Jennifer Lubell

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.

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 be spearheading 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. Eight percent 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 about $7.7 billion in total health care costs every year in Pennsylvania and 11,500 deaths in the state each year. It is also the leading cause of new blindness, end-stage renal disease, and nontraumatic amputations in the state.

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 already 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 UPMC'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 be monitoring 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 ultimate goal is to create a registry to monitor and support the needs of people affected by diabetes.

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—what they feel would improve the quality of care in diabetes patients.”

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

“We are excited about the establishment of the diabetes clinic and the positive impact this overall program will have on people with diabetes and people at risk of getting diabetes,” said Scott Becker, chief executive officer of the Conemaugh Health System. “With the right education, management, and care, people can lessen the effects of this potentially devastating disease and in many cases prevent it from happening in the first place.”

Experts estimate that 1.5 million new cases are diagnosed each year in the United States. Recent statistics from the CDC indicate that the incidence of diabetes has risen more than 14% in the last 2 years.

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 be spearheading 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. Eight percent 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 about $7.7 billion in total health care costs every year in Pennsylvania and 11,500 deaths in the state each year. It is also the leading cause of new blindness, end-stage renal disease, and nontraumatic amputations in the state.

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 already 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 UPMC'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 be monitoring 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 ultimate goal is to create a registry to monitor and support the needs of people affected by diabetes.

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—what they feel would improve the quality of care in diabetes patients.”

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

“We are excited about the establishment of the diabetes clinic and the positive impact this overall program will have on people with diabetes and people at risk of getting diabetes,” said Scott Becker, chief executive officer of the Conemaugh Health System. “With the right education, management, and care, people can lessen the effects of this potentially devastating disease and in many cases prevent it from happening in the first place.”

Experts estimate that 1.5 million new cases are diagnosed each year in the United States. Recent statistics from the CDC indicate that the incidence of diabetes has risen more than 14% in the last 2 years.

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 be spearheading 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. Eight percent 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 about $7.7 billion in total health care costs every year in Pennsylvania and 11,500 deaths in the state each year. It is also the leading cause of new blindness, end-stage renal disease, and nontraumatic amputations in the state.

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 already 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 UPMC'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 be monitoring 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 ultimate goal is to create a registry to monitor and support the needs of people affected by diabetes.

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—what they feel would improve the quality of care in diabetes patients.”

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

“We are excited about the establishment of the diabetes clinic and the positive impact this overall program will have on people with diabetes and people at risk of getting diabetes,” said Scott Becker, chief executive officer of the Conemaugh Health System. “With the right education, management, and care, people can lessen the effects of this potentially devastating disease and in many cases prevent it from happening in the first place.”

Experts estimate that 1.5 million new cases are diagnosed each year in the United States. Recent statistics from the CDC indicate that the incidence of diabetes has risen more than 14% in the last 2 years.

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.

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will only have 16 measures to choose to report on instead of 36. In addition, CMS is working to revise the program's reporting system to provide more options for physicians.

Primary care groups particularly opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes, or G-codes—a system most physicians do not use. The agency now is working with the American Medical Association to add the option to use CPT II codes as well as G-codes, CMS spokesman Peter Ashkenaz said in an interview.

“This will provide clinicians with the flexibility of utilizing either G-codes or CPT II codes” for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients. In addition, they also include surgical measures such as pre-operative β-blockers for patients with isolated coronary artery bypass grafts.

The 20 measures removed from the original set won't necessarily be thrown out, however. In a fact sheet, CMS said it intended to pursue further development of these remaining measures, as well as other measures that were suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, said that he thought the revisions were “critically important.”

As reporting and pay-for-performance programs become more widespread, “uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program,” he said.

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet “this is still a voluntary program with no immediate benefit to patients or physicians.”

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians “will be even less able to comply with any reporting, voluntary or not,” Dr. Fields said. Without a positive incentive to participate, “I expect that CMs' announcement will be met with indifference,” he added.

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) that was held before the changes were announced, several physicians said that the program would be a hassle for them to implement.

“I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers” and to CMS, said PPAC chair Dr. Ronald Castellanos. “I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program.”

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will only have 16 measures to choose to report on instead of 36. In addition, CMS is working to revise the program's reporting system to provide more options for physicians.

Primary care groups particularly opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes, or G-codes—a system most physicians do not use. The agency now is working with the American Medical Association to add the option to use CPT II codes as well as G-codes, CMS spokesman Peter Ashkenaz said in an interview.

