Jennifer Lubell

In the wake of the severe hurricane season in the Gulf Coast region, thousands of displaced physicians are searching for ways to keep practicing medicine.

For some, this means relocating to another part of the country or holding down a temporary job in the hopes they'll someday reclaim their practice from flood-ravaged areas and regroup with their patients.

Family physician Kim Edward LeBlanc, M.D., who heads the department of family medicine at the Louisiana State University School of Medicine in New Orleans, said his entire department was displaced from that city after Hurricane Katrina.

“The department had 10,000–15,000 patients, if not more,” he said in an interview.

Dr. LeBlanc has since relocated to his brother's home in Baton Rouge, La., where he plans to establish a private clinic for his patients. In the meantime, he and his department have been busy setting up other clinics in the neighboring cities of Lafayette, Lake Charles, and Kenner. The goal is to resume some functionality and start seeing patients again, to continue the training of residents and students, and to help the evacuees, he said.

Residents have been sent to a variety of areas to help out, including Angola Prison, and a small hospital called Lallie Kamp, which is part of the state's charity system and has a lot of evacuees, he said.

“I've little hope that it will ever be the same again,” said internist/infectious disease specialist Michael Hill, M.D., whose group practice has disintegrated since the hurricanes.

Of the 26 physicians who made up the multispecialty practice in various locations around New Orleans, “only 6 or 7 are going to be returning to the area,” Dr. Hill said in an interview. “Most are going to be relocating to other states, while others are in Shreveport, Baton Rouge, or Lafayette. We've just dispersed around the state in areas not affected by the hurricane.”

David D. Teuscher, M.D., an orthopedic surgeon who works at several hospitals in Beaumont, Tex., reported at press time that the area was uninhabitable in the aftermath of Hurricane Rita. The city is operating at limited capacity, he said in an interview.

“There's no potable water. Everything's operating on generators, and the National Guard isn't permitting anyone to come in. Physicians and families have fled these regions and have gone to live with family in other parts of the state and the country.” At press time, he was communicating with his staff through a daily conference call and said he hoped to restart operations at the Beaumont hospitals by early October.

Nancy G. Michaelis, M.D., an internist from Chalmette, La., obtained a temporary license to practice in Virginia. Overall, she's had three job offers, but in an interview said she's “desperately trying to get back to New Orleans.” For now, it looks like she'll be practicing in Virginia for quite some time.

“My house survived quite well … [but] St. Bernard Parish was completely destroyed. The two hospitals that I went to, Chalmette Medical Center in St. Bernard and Pendleton Memorial Methodist Hospital in East New Orleans, are not operational anymore. Furthermore, the population I used to see is not there anymore.”

Some physicians are considering a more permanent relocation. Otolaryngologist Michael S. Ellis, M.D., whose practice in Chalmette was flooded during Hurricane Katrina, is considering a move to North Carolina. Through his contacts in organized medicine, Dr. Ellis said he's been offered positions, both in private practice and in academic medicine, throughout the country.

“I've gotten job offers from North Carolina, Virginia, Tennessee … Chicago,” he said in an interview.

Many physicians like Dr. Michaelis thought they'd practice at a temporary location then come back to New Orleans, “but that's less likely to happen as time goes on,” Dr. Hill said.

Telephone service has been spotty in some places, and it's been difficult for patients to navigate around the New Orleans area and get care, he said. His practice is trying to communicate with patients through newspaper ads and its Internet site, “which has updated where we are,” he said.

At press time, Dr. Hill was working at the practice's offices in Covington, located north of Lake Pontchartrain, and in Slidell, La.

Two other physicians in the practice are working in the North Shore.

He and Dr. Ellis have been trying to organize a summit with members of Congress to establish a medical health care system within New Orleans. “We want to make sure that organized medicine has a voice” in this effort, he said.

Dr. LeBlanc's goal is to return to New Orleans and resume practice at LSU. “We optimistically look at being back in January. We all want to do that—the dean of the medical school has emphatically stated that that's what we're doing.”

Katrina Dislocated Nearly 6,000 Doctors

A recent study from the University of North Carolina at Chapel Hill estimates that Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history.

It's expected that Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

Approximately 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi that have been directly affected by Katrina flooding,” said the study's author Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

Data for the analysis were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens or temporary positions have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician search firm based in Irving, Tex.

“We're working with physicians who don't have a site of service right now because their clinic's been damaged or under water, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices, although “they're not sure whether they'll have a practice” anymore, he said.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to the normal guidelines to process state licensing and hospitals privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

In the wake of the severe hurricane season in the Gulf Coast region, thousands of displaced physicians are searching for ways to keep practicing medicine.

For some, this means relocating to another part of the country or holding down a temporary job in the hopes they'll someday reclaim their practice from flood-ravaged areas and regroup with their patients.

Family physician Kim Edward LeBlanc, M.D., who heads the department of family medicine at the Louisiana State University School of Medicine in New Orleans, said his entire department was displaced from that city after Hurricane Katrina.

“The department had 10,000–15,000 patients, if not more,” he said in an interview.

Dr. LeBlanc has since relocated to his brother's home in Baton Rouge, La., where he plans to establish a private clinic for his patients. In the meantime, he and his department have been busy setting up other clinics in the neighboring cities of Lafayette, Lake Charles, and Kenner. The goal is to resume some functionality and start seeing patients again, to continue the training of residents and students, and to help the evacuees, he said.

Residents have been sent to a variety of areas to help out, including Angola Prison, and a small hospital called Lallie Kamp, which is part of the state's charity system and has a lot of evacuees, he said.

“I've little hope that it will ever be the same again,” said internist/infectious disease specialist Michael Hill, M.D., whose group practice has disintegrated since the hurricanes.

Of the 26 physicians who made up the multispecialty practice in various locations around New Orleans, “only 6 or 7 are going to be returning to the area,” Dr. Hill said in an interview. “Most are going to be relocating to other states, while others are in Shreveport, Baton Rouge, or Lafayette. We've just dispersed around the state in areas not affected by the hurricane.”

David D. Teuscher, M.D., an orthopedic surgeon who works at several hospitals in Beaumont, Tex., reported at press time that the area was uninhabitable in the aftermath of Hurricane Rita. The city is operating at limited capacity, he said in an interview.

“There's no potable water. Everything's operating on generators, and the National Guard isn't permitting anyone to come in. Physicians and families have fled these regions and have gone to live with family in other parts of the state and the country.” At press time, he was communicating with his staff through a daily conference call and said he hoped to restart operations at the Beaumont hospitals by early October.

