Jennifer Lubell

Without the proper technology, physician practices may find it difficult to participate in Medicare's new "e-prescribing" standards under the Part D drug benefit, physician groups claim.

"Most primary care physicians will be unable to afford to implement this technology on their own, particularly with the projected cuts in Medicare physician payments of 4.4% in 2006 and a cumulative 26% reduction from 2006 to 2011," Neil Kirschner, Ph.D., senior associate for regulatory and insurer affairs with the American College of Physicians, said in an interview.

The Centers for Medicare and Medicaid Services in a final rule established the set of standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare. The standards were expected to be available for immediate use when the new prescription drug benefit began Jan. 1, according to the Federal Register.

CMS also plans to pilot test initial e-prescribing standards, which may be included in a final rule to be issued by April 2008.

"These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program," said Mike Leavitt, secretary of the Department of Health and Human Services.

For the most part, medical organizations expressed support for the agency's e-prescribing initiative.

"Having standards is good. It will provide a common language for anyone using this method," Dr. Mary Frank, board chair of the American Academy of Family Physicians, said in an interview. E-prescribing would also reduce errors, increase patient safety, and when it is fully interoperable, increase quality in health care as well, she said.

Unfortunately, few practices are currently employing this technology, Dr. Kirshner said. "Surveys vary, but the percentage of practices using it ranges somewhere from 5% to 18%." The number is even lower for the typical small practice, he added.

Only 25%–30% of the AAFP's members have electronic health records, Dr. Frank said. "They are, at present, the only ones who might be able to immediately adopt this approach. I say 'might' because not all EHR systems have the e-prescribing component."

Until there is some financial support to help doctors implement this technology, its use will not be widespread, she said.

Even if a physician does have the money to adopt e-prescribing, "he or she is at risk of purchasing a system that might not integrate" with a future electronic health record system, she said.

Dr. Kirschner noted that the recent release of safe harbor antikickback and Stark exception rules allowing hospitals, group practices, and Medicare Part D drug plan sponsors to provide necessary e-prescribing technology to physicians may help facilitate its use.

E-prescribing as an isolated technology, however, "just won't cut it," Dr. Frank said. "It is only a small piece in the safety-quality continuum." While it may eliminate issues such as bad handwriting and sound-alike medications, it doesn't necessarily address issues such as drug-drug interactions, alerts about possible problems related to existing illnesses, or abnormal lab results.

"We really have to push for a more integrated approach if we really want to improve care," she said.

E-prescribing will be optional for physicians and pharmacies under the new standards, although Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards was required as of Jan. 1, 2006, so that they will be ready for immediate use when the Medicare drug benefit begins.

Jeff Trewhitt, who is a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs that are associated with health care, the system would also promote more effective care of drug therapies for chronic conditions.

He agreed, however, that such a system must be designed and implemented correctly. "Keep in mind that the systems needed to convert to an e-Rx system don't even exist yet."

CMS's new standards for e-prescribing include the following technology:

▸ NCPDP SCRIPT, Version 5.0, for transactions between prescribers and dispensers for new prescriptions, refill requests and responses, prescription change requests and responses, prescription cancellation requests and responses, and related messaging and administrative transactions.

▸ ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors.

▸ NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors.

Without the proper technology, physician practices may find it difficult to participate in Medicare's new "e-prescribing" standards under the Part D drug benefit, physician groups claim.

"Most primary care physicians will be unable to afford to implement this technology on their own, particularly with the projected cuts in Medicare physician payments of 4.4% in 2006 and a cumulative 26% reduction from 2006 to 2011," Neil Kirschner, Ph.D., senior associate for regulatory and insurer affairs with the American College of Physicians, said in an interview.

The Centers for Medicare and Medicaid Services in a final rule established the set of standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare. The standards were expected to be available for immediate use when the new prescription drug benefit began Jan. 1, according to the Federal Register.

CMS also plans to pilot test initial e-prescribing standards, which may be included in a final rule to be issued by April 2008.

"These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program," said Mike Leavitt, secretary of the Department of Health and Human Services.

For the most part, medical organizations expressed support for the agency's e-prescribing initiative.

"Having standards is good. It will provide a common language for anyone using this method," Dr. Mary Frank, board chair of the American Academy of Family Physicians, said in an interview. E-prescribing would also reduce errors, increase patient safety, and when it is fully interoperable, increase quality in health care as well, she said.

Unfortunately, few practices are currently employing this technology, Dr. Kirshner said. "Surveys vary, but the percentage of practices using it ranges somewhere from 5% to 18%." The number is even lower for the typical small practice, he added.

Only 25%–30% of the AAFP's members have electronic health records, Dr. Frank said. "They are, at present, the only ones who might be able to immediately adopt this approach. I say 'might' because not all EHR systems have the e-prescribing component."

Until there is some financial support to help doctors implement this technology, its use will not be widespread, she said.

Even if a physician does have the money to adopt e-prescribing, "he or she is at risk of purchasing a system that might not integrate" with a future electronic health record system, she said.

Dr. Kirschner noted that the recent release of safe harbor antikickback and Stark exception rules allowing hospitals, group practices, and Medicare Part D drug plan sponsors to provide necessary e-prescribing technology to physicians may help facilitate its use.

E-prescribing as an isolated technology, however, "just won't cut it," Dr. Frank said. "It is only a small piece in the safety-quality continuum." While it may eliminate issues such as bad handwriting and sound-alike medications, it doesn't necessarily address issues such as drug-drug interactions, alerts about possible problems related to existing illnesses, or abnormal lab results.

"We really have to push for a more integrated approach if we really want to improve care," she said.

E-prescribing will be optional for physicians and pharmacies under the new standards, although Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards was required as of Jan. 1, 2006, so that they will be ready for immediate use when the Medicare drug benefit begins.

Jeff Trewhitt, who is a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs that are associated with health care, the system would also promote more effective care of drug therapies for chronic conditions.

He agreed, however, that such a system must be designed and implemented correctly. "Keep in mind that the systems needed to convert to an e-Rx system don't even exist yet."

CMS's new standards for e-prescribing include the following technology:

▸ NCPDP SCRIPT, Version 5.0, for transactions between prescribers and dispensers for new prescriptions, refill requests and responses, prescription change requests and responses, prescription cancellation requests and responses, and related messaging and administrative transactions.

▸ ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors.

▸ NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors.

Without the proper technology, physician practices may find it difficult to participate in Medicare's new "e-prescribing" standards under the Part D drug benefit, physician groups claim.

"Most primary care physicians will be unable to afford to implement this technology on their own, particularly with the projected cuts in Medicare physician payments of 4.4% in 2006 and a cumulative 26% reduction from 2006 to 2011," Neil Kirschner, Ph.D., senior associate for regulatory and insurer affairs with the American College of Physicians, said in an interview.

The Centers for Medicare and Medicaid Services in a final rule established the set of standards for electronic prescribing, or e-prescribing, of drugs covered by Medicare. The standards were expected to be available for immediate use when the new prescription drug benefit began Jan. 1, according to the Federal Register.

CMS also plans to pilot test initial e-prescribing standards, which may be included in a final rule to be issued by April 2008.

"These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program," said Mike Leavitt, secretary of the Department of Health and Human Services.

For the most part, medical organizations expressed support for the agency's e-prescribing initiative.

"Having standards is good. It will provide a common language for anyone using this method," Dr. Mary Frank, board chair of the American Academy of Family Physicians, said in an interview. E-prescribing would also reduce errors, increase patient safety, and when it is fully interoperable, increase quality in health care as well, she said.

Unfortunately, few practices are currently employing this technology, Dr. Kirshner said. "Surveys vary, but the percentage of practices using it ranges somewhere from 5% to 18%." The number is even lower for the typical small practice, he added.

Only 25%–30% of the AAFP's members have electronic health records, Dr. Frank said. "They are, at present, the only ones who might be able to immediately adopt this approach. I say 'might' because not all EHR systems have the e-prescribing component."

Until there is some financial support to help doctors implement this technology, its use will not be widespread, she said.

Even if a physician does have the money to adopt e-prescribing, "he or she is at risk of purchasing a system that might not integrate" with a future electronic health record system, she said.

Dr. Kirschner noted that the recent release of safe harbor antikickback and Stark exception rules allowing hospitals, group practices, and Medicare Part D drug plan sponsors to provide necessary e-prescribing technology to physicians may help facilitate its use.

E-prescribing as an isolated technology, however, "just won't cut it," Dr. Frank said. "It is only a small piece in the safety-quality continuum." While it may eliminate issues such as bad handwriting and sound-alike medications, it doesn't necessarily address issues such as drug-drug interactions, alerts about possible problems related to existing illnesses, or abnormal lab results.

"We really have to push for a more integrated approach if we really want to improve care," she said.

E-prescribing will be optional for physicians and pharmacies under the new standards, although Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards was required as of Jan. 1, 2006, so that they will be ready for immediate use when the Medicare drug benefit begins.

Jeff Trewhitt, who is a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that PhRMA supported the development of a standardized e-prescribing system. In addition to reducing errors and the administrative costs that are associated with health care, the system would also promote more effective care of drug therapies for chronic conditions.

He agreed, however, that such a system must be designed and implemented correctly. "Keep in mind that the systems needed to convert to an e-Rx system don't even exist yet."

CMS's new standards for e-prescribing include the following technology:

▸ NCPDP SCRIPT, Version 5.0, for transactions between prescribers and dispensers for new prescriptions, refill requests and responses, prescription change requests and responses, prescription cancellation requests and responses, and related messaging and administrative transactions.

▸ ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors.

▸ NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. Dr. Uhl also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said that they are seeking protections for patients who are not seamlessly and immediately transitioned to the new Part D drug benefit program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokes-man with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans are extremely or very satisfied with the quality of medical care they receive. However, only 28% were satisfied with the cost of health care coverage. A difference of opinion existed between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 a year to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 years and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes of less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the federal poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. Dr. Uhl also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said that they are seeking protections for patients who are not seamlessly and immediately transitioned to the new Part D drug benefit program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokes-man with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans are extremely or very satisfied with the quality of medical care they receive. However, only 28% were satisfied with the cost of health care coverage. A difference of opinion existed between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 a year to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 years and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes of less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the federal poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. Dr. Uhl also has dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—will lose their Medicaid drug coverage on Jan. 1. The groups said that they are seeking protections for patients who are not seamlessly and immediately transitioned to the new Part D drug benefit program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or only have a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokes-man with the Centers for Medicare and Medicaid Services said the agency was not commenting on the pending lawsuit.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans are extremely or very satisfied with the quality of medical care they receive. However, only 28% were satisfied with the cost of health care coverage. A difference of opinion existed between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 a year to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 years and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes of less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the federal poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And, finally, do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care?

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during the transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—lost their Medicaid drug coverage on Jan. 1. The groups said that they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or have only a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said that the agency was not commenting on the pending lawsuit.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also holds dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans who were surveyed were extremely or very satisfied with the quality of medical care that they receive. However, only 28% were satisfied with the cost of their health coverage. The survey revealed a difference of opinion between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And, finally, do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care?

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during the transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—lost their Medicaid drug coverage on Jan. 1. The groups said that they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or have only a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said that the agency was not commenting on the pending lawsuit.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also holds dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans who were surveyed were extremely or very satisfied with the quality of medical care that they receive. However, only 28% were satisfied with the cost of their health coverage. The survey revealed a difference of opinion between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Part D Enrollment Begins

Starting last month, Medicare beneficiaries began enrolling in prescription drug plans as part of the new Medicare Part D benefit that will begin on Jan. 1. Beneficiaries who enroll in drug plans by the end of this year can begin receiving benefits on Jan. 1, but individuals who haven't made up their minds can continue to enroll until May 15, 2006. As the enrollment period kicked off last month, the health insurance industry was optimistic. Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), said its member health plans were seeing higher than expected numbers of calls from Medicare beneficiaries with questions about the plans. And the questions are specific, with beneficiaries asking about drug availability, which pharmacies are participating in plans, and how much their out-of-pocket expenses will be with a plan, Ms. Ignagni said at a press conference. She recommended that Medicare beneficiaries who are evaluating different prescription drug plans consider five issues: Do they have drug coverage now? What drugs do they take? Do they purchase drugs from a particular pharmacy? How much will they pay in out-of-pocket costs for a particular plan? And, finally, do they want to stay in traditional Medicare and choose a separate drug plan or switch to a Medicare managed care plan that includes prescription drugs, physician services, and hospital care?