“This will provide clinicians with the flexibility of utilizing either G-codes or CPT II codes” for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients. In addition, they also include surgical measures such as pre-operative β-blockers for patients with isolated coronary artery bypass grafts.

The 20 measures removed from the original set won't necessarily be thrown out, however. In a fact sheet, CMS said it intended to pursue further development of these remaining measures, as well as other measures that were suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, said that he thought the revisions were “critically important.”

As reporting and pay-for-performance programs become more widespread, “uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program,” he said.

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet “this is still a voluntary program with no immediate benefit to patients or physicians.”

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians “will be even less able to comply with any reporting, voluntary or not,” Dr. Fields said. Without a positive incentive to participate, “I expect that CMs' announcement will be met with indifference,” he added.

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) that was held before the changes were announced, several physicians said that the program would be a hassle for them to implement.

“I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers” and to CMS, said PPAC chair Dr. Ronald Castellanos. “I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program.”

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Medicare is attempting to simplify the requirements of a new voluntary reporting system that physicians claim is too burdensome.

Under the latest revision from the Centers for Medicare and Medicaid Services, physicians participating in the Physician Voluntary Reporting Program (PVRP) will only have 16 measures to choose to report on instead of 36. In addition, CMS is working to revise the program's reporting system to provide more options for physicians.

Primary care groups particularly opposed CMs' decision to collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes, or G-codes—a system most physicians do not use. The agency now is working with the American Medical Association to add the option to use CPT II codes as well as G-codes, CMS spokesman Peter Ashkenaz said in an interview.

“This will provide clinicians with the flexibility of utilizing either G-codes or CPT II codes” for the program, he said.

The 16 starter measures address a wide spectrum of clinical care, including administration of aspirin at arrival for acute myocardial infarction; control of lipids, blood pressure, and glycosylated hemoglobin for patients with diabetes; and assessment of fall risk in elderly patients. In addition, they also include surgical measures such as pre-operative β-blockers for patients with isolated coronary artery bypass grafts.

The 20 measures removed from the original set won't necessarily be thrown out, however. In a fact sheet, CMS said it intended to pursue further development of these remaining measures, as well as other measures that were suggested by physician groups.

Reactions to the changes varied. Dr. C. Anderson Hedberg, president of the American College of Physicians, said that he thought the revisions were “critically important.”

As reporting and pay-for-performance programs become more widespread, “uniformity and a realistic set of measures that don't create huge administrative reporting burdens are essential for physician acceptance and the success of any quality improvement and measurement program,” he said.

Any simplification of reporting is welcome, Dr. Larry Fields, president of the American Academy of Family Physicians, noted in an interview. Yet “this is still a voluntary program with no immediate benefit to patients or physicians.”

In light of the 4.4% cut in physician pay that went into effect Jan. 1, physicians “will be even less able to comply with any reporting, voluntary or not,” Dr. Fields said. Without a positive incentive to participate, “I expect that CMs' announcement will be met with indifference,” he added.

At a meeting of Medicare's Practicing Physicians Advisory Council (PPAC) that was held before the changes were announced, several physicians said that the program would be a hassle for them to implement.

“I'm going to have to redesign my workflow between the clinical and office buildings, change the clearinghouse software, and change the software I use to send things to other providers” and to CMS, said PPAC chair Dr. Ronald Castellanos. “I had [a company] give me an estimate, and it's about $15,000. That's a lot of money to do a voluntary program.”

In return for submitting data to the program, physicians get a report telling them how well they did on each measure within their own patient population, as well as a comparison of their performance with that of other physicians regionally and nationally. Although physicians do not need to register with CMS to submit data, they must register to receive the reports.

Youth Health Statistics

Health trends among adolescents and young adults appear to be improving, Claire Brindis, Dr.P.H., codirector of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, reported during a National Institute for Health Care Management conference. Trends indicate a decrease in mortality rates during the past decade. For example, among 15− to 24-year-olds, motor vehicle accident mortality decreased from 41/100,000 in 1981 to 28/100,000 in 2002, and homicide rates decreased from 14/100,000 in 1981 to 13/100,000 in 2002. However, overall mortality rates remain high among adolescents (68/100,000) and young adults (95/100,000), she said. Pregnancy, birth, and abortion rates decreased over the past decade among adolescents and young adults, although sexual activity remains prevalent among teenagers. In 2003, 45% of high school girls reported that they had had sexual intercourse, 11% with four or more partners. Among 18− to 24-year-olds in 2003, about one-fourth were overweight and one-eighth were obese. The good news is that most in this age category are exercising: In 2003, almost 60% had engaged in vigorous physical activity.

