Jennifer Lubell

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

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

The University of Pittsburgh Diabetes Institute (UPDI) will 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.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policy makers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC president Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended on Jan. 23. CMS plans to issue a final decision within 60 days following the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study that analyzed the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to determine patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered on May 20 and Oct. 11, 2005, and for trials registered during the interval between these two dates. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policy makers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC president Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended on Jan. 23. CMS plans to issue a final decision within 60 days following the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study that analyzed the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to determine patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered on May 20 and Oct. 11, 2005, and for trials registered during the interval between these two dates. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policy makers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC president Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended on Jan. 23. CMS plans to issue a final decision within 60 days following the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study that analyzed the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to determine patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered on May 20 and Oct. 11, 2005, and for trials registered during the interval between these two dates. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

WASHINGTON — Delegates to the 2005 White House Conference on Aging made it clear that they weren't happy with Medicare's new prescription drug benefit.

Challenging administration claims that the benefit's tools were accessible and easy to use, delegates recommended that Part D be simplified to create one prescription drug program for beneficiaries.

The Medicare drug benefit was one of 50 resolutions chosen as the “top” issues on aging by the 1,200 delegates at the meeting. Delegates were then charged with drafting implementation strategies suggesting how these resolutions might be put into action. Nearly half of the resolutions addressed health care issues, including Medicare and Medicaid, long-term care, and training health care personnel.

The new drug benefit is “clearly in line” with the principles of the White House Conference on Aging to promote the dignity, health, and economic security for current and future generations, Mike Leavitt, secretary of the Department of Health and Human Services, said in his address to the delegates. “The benefit will be of immediate help to older Americans now,” plus the next group of rapidly expanding aging Americans, the baby boomers, said Mr. Leavitt, who said he helped his own parents enroll in the drug benefit.

His remarks were a hard sell for the delegates, which included governors, members of Congress, and representatives from the National Congress of American Indians, national organizations, academia, business, and industry.

The main source of frustration has been the complexity of the plan, said Ellen Camerieri, a delegate from the Bronx, N.Y., and executive director of Riverdale Senior Services Inc. “Secretary Leavitt talked about how easy it is to sign up … and to get your family together to do it. But what if [you're an aging patient] and you don't have a family?”

In her own community, she said, there's a sense of “confusion and paralysis” over the drug benefit.

Opting into a new drug program under the benefit can be daunting, especially if a beneficiary has a Medigap policy that's not a union or government pension, “but a policy to help them bridge the gap between what Medicare covers and what the actual costs are. You have a vast number of seniors who have had a relationship with a policy, and now must decide whether to continue in the new version of that policy under Part D, or go to the [numerous] other odd policies [offered] within their state.”

Dr. Mark McClellan, CMS administrator, assured delegates that the agency is taking steps to ensure that there is not any lapse in drug coverage. “For example, we have worked closely with states over the past year to obtain very high match rates between their enrollment information and Part D enrollment—match rates well over 99%.”

The agency also has developed a process for a “point of sale” solution, if the beneficiary somehow has not been automatically enrolled in Part D. In addition, multiple efforts are taking place to provide counseling and assistance to beneficiaries, he said.

Seniors “can ask” before they sign up for the plan whether all of the drugs they are taking now are covered, and the agency has tools so that patients can find the lowest cost for a particular drug, Dr. McClellan said.

Yet, his praise of the new 800-MEDICARE customer service line evoked jeers from some delegates. “He claims that every call was answered right away,” said Steve Kofahl, a delegate from Seattle. But when one of Mr. Kofahl's employees tried to call the number to get information, that person “could not get through.”

The problem is a patient has to be able to predict the future to know which plan he or she should sign up for, Ms. Camerieri said. Certain plans under the new benefit cover certain drugs and not others “and you might not be on a medication you'll be needing in 6 months” when you sign up, she said. There's a limited ability to change your plan without some penalty, she said.

Many in the health care field would like to think that Part D is for the people, Ms. Camerieri said. “But the underlying suspicion is that it was drafted to benefit the pharmaceutical and insurance companies who are the people putting together these plans,” she said.

“We want Medicare—not the private insurance companies—to negotiate drug prices,” agreed Marilyn Askin, a delegate from West Orange, N.J.

Delegates drew up language insisting that the White House recognize the work that comes out of the conference. In the meantime, they agreed to follow through on their grassroots efforts and to meet to disseminate the recommendations.