Nancy G. Michaelis, M.D., an internist from Chalmette, La., obtained a temporary license to practice in Virginia. Overall, she's had three job offers, but in an interview said she's “desperately trying to get back to New Orleans.” For now, it looks like she'll be practicing in Virginia for quite some time.

“My house survived quite well … [but] St. Bernard Parish was completely destroyed. The two hospitals that I went to, Chalmette Medical Center in St. Bernard and Pendleton Memorial Methodist Hospital in East New Orleans, are not operational anymore. Furthermore, the population I used to see is not there anymore.”

Some physicians are considering a more permanent relocation. Otolaryngologist Michael S. Ellis, M.D., whose practice in Chalmette was flooded during Hurricane Katrina, is considering a move to North Carolina. Through his contacts in organized medicine, Dr. Ellis said he's been offered positions, both in private practice and in academic medicine, throughout the country.

“I've gotten job offers from North Carolina, Virginia, Tennessee … Chicago,” he said in an interview.

Many physicians like Dr. Michaelis thought they'd practice at a temporary location then come back to New Orleans, “but that's less likely to happen as time goes on,” Dr. Hill said.

Telephone service has been spotty in some places, and it's been difficult for patients to navigate around the New Orleans area and get care, he said. His practice is trying to communicate with patients through newspaper ads and its Internet site, “which has updated where we are,” he said.

At press time, Dr. Hill was working at the practice's offices in Covington, located north of Lake Pontchartrain, and in Slidell, La.

Two other physicians in the practice are working in the North Shore.

He and Dr. Ellis have been trying to organize a summit with members of Congress to establish a medical health care system within New Orleans. “We want to make sure that organized medicine has a voice” in this effort, he said.

Dr. LeBlanc's goal is to return to New Orleans and resume practice at LSU. “We optimistically look at being back in January. We all want to do that—the dean of the medical school has emphatically stated that that's what we're doing.”

Katrina Dislocated Nearly 6,000 Doctors

A recent study from the University of North Carolina at Chapel Hill estimates that Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history.

It's expected that Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

Approximately 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi that have been directly affected by Katrina flooding,” said the study's author Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

Data for the analysis were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens or temporary positions have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician search firm based in Irving, Tex.

“We're working with physicians who don't have a site of service right now because their clinic's been damaged or under water, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices, although “they're not sure whether they'll have a practice” anymore, he said.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to the normal guidelines to process state licensing and hospitals privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

In the wake of the severe hurricane season in the Gulf Coast region, thousands of displaced physicians are searching for ways to keep practicing medicine.

For some, this means relocating to another part of the country or holding down a temporary job in the hopes they'll someday reclaim their practice from flood-ravaged areas and regroup with their patients.

Family physician Kim Edward LeBlanc, M.D., who heads the department of family medicine at the Louisiana State University School of Medicine in New Orleans, said his entire department was displaced from that city after Hurricane Katrina.

“The department had 10,000–15,000 patients, if not more,” he said in an interview.

Dr. LeBlanc has since relocated to his brother's home in Baton Rouge, La., where he plans to establish a private clinic for his patients. In the meantime, he and his department have been busy setting up other clinics in the neighboring cities of Lafayette, Lake Charles, and Kenner. The goal is to resume some functionality and start seeing patients again, to continue the training of residents and students, and to help the evacuees, he said.

Residents have been sent to a variety of areas to help out, including Angola Prison, and a small hospital called Lallie Kamp, which is part of the state's charity system and has a lot of evacuees, he said.

“I've little hope that it will ever be the same again,” said internist/infectious disease specialist Michael Hill, M.D., whose group practice has disintegrated since the hurricanes.

Of the 26 physicians who made up the multispecialty practice in various locations around New Orleans, “only 6 or 7 are going to be returning to the area,” Dr. Hill said in an interview. “Most are going to be relocating to other states, while others are in Shreveport, Baton Rouge, or Lafayette. We've just dispersed around the state in areas not affected by the hurricane.”

David D. Teuscher, M.D., an orthopedic surgeon who works at several hospitals in Beaumont, Tex., reported at press time that the area was uninhabitable in the aftermath of Hurricane Rita. The city is operating at limited capacity, he said in an interview.

“There's no potable water. Everything's operating on generators, and the National Guard isn't permitting anyone to come in. Physicians and families have fled these regions and have gone to live with family in other parts of the state and the country.” At press time, he was communicating with his staff through a daily conference call and said he hoped to restart operations at the Beaumont hospitals by early October.

Nancy G. Michaelis, M.D., an internist from Chalmette, La., obtained a temporary license to practice in Virginia. Overall, she's had three job offers, but in an interview said she's “desperately trying to get back to New Orleans.” For now, it looks like she'll be practicing in Virginia for quite some time.

“My house survived quite well … [but] St. Bernard Parish was completely destroyed. The two hospitals that I went to, Chalmette Medical Center in St. Bernard and Pendleton Memorial Methodist Hospital in East New Orleans, are not operational anymore. Furthermore, the population I used to see is not there anymore.”

Some physicians are considering a more permanent relocation. Otolaryngologist Michael S. Ellis, M.D., whose practice in Chalmette was flooded during Hurricane Katrina, is considering a move to North Carolina. Through his contacts in organized medicine, Dr. Ellis said he's been offered positions, both in private practice and in academic medicine, throughout the country.

“I've gotten job offers from North Carolina, Virginia, Tennessee … Chicago,” he said in an interview.

Many physicians like Dr. Michaelis thought they'd practice at a temporary location then come back to New Orleans, “but that's less likely to happen as time goes on,” Dr. Hill said.

Telephone service has been spotty in some places, and it's been difficult for patients to navigate around the New Orleans area and get care, he said. His practice is trying to communicate with patients through newspaper ads and its Internet site, “which has updated where we are,” he said.

At press time, Dr. Hill was working at the practice's offices in Covington, located north of Lake Pontchartrain, and in Slidell, La.

Two other physicians in the practice are working in the North Shore.

He and Dr. Ellis have been trying to organize a summit with members of Congress to establish a medical health care system within New Orleans. “We want to make sure that organized medicine has a voice” in this effort, he said.

Dr. LeBlanc's goal is to return to New Orleans and resume practice at LSU. “We optimistically look at being back in January. We all want to do that—the dean of the medical school has emphatically stated that that's what we're doing.”

Katrina Dislocated Nearly 6,000 Doctors

A recent study from the University of North Carolina at Chapel Hill estimates that Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history.