Drug Labeling Milestone

The antiepileptic drug Trileptal has become the 100th medicine to have new information for children and teenagers included in its labeling, the Food and Drug Administration (FDA) announced. The Federal Food, Drug, and Cosmetic Act (as amended by the FDA Modernization Act of 1997 and the 2002 Best Pharmaceuticals for Children Act) offers incentives to companies that “perform research to determine the safety, efficacy, dosing, and unique risks associated with medications for children, based on the same level of scientific evidence required for adults,” according to an FDA press release. Under this labeling initiative, pediatricians discovered that they weren't giving enough medicine to be effective in some instances, said Dr. Eileen M. Ouellette, president of the American Academy of Pediatrics.

Teen Pregnancy Legislation

The latest effort to prevent teen pregnancy is new legislation, introduced in the U.S. House of Representatives last December, which would create grants to develop programs aimed at delaying sexual activity and helping parents communicate with teens about sexuality. The Teen Pregnancy Prevention, Responsibility, and Opportunity Act (H.R. 4644) was introduced by Rep. Robert Menendez (D-N.J.). If enacted, the legislation would provide funds to local educational agencies, state and local public health agencies, and nonprofit groups to educate sexually active teens and those at risk of becoming sexually active about the responsibilities of parenting. The legislation was referred to the House Committee on Energy and Commerce and the Committee on Education and the Workforce.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in spending on prescription drugs has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, less than in the past few years. In a statement, the Pharmaceutical Care Management Association attributed the slowdown to increased reliance on generic drugs and mail-service pharmacies. Spending for physician services grew 9.0% in 2004, similar to the 8.6% increase in 2003. Hospital spending, by comparison, continues to accelerate, accounting for 28% of the growth in personal health spending between 1997 and 2000 and increasing to 38% by 2002–2004.

Evidence-Based Research

More cost-effectiveness studies are needed to evaluate public health interventions, Barbara K. Rimer, Dr.P.H., a member of the Task Force on Community Preventive Services, said at an audioconference sponsored by AcademyHealth, Washington. The task force is an independent, nonfederal group that was convened by the Department of Health and Human Services and is supported by staff from the Centers for Disease Control and Prevention and other public and private partners. Cost information is especially important as groups have to make decisions about scarce resources, she said. There are a number of areas where researchers can build on existing evidence-based public health research, said Dr. Rimer, who is also the dean of the school of public health at the University of North Carolina in Chapel Hill. There are also unanswered questions about the best duration for proven approaches such as disease screening, she said.

Youth Health Statistics

Health trends among adolescents and young adults appear to be improving, Claire Brindis, Dr.P.H., codirector of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, reported during a National Institute for Health Care Management conference. Trends indicate a decrease in mortality rates during the past decade. For example, among 15− to 24-year-olds, motor vehicle accident mortality decreased from 41/100,000 in 1981 to 28/100,000 in 2002, and homicide rates decreased from 14/100,000 in 1981 to 13/100,000 in 2002. However, overall mortality rates remain high among adolescents (68/100,000) and young adults (95/100,000), she said. Pregnancy, birth, and abortion rates decreased over the past decade among adolescents and young adults, although sexual activity remains prevalent among teenagers. In 2003, 45% of high school girls reported that they had had sexual intercourse, 11% with four or more partners. Among 18− to 24-year-olds in 2003, about one-fourth were overweight and one-eighth were obese. The good news is that most in this age category are exercising: In 2003, almost 60% had engaged in vigorous physical activity.

Drug Labeling Milestone

The antiepileptic drug Trileptal has become the 100th medicine to have new information for children and teenagers included in its labeling, the Food and Drug Administration (FDA) announced. The Federal Food, Drug, and Cosmetic Act (as amended by the FDA Modernization Act of 1997 and the 2002 Best Pharmaceuticals for Children Act) offers incentives to companies that “perform research to determine the safety, efficacy, dosing, and unique risks associated with medications for children, based on the same level of scientific evidence required for adults,” according to an FDA press release. Under this labeling initiative, pediatricians discovered that they weren't giving enough medicine to be effective in some instances, said Dr. Eileen M. Ouellette, president of the American Academy of Pediatrics.