WASHINGTON — Delegates to the 2005 White House Conference on Aging made it clear that they weren't happy with Medicare's new prescription drug benefit.

Challenging administration claims that the benefit's tools were accessible and easy to use, delegates recommended that Part D be simplified to create one prescription drug program for beneficiaries.

The Medicare drug benefit was one of 50 resolutions chosen as the “top” issues on aging by the 1,200 delegates at the meeting. Delegates were then charged with drafting implementation strategies suggesting how these resolutions might be put into action. Nearly half of the resolutions addressed health care issues, including Medicare and Medicaid, long-term care, and training health care personnel.

The new drug benefit is “clearly in line” with the principles of the White House Conference on Aging to promote the dignity, health, and economic security for current and future generations, Mike Leavitt, secretary of the Department of Health and Human Services, said in his address to the delegates. “The benefit will be of immediate help to older Americans now,” plus the next group of rapidly expanding aging Americans, the baby boomers, said Mr. Leavitt, who said he helped his own parents enroll in the drug benefit.

His remarks were a hard sell for the delegates, which included governors, members of Congress, and representatives from the National Congress of American Indians, national organizations, academia, business, and industry.

The main source of frustration has been the complexity of the plan, said Ellen Camerieri, a delegate from the Bronx, N.Y., and executive director of Riverdale Senior Services Inc. “Secretary Leavitt talked about how easy it is to sign up … and to get your family together to do it. But what if [you're an aging patient] and you don't have a family?”

In her own community, she said, there's a sense of “confusion and paralysis” over the drug benefit.

Opting into a new drug program under the benefit can be daunting, especially if a beneficiary has a Medigap policy that's not a union or government pension, “but a policy to help them bridge the gap between what Medicare covers and what the actual costs are. You have a vast number of seniors who have had a relationship with a policy, and now must decide whether to continue in the new version of that policy under Part D, or go to the [numerous] other odd policies [offered] within their state.”

Dr. Mark McClellan, CMS administrator, assured delegates that the agency is taking steps to ensure that there is not any lapse in drug coverage. “For example, we have worked closely with states over the past year to obtain very high match rates between their enrollment information and Part D enrollment—match rates well over 99%.”

The agency also has developed a process for a “point of sale” solution, if the beneficiary somehow has not been automatically enrolled in Part D. In addition, multiple efforts are taking place to provide counseling and assistance to beneficiaries, he said.

Seniors “can ask” before they sign up for the plan whether all of the drugs they are taking now are covered, and the agency has tools so that patients can find the lowest cost for a particular drug, Dr. McClellan said.

Yet, his praise of the new 800-MEDICARE customer service line evoked jeers from some delegates. “He claims that every call was answered right away,” said Steve Kofahl, a delegate from Seattle. But when one of Mr. Kofahl's employees tried to call the number to get information, that person “could not get through.”

The problem is a patient has to be able to predict the future to know which plan he or she should sign up for, Ms. Camerieri said. Certain plans under the new benefit cover certain drugs and not others “and you might not be on a medication you'll be needing in 6 months” when you sign up, she said. There's a limited ability to change your plan without some penalty, she said.

Many in the health care field would like to think that Part D is for the people, Ms. Camerieri said. “But the underlying suspicion is that it was drafted to benefit the pharmaceutical and insurance companies who are the people putting together these plans,” she said.

“We want Medicare—not the private insurance companies—to negotiate drug prices,” agreed Marilyn Askin, a delegate from West Orange, N.J.

Delegates drew up language insisting that the White House recognize the work that comes out of the conference. In the meantime, they agreed to follow through on their grassroots efforts and to meet to disseminate the recommendations.

WASHINGTON — Delegates to the 2005 White House Conference on Aging made it clear that they weren't happy with Medicare's new prescription drug benefit.

Challenging administration claims that the benefit's tools were accessible and easy to use, delegates recommended that Part D be simplified to create one prescription drug program for beneficiaries.

The Medicare drug benefit was one of 50 resolutions chosen as the “top” issues on aging by the 1,200 delegates at the meeting. Delegates were then charged with drafting implementation strategies suggesting how these resolutions might be put into action. Nearly half of the resolutions addressed health care issues, including Medicare and Medicaid, long-term care, and training health care personnel.