It's expected that Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

Approximately 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi that have been directly affected by Katrina flooding,” said the study's author Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

Data for the analysis were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens or temporary positions have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician search firm based in Irving, Tex.

“We're working with physicians who don't have a site of service right now because their clinic's been damaged or under water, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices, although “they're not sure whether they'll have a practice” anymore, he said.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to the normal guidelines to process state licensing and hospitals privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

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

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

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

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

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

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

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

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

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

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

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

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

The hope is to abandon the old formulas and convert to the “average manufacturer's price,” he said. “The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible,” he said. Differentiations between chain drug stores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug.

The goal of the AMP is to arrive at a realistic reimbursement number, “so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic,” he said.

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

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

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

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

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

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

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

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

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

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

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

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

The hope is to abandon the old formulas and convert to the “average manufacturer's price,” he said. “The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible,” he said. Differentiations between chain drug stores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug.

The goal of the AMP is to arrive at a realistic reimbursement number, “so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic,” he said.

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

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

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

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

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

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

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

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

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

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

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

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

The hope is to abandon the old formulas and convert to the “average manufacturer's price,” he said. “The AMP is an effort to come at a price formulation that is as close to reflecting the true cost [of the drug] as possible,” he said. Differentiations between chain drug stores, community pharmacists, and mail-order drug companies are distorting the actual cost of the drug.

The goal of the AMP is to arrive at a realistic reimbursement number, “so we don't make pharmacists bear the brunt of reforms. Expecting the dispensing agent to absorb the cost differentials, I don't think that's fair or realistic,” he said.

Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history, according to estimates from a recent study from the University of North Carolina at Chapel Hill.

It's expected that Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

Approximately 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi have been directly affected by Katrina flooding,” said the study's author Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

Data for the analysis were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens, or temporary positions, have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician search firm based in Irving, Tex. “We're working with physicians who don't have a site of service right now because their clinic's been damaged or underwater, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices, although “they're not sure whether they'll have a practice” anymore, he said.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to normal guidelines to process state licensing and hospitals privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

Not every physician is looking to reestablish a practice or begin a new one, Dr. Ricketts pointed out. Some will decide to retire instead. “We don't know what this is going to mean to health care. We've never had to deal with something like this before.”

Mr. Davis said his agency has been receiving numerous calls for physicians to extend their locum tenens job contracts for as long as 6 months.

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CARDIOLOGY News invites your letter to the editor. Letter in response to articles in CARDIOLOGY NEWS and its supplements should include your name and address, affiliation, and conflicts of interest in regard to the topic discussed. Letters may be edited for space and clarity.

Mail: Letters, CARDIOLOGY NEWS, 12230 Wilkins Ave, Rockville, MD 20852

Fax: 301-816-8738

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Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history, according to estimates from a recent study from the University of North Carolina at Chapel Hill.

It's expected that Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

Approximately 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi have been directly affected by Katrina flooding,” said the study's author Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

Data for the analysis were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens, or temporary positions, have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician search firm based in Irving, Tex. “We're working with physicians who don't have a site of service right now because their clinic's been damaged or underwater, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices, although “they're not sure whether they'll have a practice” anymore, he said.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to normal guidelines to process state licensing and hospitals privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

Not every physician is looking to reestablish a practice or begin a new one, Dr. Ricketts pointed out. Some will decide to retire instead. “We don't know what this is going to mean to health care. We've never had to deal with something like this before.”

Mr. Davis said his agency has been receiving numerous calls for physicians to extend their locum tenens job contracts for as long as 6 months.

Let Us Hear From You

CARDIOLOGY News invites your letter to the editor. Letter in response to articles in CARDIOLOGY NEWS and its supplements should include your name and address, affiliation, and conflicts of interest in regard to the topic discussed. Letters may be edited for space and clarity.

Mail: Letters, CARDIOLOGY NEWS, 12230 Wilkins Ave, Rockville, MD 20852

Fax: 301-816-8738

Email:

[email protected]

Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history, according to estimates from a recent study from the University of North Carolina at Chapel Hill.

It's expected that Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

Approximately 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi have been directly affected by Katrina flooding,” said the study's author Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

Data for the analysis were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens, or temporary positions, have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician search firm based in Irving, Tex. “We're working with physicians who don't have a site of service right now because their clinic's been damaged or underwater, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices, although “they're not sure whether they'll have a practice” anymore, he said.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to normal guidelines to process state licensing and hospitals privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

Not every physician is looking to reestablish a practice or begin a new one, Dr. Ricketts pointed out. Some will decide to retire instead. “We don't know what this is going to mean to health care. We've never had to deal with something like this before.”

Mr. Davis said his agency has been receiving numerous calls for physicians to extend their locum tenens job contracts for as long as 6 months.

Let Us Hear From You

CARDIOLOGY News invites your letter to the editor. Letter in response to articles in CARDIOLOGY NEWS and its supplements should include your name and address, affiliation, and conflicts of interest in regard to the topic discussed. Letters may be edited for space and clarity.

Mail: Letters, CARDIOLOGY NEWS, 12230 Wilkins Ave, Rockville, MD 20852

Fax: 301-816-8738

Email:

[email protected]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reforming Medicaid won't be easy to do, he said. “States have been operating under judicial constraints. We have some states that have been sued, many of them operating under consent orders that have tied their hands every time they apply to federal government for a waiver.”

The approach has to be a basic structural reform, he concluded. “You cannot achieve these goals without going back into this program and restating the concepts of the program itself. And that's always a difficult task to do.”

Because these reforms would require actual changes to the Medicaid law, he expects that “demagogues would come out of every corner accusing us of all sorts of things.” The same thing happened with welfare reform, where Congress was accused of starving people on the street, he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reforming Medicaid won't be easy to do, he said. “States have been operating under judicial constraints. We have some states that have been sued, many of them operating under consent orders that have tied their hands every time they apply to federal government for a waiver.”

The approach has to be a basic structural reform, he concluded. “You cannot achieve these goals without going back into this program and restating the concepts of the program itself. And that's always a difficult task to do.”

Because these reforms would require actual changes to the Medicaid law, he expects that “demagogues would come out of every corner accusing us of all sorts of things.” The same thing happened with welfare reform, where Congress was accused of starving people on the street, he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reforming Medicaid won't be easy to do, he said. “States have been operating under judicial constraints. We have some states that have been sued, many of them operating under consent orders that have tied their hands every time they apply to federal government for a waiver.”