Teen Pregnancy Legislation

The latest effort to prevent teen pregnancy is new legislation, introduced in the U.S. House of Representatives last December, which would create grants to develop programs aimed at delaying sexual activity and helping parents communicate with teens about sexuality. The Teen Pregnancy Prevention, Responsibility, and Opportunity Act (H.R. 4644) was introduced by Rep. Robert Menendez (D-N.J.). If enacted, the legislation would provide funds to local educational agencies, state and local public health agencies, and nonprofit groups to educate sexually active teens and those at risk of becoming sexually active about the responsibilities of parenting. The legislation was referred to the House Committee on Energy and Commerce and the Committee on Education and the Workforce.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in spending on prescription drugs has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, less than in the past few years. In a statement, the Pharmaceutical Care Management Association attributed the slowdown to increased reliance on generic drugs and mail-service pharmacies. Spending for physician services grew 9.0% in 2004, similar to the 8.6% increase in 2003. Hospital spending, by comparison, continues to accelerate, accounting for 28% of the growth in personal health spending between 1997 and 2000 and increasing to 38% by 2002–2004.

Evidence-Based Research

More cost-effectiveness studies are needed to evaluate public health interventions, Barbara K. Rimer, Dr.P.H., a member of the Task Force on Community Preventive Services, said at an audioconference sponsored by AcademyHealth, Washington. The task force is an independent, nonfederal group that was convened by the Department of Health and Human Services and is supported by staff from the Centers for Disease Control and Prevention and other public and private partners. Cost information is especially important as groups have to make decisions about scarce resources, she said. There are a number of areas where researchers can build on existing evidence-based public health research, said Dr. Rimer, who is also the dean of the school of public health at the University of North Carolina in Chapel Hill. There are also unanswered questions about the best duration for proven approaches such as disease screening, she said.

Youth Health Statistics

Health trends among adolescents and young adults appear to be improving, Claire Brindis, Dr.P.H., codirector of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, reported during a National Institute for Health Care Management conference. Trends indicate a decrease in mortality rates during the past decade. For example, among 15− to 24-year-olds, motor vehicle accident mortality decreased from 41/100,000 in 1981 to 28/100,000 in 2002, and homicide rates decreased from 14/100,000 in 1981 to 13/100,000 in 2002. However, overall mortality rates remain high among adolescents (68/100,000) and young adults (95/100,000), she said. Pregnancy, birth, and abortion rates decreased over the past decade among adolescents and young adults, although sexual activity remains prevalent among teenagers. In 2003, 45% of high school girls reported that they had had sexual intercourse, 11% with four or more partners. Among 18− to 24-year-olds in 2003, about one-fourth were overweight and one-eighth were obese. The good news is that most in this age category are exercising: In 2003, almost 60% had engaged in vigorous physical activity.

Drug Labeling Milestone

The antiepileptic drug Trileptal has become the 100th medicine to have new information for children and teenagers included in its labeling, the Food and Drug Administration (FDA) announced. The Federal Food, Drug, and Cosmetic Act (as amended by the FDA Modernization Act of 1997 and the 2002 Best Pharmaceuticals for Children Act) offers incentives to companies that “perform research to determine the safety, efficacy, dosing, and unique risks associated with medications for children, based on the same level of scientific evidence required for adults,” according to an FDA press release. Under this labeling initiative, pediatricians discovered that they weren't giving enough medicine to be effective in some instances, said Dr. Eileen M. Ouellette, president of the American Academy of Pediatrics.

Teen Pregnancy Legislation

The latest effort to prevent teen pregnancy is new legislation, introduced in the U.S. House of Representatives last December, which would create grants to develop programs aimed at delaying sexual activity and helping parents communicate with teens about sexuality. The Teen Pregnancy Prevention, Responsibility, and Opportunity Act (H.R. 4644) was introduced by Rep. Robert Menendez (D-N.J.). If enacted, the legislation would provide funds to local educational agencies, state and local public health agencies, and nonprofit groups to educate sexually active teens and those at risk of becoming sexually active about the responsibilities of parenting. The legislation was referred to the House Committee on Energy and Commerce and the Committee on Education and the Workforce.

Health Care Spending 2004

Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with the 8.2% growth rate in 2003 and 9.1% growth rate in 2002. Slower growth in spending on prescription drugs has contributed to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, less than in the past few years. In a statement, the Pharmaceutical Care Management Association attributed the slowdown to increased reliance on generic drugs and mail-service pharmacies. Spending for physician services grew 9.0% in 2004, similar to the 8.6% increase in 2003. Hospital spending, by comparison, continues to accelerate, accounting for 28% of the growth in personal health spending between 1997 and 2000 and increasing to 38% by 2002–2004.