Groups Sue Over Part D

Countless numbers of poor men and women “will fall through the cracks” during the transition to the new Part D drug benefit, medical groups stated in a lawsuit against the federal government. More than 6 million “dual eligible” patients—those who are enrolled in both Medicare and Medicaid—lost their Medicaid drug coverage on Jan. 1. The groups said that they're seeking protections for patients who are not seamlessly and immediately transitioned to the new drug program. “The poorest, sickest, and oldest Americans face grave risk of losing their life-saving medications once the clock strikes twelve on New Year's,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group and one of the plaintiffs. In particular, those beneficiaries who are cognitively impaired or have only a high school diploma will have problems mastering the complexity of the new drug benefit, the lawsuit indicated. A spokesman with the Centers for Medicare and Medicaid Services said that the agency was not commenting on the pending lawsuit.

New Head for FDA Women's Health

Kathleen Uhl, M.D., has been named director of the Office of Women's Health at the Food and Drug Administration. Dr. Uhl, a family physician and a captain in the U.S. Public Health Service, most recently served as a supervisory medical officer in the FDA's Center for Drug Evaluation and Research. “Kathleen brings a breadth of professional experience, as well as a strong science background and passion for women's health, to her new position,” said FDA Acting Commissioner Andrew von Eschenbach, M.D. Dr. Uhl's experience includes clinical practice, basic science and clinical research, drug application review, drug safety oversight, and women's health issues. She also holds dual faculty appointments at the Uniformed Services University of the Health Sciences in family medicine and internal medicine.

Patients Satisfied Despite Cost

Most Americans remain satisfied with the quality of their health care despite rising health care costs, according to a survey from the Employee Benefit Research Institute (EBRI), a nonprofit group that disseminates data on employee benefits. “Satisfaction with health care quality is high, but few are happy about the cost of health care,” EBRI President Dallas Salisbury said in a statement. “Beyond that, the survey appears to confirm the notion that Americans tend to leave cost out of the equation when considering health care quality.” Almost 6 in 10 Americans who were surveyed were extremely or very satisfied with the quality of medical care that they receive. However, only 28% were satisfied with the cost of their health coverage. The survey revealed a difference of opinion between lower and higher income patients about quality of care. Those with household incomes under $35,000 a year were less than half as likely as those with incomes of at least $75,000 to describe the health care system as excellent or very good. The survey represented telephone interviews with 1,003 individuals aged 21 and older.

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

DALLAS — Predicting more administrative burdens and an eventual mandate on performance measures, delegates at the interim meeting of the American Medical Association's House of Delegates voted to oppose the federal government's plans to implement a voluntary quality reporting program for Medicare.

Delegates adopted a report from the AMA's board of trustees that strongly objected to the coming system, and offered to assist the government in correcting the program's “strong deficiencies.”

The Centers for Medicare and Medicaid Services announced the “Physician Voluntary Reporting Program” in late October, and said that the new initiative would avoid unnecessary costs and improve quality of care.

Beginning next month, physicians who choose to participate will voluntarily send information to CMS about the quality of care they provide to beneficiaries. They will receive feedback on their performance from the agency as early as next summer.

In its report and in a letter to CMS administrator Mark B. McClellan, M.D., AMA trustees expressed doubts that the new system will improve the quality of health care.

“The physician community has made a good faith effort to develop, endorse, and implement physician performance measures,” some in collaboration with CMS, the letter said. “However, the excessive administrative requirements that this program will impose on physicians could doom this initiative.”

The program would force primary care physicians with an already busy patient load to develop a new reporting system from scratch, said Joseph Zebley, M.D., a delegate from the American Academy of Family Physicians, during committee debate on the board's report.

During the first phase of the program, CMS will collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes—also called G-codes—that will be included in the claims physicians currently submit to CMS.

The data will then be used to measure the quality of services provided to Medicare patients.

In its letter to CMS, the trustees noted that a participating primary care physician treating a 70-year-old woman with common conditions like osteoporosis, diabetes, and heart disease would have to report on approximately 2–13 measures and consider 36–39 G-codes.

Not only don't physicians use G-codes, “electronic health records don't have G-codes as part of their software,” Mary Frank, M.D., AAFP board chair and delegate to the AMA House noted. “We put CPT codes [into the electronic health records], which is what we all use.”

Dr. Zebley added that the program “would place a tremendous burden on family physicians and other primary care physicians.”

G-codes would serve as an “interim step” until the electronic submission of data through electronic health records replaced this process, CMS said when announcing the voluntary program. The agency promised it would collaborate with participating physicians to develop such electronic data submission records.

Although CMS said in its announcement that participation in the voluntary program would not affect physician reimbursement under Medicare, many delegates expressed concern that the system would eventually become mandatory.

CMS “has indicated that there could be a link between reporting data and receiving higher Medicare payments next year,” depending on the success of the voluntary reporting program, William Kobler, M.D., AMA delegate from Illinois, noted during committee proceedings.

Other business addressed by the AMA House of Delegates included:

▸ Medicaid reform. Delegates passed a resolution opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level.

▸ Smoking bans. Applying a hard-line approach to kicking the habit, delegates voted that the AMA should actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations.

The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises.

▸ Prisoner interrogation. Delegates asked that the AMA's Council on Ethical and Judicial Affairs “clearly delineate” the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.

▸ Medicare Part D. Delegates voted that the AMA should support legislation and urge the Department of Health and Human Services to modify or eliminate the exclusion of various prescription drugs from coverage under Part D, and to ensure that Medicare contractors administering the new drug benefit include on their formularies medications to treat psychiatric and substance use disorders, including benzodiazepines, methadone, buprenorphine, acamprosate, disulfiram, and naltrexone.

▸ Disaster preparedness and response. Delegates called on state and local public health entities to develop a public health disaster plan specific to their locations. National legislation should also be enacted to give qualified physicians automatic medical liability immunity in the event of a declared disaster or federal emergency.

CMS's Reporting Criteria

Thirty-six evidence-based measures are to be reported in the first phase of the voluntary reporting program, according to CMS.

The final measures run the gamut of services, from influenza, pneumococcal vaccinations, and mammography to more complex surgery-related measures, such as prolonged intubation during isolated coronary artery bypass graft procedures. Other measures include the administration of aspirin and β-blockers at the time of arrival for acute MI, and the screening of elderly patients for falls and urinary incontinence.

According to CMS, the performance measures were developed in collaboration with physicians and physician organizations, as well as other stakeholders. Work by the National Quality Forum, the Ambulatory Care Alliance, the AMA's Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND Corporation “provided the basis for the selection of these measures,” CMS indicated in a statement.

Yet many AMA delegates at the interim meeting said that they felt CMS had “sprung” the program on them at a time when they were facing a 4.4% reduction in Medicare payments.

Michael Barr, M.D., vice president of practice advocacy and improvement at the American College of Physicians (ACP), said that the ACP was discussing its concerns with CMS about the voluntary reporting program, including the fact that not all of the measures had been endorsed by the National Quality Forum.

“This is just the first step of the process” and it is voluntary, CMS spokesperson Peter Ashkenaz pointed out in an interview. “We want to be able to collect information and provide analysis to see how this works.” Ultimately, the goal is to establish a program in which CMS pays for services rendered on high quality of care, not on volume, he said.

DALLAS — Predicting more administrative burdens and an eventual mandate on performance measures, delegates at the interim meeting of the American Medical Association's House of Delegates voted to oppose the federal government's plans to implement a voluntary quality reporting program for Medicare.

Delegates adopted a report from the AMA's board of trustees that strongly objected to the coming system, and offered to assist the government in correcting the program's “strong deficiencies.”

The Centers for Medicare and Medicaid Services announced the “Physician Voluntary Reporting Program” in late October, and said that the new initiative would avoid unnecessary costs and improve quality of care.

Beginning next month, physicians who choose to participate will voluntarily send information to CMS about the quality of care they provide to beneficiaries. They will receive feedback on their performance from the agency as early as next summer.

In its report and in a letter to CMS administrator Mark B. McClellan, M.D., AMA trustees expressed doubts that the new system will improve the quality of health care.

“The physician community has made a good faith effort to develop, endorse, and implement physician performance measures,” some in collaboration with CMS, the letter said. “However, the excessive administrative requirements that this program will impose on physicians could doom this initiative.”

The program would force primary care physicians with an already busy patient load to develop a new reporting system from scratch, said Joseph Zebley, M.D., a delegate from the American Academy of Family Physicians, during committee debate on the board's report.

During the first phase of the program, CMS will collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes—also called G-codes—that will be included in the claims physicians currently submit to CMS.

The data will then be used to measure the quality of services provided to Medicare patients.

In its letter to CMS, the trustees noted that a participating primary care physician treating a 70-year-old woman with common conditions like osteoporosis, diabetes, and heart disease would have to report on approximately 2–13 measures and consider 36–39 G-codes.

Not only don't physicians use G-codes, “electronic health records don't have G-codes as part of their software,” Mary Frank, M.D., AAFP board chair and delegate to the AMA House noted. “We put CPT codes [into the electronic health records], which is what we all use.”

Dr. Zebley added that the program “would place a tremendous burden on family physicians and other primary care physicians.”

G-codes would serve as an “interim step” until the electronic submission of data through electronic health records replaced this process, CMS said when announcing the voluntary program. The agency promised it would collaborate with participating physicians to develop such electronic data submission records.

Although CMS said in its announcement that participation in the voluntary program would not affect physician reimbursement under Medicare, many delegates expressed concern that the system would eventually become mandatory.

CMS “has indicated that there could be a link between reporting data and receiving higher Medicare payments next year,” depending on the success of the voluntary reporting program, William Kobler, M.D., AMA delegate from Illinois, noted during committee proceedings.

Other business addressed by the AMA House of Delegates included:

▸ Medicaid reform. Delegates passed a resolution opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level.

▸ Smoking bans. Applying a hard-line approach to kicking the habit, delegates voted that the AMA should actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations.

The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises.

▸ Prisoner interrogation. Delegates asked that the AMA's Council on Ethical and Judicial Affairs “clearly delineate” the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.

▸ Medicare Part D. Delegates voted that the AMA should support legislation and urge the Department of Health and Human Services to modify or eliminate the exclusion of various prescription drugs from coverage under Part D, and to ensure that Medicare contractors administering the new drug benefit include on their formularies medications to treat psychiatric and substance use disorders, including benzodiazepines, methadone, buprenorphine, acamprosate, disulfiram, and naltrexone.

▸ Disaster preparedness and response. Delegates called on state and local public health entities to develop a public health disaster plan specific to their locations. National legislation should also be enacted to give qualified physicians automatic medical liability immunity in the event of a declared disaster or federal emergency.

CMS's Reporting Criteria

Thirty-six evidence-based measures are to be reported in the first phase of the voluntary reporting program, according to CMS.

The final measures run the gamut of services, from influenza, pneumococcal vaccinations, and mammography to more complex surgery-related measures, such as prolonged intubation during isolated coronary artery bypass graft procedures. Other measures include the administration of aspirin and β-blockers at the time of arrival for acute MI, and the screening of elderly patients for falls and urinary incontinence.

According to CMS, the performance measures were developed in collaboration with physicians and physician organizations, as well as other stakeholders. Work by the National Quality Forum, the Ambulatory Care Alliance, the AMA's Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND Corporation “provided the basis for the selection of these measures,” CMS indicated in a statement.

Yet many AMA delegates at the interim meeting said that they felt CMS had “sprung” the program on them at a time when they were facing a 4.4% reduction in Medicare payments.

Michael Barr, M.D., vice president of practice advocacy and improvement at the American College of Physicians (ACP), said that the ACP was discussing its concerns with CMS about the voluntary reporting program, including the fact that not all of the measures had been endorsed by the National Quality Forum.

“This is just the first step of the process” and it is voluntary, CMS spokesperson Peter Ashkenaz pointed out in an interview. “We want to be able to collect information and provide analysis to see how this works.” Ultimately, the goal is to establish a program in which CMS pays for services rendered on high quality of care, not on volume, he said.