The approach has to be a basic structural reform, he concluded. “You cannot achieve these goals without going back into this program and restating the concepts of the program itself. And that's always a difficult task to do.”

Because these reforms would require actual changes to the Medicaid law, he expects that “demagogues would come out of every corner accusing us of all sorts of things.” The same thing happened with welfare reform, where Congress was accused of starving people on the street, he said.

National Children's Study

Contracts have been awarded to six institutions to pilot and complete the first phases of the largest study undertaken by the federal government to assess the effects of the environment on child and adult health. “The National Children's Study would follow more than 100,000 children, from before birth, and, in some cases, even before pregnancy,” said Duane Alexander, M.D., director of the National Institute of Child Health and Human Development, one of the National Institutes of Health. The six centers, selected through a competitive process, had successfully demonstrated advanced clinical research and data collection capabilities. Researchers plan to examine such factors as the food children eat, the air they breathe, their schools and neighborhoods, their frequency of medical visits, and even the composition of the dust in their homes. The project will enroll participants—women of childbearing age—in mid-2007, said Sarah Keim, deputy director of the program office. “The women will be tracked and their subsequent children will be tracked until the age of 21.”

Abstinence Education

The federal government is awarding $37 million to 63 abstinence education grantees, the Department of Health and Human Services' Administration for Children and Families announced. The awards, from the Community-Based Abstinence Education program, are designed to encourage youth to remain abstinent until marriage. “The only way to be 100% certain that kids avoid pregnancy and sexually transmitted diseases is to stay abstinent until marriage,” said Wade F. Horn, Ph.D., assistant secretary for Children and Families. In a statement issued this year, the American Academy of Pediatrics didn't encourage abstinence until marriage, but said pediatricians should encourage adolescents to postpone early sexual activity.

Junk Food Prevalent in Schools

Most schools continue to sell “competitive foods,” foods that are not part of federally reimbursable school meals, the General Accountability Office reported in its review of six school districts. The nutritional value of these foods is highly unregulated, and students can purchase them, in addition to, or instead of, regular school meals. The findings show “little doubt about the proliferation of junk foods in America's schools,” said Margo G. Wootan, nutrition policy director with the Center for Science in the Public Interest. “Despite pockets of progress around the country, the GAO report shows that nearly 9 out of 10 schools offer junk foods to kids out of vending machines, school stores, and “a la carte” lines. All six of the school districts were making efforts to substitute healthy items for less- nutritious competitive foods, although some faced opposition because of concerns about revenue losses.

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% said it was important to make sure sharing could take place only after patients gave 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.

Pinpointing Side Effects

In a bid to more quickly pinpoint 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; and the privately held Harvard Pilgrim Health Care Inc. each won contracts of 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,” said Terri Madison, Ph.D., president of i3 Drug Safety (an Ingenix company), which will lead the Ingenix program. In a statement, Alan Goldhammer, Ph.D., associate vice president for regulatory affairs with the Pharmaceutical Research and Manufacturers of America, said PhRMA supported “new approaches to improving pharmacovigilance.” The group called on the Centers for Education and Research on Therapeutics to hold a workshop on this topic.

National Children's Study

Contracts have been awarded to six institutions to pilot and complete the first phases of the largest study undertaken by the federal government to assess the effects of the environment on child and adult health. “The National Children's Study would follow more than 100,000 children, from before birth, and, in some cases, even before pregnancy,” said Duane Alexander, M.D., director of the National Institute of Child Health and Human Development, one of the National Institutes of Health. The six centers, selected through a competitive process, had successfully demonstrated advanced clinical research and data collection capabilities. Researchers plan to examine such factors as the food children eat, the air they breathe, their schools and neighborhoods, their frequency of medical visits, and even the composition of the dust in their homes. The project will enroll participants—women of childbearing age—in mid-2007, said Sarah Keim, deputy director of the program office. “The women will be tracked and their subsequent children will be tracked until the age of 21.”

Abstinence Education

The federal government is awarding $37 million to 63 abstinence education grantees, the Department of Health and Human Services' Administration for Children and Families announced. The awards, from the Community-Based Abstinence Education program, are designed to encourage youth to remain abstinent until marriage. “The only way to be 100% certain that kids avoid pregnancy and sexually transmitted diseases is to stay abstinent until marriage,” said Wade F. Horn, Ph.D., assistant secretary for Children and Families. In a statement issued this year, the American Academy of Pediatrics didn't encourage abstinence until marriage, but said pediatricians should encourage adolescents to postpone early sexual activity.

Junk Food Prevalent in Schools

Most schools continue to sell “competitive foods,” foods that are not part of federally reimbursable school meals, the General Accountability Office reported in its review of six school districts. The nutritional value of these foods is highly unregulated, and students can purchase them, in addition to, or instead of, regular school meals. The findings show “little doubt about the proliferation of junk foods in America's schools,” said Margo G. Wootan, nutrition policy director with the Center for Science in the Public Interest. “Despite pockets of progress around the country, the GAO report shows that nearly 9 out of 10 schools offer junk foods to kids out of vending machines, school stores, and “a la carte” lines. All six of the school districts were making efforts to substitute healthy items for less- nutritious competitive foods, although some faced opposition because of concerns about revenue losses.

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% said it was important to make sure sharing could take place only after patients gave 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.

Pinpointing Side Effects

In a bid to more quickly pinpoint 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; and the privately held Harvard Pilgrim Health Care Inc. each won contracts of 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,” said Terri Madison, Ph.D., president of i3 Drug Safety (an Ingenix company), which will lead the Ingenix program. In a statement, Alan Goldhammer, Ph.D., associate vice president for regulatory affairs with the Pharmaceutical Research and Manufacturers of America, said PhRMA supported “new approaches to improving pharmacovigilance.” The group called on the Centers for Education and Research on Therapeutics to hold a workshop on this topic.

National Children's Study

Contracts have been awarded to six institutions to pilot and complete the first phases of the largest study undertaken by the federal government to assess the effects of the environment on child and adult health. “The National Children's Study would follow more than 100,000 children, from before birth, and, in some cases, even before pregnancy,” said Duane Alexander, M.D., director of the National Institute of Child Health and Human Development, one of the National Institutes of Health. The six centers, selected through a competitive process, had successfully demonstrated advanced clinical research and data collection capabilities. Researchers plan to examine such factors as the food children eat, the air they breathe, their schools and neighborhoods, their frequency of medical visits, and even the composition of the dust in their homes. The project will enroll participants—women of childbearing age—in mid-2007, said Sarah Keim, deputy director of the program office. “The women will be tracked and their subsequent children will be tracked until the age of 21.”