The new drug benefit is “clearly in line” with the principles of the White House Conference on Aging to promote the dignity, health, and economic security for current and future generations, Mike Leavitt, secretary of the Department of Health and Human Services, said in his address to the delegates. “The benefit will be of immediate help to older Americans now,” plus the next group of rapidly expanding aging Americans, the baby boomers, said Mr. Leavitt, who said he helped his own parents enroll in the drug benefit.

His remarks were a hard sell for the delegates, which included governors, members of Congress, and representatives from the National Congress of American Indians, national organizations, academia, business, and industry.

The main source of frustration has been the complexity of the plan, said Ellen Camerieri, a delegate from the Bronx, N.Y., and executive director of Riverdale Senior Services Inc. “Secretary Leavitt talked about how easy it is to sign up … and to get your family together to do it. But what if [you're an aging patient] and you don't have a family?”

In her own community, she said, there's a sense of “confusion and paralysis” over the drug benefit.

Opting into a new drug program under the benefit can be daunting, especially if a beneficiary has a Medigap policy that's not a union or government pension, “but a policy to help them bridge the gap between what Medicare covers and what the actual costs are. You have a vast number of seniors who have had a relationship with a policy, and now must decide whether to continue in the new version of that policy under Part D, or go to the [numerous] other odd policies [offered] within their state.”

Dr. Mark McClellan, CMS administrator, assured delegates that the agency is taking steps to ensure that there is not any lapse in drug coverage. “For example, we have worked closely with states over the past year to obtain very high match rates between their enrollment information and Part D enrollment—match rates well over 99%.”

The agency also has developed a process for a “point of sale” solution, if the beneficiary somehow has not been automatically enrolled in Part D. In addition, multiple efforts are taking place to provide counseling and assistance to beneficiaries, he said.

Seniors “can ask” before they sign up for the plan whether all of the drugs they are taking now are covered, and the agency has tools so that patients can find the lowest cost for a particular drug, Dr. McClellan said.

Yet, his praise of the new 800-MEDICARE customer service line evoked jeers from some delegates. “He claims that every call was answered right away,” said Steve Kofahl, a delegate from Seattle. But when one of Mr. Kofahl's employees tried to call the number to get information, that person “could not get through.”

The problem is a patient has to be able to predict the future to know which plan he or she should sign up for, Ms. Camerieri said. Certain plans under the new benefit cover certain drugs and not others “and you might not be on a medication you'll be needing in 6 months” when you sign up, she said. There's a limited ability to change your plan without some penalty, she said.

Many in the health care field would like to think that Part D is for the people, Ms. Camerieri said. “But the underlying suspicion is that it was drafted to benefit the pharmaceutical and insurance companies who are the people putting together these plans,” she said.

“We want Medicare—not the private insurance companies—to negotiate drug prices,” agreed Marilyn Askin, a delegate from West Orange, N.J.

Delegates drew up language insisting that the White House recognize the work that comes out of the conference. In the meantime, they agreed to follow through on their grassroots efforts and to meet to disseminate the recommendations.

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

For 19 of the top 20 drugs prescribed to seniors in 2004 in several parts 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%,” the survey indicated. “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 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.”

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

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview. 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 difference between the lowest VA prices and lowest Medicare drug plan prices of the top seven drugs prescribed for seniors, and found huge differences for a few drugs. (See chart.) The total percentage difference between VA and Medicare plan prices may be even higher than 48%, 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; 18 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. “The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Still, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.” He expressed support for a report from the nonpartisan Congressional Budget Office that said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

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

For 19 of the top 20 drugs prescribed to seniors in 2004 in several parts 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%,” the survey indicated. “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 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.”

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

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview. 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 difference between the lowest VA prices and lowest Medicare drug plan prices of the top seven drugs prescribed for seniors, and found huge differences for a few drugs. (See chart.) The total percentage difference between VA and Medicare plan prices may be even higher than 48%, 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; 18 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. “The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Still, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.” He expressed support for a report from the nonpartisan Congressional Budget Office that said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

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

For 19 of the top 20 drugs prescribed to seniors in 2004 in several parts 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%,” the survey indicated. “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 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.”