DALLAS — Predicting more administrative burdens and an eventual mandate on performance measures, delegates at the interim meeting of the American Medical Association's House of Delegates voted to oppose the federal government's plans to implement a voluntary quality reporting program for Medicare.

Delegates adopted a report from the AMA's board of trustees that strongly objected to the coming system, and offered to assist the government in correcting the program's “strong deficiencies.”

The Centers for Medicare and Medicaid Services announced the “Physician Voluntary Reporting Program” in late October, and said that the new initiative would avoid unnecessary costs and improve quality of care.

Beginning next month, physicians who choose to participate will voluntarily send information to CMS about the quality of care they provide to beneficiaries. They will receive feedback on their performance from the agency as early as next summer.

In its report and in a letter to CMS administrator Mark B. McClellan, M.D., AMA trustees expressed doubts that the new system will improve the quality of health care.

“The physician community has made a good faith effort to develop, endorse, and implement physician performance measures,” some in collaboration with CMS, the letter said. “However, the excessive administrative requirements that this program will impose on physicians could doom this initiative.”

The program would force primary care physicians with an already busy patient load to develop a new reporting system from scratch, said Joseph Zebley, M.D., a delegate from the American Academy of Family Physicians, during committee debate on the board's report.

During the first phase of the program, CMS will collect clinical data through a set of Healthcare Common Procedure Coding System (HCPCS) codes—also called G-codes—that will be included in the claims physicians currently submit to CMS.

The data will then be used to measure the quality of services provided to Medicare patients.

In its letter to CMS, the trustees noted that a participating primary care physician treating a 70-year-old woman with common conditions like osteoporosis, diabetes, and heart disease would have to report on approximately 2–13 measures and consider 36–39 G-codes.

Not only don't physicians use G-codes, “electronic health records don't have G-codes as part of their software,” Mary Frank, M.D., AAFP board chair and delegate to the AMA House noted. “We put CPT codes [into the electronic health records], which is what we all use.”

Dr. Zebley added that the program “would place a tremendous burden on family physicians and other primary care physicians.”

G-codes would serve as an “interim step” until the electronic submission of data through electronic health records replaced this process, CMS said when announcing the voluntary program. The agency promised it would collaborate with participating physicians to develop such electronic data submission records.

Although CMS said in its announcement that participation in the voluntary program would not affect physician reimbursement under Medicare, many delegates expressed concern that the system would eventually become mandatory.

CMS “has indicated that there could be a link between reporting data and receiving higher Medicare payments next year,” depending on the success of the voluntary reporting program, William Kobler, M.D., AMA delegate from Illinois, noted during committee proceedings.

Other business addressed by the AMA House of Delegates included:

▸ Medicaid reform. Delegates passed a resolution opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level.

▸ Smoking bans. Applying a hard-line approach to kicking the habit, delegates voted that the AMA should actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations.

The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises.

▸ Prisoner interrogation. Delegates asked that the AMA's Council on Ethical and Judicial Affairs “clearly delineate” the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.

▸ Medicare Part D. Delegates voted that the AMA should support legislation and urge the Department of Health and Human Services to modify or eliminate the exclusion of various prescription drugs from coverage under Part D, and to ensure that Medicare contractors administering the new drug benefit include on their formularies medications to treat psychiatric and substance use disorders, including benzodiazepines, methadone, buprenorphine, acamprosate, disulfiram, and naltrexone.

▸ Disaster preparedness and response. Delegates called on state and local public health entities to develop a public health disaster plan specific to their locations. National legislation should also be enacted to give qualified physicians automatic medical liability immunity in the event of a declared disaster or federal emergency.

CMS's Reporting Criteria

Thirty-six evidence-based measures are to be reported in the first phase of the voluntary reporting program, according to CMS.

The final measures run the gamut of services, from influenza, pneumococcal vaccinations, and mammography to more complex surgery-related measures, such as prolonged intubation during isolated coronary artery bypass graft procedures. Other measures include the administration of aspirin and β-blockers at the time of arrival for acute MI, and the screening of elderly patients for falls and urinary incontinence.

According to CMS, the performance measures were developed in collaboration with physicians and physician organizations, as well as other stakeholders. Work by the National Quality Forum, the Ambulatory Care Alliance, the AMA's Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND Corporation “provided the basis for the selection of these measures,” CMS indicated in a statement.

Yet many AMA delegates at the interim meeting said that they felt CMS had “sprung” the program on them at a time when they were facing a 4.4% reduction in Medicare payments.

Michael Barr, M.D., vice president of practice advocacy and improvement at the American College of Physicians (ACP), said that the ACP was discussing its concerns with CMS about the voluntary reporting program, including the fact that not all of the measures had been endorsed by the National Quality Forum.

“This is just the first step of the process” and it is voluntary, CMS spokesperson Peter Ashkenaz pointed out in an interview. “We want to be able to collect information and provide analysis to see how this works.” Ultimately, the goal is to establish a program in which CMS pays for services rendered on high quality of care, not on volume, he said.

WASHINGTON — Physicians will see a 4.4% cut in their Medicare fees under rules announcing next year's fee schedule, unless legislation pending in Congress supersedes those rules. Mark D. McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services, announced the fee cut at a press teleconference.

At press time, it was unclear how Congress ultimately would address the issue. The Senate had passed a budget-reconciliation package containing several provisions on pay for performance, sponsored by Sen. Charles E. “Chuck” Grassley (R-Iowa), as well as a yearlong, 1% Medicare pay increase for physicians. In the meantime, legislation by the House of Representatives did not address the pay cut.

In announcing the final rule on the 2006 fee schedule, Dr. McClellan clarified that the 1% increase contained in the Senate legislation “would link to creating a pay-for-performance fund for physician services. While we have not endorsed that approach and think that in the short term, it may be better to get more quality reporting in place effectively, we definitely want to work with interested members [of Congress] on payment reform for physicians in 2006,” he told reporters.

The American College of Cardiology supports the 1% update in the fee schedule, John W. Schaeffer, M.D., who serves on the college's advocacy committee, said in an interview.

Moving ahead with pay for performance at this time however, “is unfair and inappropriate,” he said. The Senate language barely provides an incremental increase in fees to support such a process and cover current practice expense increases.

Another problem is that pay for performance has never been tested, he said. “There are no clinical trials to show that it's safe, fair, responsible, accurate, and appropriate.” The 1% update is just a temporary fix to the serious long-term problem of correcting the sustainable growth rate (SGR), he said.

Mary Frank, M.D., board chair of the American Academy of Family Physicians, said the hope is that the budget-reconciliation package will incorporate the 1% increase with provisions from Rep. Nancy Johnson's (R-Conn.) pay-for-performance bill, which also would repeal the SGR and base future payments on the Medicare Economic Index.

As has been the case for years, the SGR is driving the cut in Medicare physician pay.

The SGR is a component in the Medicare payment formula that determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002—decreases that will continue unless the payment formula is corrected. Indeed, only congressional intervention has stopped payment cuts in the years since 2002; instead, short-term laws have provided small increases in pay.

The SGR is determined by several factors, including the projected increase in the gross domestic product; in essence, it ties medical spending to the ups and downs of the national economy.

Several organizations, such as the AAFP and Medical Group Management Association, oppose the “value-based purchasing” pay-for-performance bill sponsored by Sen. Grassley, which would link 2% of physician Medicare payments to reporting of quality data and demonstrated progress toward quality and efficiency measures but would not fix the SGR. Although the program would be voluntary, those choosing not to participate would lose the 2%.

Value-based measures require physicians to deliver more services, Michael Maves, M.D., executive vice president of the American Medical Association, recently wrote in a letter to Sen. Grassley. “Under the SGR, more physician services will result in a series of severe cuts, compounding current problems. This would make future SGR reforms more expensive.”

On the surface, pay for performance sounds good, because it would force physicians to meet certain standards, Daniel Siegel, M.D., said in an interview. Dr. Siegel of Smithtown, N.Y., represents the American Academy of Dermatology on the AMA Resource-Based Relative Value Update Committee (RUC).

The problem, he said, is that “we're not sure those measures are all that valuable.” Taking into account that 2% drop in reimbursement for not participating in Sen. Grassley's program, “the most distressing part is, it's really not pay for performance but a penalty for not meeting the new minimum standard.”

The physician fee schedule was the subject of much debate at the interim meeting of the AMA's House of Delegates.

The AMA's support for any type of pay for performance or other type of quality reporting program “is dependent on stopping the Medicare pay cuts,” AMA president J. Edward Hill, M.D., said at the meeting. In a resolution, the House of Delegates asked the organization to advocate for a repeal of the SGR without compromising the organization's principles on pay for performance.

Joyce Frieden, Associate Editor for Practice Trends, contributed to this report.

WASHINGTON — Physicians will see a 4.4% cut in their Medicare fees under rules announcing next year's fee schedule, unless legislation pending in Congress supersedes those rules. Mark D. McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services, announced the fee cut at a press teleconference.

At press time, it was unclear how Congress ultimately would address the issue. The Senate had passed a budget-reconciliation package containing several provisions on pay for performance, sponsored by Sen. Charles E. “Chuck” Grassley (R-Iowa), as well as a yearlong, 1% Medicare pay increase for physicians. In the meantime, legislation by the House of Representatives did not address the pay cut.

In announcing the final rule on the 2006 fee schedule, Dr. McClellan clarified that the 1% increase contained in the Senate legislation “would link to creating a pay-for-performance fund for physician services. While we have not endorsed that approach and think that in the short term, it may be better to get more quality reporting in place effectively, we definitely want to work with interested members [of Congress] on payment reform for physicians in 2006,” he told reporters.

The American College of Cardiology supports the 1% update in the fee schedule, John W. Schaeffer, M.D., who serves on the college's advocacy committee, said in an interview.

Moving ahead with pay for performance at this time however, “is unfair and inappropriate,” he said. The Senate language barely provides an incremental increase in fees to support such a process and cover current practice expense increases.

Another problem is that pay for performance has never been tested, he said. “There are no clinical trials to show that it's safe, fair, responsible, accurate, and appropriate.” The 1% update is just a temporary fix to the serious long-term problem of correcting the sustainable growth rate (SGR), he said.

Mary Frank, M.D., board chair of the American Academy of Family Physicians, said the hope is that the budget-reconciliation package will incorporate the 1% increase with provisions from Rep. Nancy Johnson's (R-Conn.) pay-for-performance bill, which also would repeal the SGR and base future payments on the Medicare Economic Index.

As has been the case for years, the SGR is driving the cut in Medicare physician pay.

The SGR is a component in the Medicare payment formula that determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002—decreases that will continue unless the payment formula is corrected. Indeed, only congressional intervention has stopped payment cuts in the years since 2002; instead, short-term laws have provided small increases in pay.

The SGR is determined by several factors, including the projected increase in the gross domestic product; in essence, it ties medical spending to the ups and downs of the national economy.

Several organizations, such as the AAFP and Medical Group Management Association, oppose the “value-based purchasing” pay-for-performance bill sponsored by Sen. Grassley, which would link 2% of physician Medicare payments to reporting of quality data and demonstrated progress toward quality and efficiency measures but would not fix the SGR. Although the program would be voluntary, those choosing not to participate would lose the 2%.

Value-based measures require physicians to deliver more services, Michael Maves, M.D., executive vice president of the American Medical Association, recently wrote in a letter to Sen. Grassley. “Under the SGR, more physician services will result in a series of severe cuts, compounding current problems. This would make future SGR reforms more expensive.”

On the surface, pay for performance sounds good, because it would force physicians to meet certain standards, Daniel Siegel, M.D., said in an interview. Dr. Siegel of Smithtown, N.Y., represents the American Academy of Dermatology on the AMA Resource-Based Relative Value Update Committee (RUC).

The problem, he said, is that “we're not sure those measures are all that valuable.” Taking into account that 2% drop in reimbursement for not participating in Sen. Grassley's program, “the most distressing part is, it's really not pay for performance but a penalty for not meeting the new minimum standard.”

The physician fee schedule was the subject of much debate at the interim meeting of the AMA's House of Delegates.