Abstinence Education

The federal government is awarding $37 million to 63 abstinence education grantees, the Department of Health and Human Services' Administration for Children and Families announced. The awards, from the Community-Based Abstinence Education program, are designed to encourage youth to remain abstinent until marriage. “The only way to be 100% certain that kids avoid pregnancy and sexually transmitted diseases is to stay abstinent until marriage,” said Wade F. Horn, Ph.D., assistant secretary for Children and Families. In a statement issued this year, the American Academy of Pediatrics didn't encourage abstinence until marriage, but said pediatricians should encourage adolescents to postpone early sexual activity.

Junk Food Prevalent in Schools

Most schools continue to sell “competitive foods,” foods that are not part of federally reimbursable school meals, the General Accountability Office reported in its review of six school districts. The nutritional value of these foods is highly unregulated, and students can purchase them, in addition to, or instead of, regular school meals. The findings show “little doubt about the proliferation of junk foods in America's schools,” said Margo G. Wootan, nutrition policy director with the Center for Science in the Public Interest. “Despite pockets of progress around the country, the GAO report shows that nearly 9 out of 10 schools offer junk foods to kids out of vending machines, school stores, and “a la carte” lines. All six of the school districts were making efforts to substitute healthy items for less- nutritious competitive foods, although some faced opposition because of concerns about revenue losses.

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% said it was important to make sure sharing could take place only after patients gave 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.

Pinpointing Side Effects

In a bid to more quickly pinpoint 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; and the privately held Harvard Pilgrim Health Care Inc. each won contracts of 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,” said Terri Madison, Ph.D., president of i3 Drug Safety (an Ingenix company), which will lead the Ingenix program. In a statement, Alan Goldhammer, Ph.D., associate vice president for regulatory affairs with the Pharmaceutical Research and Manufacturers of America, said PhRMA supported “new approaches to improving pharmacovigilance.” The group called on the Centers for Education and Research on Therapeutics to hold a workshop on this topic.

The widespread implementation of electronic medical record systems by physicians could lead to $142 billion in net savings over 15 years, according to a study from the Rand Corp.

And the implementation of hospital-based systems could mean a savings of $371 billion over 15 years, according to the study, which was published in the September/October issue of Health Affairs.

“Our findings strongly suggest that it is time for the government and others who pay for health care to aggressively promote health information technology,” Richard Hillestad, the Rand senior management scientist who led the study, said in a statement.

While the potential savings would outweigh the costs quickly during the adoption cycle, there are still a number of barriers to the effective adoption and application of health information technology, the researchers wrote. For instance, although providers would pay to implement the system, it's the payers and consumers who are likely to experience savings. In addition, even if the systems are widely adopted, interoperability and information exchange networks might not be developed, according to the study.

The widespread implementation of electronic medical record systems by physicians could lead to $142 billion in net savings over 15 years, according to a study from the Rand Corp.

And the implementation of hospital-based systems could mean a savings of $371 billion over 15 years, according to the study, which was published in the September/October issue of Health Affairs.

“Our findings strongly suggest that it is time for the government and others who pay for health care to aggressively promote health information technology,” Richard Hillestad, the Rand senior management scientist who led the study, said in a statement.

While the potential savings would outweigh the costs quickly during the adoption cycle, there are still a number of barriers to the effective adoption and application of health information technology, the researchers wrote. For instance, although providers would pay to implement the system, it's the payers and consumers who are likely to experience savings. In addition, even if the systems are widely adopted, interoperability and information exchange networks might not be developed, according to the study.

The widespread implementation of electronic medical record systems by physicians could lead to $142 billion in net savings over 15 years, according to a study from the Rand Corp.

And the implementation of hospital-based systems could mean a savings of $371 billion over 15 years, according to the study, which was published in the September/October issue of Health Affairs.

“Our findings strongly suggest that it is time for the government and others who pay for health care to aggressively promote health information technology,” Richard Hillestad, the Rand senior management scientist who led the study, said in a statement.

While the potential savings would outweigh the costs quickly during the adoption cycle, there are still a number of barriers to the effective adoption and application of health information technology, the researchers wrote. For instance, although providers would pay to implement the system, it's the payers and consumers who are likely to experience savings. In addition, even if the systems are widely adopted, interoperability and information exchange networks might not be developed, according to the study.

In the wake of the severe hurricane season on the Gulf Coast, thousands of displaced physicians are looking for ways to keep practicing medicine.

For some, this means relocating to another part of the country or holding down a temporary job in the hopes they'll someday reclaim their practice from flood-ravaged areas and regroup with their patients.

Family physician Kim Edward LeBlanc, M.D., who heads the department of family medicine at the Louisiana State University in New Orleans, said his entire department was displaced after Hurricane Katrina.

“The department had 10,000–15,000 patients, if not more,” he said in an interview.

Dr. LeBlanc has since relocated to his brother's home in Baton Rouge, where he plans to establish a private clinic for his patients. In the meantime, he and his department have been busy setting up other clinics in the neighboring cities of Lafayette, Lake Charles, and Kenner. The goal is to resume some functionality and start seeing patients again, to continue the training of residents and students, and to help the evacuees, he commented.

Residents have been sent to a variety of areas to help out, including Angola (La.) Prison, and a small hospital called Lallie Kamp, which is part of the state's charity system and has a lot of evacuees, he said.

“I've little hope that it will ever be the same again,” said internist/infectious disease specialist Michael Hill, M.D., whose group practice has disintegrated since the hurricanes.

Of the 26 physicians who made up the multispecialty practice in various locations around New Orleans, “only 6 or 7 are going to be returning to the area,” Dr. Hill said in an interview. “Most are going to be relocating to other states, while others are in Shreveport, Baton Rouge, or Lafayette. We've just dispersed around the state in areas not affected by the hurricane.”

David D. Teuscher, M.D., an orthopedic surgeon who works at several hospitals in Beaumont, Tex., reported at press time that the area was uninhabitable in the aftermath of Hurricane Rita. The city is operating at limited capacity, he said in an interview. “There's no potable water. Everything's operating on generators, and the National Guard isn't permitting anyone to come in. Physicians and families have fled these regions and have gone to live with family in other parts of the state and the country.”

At press time, he was communicating with his staff through a daily conference call and said he hoped to restart operations at the Beaumont hospitals by early October.