Evidence-Based Research

More cost-effectiveness studies are needed to evaluate public health interventions, Barbara K. Rimer, Dr.P.H., a member of the Task Force on Community Preventive Services, said at an audioconference sponsored by AcademyHealth, Washington. The task force is an independent, nonfederal group that was convened by the Department of Health and Human Services and is supported by staff from the Centers for Disease Control and Prevention and other public and private partners. Cost information is especially important as groups have to make decisions about scarce resources, she said. There are a number of areas where researchers can build on existing evidence-based public health research, said Dr. Rimer, who is also the dean of the school of public health at the University of North Carolina in Chapel Hill. There are also unanswered questions about the best duration for proven approaches such as disease screening, she said.

The Centers for Disease Control and Prevention has added Merck & Co.'s quadrivalent measles-mumps-rubella-varicella vaccine, Proquad, to its Vaccines for Children contract.

The approval will help set a standard of care for the vaccine (MMRV), Dr. Michael Brady, a member of the American Academy of Pediatrics' Committee on Infectious Diseases, said in an interview.

“Getting the federal government to acknowledge the value of a new vaccine means a greater possibility of getting it to all children who would benefit,” he said, adding that approval by the Vaccines for Children program “makes it easier to get coverage through commercial payers.”

VFC provides free vaccines to Medicaid beneficiaries, the uninsured, and other children with limited health insurance coverage. The CDC's Advisory Committee for Immunization Practices recommended last October that MMRV be added to the Vaccines for Children program.

“With Proquad now available through the [Vaccines for Children] program, more children are able to gain access to a vaccine that helps protect against four serious diseases,” said Dr. Mark Feinberg, vice president for policy, public health, and medical affairs for Merck Vaccines Division, in a statement.

Dr. Sarah S. Long, who also serves on the AAP Committee on Infectious Diseases, anticipates that the academy may recommend a second dose of the varicella vaccine, now that the MMRV has been accepted into the Vaccines for Children program.

The AAP supports combination vaccines and is confident of the safety and immunogenicity of the MMRV, she said in an interview. The academy currently recommends that children get immunized twice for measles-mumps-rubella (MMR), but no such recommendation exists for varicella.

“We're still looking at data to see if it's warranted to give a second dose of varicella vaccine as well. But that's not going to be practical unless you have a vaccine with all four viruses. Proquad will be able to satisfy that recommendation in a single injection,” she said.

One injection means physicians will have more of an incentive to give a second dose of varicella, Dr. Brady said. “It would make a big difference in trying to increase immunity to varicella.”

The MMRV was approved last September by the Food and Drug Administration for simultaneous vaccination against measles, mumps, rubella and varicella in children aged 12 months to 12 years. The vaccine combined two existing Merck vaccines: MMR and varicella (Varivax).

The vaccine is costly however, and the concern is whether the federal government will be able to afford it under this free program, Dr. Long said. Cost for the MMRV under the Vaccines for Children program is a bit more than purchasing the old vaccines separately—but not by much, a CDC spokeswoman said in an interview.

The federal government will be paying $74.85/dose for the new combination vaccine, she said. By comparison, it currently pays $16.67 for MMR and $52.25 for varicella on its federal contract, which adds up to $68.92, about $6 less than the combination vaccine. For now, the CDC seems to think it's worth the extra cost. The MMRV “is beneficial in that the child receives one injection instead of two,” the spokeswoman said.

The Centers for Disease Control and Prevention has added Merck & Co.'s quadrivalent measles-mumps-rubella-varicella vaccine, Proquad, to its Vaccines for Children contract.

The approval will help set a standard of care for the vaccine (MMRV), Dr. Michael Brady, a member of the American Academy of Pediatrics' Committee on Infectious Diseases, said in an interview.

“Getting the federal government to acknowledge the value of a new vaccine means a greater possibility of getting it to all children who would benefit,” he said, adding that approval by the Vaccines for Children program “makes it easier to get coverage through commercial payers.”

VFC provides free vaccines to Medicaid beneficiaries, the uninsured, and other children with limited health insurance coverage. The CDC's Advisory Committee for Immunization Practices recommended last October that MMRV be added to the Vaccines for Children program.

“With Proquad now available through the [Vaccines for Children] program, more children are able to gain access to a vaccine that helps protect against four serious diseases,” said Dr. Mark Feinberg, vice president for policy, public health, and medical affairs for Merck Vaccines Division, in a statement.

