy, cardiovascular disease, and lower-extremity arterial disease.

Nationally, diabetes is the fifth leading cause of death, according to the American Diabetes Association. One out of every 10 health care dollars is spent on diabetes and its complications.

WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.

In one of the many implementation plans to improve the health care of aging patients, the delegates to the conference called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit that would be available to Americans of all ages.

Because Medicare is going bankrupt, and most monies used to pay for long-term care come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.

Most nursing home beds are long-term care—paid for either by private funding sources or by Medicaid. A few of the beds, however, qualify as “skilled” facilities and are paid for by Medicare Part A.

“In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.

Patients have only a small number of options once their coverage for skilled care has been terminated, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.

Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the Medicare payment is limited to a period of 100 days per condition per lifetime. Such a payment level is “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.

Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.

For these reasons, a Part E should also cover home care, in addition to nursing home care; “otherwise it will not be of great value,” she said.

There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”

Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.

It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”

Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.

“It's a pipe dream. Congress is not going to approve it,” he said.

To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.

Until that's accomplished, “I don't see how we'll have funding available,” Dr. Black said.

WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.

In one of the many implementation plans to improve the health care of aging patients, the delegates to the conference called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit that would be available to Americans of all ages.

Because Medicare is going bankrupt, and most monies used to pay for long-term care come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.

Most nursing home beds are long-term care—paid for either by private funding sources or by Medicaid. A few of the beds, however, qualify as “skilled” facilities and are paid for by Medicare Part A.

“In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.

Patients have only a small number of options once their coverage for skilled care has been terminated, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.

Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the Medicare payment is limited to a period of 100 days per condition per lifetime. Such a payment level is “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.

Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.

For these reasons, a Part E should also cover home care, in addition to nursing home care; “otherwise it will not be of great value,” she said.

There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”

Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.

It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”

Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.

“It's a pipe dream. Congress is not going to approve it,” he said.

To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.

Until that's accomplished, “I don't see how we'll have funding available,” Dr. Black said.

WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.

In one of the many implementation plans to improve the health care of aging patients, the delegates to the conference called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit that would be available to Americans of all ages.

Because Medicare is going bankrupt, and most monies used to pay for long-term care come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.

Most nursing home beds are long-term care—paid for either by private funding sources or by Medicaid. A few of the beds, however, qualify as “skilled” facilities and are paid for by Medicare Part A.

“In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.

Patients have only a small number of options once their coverage for skilled care has been terminated, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.

Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the Medicare payment is limited to a period of 100 days per condition per lifetime. Such a payment level is “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.

Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.

For these reasons, a Part E should also cover home care, in addition to nursing home care; “otherwise it will not be of great value,” she said.

There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”

Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.

It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”

Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.

“It's a pipe dream. Congress is not going to approve it,” he said.

To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.

Until that's accomplished, “I don't see how we'll have funding available,” Dr. Black said.

Bill Halts 4.4% Cut

Congres's 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 Research 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

Congres's 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 Research 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

Congres's 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 Research 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.

WASHINGTON — Young adults are more likely than are adolescents to be uninsured, attorney Abigail English said during a meeting sponsored by the National Institute for Health Care Management Foundation.

“As you move up the age groups you move into higher and higher rates of uninsurance,” said Ms. English, director of the Center for Adolescent Health and the Law, Chapel Hill, N.C. “Adolescents fare better.”

According to 2004 census data, 8.8 million young adults (31% of 18- to 24-year-olds) were uninsured. By comparison, 3.2 million adolescents (12.5% of 12- to 17-year-olds) were uninsured in the same year. Of those numbers, 2.3 million uninsured young adults aged 18–24 (nearly 45%) were at income levels at or below 100% of the federal poverty level. This is double the percentage of uninsured adolescents aged 12–17 (0.9 million, or 22%) who were at or below the 100% federal poverty level in 2004.

Several factors contribute to young adults being uninsured, Ms. English said. Public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) usually end coverage at age 19 years, and most employer-based coverage for dependents ends at age 18 years unless the dependent is a full-time student.

In addition, the cost of individual policies for those not covered by public health insurance or employer-based programs has been prohibitive, Ms. English said.