The AMA's support for any type of pay for performance or other type of quality reporting program “is dependent on stopping the Medicare pay cuts,” AMA president J. Edward Hill, M.D., said at the meeting. In a resolution, the House of Delegates asked the organization to advocate for a repeal of the SGR without compromising the organization's principles on pay for performance.

Joyce Frieden, Associate Editor for Practice Trends, contributed to this report.

WASHINGTON — Physicians will see a 4.4% cut in their Medicare fees under rules announcing next year's fee schedule, unless legislation pending in Congress supersedes those rules. Mark D. McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services, announced the fee cut at a press teleconference.

At press time, it was unclear how Congress ultimately would address the issue. The Senate had passed a budget-reconciliation package containing several provisions on pay for performance, sponsored by Sen. Charles E. “Chuck” Grassley (R-Iowa), as well as a yearlong, 1% Medicare pay increase for physicians. In the meantime, legislation by the House of Representatives did not address the pay cut.

In announcing the final rule on the 2006 fee schedule, Dr. McClellan clarified that the 1% increase contained in the Senate legislation “would link to creating a pay-for-performance fund for physician services. While we have not endorsed that approach and think that in the short term, it may be better to get more quality reporting in place effectively, we definitely want to work with interested members [of Congress] on payment reform for physicians in 2006,” he told reporters.

The American College of Cardiology supports the 1% update in the fee schedule, John W. Schaeffer, M.D., who serves on the college's advocacy committee, said in an interview.

Moving ahead with pay for performance at this time however, “is unfair and inappropriate,” he said. The Senate language barely provides an incremental increase in fees to support such a process and cover current practice expense increases.

Another problem is that pay for performance has never been tested, he said. “There are no clinical trials to show that it's safe, fair, responsible, accurate, and appropriate.” The 1% update is just a temporary fix to the serious long-term problem of correcting the sustainable growth rate (SGR), he said.

Mary Frank, M.D., board chair of the American Academy of Family Physicians, said the hope is that the budget-reconciliation package will incorporate the 1% increase with provisions from Rep. Nancy Johnson's (R-Conn.) pay-for-performance bill, which also would repeal the SGR and base future payments on the Medicare Economic Index.

As has been the case for years, the SGR is driving the cut in Medicare physician pay.

The SGR is a component in the Medicare payment formula that determines the conversion factor update each year. Errors made to the formula in 1998 and 1999 led to a 5.4% decrease in physician payments in 2002—decreases that will continue unless the payment formula is corrected. Indeed, only congressional intervention has stopped payment cuts in the years since 2002; instead, short-term laws have provided small increases in pay.

The SGR is determined by several factors, including the projected increase in the gross domestic product; in essence, it ties medical spending to the ups and downs of the national economy.

Several organizations, such as the AAFP and Medical Group Management Association, oppose the “value-based purchasing” pay-for-performance bill sponsored by Sen. Grassley, which would link 2% of physician Medicare payments to reporting of quality data and demonstrated progress toward quality and efficiency measures but would not fix the SGR. Although the program would be voluntary, those choosing not to participate would lose the 2%.

Value-based measures require physicians to deliver more services, Michael Maves, M.D., executive vice president of the American Medical Association, recently wrote in a letter to Sen. Grassley. “Under the SGR, more physician services will result in a series of severe cuts, compounding current problems. This would make future SGR reforms more expensive.”

On the surface, pay for performance sounds good, because it would force physicians to meet certain standards, Daniel Siegel, M.D., said in an interview. Dr. Siegel of Smithtown, N.Y., represents the American Academy of Dermatology on the AMA Resource-Based Relative Value Update Committee (RUC).

The problem, he said, is that “we're not sure those measures are all that valuable.” Taking into account that 2% drop in reimbursement for not participating in Sen. Grassley's program, “the most distressing part is, it's really not pay for performance but a penalty for not meeting the new minimum standard.”

The physician fee schedule was the subject of much debate at the interim meeting of the AMA's House of Delegates.

The AMA's support for any type of pay for performance or other type of quality reporting program “is dependent on stopping the Medicare pay cuts,” AMA president J. Edward Hill, M.D., said at the meeting. In a resolution, the House of Delegates asked the organization to advocate for a repeal of the SGR without compromising the organization's principles on pay for performance.

Joyce Frieden, Associate Editor for Practice Trends, contributed to this report.

Universal Health Care in Illinois

Universal health care coverage will be available to children in the state of Illinois next year. Gov. Rod R. Blagojevich (D) recently signed the “All Kids” plan into law, which makes comprehensive health insurance available to all children—regardless of family income—with parents paying monthly premiums and co-payments for physician's visits and prescription drugs at affordable rates. The coverage also includes inpatient care, vision care, dental care, and medical devices such as inhalers. The plan specifically targets uninsured children that come from working and middle-class families—those whose parents earn too much to qualify for public programs like KidCare, but still can't afford private insurance. “This plan makes Illinois the first state in the country to provide comprehensive health care coverage to uninsured children,” said Ron Pollack, executive director of Families USA, in a statement. “This enormous breakthrough may set an example for other states and the federal government to extend help to the parents of uninsured children all across the country,” he said. The plan goes into effect on July 1.

Autism and Genetics

Five institutes at the National Institutes of Health and three private organizations have formed a consortium to identify genes that may contribute to the development of autism and autism spectrum disorders. The consortium has funded five grants totaling $10.8 million, to be given out over a 5-year period. “This initiative seeks to expand our knowledge of the genetic factors involved in this disorder that affects so many families,” said Thomas R. Insel, director of the National Institute of Mental Health, one of the consortium members. The other members from NIH are the National Institute on Deafness and Other Communication Disorders, the National Institute of Environmental Health Sciences, the National Institute of Neurological Disorders and Stroke, and the National Institute of Child Health and Human Development. The private organizations are the National Alliance for Autism Research, Cure Autism Now, and the Southwest Autism Research and Resource Center.

AMA Addresses Medicaid Reform

Delegates to the American Medical Association's interim meeting tackled the issues of Medicaid reform and the uninsured, opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level. In addition, they adopted a report that would place a high priority on expanding health insurance coverage for “all Americans,” including the uninsured, and also called on the AMA to pursue bipartisan support for federally funded tax credits as a preferred long-term solution for covering all patients. A resolution calling for the AMA to endorse health savings accounts for Medicaid patients ended up getting referred back to the AMA's Board of Trustees.

Smoking Ban in Public Places

Applying a hard-line approach to kicking the habit, AMA delegates voted to actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations. The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises. The language initially just called for a ban in restaurants, “but we recognized that there was no reason to limit it to eating establishments,” said AMA Trustee Robert Wah, M.D. “The public workplace needed to be protected as well.”

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Universal Health Care in Illinois

Universal health care coverage will be available to children in the state of Illinois next year. Gov. Rod R. Blagojevich (D) recently signed the “All Kids” plan into law, which makes comprehensive health insurance available to all children—regardless of family income—with parents paying monthly premiums and co-payments for physician's visits and prescription drugs at affordable rates. The coverage also includes inpatient care, vision care, dental care, and medical devices such as inhalers. The plan specifically targets uninsured children that come from working and middle-class families—those whose parents earn too much to qualify for public programs like KidCare, but still can't afford private insurance. “This plan makes Illinois the first state in the country to provide comprehensive health care coverage to uninsured children,” said Ron Pollack, executive director of Families USA, in a statement. “This enormous breakthrough may set an example for other states and the federal government to extend help to the parents of uninsured children all across the country,” he said. The plan goes into effect on July 1.

Autism and Genetics

Five institutes at the National Institutes of Health and three private organizations have formed a consortium to identify genes that may contribute to the development of autism and autism spectrum disorders. The consortium has funded five grants totaling $10.8 million, to be given out over a 5-year period. “This initiative seeks to expand our knowledge of the genetic factors involved in this disorder that affects so many families,” said Thomas R. Insel, director of the National Institute of Mental Health, one of the consortium members. The other members from NIH are the National Institute on Deafness and Other Communication Disorders, the National Institute of Environmental Health Sciences, the National Institute of Neurological Disorders and Stroke, and the National Institute of Child Health and Human Development. The private organizations are the National Alliance for Autism Research, Cure Autism Now, and the Southwest Autism Research and Resource Center.

AMA Addresses Medicaid Reform

Delegates to the American Medical Association's interim meeting tackled the issues of Medicaid reform and the uninsured, opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level. In addition, they adopted a report that would place a high priority on expanding health insurance coverage for “all Americans,” including the uninsured, and also called on the AMA to pursue bipartisan support for federally funded tax credits as a preferred long-term solution for covering all patients. A resolution calling for the AMA to endorse health savings accounts for Medicaid patients ended up getting referred back to the AMA's Board of Trustees.

Smoking Ban in Public Places

Applying a hard-line approach to kicking the habit, AMA delegates voted to actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations. The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises. The language initially just called for a ban in restaurants, “but we recognized that there was no reason to limit it to eating establishments,” said AMA Trustee Robert Wah, M.D. “The public workplace needed to be protected as well.”

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Universal Health Care in Illinois

Universal health care coverage will be available to children in the state of Illinois next year. Gov. Rod R. Blagojevich (D) recently signed the “All Kids” plan into law, which makes comprehensive health insurance available to all children—regardless of family income—with parents paying monthly premiums and co-payments for physician's visits and prescription drugs at affordable rates. The coverage also includes inpatient care, vision care, dental care, and medical devices such as inhalers. The plan specifically targets uninsured children that come from working and middle-class families—those whose parents earn too much to qualify for public programs like KidCare, but still can't afford private insurance. “This plan makes Illinois the first state in the country to provide comprehensive health care coverage to uninsured children,” said Ron Pollack, executive director of Families USA, in a statement. “This enormous breakthrough may set an example for other states and the federal government to extend help to the parents of uninsured children all across the country,” he said. The plan goes into effect on July 1.

Autism and Genetics

Five institutes at the National Institutes of Health and three private organizations have formed a consortium to identify genes that may contribute to the development of autism and autism spectrum disorders. The consortium has funded five grants totaling $10.8 million, to be given out over a 5-year period. “This initiative seeks to expand our knowledge of the genetic factors involved in this disorder that affects so many families,” said Thomas R. Insel, director of the National Institute of Mental Health, one of the consortium members. The other members from NIH are the National Institute on Deafness and Other Communication Disorders, the National Institute of Environmental Health Sciences, the National Institute of Neurological Disorders and Stroke, and the National Institute of Child Health and Human Development. The private organizations are the National Alliance for Autism Research, Cure Autism Now, and the Southwest Autism Research and Resource Center.

AMA Addresses Medicaid Reform

Delegates to the American Medical Association's interim meeting tackled the issues of Medicaid reform and the uninsured, opposing Medicaid reform legislation—now pending in the U.S. House of Representatives—that would mandate premiums and copayments for acute care services and pharmaceuticals for children who live at or below 133% of the federal poverty level. In addition, they adopted a report that would place a high priority on expanding health insurance coverage for “all Americans,” including the uninsured, and also called on the AMA to pursue bipartisan support for federally funded tax credits as a preferred long-term solution for covering all patients. A resolution calling for the AMA to endorse health savings accounts for Medicaid patients ended up getting referred back to the AMA's Board of Trustees.

Smoking Ban in Public Places

Applying a hard-line approach to kicking the habit, AMA delegates voted to actively support national, state, and local legislation and pursue regulations banning smoking in all workplaces. In addition, the AMA should work to ensure that federal legislation banning smoking in all workplaces does not prohibit or weaken existing and stricter state or local regulations. The AMA should also actively pursue national legislation banning smoking in all cafeterias, restaurants, cafes, supermarkets, and other venues where food or drink is consumed on the premises. The language initially just called for a ban in restaurants, “but we recognized that there was no reason to limit it to eating establishments,” said AMA Trustee Robert Wah, M.D. “The public workplace needed to be protected as well.”