Dr. Sarah S. Long, who also serves on the AAP Committee on Infectious Diseases, anticipates that the academy may recommend a second dose of the varicella vaccine, now that the MMRV has been accepted into the Vaccines for Children program.

The AAP supports combination vaccines and is confident of the safety and immunogenicity of the MMRV, she said in an interview. The academy currently recommends that children get immunized twice for measles-mumps-rubella (MMR), but no such recommendation exists for varicella.

“We're still looking at data to see if it's warranted to give a second dose of varicella vaccine as well. But that's not going to be practical unless you have a vaccine with all four viruses. Proquad will be able to satisfy that recommendation in a single injection,” she said.

One injection means physicians will have more of an incentive to give a second dose of varicella, Dr. Brady said. “It would make a big difference in trying to increase immunity to varicella.”

The MMRV was approved last September by the Food and Drug Administration for simultaneous vaccination against measles, mumps, rubella and varicella in children aged 12 months to 12 years. The vaccine combined two existing Merck vaccines: MMR and varicella (Varivax).

The vaccine is costly however, and the concern is whether the federal government will be able to afford it under this free program, Dr. Long said. Cost for the MMRV under the Vaccines for Children program is a bit more than purchasing the old vaccines separately—but not by much, a CDC spokeswoman said in an interview.

The federal government will be paying $74.85/dose for the new combination vaccine, she said. By comparison, it currently pays $16.67 for MMR and $52.25 for varicella on its federal contract, which adds up to $68.92, about $6 less than the combination vaccine. For now, the CDC seems to think it's worth the extra cost. The MMRV “is beneficial in that the child receives one injection instead of two,” the spokeswoman said.

The Centers for Disease Control and Prevention has added Merck & Co.'s quadrivalent measles-mumps-rubella-varicella vaccine, Proquad, to its Vaccines for Children contract.

The approval will help set a standard of care for the vaccine (MMRV), Dr. Michael Brady, a member of the American Academy of Pediatrics' Committee on Infectious Diseases, said in an interview.

“Getting the federal government to acknowledge the value of a new vaccine means a greater possibility of getting it to all children who would benefit,” he said, adding that approval by the Vaccines for Children program “makes it easier to get coverage through commercial payers.”

VFC provides free vaccines to Medicaid beneficiaries, the uninsured, and other children with limited health insurance coverage. The CDC's Advisory Committee for Immunization Practices recommended last October that MMRV be added to the Vaccines for Children program.

“With Proquad now available through the [Vaccines for Children] program, more children are able to gain access to a vaccine that helps protect against four serious diseases,” said Dr. Mark Feinberg, vice president for policy, public health, and medical affairs for Merck Vaccines Division, in a statement.

Dr. Sarah S. Long, who also serves on the AAP Committee on Infectious Diseases, anticipates that the academy may recommend a second dose of the varicella vaccine, now that the MMRV has been accepted into the Vaccines for Children program.

The AAP supports combination vaccines and is confident of the safety and immunogenicity of the MMRV, she said in an interview. The academy currently recommends that children get immunized twice for measles-mumps-rubella (MMR), but no such recommendation exists for varicella.

“We're still looking at data to see if it's warranted to give a second dose of varicella vaccine as well. But that's not going to be practical unless you have a vaccine with all four viruses. Proquad will be able to satisfy that recommendation in a single injection,” she said.

One injection means physicians will have more of an incentive to give a second dose of varicella, Dr. Brady said. “It would make a big difference in trying to increase immunity to varicella.”

The MMRV was approved last September by the Food and Drug Administration for simultaneous vaccination against measles, mumps, rubella and varicella in children aged 12 months to 12 years. The vaccine combined two existing Merck vaccines: MMR and varicella (Varivax).

The vaccine is costly however, and the concern is whether the federal government will be able to afford it under this free program, Dr. Long said. Cost for the MMRV under the Vaccines for Children program is a bit more than purchasing the old vaccines separately—but not by much, a CDC spokeswoman said in an interview.

The federal government will be paying $74.85/dose for the new combination vaccine, she said. By comparison, it currently pays $16.67 for MMR and $52.25 for varicella on its federal contract, which adds up to $68.92, about $6 less than the combination vaccine. For now, the CDC seems to think it's worth the extra cost. The MMRV “is beneficial in that the child receives one injection instead of two,” the spokeswoman said.