States, in recent years, have made efforts to accommodate the insurance needs of young adults, she noted. For example, in 2002 about 40% of the states provided Medicaid coverage for very-low-income adolescents and young adults up to ages 19, 20, or 21.

Young adults leaving foster care have some options available to them to receive Medicaid, such as the Foster Care Independence Act of 1999 Medicaid expansion option, which allows states to provide Medicaid coverage up to age 21 years for former foster youth.

Some insurers have pioneered individual health insurance plans for young adults. For example, Blue Cross of California offers “Tonik,” a health plan with three types of low-cost options for young adults with active lifestyles. A specific perk is the low monthly premiums, which range from $64 to $123. San Francisco is piloting a program that targets low-income people aged 19–24 years who have aged out of public health insurance or have no employer-based coverage.

Congress has missed some opportunities to provide more universal coverage options for young adults and adolescents, Ms. English said. This includes the MediKids Health Insurance Act, which would have offered coverage for all children, adolescents, and young adults from birth to age 23 years, and the Medicaid/SCHIP Optional Coverage for Young Adults Act of 2003, which proposed a state option to offer public coverage to low-income youth up to age 23. Neither bill was enacted.

Utah currently has a mandated benefits law, which requires all employer-based insurance with dependent coverage to offer insurance to unmarried dependents under the age of 26 years. The Federal Employee Health Benefits Program, which currently offers coverage to unmarried dependents under age 22 years, could cover 800,000 more people if the program extended coverage to those who are 23 years old, she said.

But there are obstacles that threaten expansions to insurance coverage for young adults, Ms. English said. This includes the federal deficit and debt, state budget problems, increased health costs for employers, and cuts and restructuring in Medicaid and SCHIP.

Policy options do exist for increasing health care insurance for young adults, Ms. English said. “Advocacy and political [action] will be required to protect existing coverage and expand coverage for these vulnerable young people.”

WASHINGTON — Young adults are more likely than are adolescents to be uninsured, attorney Abigail English said during a meeting sponsored by the National Institute for Health Care Management Foundation.

“As you move up the age groups you move into higher and higher rates of uninsurance,” said Ms. English, director of the Center for Adolescent Health and the Law, Chapel Hill, N.C. “Adolescents fare better.”

According to 2004 census data, 8.8 million young adults (31% of 18- to 24-year-olds) were uninsured. By comparison, 3.2 million adolescents (12.5% of 12- to 17-year-olds) were uninsured in the same year. Of those numbers, 2.3 million uninsured young adults aged 18–24 (nearly 45%) were at income levels at or below 100% of the federal poverty level. This is double the percentage of uninsured adolescents aged 12–17 (0.9 million, or 22%) who were at or below the 100% federal poverty level in 2004.

Several factors contribute to young adults being uninsured, Ms. English said. Public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) usually end coverage at age 19 years, and most employer-based coverage for dependents ends at age 18 years unless the dependent is a full-time student.

In addition, the cost of individual policies for those not covered by public health insurance or employer-based programs has been prohibitive, Ms. English said.

States, in recent years, have made efforts to accommodate the insurance needs of young adults, she noted. For example, in 2002 about 40% of the states provided Medicaid coverage for very-low-income adolescents and young adults up to ages 19, 20, or 21.

Young adults leaving foster care have some options available to them to receive Medicaid, such as the Foster Care Independence Act of 1999 Medicaid expansion option, which allows states to provide Medicaid coverage up to age 21 years for former foster youth.

Some insurers have pioneered individual health insurance plans for young adults. For example, Blue Cross of California offers “Tonik,” a health plan with three types of low-cost options for young adults with active lifestyles. A specific perk is the low monthly premiums, which range from $64 to $123. San Francisco is piloting a program that targets low-income people aged 19–24 years who have aged out of public health insurance or have no employer-based coverage.

Congress has missed some opportunities to provide more universal coverage options for young adults and adolescents, Ms. English said. This includes the MediKids Health Insurance Act, which would have offered coverage for all children, adolescents, and young adults from birth to age 23 years, and the Medicaid/SCHIP Optional Coverage for Young Adults Act of 2003, which proposed a state option to offer public coverage to low-income youth up to age 23. Neither bill was enacted.