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

The VA has a restricted formulary and limits where patients can get their drugs, he said. “You have to get your drugs from a VA doctor, at a VA facility. For example, in Georgia there are 9 VA pharmacies, compared [with] 1,833 local pharmacies in that state,” Mr. Ashkenaz said in an interview. 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 difference between the lowest VA prices and lowest Medicare drug plan prices of the top seven drugs prescribed for seniors, and found huge differences for a few drugs. (See chart.) The total percentage difference between VA and Medicare plan prices may be even higher than 48%, 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; 18 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. “The VA is not a competitive marketplace. It has a mandatory 24% rebate, one of those special occasions where we have price controls in this country,” he said in an interview. Still, VA hospitals often try to negotiate something even higher than that percentage, he noted.

One thing to keep in mind is that VA hospitals and clinics make up only 1%–2% of the marketplace, Mr. Trewhitt said. “If we extended that type of mandatory rebate across the market, it would hurt the ability of the worlds' leading pharmaceutical and biotechnology companies to create new medicines.” He expressed support for a report from the nonpartisan Congressional Budget Office that said the best way to achieve cost savings was to provide drug coverage using a wide range of competitive private health plans.

WASHINGTON — Whether Medicare's oncology demonstration program is a good idea depends on which federal advisory committee you ask.

Members of the Practicing Physicians Advisory Council (PPAC), which advises Medicare officials on issues of concern to physicians, said they think the program—which pays hematologists and oncologists to report on whether they are following practice guidelines in the treatment of patients with certain types of cancer—is a great idea.

Dr. Peter B. Bach, senior policy adviser at the Centers for Medicare and Medicaid Services (CMS), reminded council members that program participants are paid for data submission, regardless of whether the guidelines are being adhered to. “This is not pay for performance,” he said.

Physicians who participate in the demonstration must report on the reason for the patient's visit, the patient's condition, and their use of clinical guidelines to treat the patient. Those who comply will receive an additional payment of $23.00.

Payments for reporting the data are tied to visits for evaluation and management by Medicare beneficiaries with any of 13 different cancers. This is a change from last year, when the payments were tied to chemotherapy visits. CMS also has replaced some of the G-codes used in the 2005 program with new G-codes, and has added 81 new codes, most of which deal with current disease status.

PPAC members said that they liked the program so much that they would like to see it extended to other specialists who treat cancer patients. For example, when it comes to prostate cancer patients, “oncologists are not the appropriate physician to evaluate [the treatment for] that cancer,” said Dr. Peter D. Grimm, a radiation oncologist in Seattle. “I manage prostate cancer almost exclusively; only a very small percentage of prostate cancer patients are seen by oncologists.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, agreed. “We're the people who find [prostate cancer] when we're looking for other stuff, or see them if they become hormone refractory and are sent on.”

The council recommended that CMS open up the program to include other specialties that “have the primary responsibility for treating the particular types of cancer [involved].”

PPAC Chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said this was not the first time the issue of extending the demonstration had been raised. “We went through this last year … and there was lot of discussion about opening the program up to other specialties,” he said. “As I remember, the discussion at that time was, 'This is a program for next year; next year we'll consider it.' You say you want a spectrum of care of each of these disease processes; you're not going to get that by just talking to the oncologist or the hematologist.”

In contrast, members of the Medicare Payment Advisory Commission (MedPAC) said that such demonstration projects should not be used solely to increase payments for oncology services.

Instead, the secretary of the Department of Health and Human Services should use these demonstrations to test innovations in delivery of quality health care, according to MedPAC, which advises Congress on Medicare payment issues. This should result in long-term benefits to both providers and beneficiaries.

The demonstration project has limited the ability of both MedPAC and Congress to assess the impact of payment changes for oncology drugs and drug administration services, said Joan Sokolovsky, a MedPAC senior analyst. “These projects are not budget neutral. They are designed to increase payments to specific specialties,” she said.

If the payment rates aren't accurate, CMS or Congress should address it, she continued. “It should not make payment policy through the creation of demonstration projects.”

MedPAC Commissioner David A. Smith, a senior fellow for business and society with Demos, a research and advocacy organization in New York, thought the demonstration should be scrapped altogether.

“We're spending another $150 million of taxpayer money, and we argue—I think, convincingly … that there's no value from this demonstration.” Other commissioners agreed that the project would increase costs for beneficiaries but not provide foreseeable benefits.

However, some cautioned that pulling the plug might be a premature move.

At press time, MedPAC was preparing to release a report on oncology payment issues to Congress in January, which would include its recommendation on the proper use of demonstration projects.