Nancy G. Michaelis, M.D., an internist from Chalmette, La., obtained a temporary license to practice in Virginia. Overall, she's had three job offers, but in an interview said she's “desperately trying to get back to New Orleans.”

For now, it looks like she'll be practicing in Virginia for quite some time.

“My house survived quite well … [but] St. Bernard Parish was completely destroyed. The two hospitals that I went to, Chalmette Medical Center in St. Bernard and Pendleton Memorial Methodist Hospital in East New Orleans, are not operational anymore. Furthermore, the population I used to see is not there anymore.”

Many physicians like Dr. Michaelis thought they'd practice at a temporary location then come back to New Orleans, “but that's less likely to happen as time goes on,” Dr. Hill said.

6,000 Gulf Coast Physicians Displaced

A recent study from the University of North Carolina at Chapel Hill estimates that Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history.

Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

About 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi have been directly affected by Katrina flooding,” said the study's author, Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

The data were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens or temporary positions have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician-search firm based in Irving, Tex.

“We're working with physicians who don't have a site of service right now because their clinic's been damaged or under water, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to the normal guidelines to process state licensing and hospital privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

In the wake of the severe hurricane season on the Gulf Coast, thousands of displaced physicians are looking for ways to keep practicing medicine.

For some, this means relocating to another part of the country or holding down a temporary job in the hopes they'll someday reclaim their practice from flood-ravaged areas and regroup with their patients.

Family physician Kim Edward LeBlanc, M.D., who heads the department of family medicine at the Louisiana State University in New Orleans, said his entire department was displaced after Hurricane Katrina.

“The department had 10,000–15,000 patients, if not more,” he said in an interview.

Dr. LeBlanc has since relocated to his brother's home in Baton Rouge, where he plans to establish a private clinic for his patients. In the meantime, he and his department have been busy setting up other clinics in the neighboring cities of Lafayette, Lake Charles, and Kenner. The goal is to resume some functionality and start seeing patients again, to continue the training of residents and students, and to help the evacuees, he commented.

Residents have been sent to a variety of areas to help out, including Angola (La.) Prison, and a small hospital called Lallie Kamp, which is part of the state's charity system and has a lot of evacuees, he said.

“I've little hope that it will ever be the same again,” said internist/infectious disease specialist Michael Hill, M.D., whose group practice has disintegrated since the hurricanes.

Of the 26 physicians who made up the multispecialty practice in various locations around New Orleans, “only 6 or 7 are going to be returning to the area,” Dr. Hill said in an interview. “Most are going to be relocating to other states, while others are in Shreveport, Baton Rouge, or Lafayette. We've just dispersed around the state in areas not affected by the hurricane.”

David D. Teuscher, M.D., an orthopedic surgeon who works at several hospitals in Beaumont, Tex., reported at press time that the area was uninhabitable in the aftermath of Hurricane Rita. The city is operating at limited capacity, he said in an interview. “There's no potable water. Everything's operating on generators, and the National Guard isn't permitting anyone to come in. Physicians and families have fled these regions and have gone to live with family in other parts of the state and the country.”

At press time, he was communicating with his staff through a daily conference call and said he hoped to restart operations at the Beaumont hospitals by early October.

Nancy G. Michaelis, M.D., an internist from Chalmette, La., obtained a temporary license to practice in Virginia. Overall, she's had three job offers, but in an interview said she's “desperately trying to get back to New Orleans.”

For now, it looks like she'll be practicing in Virginia for quite some time.

“My house survived quite well … [but] St. Bernard Parish was completely destroyed. The two hospitals that I went to, Chalmette Medical Center in St. Bernard and Pendleton Memorial Methodist Hospital in East New Orleans, are not operational anymore. Furthermore, the population I used to see is not there anymore.”

Many physicians like Dr. Michaelis thought they'd practice at a temporary location then come back to New Orleans, “but that's less likely to happen as time goes on,” Dr. Hill said.

6,000 Gulf Coast Physicians Displaced

A recent study from the University of North Carolina at Chapel Hill estimates that Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history.

Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

About 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi have been directly affected by Katrina flooding,” said the study's author, Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

The data were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens or temporary positions have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician-search firm based in Irving, Tex.

“We're working with physicians who don't have a site of service right now because their clinic's been damaged or under water, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to the normal guidelines to process state licensing and hospital privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

In the wake of the severe hurricane season on the Gulf Coast, thousands of displaced physicians are looking for ways to keep practicing medicine.

For some, this means relocating to another part of the country or holding down a temporary job in the hopes they'll someday reclaim their practice from flood-ravaged areas and regroup with their patients.

Family physician Kim Edward LeBlanc, M.D., who heads the department of family medicine at the Louisiana State University in New Orleans, said his entire department was displaced after Hurricane Katrina.

“The department had 10,000–15,000 patients, if not more,” he said in an interview.

Dr. LeBlanc has since relocated to his brother's home in Baton Rouge, where he plans to establish a private clinic for his patients. In the meantime, he and his department have been busy setting up other clinics in the neighboring cities of Lafayette, Lake Charles, and Kenner. The goal is to resume some functionality and start seeing patients again, to continue the training of residents and students, and to help the evacuees, he commented.

Residents have been sent to a variety of areas to help out, including Angola (La.) Prison, and a small hospital called Lallie Kamp, which is part of the state's charity system and has a lot of evacuees, he said.

“I've little hope that it will ever be the same again,” said internist/infectious disease specialist Michael Hill, M.D., whose group practice has disintegrated since the hurricanes.

Of the 26 physicians who made up the multispecialty practice in various locations around New Orleans, “only 6 or 7 are going to be returning to the area,” Dr. Hill said in an interview. “Most are going to be relocating to other states, while others are in Shreveport, Baton Rouge, or Lafayette. We've just dispersed around the state in areas not affected by the hurricane.”

David D. Teuscher, M.D., an orthopedic surgeon who works at several hospitals in Beaumont, Tex., reported at press time that the area was uninhabitable in the aftermath of Hurricane Rita. The city is operating at limited capacity, he said in an interview. “There's no potable water. Everything's operating on generators, and the National Guard isn't permitting anyone to come in. Physicians and families have fled these regions and have gone to live with family in other parts of the state and the country.”

At press time, he was communicating with his staff through a daily conference call and said he hoped to restart operations at the Beaumont hospitals by early October.

Nancy G. Michaelis, M.D., an internist from Chalmette, La., obtained a temporary license to practice in Virginia. Overall, she's had three job offers, but in an interview said she's “desperately trying to get back to New Orleans.”