Utah currently has a mandated benefits law, which requires all employer-based insurance with dependent coverage to offer insurance to unmarried dependents under the age of 26 years. The Federal Employee Health Benefits Program, which currently offers coverage to unmarried dependents under age 22 years, could cover 800,000 more people if the program extended coverage to those who are 23 years old, she said.

But there are obstacles that threaten expansions to insurance coverage for young adults, Ms. English said. This includes the federal deficit and debt, state budget problems, increased health costs for employers, and cuts and restructuring in Medicaid and SCHIP.

Policy options do exist for increasing health care insurance for young adults, Ms. English said. “Advocacy and political [action] will be required to protect existing coverage and expand coverage for these vulnerable young people.”

WASHINGTON — Young adults are more likely than are adolescents to be uninsured, attorney Abigail English said during a meeting sponsored by the National Institute for Health Care Management Foundation.

“As you move up the age groups you move into higher and higher rates of uninsurance,” said Ms. English, director of the Center for Adolescent Health and the Law, Chapel Hill, N.C. “Adolescents fare better.”

According to 2004 census data, 8.8 million young adults (31% of 18- to 24-year-olds) were uninsured. By comparison, 3.2 million adolescents (12.5% of 12- to 17-year-olds) were uninsured in the same year. Of those numbers, 2.3 million uninsured young adults aged 18–24 (nearly 45%) were at income levels at or below 100% of the federal poverty level. This is double the percentage of uninsured adolescents aged 12–17 (0.9 million, or 22%) who were at or below the 100% federal poverty level in 2004.

Several factors contribute to young adults being uninsured, Ms. English said. Public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) usually end coverage at age 19 years, and most employer-based coverage for dependents ends at age 18 years unless the dependent is a full-time student.

In addition, the cost of individual policies for those not covered by public health insurance or employer-based programs has been prohibitive, Ms. English said.

States, in recent years, have made efforts to accommodate the insurance needs of young adults, she noted. For example, in 2002 about 40% of the states provided Medicaid coverage for very-low-income adolescents and young adults up to ages 19, 20, or 21.

Young adults leaving foster care have some options available to them to receive Medicaid, such as the Foster Care Independence Act of 1999 Medicaid expansion option, which allows states to provide Medicaid coverage up to age 21 years for former foster youth.

Some insurers have pioneered individual health insurance plans for young adults. For example, Blue Cross of California offers “Tonik,” a health plan with three types of low-cost options for young adults with active lifestyles. A specific perk is the low monthly premiums, which range from $64 to $123. San Francisco is piloting a program that targets low-income people aged 19–24 years who have aged out of public health insurance or have no employer-based coverage.

Congress has missed some opportunities to provide more universal coverage options for young adults and adolescents, Ms. English said. This includes the MediKids Health Insurance Act, which would have offered coverage for all children, adolescents, and young adults from birth to age 23 years, and the Medicaid/SCHIP Optional Coverage for Young Adults Act of 2003, which proposed a state option to offer public coverage to low-income youth up to age 23. Neither bill was enacted.

Utah currently has a mandated benefits law, which requires all employer-based insurance with dependent coverage to offer insurance to unmarried dependents under the age of 26 years. The Federal Employee Health Benefits Program, which currently offers coverage to unmarried dependents under age 22 years, could cover 800,000 more people if the program extended coverage to those who are 23 years old, she said.

But there are obstacles that threaten expansions to insurance coverage for young adults, Ms. English said. This includes the federal deficit and debt, state budget problems, increased health costs for employers, and cuts and restructuring in Medicaid and SCHIP.

Policy options do exist for increasing health care insurance for young adults, Ms. English said. “Advocacy and political [action] will be required to protect existing coverage and expand coverage for these vulnerable young people.”

While various organizations have made substantial progress developing health care performance measures, it's time for Congress to establish an entity that can standardize these measures across the health care system, according to a report from the Institute of Medicine.

Such a board should be part of the Department of Health and Human Services, according to the report.

In particular, any participating provider should be required to submit performance data to the board, so that Medicare could use the information for quality improvement activities or as a basis for payment incentives and public reporting, the IOM committee wrote. The committee's efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

A standard nationwide set of measures “would avoid the morass of everyone developing their own, including the government,” Dr. Larry Fields, president of the American Academy of Family Physicians, said in an interview.