Improving Uncompensated Care

Hospitals have established more generous uncompensated-care guidelines for uninsured patients after a torrent of publicity about aggressive hospital billing and collection practices and a series of lawsuits alleging that hospitals overcharge these patients, the Center for Studying Health System Change (HSC) reported. The study is based on HSC's 2005 site visits to 12 nationally representative communities. “In every HSC community, most hospitals have either recently changed their pricing, billing, and collection policies or tried to improve the clarity of the information provided to patients,” said HSC research analyst Andrea B. Staiti, coauthor of the study. For example, it is now common for hospitals in the 12 surveyed communities to provide uncompensated care to uninsured patients with incomes less than 200% of the federal poverty level, and to offer sliding-scale discounts for patients with incomes up to 400% or 500% of the poverty level.

Cream Skimming Continues

Specialty hospitals are under scrutiny once again. A study found that Arizona heart physicians who partly owned cardiac specialty hospitals were more likely than were physicians with no ownership stake to treat low-acuity, high-profit cases in their own facilities and refer the more complex, lower-profit cases to community hospitals. Jean Mitchell, Ph.D., a professor of public policy at Georgetown University, Washington, analyzed 6 years of inpatient discharge data to compare the practice patterns of physicians who were owners of cardiac specialty hospitals in Phoenix and Tucson with those of physicians who only treated patients in full-service community hospitals with an accredited cardiac care program. She found that physician-owners treated higher percentages of patients with Medicare fee-for-service or commercial PPOs, and lower percentages of patients enrolled in Medicaid and HMOs. The American Medical Association endorses the existence of such hospitals, although the Center for Medicare and Medicaid Services has reinstituted a freeze on the approval of new specialty hospitals until it completes a review next year. The study appeared as a Health Affairs Web-exclusive article.

HHS Mulls Investigation

The Department of Health and Human Services' Office of Inspector General is looking into the circumstances surrounding the resignation of former Food and Drug Administration Commissioner Lester M. Crawford, D.V.M., Ph.D., to determine if an investigation should be opened, an OIG spokeswoman said. In a response to a query from Rep. Maurice Hinchey (D-N.Y.), HHS Inspector General Daniel R. Levinson said that the OIG is doing an initial review of the facts, not an investigation in any regulatory sense, according to the spokeswoman. “After reviewing the facts, the OIG will determine if an investigation is formally launched,” she said. “Dr. Crawford's departure, a mere 2 months after confirmation to his position, raises significant questions,” Rep. Hinchey and several fellow members of Congress wrote in their request. Dr. Crawford had resigned his position after a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts.

Alternative Medicine Centers

The National Center for Complementary and Alternative Medicine (NCCAM) is funding five new research centers to study complementary and alternative approaches to HIV/AIDS, arthritis, asthma, and pain. Three of the new centers will focus on therapies used in traditional Chinese medicine, such as acupuncture and Chinese herbal mixtures. The other centers will study millimeter wave therapy—a type of energy medicine—and botanical therapies used by traditional healers in Africa. For example, NCCAM has awarded $1.2 million in first-year funding to the Center for Arthritis and Traditional Chinese Medicine at the University of Maryland in Baltimore. Researchers there will conduct a clinical trial of an 11-herb Chinese formula known as HLXL for osteoarthritis of the knee; assess acupuncture's effect on inflammatory pain in an animal model; and study the efficacy of HLXL in an animal model of autoimmune arthritis. NCCAM is a component of the National Institutes of Health.

Perceptions on Seeking Care

It's the lack of insurance, not a lack of concern, that keeps uninsured people from getting care, the Center for Studying Health System Change concluded in a study. When confronted with a serious new medical symptom, insured and uninsured people shared similar perceptions about the need to see a medical provider. In fact, the study found that uninsured people aged 18 years and older were more likely than were insured people (23% vs. 19%) to report the recent onset of at least one of 15 serious symptoms, such as shortness of breath, chest pain, persistent headache, or loss of consciousness. About 58% of insured and uninsured people with a new symptom believed they needed to see or talk to a medical provider. But even with similar conditions and similar severity levels, uninsured people were much less likely than were the insured to obtain medical care in response to the new symptom. The analysis, drawn from the center's Community Tracking Study Household Survey, was limited to 1,937 adults without Medicare coverage—1,024 uninsured and 913 insured patients.

Groups Call for Alcohol Labeling

Two consumer groups, the National Consumers League and Shape Up America!, are calling on the federal government to require standardized labeling on alcoholic beverages similar to that appearing on packaged food and over-the-counter medications. “Even the most basic information about alcohol beverages is not required to be provided on the labels of most alcohol beverage products,” said NCL President Linda Golodner. “Just as conventional foods, dietary supplements, and nonprescription drugs are required to provide a basic minimum of information needed by consumers to make informed purchasing decisions, alcohol beverage labels should also be required to provide this information.” Information the groups would like to see on the label includes serving size, alcohol content, calories, the definition of a “standard drink,” and advice from federal dietary guidelines about moderate alcohol consumption. The two groups were responding to a request for comment from the U.S. Treasury's Alcohol and Tobacco Tax and Trade Bureau on a proposal to revise the current labeling rules.

Cream Skimming Continues

Specialty hospitals are under scrutiny once again. A study found that Arizona heart physicians who partly owned cardiac specialty hospitals were more likely than were physicians with no ownership stake to treat low-acuity, high-profit cases in their own facilities and refer the more complex, lower-profit cases to community hospitals. Jean Mitchell, Ph.D., a professor of public policy at Georgetown University, Washington, analyzed 6 years of inpatient discharge data to compare the practice patterns of physicians who were owners of cardiac specialty hospitals in Phoenix and Tucson with those of physicians who only treated patients in full-service community hospitals with an accredited cardiac care program. She found that physician-owners treated higher percentages of patients with Medicare fee-for-service or commercial PPOs, and lower percentages of patients enrolled in Medicaid and HMOs. The American Medical Association endorses the existence of such hospitals, although the Center for Medicare and Medicaid Services has reinstituted a freeze on the approval of new specialty hospitals until it completes a review next year. The study appeared as a Health Affairs Web-exclusive article.

HHS Mulls Investigation

The Department of Health and Human Services' Office of Inspector General is looking into the circumstances surrounding the resignation of former Food and Drug Administration Commissioner Lester M. Crawford, D.V.M., Ph.D., to determine if an investigation should be opened, an OIG spokeswoman said. In a response to a query from Rep. Maurice Hinchey (D-N.Y.), HHS Inspector General Daniel R. Levinson said that the OIG is doing an initial review of the facts, not an investigation in any regulatory sense, according to the spokeswoman. “After reviewing the facts, the OIG will determine if an investigation is formally launched,” she said. “Dr. Crawford's departure, a mere 2 months after confirmation to his position, raises significant questions,” Rep. Hinchey and several fellow members of Congress wrote in their request. Dr. Crawford had resigned his position after a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts.

Alternative Medicine Centers

The National Center for Complementary and Alternative Medicine (NCCAM) is funding five new research centers to study complementary and alternative approaches to HIV/AIDS, arthritis, asthma, and pain. Three of the new centers will focus on therapies used in traditional Chinese medicine, such as acupuncture and Chinese herbal mixtures. The other centers will study millimeter wave therapy—a type of energy medicine—and botanical therapies used by traditional healers in Africa. For example, NCCAM has awarded $1.2 million in first-year funding to the Center for Arthritis and Traditional Chinese Medicine at the University of Maryland in Baltimore. Researchers there will conduct a clinical trial of an 11-herb Chinese formula known as HLXL for osteoarthritis of the knee; assess acupuncture's effect on inflammatory pain in an animal model; and study the efficacy of HLXL in an animal model of autoimmune arthritis. NCCAM is a component of the National Institutes of Health.

Perceptions on Seeking Care

It's the lack of insurance, not a lack of concern, that keeps uninsured people from getting care, the Center for Studying Health System Change concluded in a study. When confronted with a serious new medical symptom, insured and uninsured people shared similar perceptions about the need to see a medical provider. In fact, the study found that uninsured people aged 18 years and older were more likely than were insured people (23% vs. 19%) to report the recent onset of at least one of 15 serious symptoms, such as shortness of breath, chest pain, persistent headache, or loss of consciousness. About 58% of insured and uninsured people with a new symptom believed they needed to see or talk to a medical provider. But even with similar conditions and similar severity levels, uninsured people were much less likely than were the insured to obtain medical care in response to the new symptom. The analysis, drawn from the center's Community Tracking Study Household Survey, was limited to 1,937 adults without Medicare coverage—1,024 uninsured and 913 insured patients.

Groups Call for Alcohol Labeling

Two consumer groups, the National Consumers League and Shape Up America!, are calling on the federal government to require standardized labeling on alcoholic beverages similar to that appearing on packaged food and over-the-counter medications. “Even the most basic information about alcohol beverages is not required to be provided on the labels of most alcohol beverage products,” said NCL President Linda Golodner. “Just as conventional foods, dietary supplements, and nonprescription drugs are required to provide a basic minimum of information needed by consumers to make informed purchasing decisions, alcohol beverage labels should also be required to provide this information.” Information the groups would like to see on the label includes serving size, alcohol content, calories, the definition of a “standard drink,” and advice from federal dietary guidelines about moderate alcohol consumption. The two groups were responding to a request for comment from the U.S. Treasury's Alcohol and Tobacco Tax and Trade Bureau on a proposal to revise the current labeling rules.

Cream Skimming Continues

Specialty hospitals are under scrutiny once again. A study found that Arizona heart physicians who partly owned cardiac specialty hospitals were more likely than were physicians with no ownership stake to treat low-acuity, high-profit cases in their own facilities and refer the more complex, lower-profit cases to community hospitals. Jean Mitchell, Ph.D., a professor of public policy at Georgetown University, Washington, analyzed 6 years of inpatient discharge data to compare the practice patterns of physicians who were owners of cardiac specialty hospitals in Phoenix and Tucson with those of physicians who only treated patients in full-service community hospitals with an accredited cardiac care program. She found that physician-owners treated higher percentages of patients with Medicare fee-for-service or commercial PPOs, and lower percentages of patients enrolled in Medicaid and HMOs. The American Medical Association endorses the existence of such hospitals, although the Center for Medicare and Medicaid Services has reinstituted a freeze on the approval of new specialty hospitals until it completes a review next year. The study appeared as a Health Affairs Web-exclusive article.

HHS Mulls Investigation

The Department of Health and Human Services' Office of Inspector General is looking into the circumstances surrounding the resignation of former Food and Drug Administration Commissioner Lester M. Crawford, D.V.M., Ph.D., to determine if an investigation should be opened, an OIG spokeswoman said. In a response to a query from Rep. Maurice Hinchey (D-N.Y.), HHS Inspector General Daniel R. Levinson said that the OIG is doing an initial review of the facts, not an investigation in any regulatory sense, according to the spokeswoman. “After reviewing the facts, the OIG will determine if an investigation is formally launched,” she said. “Dr. Crawford's departure, a mere 2 months after confirmation to his position, raises significant questions,” Rep. Hinchey and several fellow members of Congress wrote in their request. Dr. Crawford had resigned his position after a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts.

Alternative Medicine Centers

The National Center for Complementary and Alternative Medicine (NCCAM) is funding five new research centers to study complementary and alternative approaches to HIV/AIDS, arthritis, asthma, and pain. Three of the new centers will focus on therapies used in traditional Chinese medicine, such as acupuncture and Chinese herbal mixtures. The other centers will study millimeter wave therapy—a type of energy medicine—and botanical therapies used by traditional healers in Africa. For example, NCCAM has awarded $1.2 million in first-year funding to the Center for Arthritis and Traditional Chinese Medicine at the University of Maryland in Baltimore. Researchers there will conduct a clinical trial of an 11-herb Chinese formula known as HLXL for osteoarthritis of the knee; assess acupuncture's effect on inflammatory pain in an animal model; and study the efficacy of HLXL in an animal model of autoimmune arthritis. NCCAM is a component of the National Institutes of Health.

Perceptions on Seeking Care

It's the lack of insurance, not a lack of concern, that keeps uninsured people from getting care, the Center for Studying Health System Change concluded in a study. When confronted with a serious new medical symptom, insured and uninsured people shared similar perceptions about the need to see a medical provider. In fact, the study found that uninsured people aged 18 years and older were more likely than were insured people (23% vs. 19%) to report the recent onset of at least one of 15 serious symptoms, such as shortness of breath, chest pain, persistent headache, or loss of consciousness. About 58% of insured and uninsured people with a new symptom believed they needed to see or talk to a medical provider. But even with similar conditions and similar severity levels, uninsured people were much less likely than were the insured to obtain medical care in response to the new symptom. The analysis, drawn from the center's Community Tracking Study Household Survey, was limited to 1,937 adults without Medicare coverage—1,024 uninsured and 913 insured patients.