“By the time our report comes out, [the demonstration] will be a month and a half down the road,” commented Robert D. Reischauer, Ph.D., a MedPAC commissioner and president of the Urban Institute, Washington. “I think the real issue is whether we should provide guidance for 2007 … and say something about ensuring that payments are adequate so you don't have to 'phony' them up with a demonstration.”

The dilemma is finding a payment system that ensures access to quality care for oncology patients. “We still don't know what the right level is,” said MedPAC Chair Glenn M. Hackbarth.

WASHINGTON — Whether Medicare's oncology demonstration program is a good idea depends on which federal advisory committee you ask.

Members of the Practicing Physicians Advisory Council (PPAC), which advises Medicare officials on issues of concern to physicians, said they think the program—which pays hematologists and oncologists to report on whether they are following practice guidelines in the treatment of patients with certain types of cancer—is a great idea.

Dr. Peter B. Bach, senior policy adviser at the Centers for Medicare and Medicaid Services (CMS), reminded council members that program participants are paid for data submission, regardless of whether the guidelines are being adhered to. “This is not pay for performance,” he said.

Physicians who participate in the demonstration must report on the reason for the patient's visit, the patient's condition, and their use of clinical guidelines to treat the patient. Those who comply will receive an additional payment of $23.00.

Payments for reporting the data are tied to visits for evaluation and management by Medicare beneficiaries with any of 13 different cancers. This is a change from last year, when the payments were tied to chemotherapy visits. CMS also has replaced some of the G-codes used in the 2005 program with new G-codes, and has added 81 new codes, most of which deal with current disease status.

PPAC members said that they liked the program so much that they would like to see it extended to other specialists who treat cancer patients. For example, when it comes to prostate cancer patients, “oncologists are not the appropriate physician to evaluate [the treatment for] that cancer,” said Dr. Peter D. Grimm, a radiation oncologist in Seattle. “I manage prostate cancer almost exclusively; only a very small percentage of prostate cancer patients are seen by oncologists.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, agreed. “We're the people who find [prostate cancer] when we're looking for other stuff, or see them if they become hormone refractory and are sent on.”

The council recommended that CMS open up the program to include other specialties that “have the primary responsibility for treating the particular types of cancer [involved].”

PPAC Chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said this was not the first time the issue of extending the demonstration had been raised. “We went through this last year … and there was lot of discussion about opening the program up to other specialties,” he said. “As I remember, the discussion at that time was, 'This is a program for next year; next year we'll consider it.' You say you want a spectrum of care of each of these disease processes; you're not going to get that by just talking to the oncologist or the hematologist.”

In contrast, members of the Medicare Payment Advisory Commission (MedPAC) said that such demonstration projects should not be used solely to increase payments for oncology services.

Instead, the secretary of the Department of Health and Human Services should use these demonstrations to test innovations in delivery of quality health care, according to MedPAC, which advises Congress on Medicare payment issues. This should result in long-term benefits to both providers and beneficiaries.

The demonstration project has limited the ability of both MedPAC and Congress to assess the impact of payment changes for oncology drugs and drug administration services, said Joan Sokolovsky, a MedPAC senior analyst. “These projects are not budget neutral. They are designed to increase payments to specific specialties,” she said.

If the payment rates aren't accurate, CMS or Congress should address it, she continued. “It should not make payment policy through the creation of demonstration projects.”

MedPAC Commissioner David A. Smith, a senior fellow for business and society with Demos, a research and advocacy organization in New York, thought the demonstration should be scrapped altogether.

“We're spending another $150 million of taxpayer money, and we argue—I think, convincingly … that there's no value from this demonstration.” Other commissioners agreed that the project would increase costs for beneficiaries but not provide foreseeable benefits.

However, some cautioned that pulling the plug might be a premature move.

At press time, MedPAC was preparing to release a report on oncology payment issues to Congress in January, which would include its recommendation on the proper use of demonstration projects.

“By the time our report comes out, [the demonstration] will be a month and a half down the road,” commented Robert D. Reischauer, Ph.D., a MedPAC commissioner and president of the Urban Institute, Washington. “I think the real issue is whether we should provide guidance for 2007 … and say something about ensuring that payments are adequate so you don't have to 'phony' them up with a demonstration.”

The dilemma is finding a payment system that ensures access to quality care for oncology patients. “We still don't know what the right level is,” said MedPAC Chair Glenn M. Hackbarth.