But it may not necessarily take a national board to get people to adopt a consensus on measures, he added. The key is to have a set of measures that are accepted as reasonable by these programs. “Other measures can be added as necessary.”

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

The problem is all of these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. As one of the founding members of the Ambulatory Care Quality Alliance (AQA), the ACP was pleased that the starter set proposed by the IOM comprised the AQA's 26 clinical performance measures for the ambulatory care setting.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said the IOM's committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray costs of this type of reporting, Dr. Fields said. “The two must go hand in hand, because this type of reporting costs money.” Otherwise, pay for performance is going to be an extreme burden to physicians—primary care physicians in particular—if they don't have technology to do pay for performance, he said.

Questions remain on whether pay for performance can improve quality, Dr. Fields noted. “Some of the private payers don't buy into that. When they talk about quality, what they really mean is saving money.” For certain diseases, this type of reporting has been effective, “but it's not yet been shown to be effective over a wide series of medical problems.”

If a universal system is instituted, it needs to be pilot tested first, to find out if it can improve quality, he said. “There needs to be a gradual shift from reporting aspects [of clinical measures] to actual quality measures.”

Requested by Congress, the report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.

This Month's Talk Back Question

How important is it to have national, universally accepted clinical performance measures?

While various organizations have made substantial progress developing health care performance measures, it's time for Congress to establish an entity that can standardize these measures across the health care system, according to a report from the Institute of Medicine.

Such a board should be part of the Department of Health and Human Services, according to the report.

In particular, any participating provider should be required to submit performance data to the board, so that Medicare could use the information for quality improvement activities or as a basis for payment incentives and public reporting, the IOM committee wrote. The committee's efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

A standard nationwide set of measures “would avoid the morass of everyone developing their own, including the government,” Dr. Larry Fields, president of the American Academy of Family Physicians, said in an interview.

But it may not necessarily take a national board to get people to adopt a consensus on measures, he added. The key is to have a set of measures that are accepted as reasonable by these programs. “Other measures can be added as necessary.”

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

The problem is all of these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. As one of the founding members of the Ambulatory Care Quality Alliance (AQA), the ACP was pleased that the starter set proposed by the IOM comprised the AQA's 26 clinical performance measures for the ambulatory care setting.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said the IOM's committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray costs of this type of reporting, Dr. Fields said. “The two must go hand in hand, because this type of reporting costs money.” Otherwise, pay for performance is going to be an extreme burden to physicians—primary care physicians in particular—if they don't have technology to do pay for performance, he said.

Questions remain on whether pay for performance can improve quality, Dr. Fields noted. “Some of the private payers don't buy into that. When they talk about quality, what they really mean is saving money.” For certain diseases, this type of reporting has been effective, “but it's not yet been shown to be effective over a wide series of medical problems.”

If a universal system is instituted, it needs to be pilot tested first, to find out if it can improve quality, he said. “There needs to be a gradual shift from reporting aspects [of clinical measures] to actual quality measures.”

Requested by Congress, the report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.

This Month's Talk Back Question

How important is it to have national, universally accepted clinical performance measures?

While various organizations have made substantial progress developing health care performance measures, it's time for Congress to establish an entity that can standardize these measures across the health care system, according to a report from the Institute of Medicine.

Such a board should be part of the Department of Health and Human Services, according to the report.

In particular, any participating provider should be required to submit performance data to the board, so that Medicare could use the information for quality improvement activities or as a basis for payment incentives and public reporting, the IOM committee wrote. The committee's efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

A standard nationwide set of measures “would avoid the morass of everyone developing their own, including the government,” Dr. Larry Fields, president of the American Academy of Family Physicians, said in an interview.

But it may not necessarily take a national board to get people to adopt a consensus on measures, he added. The key is to have a set of measures that are accepted as reasonable by these programs. “Other measures can be added as necessary.”

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

The problem is all of these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. As one of the founding members of the Ambulatory Care Quality Alliance (AQA), the ACP was pleased that the starter set proposed by the IOM comprised the AQA's 26 clinical performance measures for the ambulatory care setting.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said the IOM's committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray costs of this type of reporting, Dr. Fields said. “The two must go hand in hand, because this type of reporting costs money.” Otherwise, pay for performance is going to be an extreme burden to physicians—primary care physicians in particular—if they don't have technology to do pay for performance, he said.