For now, it looks like she'll be practicing in Virginia for quite some time.

“My house survived quite well … [but] St. Bernard Parish was completely destroyed. The two hospitals that I went to, Chalmette Medical Center in St. Bernard and Pendleton Memorial Methodist Hospital in East New Orleans, are not operational anymore. Furthermore, the population I used to see is not there anymore.”

Many physicians like Dr. Michaelis thought they'd practice at a temporary location then come back to New Orleans, “but that's less likely to happen as time goes on,” Dr. Hill said.

6,000 Gulf Coast Physicians Displaced

A recent study from the University of North Carolina at Chapel Hill estimates that Hurricane Katrina and flooding in New Orleans may have dislocated up to 5,944 active, patient-care physicians, the largest single displacement of doctors in U.S. history.

Hurricane Rita may boost the total to an unknown degree, according to the as-yet-unpublished study.

About 6,000 “physicians doing primarily patient care in the 10 counties and parishes in Louisiana and Mississippi have been directly affected by Katrina flooding,” said the study's author, Thomas C. Ricketts III, M.D., deputy director for policy analysis at the university's Cecil G. Sheps Center for Health Services Research.

Of the physicians in the Katrina flood-affected areas, which included six Louisiana and four Mississippi counties or parishes, most doctors—2,952—were specialists, with 1,292 in primary care and 272 in ob.gyn. practice.

The data were drawn from the American Medical Association's master file of physicians for the month of March and FEMA-posted information, as well as data from the American Association of Medical Colleges, Tulane University and Louisiana State University medical schools, the Texas Board of Medicine, and the state of Louisiana.

In an interview, Dr. Ricketts said most of the calls he's gotten to date have either been from physician recruiters or from practices in various parts of the country, asking for names of physicians who need a job.

Locum tenens or temporary positions have been an option for many of these physicians, according to Phil Miller, a spokesman for Merritt, Hawkins & Associates, a physician-search firm based in Irving, Tex.

“We're working with physicians who don't have a site of service right now because their clinic's been damaged or under water, and they don't have any patients.” In the meantime, these physicians still need income, and the locum tenens option offers them financial backing until they return to their practices.

Staff Care Inc., the locum tenens agency of the Merritt, Hawkins group, has been placing physicians all over the country—in Texas, Oklahoma, the Carolinas, and Florida—Trey Davis, executive vice president for the agency, said in an interview. Hospitals and state licensing boards have facilitated this effort by making some exceptions to the normal guidelines to process state licensing and hospital privileges, he said.

“We had a physician who contacted us a couple of days after Katrina hit. He flew his small, private plane to a location in Oklahoma and did a face-to-face interview with a government facility. Within 4 days, we pushed his privileges through, and he was seeing patients in less than a week.”

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 imroving 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 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 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 to date 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. “We're beginning to see blood pressure scores improving because of the way patients are beginning to use care managers,” he said.

There has been a 99% increase in the number of 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. The problem is “he didn't understand his disease,” Mr. Sory said.

Under the program, a caregiver drives out to visit him and instructs him on using his medications, such as putting one rubber band on the medicine he takes once a day, and three on the medicines he takes three times daily.

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 imroving 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 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 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 to date 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. “We're beginning to see blood pressure scores improving because of the way patients are beginning to use care managers,” he said.

There has been a 99% increase in the number of 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. The problem is “he didn't understand his disease,” Mr. Sory said.

Under the program, a caregiver drives out to visit him and instructs him on using his medications, such as putting one rubber band on the medicine he takes once a day, and three on the medicines he takes three times daily.

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 imroving 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 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 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 to date 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. “We're beginning to see blood pressure scores improving because of the way patients are beginning to use care managers,” he said.

There has been a 99% increase in the number of 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. The problem is “he didn't understand his disease,” Mr. Sory said.

Under the program, a caregiver drives out to visit him and instructs him on using his medications, such as putting one rubber band on the medicine he takes once a day, and three on the medicines he takes three times daily.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reforming Medicaid won't be easy to do, he said. “States have been operating under judicial constraints. We have some states that have been sued, many of them operating under consent orders that have tied their hands every time they apply to federal government for a waiver.”

The approach has to be a basic structural reform, he concluded. “You cannot achieve these goals without going back into this program and restating the concepts of the program itself. And that's always a difficult task to do.”

Because these reforms would require changes to the Medicaid law, he expects that “demagogues would come out of every corner accusing us of all sorts of things.” The same thing happened with welfare reform, where Congress was accused of starving people on the street, he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reforming Medicaid won't be easy to do, he said. “States have been operating under judicial constraints. We have some states that have been sued, many of them operating under consent orders that have tied their hands every time they apply to federal government for a waiver.”

The approach has to be a basic structural reform, he concluded. “You cannot achieve these goals without going back into this program and restating the concepts of the program itself. And that's always a difficult task to do.”

Because these reforms would require changes to the Medicaid law, he expects that “demagogues would come out of every corner accusing us of all sorts of things.” The same thing happened with welfare reform, where Congress was accused of starving people on the street, he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reforming Medicaid won't be easy to do, he said. “States have been operating under judicial constraints. We have some states that have been sued, many of them operating under consent orders that have tied their hands every time they apply to federal government for a waiver.”

The approach has to be a basic structural reform, he concluded. “You cannot achieve these goals without going back into this program and restating the concepts of the program itself. And that's always a difficult task to do.”

Because these reforms would require changes to the Medicaid law, he expects that “demagogues would come out of every corner accusing us of all sorts of things.” The same thing happened with welfare reform, where Congress was accused of starving people on the street, he said.

A PAC Is Born

The American Academy of Family Physicians has launched FamMedPAC, its political action committee, with the goal of raising $1 million in this election cycle. The idea for the PAC was approved at last year's Congress of Delegates meeting and it got underway in June. At press time, the PAC had raised more than $100,000. All of the contributions will go toward contributions to federal campaigns. Already, the PAC has contributed on a bipartisan basis to five sitting House members, including Rep. Patrick Kennedy (D-R.I.) and Rep. Tim Murphy (R-Pa.), who have cosponsored legislation encouraging the use of health information technology. Issues on the top of the PAC's agenda this year include medical liability reform and a fix to the physician pay formula, according to PAC board member Jim King, M.D., a family physician in Selmer, Tenn. He said that before the PAC was established, the AAFP had hit the limit on what it could accomplish politically. “The PAC takes us to a different level in the political game,” Dr. King said. The establishment of PACs within medicine seems to be a growing trend: In 2004, the internal medicine community formed the ACP Services PAC, which was very active during the 2004 election season.