WASHINGTON — Whether Medicare's oncology demonstration program is a good idea depends on which federal advisory committee you ask.

Members of the Practicing Physicians Advisory Council (PPAC), which advises Medicare officials on issues of concern to physicians, said they think the program—which pays hematologists and oncologists to report on whether they are following practice guidelines in the treatment of patients with certain types of cancer—is a great idea.

Dr. Peter B. Bach, senior policy adviser at the Centers for Medicare and Medicaid Services (CMS), reminded council members that program participants are paid for data submission, regardless of whether the guidelines are being adhered to. “This is not pay for performance,” he said.

Physicians who participate in the demonstration must report on the reason for the patient's visit, the patient's condition, and their use of clinical guidelines to treat the patient. Those who comply will receive an additional payment of $23.00.

Payments for reporting the data are tied to visits for evaluation and management by Medicare beneficiaries with any of 13 different cancers. This is a change from last year, when the payments were tied to chemotherapy visits. CMS also has replaced some of the G-codes used in the 2005 program with new G-codes, and has added 81 new codes, most of which deal with current disease status.

PPAC members said that they liked the program so much that they would like to see it extended to other specialists who treat cancer patients. For example, when it comes to prostate cancer patients, “oncologists are not the appropriate physician to evaluate [the treatment for] that cancer,” said Dr. Peter D. Grimm, a radiation oncologist in Seattle. “I manage prostate cancer almost exclusively; only a very small percentage of prostate cancer patients are seen by oncologists.”

Council member Dr. Barbara L. McAneny, a clinical oncologist in Albuquerque, agreed. “We're the people who find [prostate cancer] when we're looking for other stuff, or see them if they become hormone refractory and are sent on.”

The council recommended that CMS open up the program to include other specialties that “have the primary responsibility for treating the particular types of cancer [involved].”

PPAC Chair Dr. Ronald D. Castellanos, a urologist in Cape Coral, Fla., said this was not the first time the issue of extending the demonstration had been raised. “We went through this last year … and there was lot of discussion about opening the program up to other specialties,” he said. “As I remember, the discussion at that time was, 'This is a program for next year; next year we'll consider it.' You say you want a spectrum of care of each of these disease processes; you're not going to get that by just talking to the oncologist or the hematologist.”

In contrast, members of the Medicare Payment Advisory Commission (MedPAC) said that such demonstration projects should not be used solely to increase payments for oncology services.

Instead, the secretary of the Department of Health and Human Services should use these demonstrations to test innovations in delivery of quality health care, according to MedPAC, which advises Congress on Medicare payment issues. This should result in long-term benefits to both providers and beneficiaries.

The demonstration project has limited the ability of both MedPAC and Congress to assess the impact of payment changes for oncology drugs and drug administration services, said Joan Sokolovsky, a MedPAC senior analyst. “These projects are not budget neutral. They are designed to increase payments to specific specialties,” she said.

If the payment rates aren't accurate, CMS or Congress should address it, she continued. “It should not make payment policy through the creation of demonstration projects.”

MedPAC Commissioner David A. Smith, a senior fellow for business and society with Demos, a research and advocacy organization in New York, thought the demonstration should be scrapped altogether.

“We're spending another $150 million of taxpayer money, and we argue—I think, convincingly … that there's no value from this demonstration.” Other commissioners agreed that the project would increase costs for beneficiaries but not provide foreseeable benefits.

However, some cautioned that pulling the plug might be a premature move.

At press time, MedPAC was preparing to release a report on oncology payment issues to Congress in January, which would include its recommendation on the proper use of demonstration projects.

“By the time our report comes out, [the demonstration] will be a month and a half down the road,” commented Robert D. Reischauer, Ph.D., a MedPAC commissioner and president of the Urban Institute, Washington. “I think the real issue is whether we should provide guidance for 2007 … and say something about ensuring that payments are adequate so you don't have to 'phony' them up with a demonstration.”

The dilemma is finding a payment system that ensures access to quality care for oncology patients. “We still don't know what the right level is,” said MedPAC Chair Glenn M. Hackbarth.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

Medicare Patients Welcome

Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.

Ban on False Information

The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”

Cardiac Rehab Coverage Expanded

Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.

Patterns of Trial Registration

The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”

Top Stories of 2005

The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.

WASHINGTON — States should have the flexibility to experiment with innovative measures to improve the Medicaid program, Rep. Nathan Deal (R-Ga.) said during a meeting sponsored by the Center for Health Transformation.