Questions remain on whether pay for performance can improve quality, Dr. Fields noted. “Some of the private payers don't buy into that. When they talk about quality, what they really mean is saving money.” For certain diseases, this type of reporting has been effective, “but it's not yet been shown to be effective over a wide series of medical problems.”

If a universal system is instituted, it needs to be pilot tested first, to find out if it can improve quality, he said. “There needs to be a gradual shift from reporting aspects [of clinical measures] to actual quality measures.”

Requested by Congress, the report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.

This Month's Talk Back Question

How important is it to have national, universally accepted clinical performance measures?

WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.

In one of the many implementation plans to improve the health care of aging patients, the delegates called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit available to Americans of all ages.

Because Medicare is going bankrupt, and most of long-term care monies come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.

Most nursing home beds are long-term care—paid for by either private funding or Medicaid. A few, however, qualify as “skilled” facilities and are paid for by Medicare Part A. “In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions—for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.

Patients have few options once coverage for skilled care stops, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.

Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the payment is limited to 100 days per condition per lifetime, “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.

Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening, would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.

For these reasons, a Part E should also cover home care, in addition to nursing home care, “otherwise it will not be of great value,” she said. There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”

Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.

It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”

Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.

“It's a pipe dream. Congress is not going to approve it,” he said.

To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.

Until that's accomplished, “I don't see how we'll have funding available,” she said.

WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.

In one of the many implementation plans to improve the health care of aging patients, the delegates called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit available to Americans of all ages.

Because Medicare is going bankrupt, and most of long-term care monies come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.

Most nursing home beds are long-term care—paid for by either private funding or Medicaid. A few, however, qualify as “skilled” facilities and are paid for by Medicare Part A. “In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions—for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.

Patients have few options once coverage for skilled care stops, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.

Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the payment is limited to 100 days per condition per lifetime, “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.

Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening, would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.

For these reasons, a Part E should also cover home care, in addition to nursing home care, “otherwise it will not be of great value,” she said. There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”

Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.

It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”

Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.

“It's a pipe dream. Congress is not going to approve it,” he said.

To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.

Until that's accomplished, “I don't see how we'll have funding available,” she said.

WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.

In one of the many implementation plans to improve the health care of aging patients, the delegates called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit available to Americans of all ages.

Because Medicare is going bankrupt, and most of long-term care monies come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.

Most nursing home beds are long-term care—paid for by either private funding or Medicaid. A few, however, qualify as “skilled” facilities and are paid for by Medicare Part A. “In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions—for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.

Patients have few options once coverage for skilled care stops, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.

Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the payment is limited to 100 days per condition per lifetime, “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.

Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening, would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.

For these reasons, a Part E should also cover home care, in addition to nursing home care, “otherwise it will not be of great value,” she said. There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”

Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.

It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”

Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.

“It's a pipe dream. Congress is not going to approve it,” he said.

To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.

Until that's accomplished, “I don't see how we'll have funding available,” she said.

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

“Many other countries are ahead of us,” said Mr. Barrett. For example, in Korea, user-friendly devices such as cell phones that double as glucose monitors are being tested.

Research and development funding is needed to fast-track approval for this type of technology and to bring it to the market, Mr. Barrett said. Trials of this kind are taking place in Europe, but in the United States, licensing, regulatory issues, issues of reimbursement, and liability concerns are holding things up, he said. Physicians, for example, don't use e-mail to communicate with patients because they are not reimbursed for giving advice over the Internet.

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

Those efforts would also 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. “If we can figure out a way to lower those costs to help that small population of people, we'd be much farther ahead.”

A variety of devices capable of monitoring information about diseases could be made available to the three major participants in health care: the individual patient, the caretakers, and family doctors, he said.

“You could turn the health care system around so that all sorts of technology could be used at home to ward off having to go to the hospital,” he said. For example, one could put a pedometer on a patient who has a wireless connection to a PC to encourage him or her to walk 4 miles a day. This would outline the goals and allow the patient to monitor performance and achieve the goals.