Groups Call for Alcohol Labeling

Two consumer groups, the National Consumers League and Shape Up America!, are calling on the federal government to require standardized labeling on alcoholic beverages similar to that appearing on packaged food and over-the-counter medications. “Even the most basic information about alcohol beverages is not required to be provided on the labels of most alcohol beverage products,” said NCL President Linda Golodner. “Just as conventional foods, dietary supplements, and nonprescription drugs are required to provide a basic minimum of information needed by consumers to make informed purchasing decisions, alcohol beverage labels should also be required to provide this information.” Information the groups would like to see on the label includes serving size, alcohol content, calories, the definition of a “standard drink,” and advice from federal dietary guidelines about moderate alcohol consumption. The two groups were responding to a request for comment from the U.S. Treasury's Alcohol and Tobacco Tax and Trade Bureau on a proposal to revise the current labeling rules.

WASHINGTON — Vendors should not be allowed to cut off distribution of drugs to patients regardless of their ability to pay under Medicare's new drug acquisition program, the Practicing Physicians Advisory Council recommended.

Scheduled to begin mid-2006, the Medicare competitive acquisition program (CAP) for Part B drugs and biologicals will select vendors through a bidding process to bill Medicare for these types of drugs and collect coinsurance or deductibles from patients.

Currently, physicians must purchase these drugs and biologicals from a distributor or manufacturer and then bill Medicare for reimbursement, which is set at a statutorily mandated payment rate of 106% of the manufacturer's average sales price (or ASP + 6%). Medicare pays 80% of this rate, and the physician collects a 20% copayment from the beneficiary.

Under the CAP, the only thing the physician has to do is purchase the drugs from the preselected vendors. The program was designed to reduce the administrative burden for physicians by taking them out of the financial loop. However, it also means that physicians won't have as much control over these drugs—and that vendors can elect not to ship a drug if the patient has not met some of the copay obligations.

This system will inevitably work against patients who need therapy but have no money and the physicians who treat them, said Barbara McAneny, M.D., a member of the PPAC and an oncologist, who proposed the recommendation.

Physicians are required by law to attempt to collect those copayments, “but we know that we're going to end up eating [the cost of the drug] because the patient doesn't have it.” However, the physician is going to continue treating those patients.

The provision that an executive of a vendor corporation can make the decision to cut somebody off 15 days after they've failed to make a payment is unfair, Dr. McAneny said. The vendors “never have to face that person and say, 'I'm sorry, you get to die now.' But when I'm in my practice looking at that person, that's what it will come down to. The person they'll see will be me.”

From a moral and ethical standpoint, the interim final rule leaves physicians with only one option: to opt out of the CAP to avoid abandoning patients, continue to purchase drugs on the ASP + 6% market, receive 86% of the cost of the drug, “and chew up the rest,” she said.

Medicare's reimbursement under ASP can fall short of what the drugs actually cost, given fluctuations in what distributors and manufacturers charge for the drugs.

“I assume the vendors, who tend to be large pharmaceutical manufacturing corporations, would be in a much better position to eat those costs than I would as an individual physician,” Dr. McAneny said.

Amy Bassano, director of the division of ambulatory services at the Centers for Medicare and Medicaid Services (CMS) Center for Medicare Management, noted that Medicare supplier provider agreements do not require services to be provided except in cases of emergency and civil rights. “That's what we're coming up against,” she said. However, there are cases where coinsurance could be waived if there is a demonstrated financial hardship and the vendor made an attempt to collect, she added.

The panel decided that CMS should reevaluate its contention that working with CAP vendors would not increase the administrative burden of physicians.

In other PPAC recommendations:

▸ CMS should work with Bill Thomas (R-Calif.), chairman of the House Ways and Means Committee, to clarify how Congress intended the ASP and CAP to function independently of each other.

▸ CAP vendor prices should not be included in the calculation of the ASP. The inclusion is duplicative and unfair to physicians not participating in the CAP, the PPAC determined.

Given that the CMS has recognized the increased cost of dispensing drugs by pharmacies and has added 2% of the average sales price to cover pharmacy overhead costs under the ASP, the PPAC recommended that the CMS “treat physicians equally” and add 2% for physicians using the ASP + 6% and a dispensing fee for physicians using the CAP.

Physicians under the interim final rule would have only 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. Taking into account the challenges associated with meeting that deadline, the PPAC recommended that the time frame be extended to 30 days.

Also, CAP participation should be determined on an individual basis, and not as a group requirement, the panel recommended. Under the interim final rule, if one physician in a group practice decides to participate in the CAP, all of the physicians in that practice are forced to do so, Ronald Castellanos, M.D., chairman of the PPAC, said in an interview.

The program's launch was originally scheduled for January 2006, but it was delayed for 6 months after the CMS announced the suspension of the vendor bidding process to allow more time for review of public comments. The agency expects to publish a final rule on the CAP in late 2005, which would reopen bidding.

WASHINGTON — Vendors should not be allowed to cut off distribution of drugs to patients regardless of their ability to pay under Medicare's new drug acquisition program, the Practicing Physicians Advisory Council recommended.

Scheduled to begin mid-2006, the Medicare competitive acquisition program (CAP) for Part B drugs and biologicals will select vendors through a bidding process to bill Medicare for these types of drugs and collect coinsurance or deductibles from patients.

Currently, physicians must purchase these drugs and biologicals from a distributor or manufacturer and then bill Medicare for reimbursement, which is set at a statutorily mandated payment rate of 106% of the manufacturer's average sales price (or ASP + 6%). Medicare pays 80% of this rate, and the physician collects a 20% copayment from the beneficiary.

Under the CAP, the only thing the physician has to do is purchase the drugs from the preselected vendors. The program was designed to reduce the administrative burden for physicians by taking them out of the financial loop. However, it also means that physicians won't have as much control over these drugs—and that vendors can elect not to ship a drug if the patient has not met some of the copay obligations.

This system will inevitably work against patients who need therapy but have no money and the physicians who treat them, said Barbara McAneny, M.D., a member of the PPAC and an oncologist, who proposed the recommendation.

Physicians are required by law to attempt to collect those copayments, “but we know that we're going to end up eating [the cost of the drug] because the patient doesn't have it.” However, the physician is going to continue treating those patients.

The provision that an executive of a vendor corporation can make the decision to cut somebody off 15 days after they've failed to make a payment is unfair, Dr. McAneny said. The vendors “never have to face that person and say, 'I'm sorry, you get to die now.' But when I'm in my practice looking at that person, that's what it will come down to. The person they'll see will be me.”

From a moral and ethical standpoint, the interim final rule leaves physicians with only one option: to opt out of the CAP to avoid abandoning patients, continue to purchase drugs on the ASP + 6% market, receive 86% of the cost of the drug, “and chew up the rest,” she said.

Medicare's reimbursement under ASP can fall short of what the drugs actually cost, given fluctuations in what distributors and manufacturers charge for the drugs.

“I assume the vendors, who tend to be large pharmaceutical manufacturing corporations, would be in a much better position to eat those costs than I would as an individual physician,” Dr. McAneny said.

Amy Bassano, director of the division of ambulatory services at the Centers for Medicare and Medicaid Services (CMS) Center for Medicare Management, noted that Medicare supplier provider agreements do not require services to be provided except in cases of emergency and civil rights. “That's what we're coming up against,” she said. However, there are cases where coinsurance could be waived if there is a demonstrated financial hardship and the vendor made an attempt to collect, she added.

The panel decided that CMS should reevaluate its contention that working with CAP vendors would not increase the administrative burden of physicians.

In other PPAC recommendations:

▸ CMS should work with Bill Thomas (R-Calif.), chairman of the House Ways and Means Committee, to clarify how Congress intended the ASP and CAP to function independently of each other.

▸ CAP vendor prices should not be included in the calculation of the ASP. The inclusion is duplicative and unfair to physicians not participating in the CAP, the PPAC determined.

Given that the CMS has recognized the increased cost of dispensing drugs by pharmacies and has added 2% of the average sales price to cover pharmacy overhead costs under the ASP, the PPAC recommended that the CMS “treat physicians equally” and add 2% for physicians using the ASP + 6% and a dispensing fee for physicians using the CAP.

Physicians under the interim final rule would have only 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. Taking into account the challenges associated with meeting that deadline, the PPAC recommended that the time frame be extended to 30 days.

Also, CAP participation should be determined on an individual basis, and not as a group requirement, the panel recommended. Under the interim final rule, if one physician in a group practice decides to participate in the CAP, all of the physicians in that practice are forced to do so, Ronald Castellanos, M.D., chairman of the PPAC, said in an interview.

The program's launch was originally scheduled for January 2006, but it was delayed for 6 months after the CMS announced the suspension of the vendor bidding process to allow more time for review of public comments. The agency expects to publish a final rule on the CAP in late 2005, which would reopen bidding.

WASHINGTON — Vendors should not be allowed to cut off distribution of drugs to patients regardless of their ability to pay under Medicare's new drug acquisition program, the Practicing Physicians Advisory Council recommended.

Scheduled to begin mid-2006, the Medicare competitive acquisition program (CAP) for Part B drugs and biologicals will select vendors through a bidding process to bill Medicare for these types of drugs and collect coinsurance or deductibles from patients.

Currently, physicians must purchase these drugs and biologicals from a distributor or manufacturer and then bill Medicare for reimbursement, which is set at a statutorily mandated payment rate of 106% of the manufacturer's average sales price (or ASP + 6%). Medicare pays 80% of this rate, and the physician collects a 20% copayment from the beneficiary.

Under the CAP, the only thing the physician has to do is purchase the drugs from the preselected vendors. The program was designed to reduce the administrative burden for physicians by taking them out of the financial loop. However, it also means that physicians won't have as much control over these drugs—and that vendors can elect not to ship a drug if the patient has not met some of the copay obligations.

This system will inevitably work against patients who need therapy but have no money and the physicians who treat them, said Barbara McAneny, M.D., a member of the PPAC and an oncologist, who proposed the recommendation.

Physicians are required by law to attempt to collect those copayments, “but we know that we're going to end up eating [the cost of the drug] because the patient doesn't have it.” However, the physician is going to continue treating those patients.

The provision that an executive of a vendor corporation can make the decision to cut somebody off 15 days after they've failed to make a payment is unfair, Dr. McAneny said. The vendors “never have to face that person and say, 'I'm sorry, you get to die now.' But when I'm in my practice looking at that person, that's what it will come down to. The person they'll see will be me.”

From a moral and ethical standpoint, the interim final rule leaves physicians with only one option: to opt out of the CAP to avoid abandoning patients, continue to purchase drugs on the ASP + 6% market, receive 86% of the cost of the drug, “and chew up the rest,” she said.

Medicare's reimbursement under ASP can fall short of what the drugs actually cost, given fluctuations in what distributors and manufacturers charge for the drugs.

“I assume the vendors, who tend to be large pharmaceutical manufacturing corporations, would be in a much better position to eat those costs than I would as an individual physician,” Dr. McAneny said.

Amy Bassano, director of the division of ambulatory services at the Centers for Medicare and Medicaid Services (CMS) Center for Medicare Management, noted that Medicare supplier provider agreements do not require services to be provided except in cases of emergency and civil rights. “That's what we're coming up against,” she said. However, there are cases where coinsurance could be waived if there is a demonstrated financial hardship and the vendor made an attempt to collect, she added.

The panel decided that CMS should reevaluate its contention that working with CAP vendors would not increase the administrative burden of physicians.

In other PPAC recommendations:

▸ CMS should work with Bill Thomas (R-Calif.), chairman of the House Ways and Means Committee, to clarify how Congress intended the ASP and CAP to function independently of each other.

▸ CAP vendor prices should not be included in the calculation of the ASP. The inclusion is duplicative and unfair to physicians not participating in the CAP, the PPAC determined.