"One size fits all" was the concept at Medicaid's inception, but the truth is "no one size fits everybody, every state," said Rep. Deal, chairman of the House Committee on Energy and Commerce Subcommittee on Health. States over the years have gotten out of this one-size-fits-all approach by applying for waivers, which has resulted in a patchwork of Medicaid programs, he said.

States are the testing ground for what works, he said. For that reason, the congressional role in Medicaid reform should be to make broad program outlines that would give "states the ability to tailor their programs as best as they think meets their needs, without having to come to Washington to ask for waivers all the time," he said.

Medicaid is the single largest component of every state's budget, Rep. Deal noted. Even though it's technically a federal-state partnership, many states can't pay their portion. "It's breaking their budget."

The nation's governors have proposed a framework that Congress has been working to implement, he said. One of the things the governors asked of Congress "is to be more selective in the way we allow them to present and manage their programs."

Instilling a sense of personal responsibility in the beneficiaries and giving them more choice in their care will help the states achieve that goal, he said.

The irony about Medicaid is that "we have created a tax-supported health delivery system that's much more generous than what any of us can buy in the private insurance market. And certainly much better than what you could buy as an individual insurance policy."

The problem is that once you cross the Medicaid eligibility threshold, "all of sudden you're in a vast land of health care delivery, where you have all of these benefits whether you need them or not." This entitlement structure does not allow the health delivery system to do disease management, to focus resources on particular medical needs, or to do overall management of the health care system, he said.

Medicaid also has limited deductibles and copays built into its federal formulation. "The governors have asked us to change that," he said. Making copays mandatory or enforceable "goes a long way for putting the idea of personal responsibility back into the system."

Obviously, the mandate would have to exclude certain categories, such as children below the poverty level and certain disabled beneficiaries. However, for those with eligibility levels in the upper categories, "that's certainly an appropriate place to go," he said.

Instead of walking behind that "magic curtain" and being eligible for everything, the governors are saying "let us make the benefits flexible, tailored to the needs of the beneficiary, and thereby allow us to save money, and in the process do a better job of delivering better health care," Rep. Deal said.

A difficult area in need of reform is reimbursement for drugs, he said. The current system "is very complicated and, I think, subject to manipulation."

The hope is to abandon the old formulas and convert to the "average manufacturer's price," he said. "The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible," he said. Differentiations between chain drugstores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug. The goal of the AMP is to arrive at a realistic reimbursement number, "so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic."

In long-term health care, "we also need to begin the cycle of taking care of ourselves when we can, by buying long-term health care insurance," he said. The federal government could set an example with its own employees, and provide some tax incentives to spur that effort, he said. Getting federal and state employees into a long-term heath care insurance plan would dramatically reduce the cost of Medicaid in the long term, he said.

WASHINGTON — States should have the flexibility to experiment with innovative measures to improve the Medicaid program, Rep. Nathan Deal (R-Ga.) said during a meeting sponsored by the Center for Health Transformation.

"One size fits all" was the concept at Medicaid's inception, but the truth is "no one size fits everybody, every state," said Rep. Deal, chairman of the House Committee on Energy and Commerce Subcommittee on Health. States over the years have gotten out of this one-size-fits-all approach by applying for waivers, which has resulted in a patchwork of Medicaid programs, he said.

States are the testing ground for what works, he said. For that reason, the congressional role in Medicaid reform should be to make broad program outlines that would give "states the ability to tailor their programs as best as they think meets their needs, without having to come to Washington to ask for waivers all the time," he said.

Medicaid is the single largest component of every state's budget, Rep. Deal noted. Even though it's technically a federal-state partnership, many states can't pay their portion. "It's breaking their budget."

The nation's governors have proposed a framework that Congress has been working to implement, he said. One of the things the governors asked of Congress "is to be more selective in the way we allow them to present and manage their programs."

Instilling a sense of personal responsibility in the beneficiaries and giving them more choice in their care will help the states achieve that goal, he said.

The irony about Medicaid is that "we have created a tax-supported health delivery system that's much more generous than what any of us can buy in the private insurance market. And certainly much better than what you could buy as an individual insurance policy."

The problem is that once you cross the Medicaid eligibility threshold, "all of sudden you're in a vast land of health care delivery, where you have all of these benefits whether you need them or not." This entitlement structure does not allow the health delivery system to do disease management, to focus resources on particular medical needs, or to do overall management of the health care system, he said.