By placing monitoring devices in the home, “you could sense if individuals are walking around, opening refrigerators, if they're taking their medication.” The monitoring could be done remotely so that caregivers and family could regularly check on their elderly patients or parents.

Monitoring technology could also help track the condition of a patient with a chronic disease, to see if a patient is worsening. Variables such as mobility, sleep quality, heartbeat, and breathing regularity can be readily tracked using sensors that are available today, he said.

Finally, such technology could be used to improve lifestyles of older patients, said Mr. Barrett. “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 who's at the door.” One solution would be to give such patients a simple, enhanced call monitoring system that shows a picture of the caller or visitor, explains their relationship, and informs the patient when they last spoke.

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

▸ Updating Medicare to emphasize the establishment of cost-effective linkages to home and community-based options through the Aging Network, to promote chronic disease management, and to increase health promotion and disease prevention measures.

▸ Establishing a new title under the Older Americans Act to create aging and disability resource centers as single points of entry in each region across the country to coordinate health and aging programs and ensure access to diverse populations.

▸ Including provisions in the Older Americans Act to foster the development of a virtual electronic database that providers can share.

▸ Amending the Health Insurance Portability and Accountability Act and other “restrictive” regulations to allow for communication between health providers and the Aging Network.

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

“Many other countries are ahead of us,” said Mr. Barrett. For example, in Korea, user-friendly devices such as cell phones that double as glucose monitors are being tested.

Research and development funding is needed to fast-track approval for this type of technology and to bring it to the market, Mr. Barrett said. Trials of this kind are taking place in Europe, but in the United States, licensing, regulatory issues, issues of reimbursement, and liability concerns are holding things up, he said. Physicians, for example, don't use e-mail to communicate with patients because they are not reimbursed for giving advice over the Internet.

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

Those efforts would also 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. “If we can figure out a way to lower those costs to help that small population of people, we'd be much farther ahead.”

A variety of devices capable of monitoring information about diseases could be made available to the three major participants in health care: the individual patient, the caretakers, and family doctors, he said.

“You could turn the health care system around so that all sorts of technology could be used at home to ward off having to go to the hospital,” he said. For example, one could put a pedometer on a patient who has a wireless connection to a PC to encourage him or her to walk 4 miles a day. This would outline the goals and allow the patient to monitor performance and achieve the goals.

By placing monitoring devices in the home, “you could sense if individuals are walking around, opening refrigerators, if they're taking their medication.” The monitoring could be done remotely so that caregivers and family could regularly check on their elderly patients or parents.

Monitoring technology could also help track the condition of a patient with a chronic disease, to see if a patient is worsening. Variables such as mobility, sleep quality, heartbeat, and breathing regularity can be readily tracked using sensors that are available today, he said.

Finally, such technology could be used to improve lifestyles of older patients, said Mr. Barrett. “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 who's at the door.” One solution would be to give such patients a simple, enhanced call monitoring system that shows a picture of the caller or visitor, explains their relationship, and informs the patient when they last spoke.

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

▸ Updating Medicare to emphasize the establishment of cost-effective linkages to home and community-based options through the Aging Network, to promote chronic disease management, and to increase health promotion and disease prevention measures.

▸ Establishing a new title under the Older Americans Act to create aging and disability resource centers as single points of entry in each region across the country to coordinate health and aging programs and ensure access to diverse populations.

▸ Including provisions in the Older Americans Act to foster the development of a virtual electronic database that providers can share.

▸ Amending the Health Insurance Portability and Accountability Act and other “restrictive” regulations to allow for communication between health providers and the Aging Network.

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

“Many other countries are ahead of us,” said Mr. Barrett. For example, in Korea, user-friendly devices such as cell phones that double as glucose monitors are being tested.

Research and development funding is needed to fast-track approval for this type of technology and to bring it to the market, Mr. Barrett said. Trials of this kind are taking place in Europe, but in the United States, licensing, regulatory issues, issues of reimbursement, and liability concerns are holding things up, he said. Physicians, for example, don't use e-mail to communicate with patients because they are not reimbursed for giving advice over the Internet.

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

Those efforts would also 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. “If we can figure out a way to lower those costs to help that small population of people, we'd be much farther ahead.”