Given that the CMS has recognized the increased cost of dispensing drugs by pharmacies and has added 2% of the average sales price to cover pharmacy overhead costs under the ASP, the PPAC recommended that the CMS “treat physicians equally” and add 2% for physicians using the ASP + 6% and a dispensing fee for physicians using the CAP.

Physicians under the interim final rule would have only 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. Taking into account the challenges associated with meeting that deadline, the PPAC recommended that the time frame be extended to 30 days.

Also, CAP participation should be determined on an individual basis, and not as a group requirement, the panel recommended. Under the interim final rule, if one physician in a group practice decides to participate in the CAP, all of the physicians in that practice are forced to do so, Ronald Castellanos, M.D., chairman of the PPAC, said in an interview.

The program's launch was originally scheduled for January 2006, but it was delayed for 6 months after the CMS announced the suspension of the vendor bidding process to allow more time for review of public comments. The agency expects to publish a final rule on the CAP in late 2005, which would reopen bidding.

HHS Buys More Avian Flu Vaccine

The Department of Health and Human Services is spending another $62.5 million to buy vaccine to be used in the event of an avian influenza pandemic. HHS awarded the contract to Chiron Corp. to produce vaccine against the H5N1 influenza strain. “An influenza vaccine effective against the H5N1 virus is our best hope of protecting the American people from a virus for which they have no immunity,” Secretary Mike Leavitt said in a statement. Last month, the government awarded a $100 million contract to Sanofi Pasteur to produce a similar vaccine. HHS officials plan to buy enough H5N1 vaccine for 20 million people and enough influenza antiviral medication for an additional 20 million people. Both will become part of the Strategic National Stockpile.

Finance a Challenge

Most physicians say that managing their finances will become more challenging over the next few years, according to a survey conducted by American Express. The survey was based on online interviews with 360 mostly primary care physicians and ob.gyns. in private practice. Additionally, 100 oncologists, 102 dermatologists, 100 urologists, 101 ophthalmologists, and 116 dentists in private practice were surveyed. For 83% of the survey respondents, managing the dual role of practicing medicine and running their business is a challenge. Nearly 75% said they need more financial training

Humana Settles Class Action Suit

Humana and representatives of more than 700,000 physicians settled a nationwide class action suit that had been pending in U.S. District Court for the Southern District of Florida for more than 6 years. The original lawsuit alleged a conspiracy between Humana and other HMOs against physicians, “to manipulate software to cheat the doctor out of getting paid money due for services rendered,” Archie Lamb, lead co-counsel for the physicians, said in an interview. Pursuant to the settlement, Humana has agreed to pay $40 million to physicians, as well as modify its software system to make it more fair and efficient for physicians—changes worth more than $75 million. “Humana should be commended for joining the growing list of health insurance companies that have settled with the nation's physicians,” Mr. Lamb said. Those companies include Aetna, Cigna, Prudential, and HealthNet.

Public Favors EHRs

Nearly three-fourths of Americans favor establishing a nationwide electronic information exchange to allow patient health records to be shared quickly among health professionals via the Internet, according to a survey of 800 adults sponsored by the Markle Foundation. However, 79% of respondents said it was important to make sure sharing could take place only after patients gave their permission. “Americans use digital information technology to pay bills, book flights, and customize the music they listen to, and our research shows they now want to use health information technology to get the best care possible for themselves,” said Zoe Baird, the foundation's president. “People realize that if they or those they love are in an accident or disaster, having their medical records available at a moment's notice through secure, electronic information exchange could mean the difference between life and death.”

Pinpointing Side Effects

In an attempt to more quickly pinpoint the potential side effects of drugs on the market, the Food and Drug Administration has contracted with several organizations to access their prescription drug data. Ingenix Inc., a unit of UnitedHealth Group Inc.; the Kaiser Foundation Research Institute; Vanderbilt University, Nashville, Tenn.; and the privately held Harvard Pilgrim Health Care Inc. each won contracts worth about $1.35 million to provide the data. Under the agreements, FDA scientists will be able to search each organization's database of medical claims and prescription drug use. The databases include information from patients enrolled in private insurance plans and state Medicaid programs. “These proactive efforts should enhance the FDA's ability to identify and assess issues and potential risks related to pharmaceutical agents in a more timely fashion than ever before,” said Terri Madison, Ph.D., president of i3 Drug Safety, which will lead the Ingenix program. In a statement, Alan Goldhammer, Ph.D., associate vice president for regulatory affairs at Pharmaceutical Research and Manufacturers of America, said PhRMA supported “new approaches to improving pharmacovigilance.” The group called on the CERTs (Centers for Education and Research on Therapeutics) to hold a workshop on this topic.

Voters Doubt Congress on Access

Roughly two-thirds of voters think Congress has not made much progress on helping those without health insurance, and is not likely to make much more in the next 5–10 years, according to a survey of 800 likely voters sponsored by Ceasefire on Health Care, a group whose aim is to stimulate dialogue on health care between Republican and Democratic policy makers. Overall, poll respondents listed their top four health care priorities as making sure all U.S. children have access to basic health care, guaranteeing health care to every American citizen, providing better preventive health care to all Americans, and helping control the amount of out-of-pocket health care costs. About “88% of those surveyed want Congress to compromise on the issue of the uninsured,” said former Sen. John Breaux (D-La.), who is leading the group.

HHS Buys More Avian Flu Vaccine

The Department of Health and Human Services is spending another $62.5 million to buy vaccine to be used in the event of an avian influenza pandemic. HHS awarded the contract to Chiron Corp. to produce vaccine against the H5N1 influenza strain. “An influenza vaccine effective against the H5N1 virus is our best hope of protecting the American people from a virus for which they have no immunity,” Secretary Mike Leavitt said in a statement. Last month, the government awarded a $100 million contract to Sanofi Pasteur to produce a similar vaccine. HHS officials plan to buy enough H5N1 vaccine for 20 million people and enough influenza antiviral medication for an additional 20 million people. Both will become part of the Strategic National Stockpile.

Finance a Challenge

Most physicians say that managing their finances will become more challenging over the next few years, according to a survey conducted by American Express. The survey was based on online interviews with 360 mostly primary care physicians and ob.gyns. in private practice. Additionally, 100 oncologists, 102 dermatologists, 100 urologists, 101 ophthalmologists, and 116 dentists in private practice were surveyed. For 83% of the survey respondents, managing the dual role of practicing medicine and running their business is a challenge. Nearly 75% said they need more financial training

Humana Settles Class Action Suit

Humana and representatives of more than 700,000 physicians settled a nationwide class action suit that had been pending in U.S. District Court for the Southern District of Florida for more than 6 years. The original lawsuit alleged a conspiracy between Humana and other HMOs against physicians, “to manipulate software to cheat the doctor out of getting paid money due for services rendered,” Archie Lamb, lead co-counsel for the physicians, said in an interview. Pursuant to the settlement, Humana has agreed to pay $40 million to physicians, as well as modify its software system to make it more fair and efficient for physicians—changes worth more than $75 million. “Humana should be commended for joining the growing list of health insurance companies that have settled with the nation's physicians,” Mr. Lamb said. Those companies include Aetna, Cigna, Prudential, and HealthNet.

Public Favors EHRs

Nearly three-fourths of Americans favor establishing a nationwide electronic information exchange to allow patient health records to be shared quickly among health professionals via the Internet, according to a survey of 800 adults sponsored by the Markle Foundation. However, 79% of respondents said it was important to make sure sharing could take place only after patients gave their permission. “Americans use digital information technology to pay bills, book flights, and customize the music they listen to, and our research shows they now want to use health information technology to get the best care possible for themselves,” said Zoe Baird, the foundation's president. “People realize that if they or those they love are in an accident or disaster, having their medical records available at a moment's notice through secure, electronic information exchange could mean the difference between life and death.”

Pinpointing Side Effects

In an attempt to more quickly pinpoint the potential side effects of drugs on the market, the Food and Drug Administration has contracted with several organizations to access their prescription drug data. Ingenix Inc., a unit of UnitedHealth Group Inc.; the Kaiser Foundation Research Institute; Vanderbilt University, Nashville, Tenn.; and the privately held Harvard Pilgrim Health Care Inc. each won contracts worth about $1.35 million to provide the data. Under the agreements, FDA scientists will be able to search each organization's database of medical claims and prescription drug use. The databases include information from patients enrolled in private insurance plans and state Medicaid programs. “These proactive efforts should enhance the FDA's ability to identify and assess issues and potential risks related to pharmaceutical agents in a more timely fashion than ever before,” said Terri Madison, Ph.D., president of i3 Drug Safety, which will lead the Ingenix program. In a statement, Alan Goldhammer, Ph.D., associate vice president for regulatory affairs at Pharmaceutical Research and Manufacturers of America, said PhRMA supported “new approaches to improving pharmacovigilance.” The group called on the CERTs (Centers for Education and Research on Therapeutics) to hold a workshop on this topic.

Voters Doubt Congress on Access

Roughly two-thirds of voters think Congress has not made much progress on helping those without health insurance, and is not likely to make much more in the next 5–10 years, according to a survey of 800 likely voters sponsored by Ceasefire on Health Care, a group whose aim is to stimulate dialogue on health care between Republican and Democratic policy makers. Overall, poll respondents listed their top four health care priorities as making sure all U.S. children have access to basic health care, guaranteeing health care to every American citizen, providing better preventive health care to all Americans, and helping control the amount of out-of-pocket health care costs. About “88% of those surveyed want Congress to compromise on the issue of the uninsured,” said former Sen. John Breaux (D-La.), who is leading the group.

HHS Buys More Avian Flu Vaccine

The Department of Health and Human Services is spending another $62.5 million to buy vaccine to be used in the event of an avian influenza pandemic. HHS awarded the contract to Chiron Corp. to produce vaccine against the H5N1 influenza strain. “An influenza vaccine effective against the H5N1 virus is our best hope of protecting the American people from a virus for which they have no immunity,” Secretary Mike Leavitt said in a statement. Last month, the government awarded a $100 million contract to Sanofi Pasteur to produce a similar vaccine. HHS officials plan to buy enough H5N1 vaccine for 20 million people and enough influenza antiviral medication for an additional 20 million people. Both will become part of the Strategic National Stockpile.

Finance a Challenge

Most physicians say that managing their finances will become more challenging over the next few years, according to a survey conducted by American Express. The survey was based on online interviews with 360 mostly primary care physicians and ob.gyns. in private practice. Additionally, 100 oncologists, 102 dermatologists, 100 urologists, 101 ophthalmologists, and 116 dentists in private practice were surveyed. For 83% of the survey respondents, managing the dual role of practicing medicine and running their business is a challenge. Nearly 75% said they need more financial training

Humana Settles Class Action Suit

Humana and representatives of more than 700,000 physicians settled a nationwide class action suit that had been pending in U.S. District Court for the Southern District of Florida for more than 6 years. The original lawsuit alleged a conspiracy between Humana and other HMOs against physicians, “to manipulate software to cheat the doctor out of getting paid money due for services rendered,” Archie Lamb, lead co-counsel for the physicians, said in an interview. Pursuant to the settlement, Humana has agreed to pay $40 million to physicians, as well as modify its software system to make it more fair and efficient for physicians—changes worth more than $75 million. “Humana should be commended for joining the growing list of health insurance companies that have settled with the nation's physicians,” Mr. Lamb said. Those companies include Aetna, Cigna, Prudential, and HealthNet.

Public Favors EHRs

Nearly three-fourths of Americans favor establishing a nationwide electronic information exchange to allow patient health records to be shared quickly among health professionals via the Internet, according to a survey of 800 adults sponsored by the Markle Foundation. However, 79% of respondents said it was important to make sure sharing could take place only after patients gave their permission. “Americans use digital information technology to pay bills, book flights, and customize the music they listen to, and our research shows they now want to use health information technology to get the best care possible for themselves,” said Zoe Baird, the foundation's president. “People realize that if they or those they love are in an accident or disaster, having their medical records available at a moment's notice through secure, electronic information exchange could mean the difference between life and death.”