Medicaid also has limited deductibles and copays built into its federal formulation. "The governors have asked us to change that," he said. Making copays mandatory or enforceable "goes a long way for putting the idea of personal responsibility back into the system."

Obviously, the mandate would have to exclude certain categories, such as children below the poverty level and certain disabled beneficiaries. However, for those with eligibility levels in the upper categories, "that's certainly an appropriate place to go," he said.

Instead of walking behind that "magic curtain" and being eligible for everything, the governors are saying "let us make the benefits flexible, tailored to the needs of the beneficiary, and thereby allow us to save money, and in the process do a better job of delivering better health care," Rep. Deal said.

A difficult area in need of reform is reimbursement for drugs, he said. The current system "is very complicated and, I think, subject to manipulation."

The hope is to abandon the old formulas and convert to the "average manufacturer's price," he said. "The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible," he said. Differentiations between chain drugstores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug. The goal of the AMP is to arrive at a realistic reimbursement number, "so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic."

In long-term health care, "we also need to begin the cycle of taking care of ourselves when we can, by buying long-term health care insurance," he said. The federal government could set an example with its own employees, and provide some tax incentives to spur that effort, he said. Getting federal and state employees into a long-term heath care insurance plan would dramatically reduce the cost of Medicaid in the long term, he said.

WASHINGTON — States should have the flexibility to experiment with innovative measures to improve the Medicaid program, Rep. Nathan Deal (R-Ga.) said during a meeting sponsored by the Center for Health Transformation.

"One size fits all" was the concept at Medicaid's inception, but the truth is "no one size fits everybody, every state," said Rep. Deal, chairman of the House Committee on Energy and Commerce Subcommittee on Health. States over the years have gotten out of this one-size-fits-all approach by applying for waivers, which has resulted in a patchwork of Medicaid programs, he said.

States are the testing ground for what works, he said. For that reason, the congressional role in Medicaid reform should be to make broad program outlines that would give "states the ability to tailor their programs as best as they think meets their needs, without having to come to Washington to ask for waivers all the time," he said.

Medicaid is the single largest component of every state's budget, Rep. Deal noted. Even though it's technically a federal-state partnership, many states can't pay their portion. "It's breaking their budget."

The nation's governors have proposed a framework that Congress has been working to implement, he said. One of the things the governors asked of Congress "is to be more selective in the way we allow them to present and manage their programs."

Instilling a sense of personal responsibility in the beneficiaries and giving them more choice in their care will help the states achieve that goal, he said.

The irony about Medicaid is that "we have created a tax-supported health delivery system that's much more generous than what any of us can buy in the private insurance market. And certainly much better than what you could buy as an individual insurance policy."

The problem is that once you cross the Medicaid eligibility threshold, "all of sudden you're in a vast land of health care delivery, where you have all of these benefits whether you need them or not." This entitlement structure does not allow the health delivery system to do disease management, to focus resources on particular medical needs, or to do overall management of the health care system, he said.

Medicaid also has limited deductibles and copays built into its federal formulation. "The governors have asked us to change that," he said. Making copays mandatory or enforceable "goes a long way for putting the idea of personal responsibility back into the system."

Obviously, the mandate would have to exclude certain categories, such as children below the poverty level and certain disabled beneficiaries. However, for those with eligibility levels in the upper categories, "that's certainly an appropriate place to go," he said.

Instead of walking behind that "magic curtain" and being eligible for everything, the governors are saying "let us make the benefits flexible, tailored to the needs of the beneficiary, and thereby allow us to save money, and in the process do a better job of delivering better health care," Rep. Deal said.

A difficult area in need of reform is reimbursement for drugs, he said. The current system "is very complicated and, I think, subject to manipulation."

The hope is to abandon the old formulas and convert to the "average manufacturer's price," he said. "The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible," he said. Differentiations between chain drugstores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug. The goal of the AMP is to arrive at a realistic reimbursement number, "so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic."

In long-term health care, "we also need to begin the cycle of taking care of ourselves when we can, by buying long-term health care insurance," he said. The federal government could set an example with its own employees, and provide some tax incentives to spur that effort, he said. Getting federal and state employees into a long-term heath care insurance plan would dramatically reduce the cost of Medicaid in the long term, he said.