A variety of devices capable of monitoring information about diseases could be made available to the three major participants in health care: the individual patient, the caretakers, and family doctors, he said.

“You could turn the health care system around so that all sorts of technology could be used at home to ward off having to go to the hospital,” he said. For example, one could put a pedometer on a patient who has a wireless connection to a PC to encourage him or her to walk 4 miles a day. This would outline the goals and allow the patient to monitor performance and achieve the goals.

By placing monitoring devices in the home, “you could sense if individuals are walking around, opening refrigerators, if they're taking their medication.” The monitoring could be done remotely so that caregivers and family could regularly check on their elderly patients or parents.

Monitoring technology could also help track the condition of a patient with a chronic disease, to see if a patient is worsening. Variables such as mobility, sleep quality, heartbeat, and breathing regularity can be readily tracked using sensors that are available today, he said.

Finally, such technology could be used to improve lifestyles of older patients, said Mr. Barrett. “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 who's at the door.” One solution would be to give such patients a simple, enhanced call monitoring system that shows a picture of the caller or visitor, explains their relationship, and informs the patient when they last spoke.

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

▸ Updating Medicare to emphasize the establishment of cost-effective linkages to home and community-based options through the Aging Network, to promote chronic disease management, and to increase health promotion and disease prevention measures.

▸ Establishing a new title under the Older Americans Act to create aging and disability resource centers as single points of entry in each region across the country to coordinate health and aging programs and ensure access to diverse populations.

▸ Including provisions in the Older Americans Act to foster the development of a virtual electronic database that providers can share.

▸ Amending the Health Insurance Portability and Accountability Act and other “restrictive” regulations to allow for communication between health providers and the Aging Network.

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.”

In Korea, for example, user-friendly devices such as cell phones that double as glucose monitors are being tested. “It's not trialed here. It's not allowed,” he said.

Bringing such technology to market requires research 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. “If we can figure out a way to lower those medical costs to help that small population of people, we'd be much farther ahead.”

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 help prevent disease, entice people to exercise right.” For example, you could put a pedometer on a patient that has a wireless connection to a PC and encourage the patient to walk 4 miles a day, then monitor the patient's progress, 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 that are available today could be usd 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 who's at the door.”

A potential solution is to give elderly 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 and more broadband, the connectivity between homes, offices, and individuals, becomes easier and more useful.”

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, charged to coordinate health and aging programs and ensure access to diverse populations.

▸ 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.”

In Korea, for example, user-friendly devices such as cell phones that double as glucose monitors are being tested. “It's not trialed here. It's not allowed,” he said.

Bringing such technology to market requires research 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. “If we can figure out a way to lower those medical costs to help that small population of people, we'd be much farther ahead.”

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 help prevent disease, entice people to exercise right.” For example, you could put a pedometer on a patient that has a wireless connection to a PC and encourage the patient to walk 4 miles a day, then monitor the patient's progress, 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 that are available today could be usd 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 who's at the door.”

A potential solution is to give elderly 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 and more broadband, the connectivity between homes, offices, and individuals, becomes easier and more useful.”

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, charged to coordinate health and aging programs and ensure access to diverse populations.

▸ 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.”

In Korea, for example, user-friendly devices such as cell phones that double as glucose monitors are being tested. “It's not trialed here. It's not allowed,” he said.

Bringing such technology to market requires research 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. “If we can figure out a way to lower those medical costs to help that small population of people, we'd be much farther ahead.”

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 help prevent disease, entice people to exercise right.” For example, you could put a pedometer on a patient that has a wireless connection to a PC and encourage the patient to walk 4 miles a day, then monitor the patient's progress, 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 that are available today could be usd 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 who's at the door.”

A potential solution is to give elderly 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 and more broadband, the connectivity between homes, offices, and individuals, becomes easier and more useful.”

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, charged to coordinate health and aging programs and ensure access to diverse populations.

▸ 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.

Congress needs to establish an entity within the Department of Health and Human Services that can standardize health care performance measures across the health care system, according to a report from the Institute of Medicine.

Participating providers should be required to submit performance data to the board, so that Medicare can use the information for quality improvement activities or as a basis for payment incentives and public reporting, wrote the IOM committee, whose efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

Yet these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said the IOM's committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for health care improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund.