Pinpointing Side Effects

In an attempt to more quickly pinpoint the potential side effects of drugs on the market, the Food and Drug Administration has contracted with several organizations to access their prescription drug data. Ingenix Inc., a unit of UnitedHealth Group Inc.; the Kaiser Foundation Research Institute; Vanderbilt University, Nashville, Tenn.; and the privately held Harvard Pilgrim Health Care Inc. each won contracts worth about $1.35 million to provide the data. Under the agreements, FDA scientists will be able to search each organization's database of medical claims and prescription drug use. The databases include information from patients enrolled in private insurance plans and state Medicaid programs. “These proactive efforts should enhance the FDA's ability to identify and assess issues and potential risks related to pharmaceutical agents in a more timely fashion than ever before,” said Terri Madison, Ph.D., president of i3 Drug Safety, which will lead the Ingenix program. In a statement, Alan Goldhammer, Ph.D., associate vice president for regulatory affairs at Pharmaceutical Research and Manufacturers of America, said PhRMA supported “new approaches to improving pharmacovigilance.” The group called on the CERTs (Centers for Education and Research on Therapeutics) to hold a workshop on this topic.

Voters Doubt Congress on Access

Roughly two-thirds of voters think Congress has not made much progress on helping those without health insurance, and is not likely to make much more in the next 5–10 years, according to a survey of 800 likely voters sponsored by Ceasefire on Health Care, a group whose aim is to stimulate dialogue on health care between Republican and Democratic policy makers. Overall, poll respondents listed their top four health care priorities as making sure all U.S. children have access to basic health care, guaranteeing health care to every American citizen, providing better preventive health care to all Americans, and helping control the amount of out-of-pocket health care costs. About “88% of those surveyed want Congress to compromise on the issue of the uninsured,” said former Sen. John Breaux (D-La.), who is leading the group.

WASHINGTON — A focus on specific diseases and patient needs can improve care and reduce costs to Medicaid by keeping patients healthier and out of hospitals, John Sory said at a meeting sponsored by the Center for Health Transformation.

Pfizer Health Solutions, a care management subsidiary of Pfizer Inc., has applied such an approach to Florida's Medicaid program, the fourth largest program in the country, said Mr. Sory, the company's vice president.

The company partners with health care and community organizations to implement patient-centered programs that focus on prevention, disease management, and care coordination. Through an agreement with Florida Medicaid, “we took responsibility for improving the health of a significant part of the Medicaid population, through creation of a program that connects 10 hospital systems around the state, trains nurse care managers employed by those hospitals, provides clinical technologies to support the nurses, distributes medical equipment to patients' homes, and guarantees that the better patient health will reduce overall cost of care for this population,” Mr. Sory said.

The state's Medicaid program has more than 2 million beneficiaries and takes up 24% of the state's budget. Nearly 50% of expenditures are spent on institutional services such as hospitals and nursing homes.

Access to care is a significant issue for Medicaid beneficiaries in Florida. Although the number of health care providers in Florida has increased in recent years, there has also been a notable decrease in the number of providers willing to see Medicaid patients, he said.

Prevalence of chronic disease and unhealthy behaviors has been rising in the Medicaid population in Florida. There is low treatment compliance because patients “don't necessarily know what steps they can take to be healthier,” Mr. Sory said. In addition, there are few tests and services for those who need monitoring, coordination, and continual follow-up.

Pfizer Health Solutions began in 2001 with a goal of looking at specific populations—patients with asthma, heart failure, hypertension, and diabetes—with an eye to decreasing Medicaid costs for them, he said.

Working with the state's government, Pfizer Health Solutions identified diagnoses and comorbidities then “built a network around those patients, to find new care managers who could work with them, and match the intensity of the intervention with the patients' diseases.”

For example, high-risk patients that tend to visit the emergency department would receive more intensive intervention from care managers.

“Patient-centered care” means instructing patients on when and how to call their physician, he explained. Some patients don't interact with the health care system except in the emergency department, so they're not ready to handle hour-long phone conversations with a nurse.

Coordination of care with local providers is important to make sure that patients get appropriate referrals and that data tracking takes place for each patient, he said. Ten health systems and 50 care managers have been integrated into the program.

No program will work unless you measure the outcomes and promote results, Mr. Sory said. This involves measuring clinical changes such as asthma severity or blood pressure scores, as well as tracking the satisfaction of physicians and patients. “Are patients using the emergency room less, and is this lowering the overall health system costs?” These are the outcomes a successful program has to track, he said.

Among the improvements in patient behavior, 39% of patients have increased their compliance with medication regimens prescribed, 19% of patients have reported following a special diet, and 52% improved physical health scores, he said.

There has been a 99% increase in patients who monitor their peak airflow at home and a 72% reduction in diabetes patients who fail to check their feet. Mr. Sory said more than 240,000 lancets have been distributed to monitor blood glucose at home. In addition, thousands of blood pressure monitors have been distributed to patients with hypertension, as well as 3,700 peak flow meters to asthma patients.

Mr. Sory gave the example of one patient, a recent immigrant, who was legally blind, had asthma, and was taking multiple medications. Under the program, a caregiver drives out to visit him and instructs him on using his medications and ways to ensure he takes each at the right time.

In addition, the caregiver told him what environmental triggers for his asthma might send him to the emergency department, and found a physician for him. Such changes have an impact on the number of hospital visits and also reduce costs, Mr. Sory said.

Pfizer sponsored the interactive Webcast for the meeting.

WASHINGTON — A focus on specific diseases and patient needs can improve care and reduce costs to Medicaid by keeping patients healthier and out of hospitals, John Sory said at a meeting sponsored by the Center for Health Transformation.

Pfizer Health Solutions, a care management subsidiary of Pfizer Inc., has applied such an approach to Florida's Medicaid program, the fourth largest program in the country, said Mr. Sory, the company's vice president.

The company partners with health care and community organizations to implement patient-centered programs that focus on prevention, disease management, and care coordination. Through an agreement with Florida Medicaid, “we took responsibility for improving the health of a significant part of the Medicaid population, through creation of a program that connects 10 hospital systems around the state, trains nurse care managers employed by those hospitals, provides clinical technologies to support the nurses, distributes medical equipment to patients' homes, and guarantees that the better patient health will reduce overall cost of care for this population,” Mr. Sory said.

The state's Medicaid program has more than 2 million beneficiaries and takes up 24% of the state's budget. Nearly 50% of expenditures are spent on institutional services such as hospitals and nursing homes.

Access to care is a significant issue for Medicaid beneficiaries in Florida. Although the number of health care providers in Florida has increased in recent years, there has also been a notable decrease in the number of providers willing to see Medicaid patients, he said.

Prevalence of chronic disease and unhealthy behaviors has been rising in the Medicaid population in Florida. There is low treatment compliance because patients “don't necessarily know what steps they can take to be healthier,” Mr. Sory said. In addition, there are few tests and services for those who need monitoring, coordination, and continual follow-up.

Pfizer Health Solutions began in 2001 with a goal of looking at specific populations—patients with asthma, heart failure, hypertension, and diabetes—with an eye to decreasing Medicaid costs for them, he said.

Working with the state's government, Pfizer Health Solutions identified diagnoses and comorbidities then “built a network around those patients, to find new care managers who could work with them, and match the intensity of the intervention with the patients' diseases.”

For example, high-risk patients that tend to visit the emergency department would receive more intensive intervention from care managers.

“Patient-centered care” means instructing patients on when and how to call their physician, he explained. Some patients don't interact with the health care system except in the emergency department, so they're not ready to handle hour-long phone conversations with a nurse.

Coordination of care with local providers is important to make sure that patients get appropriate referrals and that data tracking takes place for each patient, he said. Ten health systems and 50 care managers have been integrated into the program.

No program will work unless you measure the outcomes and promote results, Mr. Sory said. This involves measuring clinical changes such as asthma severity or blood pressure scores, as well as tracking the satisfaction of physicians and patients. “Are patients using the emergency room less, and is this lowering the overall health system costs?” These are the outcomes a successful program has to track, he said.

Among the improvements in patient behavior, 39% of patients have increased their compliance with medication regimens prescribed, 19% of patients have reported following a special diet, and 52% improved physical health scores, he said.

There has been a 99% increase in patients who monitor their peak airflow at home and a 72% reduction in diabetes patients who fail to check their feet. Mr. Sory said more than 240,000 lancets have been distributed to monitor blood glucose at home. In addition, thousands of blood pressure monitors have been distributed to patients with hypertension, as well as 3,700 peak flow meters to asthma patients.

Mr. Sory gave the example of one patient, a recent immigrant, who was legally blind, had asthma, and was taking multiple medications. Under the program, a caregiver drives out to visit him and instructs him on using his medications and ways to ensure he takes each at the right time.

In addition, the caregiver told him what environmental triggers for his asthma might send him to the emergency department, and found a physician for him. Such changes have an impact on the number of hospital visits and also reduce costs, Mr. Sory said.

Pfizer sponsored the interactive Webcast for the meeting.

WASHINGTON — A focus on specific diseases and patient needs can improve care and reduce costs to Medicaid by keeping patients healthier and out of hospitals, John Sory said at a meeting sponsored by the Center for Health Transformation.

Pfizer Health Solutions, a care management subsidiary of Pfizer Inc., has applied such an approach to Florida's Medicaid program, the fourth largest program in the country, said Mr. Sory, the company's vice president.

The company partners with health care and community organizations to implement patient-centered programs that focus on prevention, disease management, and care coordination. Through an agreement with Florida Medicaid, “we took responsibility for improving the health of a significant part of the Medicaid population, through creation of a program that connects 10 hospital systems around the state, trains nurse care managers employed by those hospitals, provides clinical technologies to support the nurses, distributes medical equipment to patients' homes, and guarantees that the better patient health will reduce overall cost of care for this population,” Mr. Sory said.

The state's Medicaid program has more than 2 million beneficiaries and takes up 24% of the state's budget. Nearly 50% of expenditures are spent on institutional services such as hospitals and nursing homes.

Access to care is a significant issue for Medicaid beneficiaries in Florida. Although the number of health care providers in Florida has increased in recent years, there has also been a notable decrease in the number of providers willing to see Medicaid patients, he said.

Prevalence of chronic disease and unhealthy behaviors has been rising in the Medicaid population in Florida. There is low treatment compliance because patients “don't necessarily know what steps they can take to be healthier,” Mr. Sory said. In addition, there are few tests and services for those who need monitoring, coordination, and continual follow-up.

Pfizer Health Solutions began in 2001 with a goal of looking at specific populations—patients with asthma, heart failure, hypertension, and diabetes—with an eye to decreasing Medicaid costs for them, he said.

Working with the state's government, Pfizer Health Solutions identified diagnoses and comorbidities then “built a network around those patients, to find new care managers who could work with them, and match the intensity of the intervention with the patients' diseases.”

For example, high-risk patients that tend to visit the emergency department would receive more intensive intervention from care managers.

“Patient-centered care” means instructing patients on when and how to call their physician, he explained. Some patients don't interact with the health care system except in the emergency department, so they're not ready to handle hour-long phone conversations with a nurse.

Coordination of care with local providers is important to make sure that patients get appropriate referrals and that data tracking takes place for each patient, he said. Ten health systems and 50 care managers have been integrated into the program.

No program will work unless you measure the outcomes and promote results, Mr. Sory said. This involves measuring clinical changes such as asthma severity or blood pressure scores, as well as tracking the satisfaction of physicians and patients. “Are patients using the emergency room less, and is this lowering the overall health system costs?” These are the outcomes a successful program has to track, he said.

Among the improvements in patient behavior, 39% of patients have increased their compliance with medication regimens prescribed, 19% of patients have reported following a special diet, and 52% improved physical health scores, he said.

There has been a 99% increase in patients who monitor their peak airflow at home and a 72% reduction in diabetes patients who fail to check their feet. Mr. Sory said more than 240,000 lancets have been distributed to monitor blood glucose at home. In addition, thousands of blood pressure monitors have been distributed to patients with hypertension, as well as 3,700 peak flow meters to asthma patients.

Mr. Sory gave the example of one patient, a recent immigrant, who was legally blind, had asthma, and was taking multiple medications. Under the program, a caregiver drives out to visit him and instructs him on using his medications and ways to ensure he takes each at the right time.

In addition, the caregiver told him what environmental triggers for his asthma might send him to the emergency department, and found a physician for him. Such changes have an impact on the number of hospital visits and also reduce costs, Mr. Sory said.

Pfizer sponsored the interactive Webcast for the meeting.