This amounts to less than 1/10 of 1% of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray the costs of reporting, especially with regard to technology needed to do pay for performance.

Further, “quality” translates to “saving money” for some private payers. Also, pay for performance has not yet been shown to be effective over a wide range of disorders.

Congress needs to establish an entity within the Department of Health and Human Services that can standardize health care performance measures across the health care system, according to a report from the Institute of Medicine.

Participating providers should be required to submit performance data to the board, so that Medicare can use the information for quality improvement activities or as a basis for payment incentives and public reporting, wrote the IOM committee, whose efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

Yet these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said the IOM's committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for health care improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund.

This amounts to less than 1/10 of 1% of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray the costs of reporting, especially with regard to technology needed to do pay for performance.

Further, “quality” translates to “saving money” for some private payers. Also, pay for performance has not yet been shown to be effective over a wide range of disorders.

Congress needs to establish an entity within the Department of Health and Human Services that can standardize health care performance measures across the health care system, according to a report from the Institute of Medicine.

Participating providers should be required to submit performance data to the board, so that Medicare can use the information for quality improvement activities or as a basis for payment incentives and public reporting, wrote the IOM committee, whose efforts were mandated by Congress and sponsored by the HHS.

In a statement, Dr. C. Anderson Hedberg, president of the American College of Physicians, praised the IOM's intention to establish a centralized organizing structure.

“This may be one way to set clear quality goals, coordinate performance measurement efforts, support fair comparisons of cost and quality, and ensure stable funding for organizations involved in performance measurement,” Dr. Hedberg said.

Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care. Examples include regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.

Yet these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. “But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well coordinated.”

As an initial step toward achieving a universally accepted set of measures, the report recommended the adoption of an evidence-based “starter set” of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers.

The board should also guide development in areas that are currently lacking in performance measures, such as efficiency, equity, and patient-centered care, the committee noted.

“One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations,” said the IOM's committee chair Steven Schroeder, Ph.D., professor of health and health care, University of California, San Francisco. Leadership at the federal level is needed to ensure that performance measures achieve national goals for health care improvement, he said.

The committee recommended that Congress should authorize $100 million to $200 million in annual funding for the national board from the Medicare Trust Fund.

This amounts to less than 1/10 of 1% of annual Medicare expenditures.

What's lacking in the report is a recommendation for Congress and the private payers to put money into the system to help defray the costs of reporting, especially with regard to technology needed to do pay for performance.

Further, “quality” translates to “saving money” for some private payers. Also, pay for performance has not yet been shown to be effective over a wide range of disorders.

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). “The median price difference for the top 20 drugs was 48.2%. This means that, 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 Peter Ashkenaz, deputy director of public affairs for the Centers for Medicare and Medicaid Services, Families USA just rehashed the 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. Also, the Government Accountability Office looked at using the VA model for the Medicare Part D drug benefit, “and found that doing so would raise prices in the commercial market and thus in Medicare.”

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—a private marketplace system—to a government-mandated price control system such as the VA. One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, he said.

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.

“We agree with that conclusion,” Mr. Trewhitt 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). “The median price difference for the top 20 drugs was 48.2%. This means that, 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 Peter Ashkenaz, deputy director of public affairs for the Centers for Medicare and Medicaid Services, Families USA just rehashed the 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. Also, the Government Accountability Office looked at using the VA model for the Medicare Part D drug benefit, “and found that doing so would raise prices in the commercial market and thus in Medicare.”

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—a private marketplace system—to a government-mandated price control system such as the VA. One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, he said.

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.

“We agree with that conclusion,” Mr. Trewhitt 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). “The median price difference for the top 20 drugs was 48.2%. This means that, 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 Peter Ashkenaz, deputy director of public affairs for the Centers for Medicare and Medicaid Services, Families USA just rehashed the 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. Also, the Government Accountability Office looked at using the VA model for the Medicare Part D drug benefit, “and found that doing so would raise prices in the commercial market and thus in Medicare.”

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—a private marketplace system—to a government-mandated price control system such as the VA. One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, he said.

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.

“We agree with that conclusion,” Mr. Trewhitt said.