No Free Lunch

Among the many exhibits showcasing pharmaceuticals and technology products at this year's AAFP meeting was one exhibit devoted to urging physicians not to accept free gifts from pharmaceutical reps. No Free Lunch is a group of physicians and other health care providers who say that the promotional efforts of drug companies are unduly influencing physicians. The issue is “much bigger than pens and gifts,” said Paul Bergeron, M.D., an internist based in Portsmouth, N.H., who participated in an ethics panel discussion at the American College of Physicians meeting earlier this year. If the pharmaceutical company offers something that benefits patients, such as compliance programs free of charge, that's okay, he said. “What we should not be taking are things that personally benefit the physician. If they pay me $1,000 to talk about a drug at a conference, that's not appropriate.”

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 21.5% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004, (up 4.6 points to 66.8%) along with cholesterol control for people with diabetes (up 4.4 points to 64.8%). Fewer patients are enrolled in plans that publicly report their data, due largely to shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply. With few exceptions, these plans tend not to measure or report on their performance. “Today we see a lot of health plans that aren't measuring anything. The right response as a consumer to these plans is simply, don't buy them,” said NCQA President Margaret E. O'Kane. “The new mantra for health care purchasers needs to be, 'show us your data.' Why trust your family's health to an organization that operates behind closed doors?” As many as 67,000 deaths have been prevented to date as a result of improvements recorded over the past 6 years.

von Eschenbach to FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time at the age of 67, to step aside,” he said. In a statement, Michael Jacobson, executive director of the Center for Science in the Public Interest said CSPI would “miss Dr. Crawford for his openness, despite various policy disagreements. He was one of the only FDA commissioners who had substantive experience with food safety.”

Public Health Unpreparedness

Many local public health agencies are ill-prepared to learn about and respond to naturally occurring outbreaks of deadly infectious diseases or acts of bioterrorism, a test by the RAND Corporation has found. To conduct the test, researchers posed as local physicians who were reporting fictitious cases of botulism, anthrax, smallpox, bubonic plague, and other diseases to 19 public health agencies in 18 states nationwide. (Agency directors agreed in advance to participate in the test, but did not tell their staff members.) In one case, after listening to a description of the classic symptoms of bubonic plague, a public health worker advised the caller not to worry because no similar cases had been reported. Another caller who reported a botulism case was told: “You're right; it does sound like botulism. I wouldn't worry too much if I were you.” The article appears in the Aug. 30 online edition of Health Affairs.

A PAC Is Born

The American Academy of Family Physicians has launched FamMedPAC, its political action committee, with the goal of raising $1 million in this election cycle. The idea for the PAC was approved at last year's Congress of Delegates meeting and it got underway in June. At press time, the PAC had raised more than $100,000. All of the contributions will go toward contributions to federal campaigns. Already, the PAC has contributed on a bipartisan basis to five sitting House members, including Rep. Patrick Kennedy (D-R.I.) and Rep. Tim Murphy (R-Pa.), who have cosponsored legislation encouraging the use of health information technology. Issues on the top of the PAC's agenda this year include medical liability reform and a fix to the physician pay formula, according to PAC board member Jim King, M.D., a family physician in Selmer, Tenn. He said that before the PAC was established, the AAFP had hit the limit on what it could accomplish politically. “The PAC takes us to a different level in the political game,” Dr. King said. The establishment of PACs within medicine seems to be a growing trend: In 2004, the internal medicine community formed the ACP Services PAC, which was very active during the 2004 election season.

No Free Lunch

Among the many exhibits showcasing pharmaceuticals and technology products at this year's AAFP meeting was one exhibit devoted to urging physicians not to accept free gifts from pharmaceutical reps. No Free Lunch is a group of physicians and other health care providers who say that the promotional efforts of drug companies are unduly influencing physicians. The issue is “much bigger than pens and gifts,” said Paul Bergeron, M.D., an internist based in Portsmouth, N.H., who participated in an ethics panel discussion at the American College of Physicians meeting earlier this year. If the pharmaceutical company offers something that benefits patients, such as compliance programs free of charge, that's okay, he said. “What we should not be taking are things that personally benefit the physician. If they pay me $1,000 to talk about a drug at a conference, that's not appropriate.”

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 21.5% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004, (up 4.6 points to 66.8%) along with cholesterol control for people with diabetes (up 4.4 points to 64.8%). Fewer patients are enrolled in plans that publicly report their data, due largely to shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply. With few exceptions, these plans tend not to measure or report on their performance. “Today we see a lot of health plans that aren't measuring anything. The right response as a consumer to these plans is simply, don't buy them,” said NCQA President Margaret E. O'Kane. “The new mantra for health care purchasers needs to be, 'show us your data.' Why trust your family's health to an organization that operates behind closed doors?” As many as 67,000 deaths have been prevented to date as a result of improvements recorded over the past 6 years.

von Eschenbach to FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time at the age of 67, to step aside,” he said. In a statement, Michael Jacobson, executive director of the Center for Science in the Public Interest said CSPI would “miss Dr. Crawford for his openness, despite various policy disagreements. He was one of the only FDA commissioners who had substantive experience with food safety.”

Public Health Unpreparedness

Many local public health agencies are ill-prepared to learn about and respond to naturally occurring outbreaks of deadly infectious diseases or acts of bioterrorism, a test by the RAND Corporation has found. To conduct the test, researchers posed as local physicians who were reporting fictitious cases of botulism, anthrax, smallpox, bubonic plague, and other diseases to 19 public health agencies in 18 states nationwide. (Agency directors agreed in advance to participate in the test, but did not tell their staff members.) In one case, after listening to a description of the classic symptoms of bubonic plague, a public health worker advised the caller not to worry because no similar cases had been reported. Another caller who reported a botulism case was told: “You're right; it does sound like botulism. I wouldn't worry too much if I were you.” The article appears in the Aug. 30 online edition of Health Affairs.

A PAC Is Born

The American Academy of Family Physicians has launched FamMedPAC, its political action committee, with the goal of raising $1 million in this election cycle. The idea for the PAC was approved at last year's Congress of Delegates meeting and it got underway in June. At press time, the PAC had raised more than $100,000. All of the contributions will go toward contributions to federal campaigns. Already, the PAC has contributed on a bipartisan basis to five sitting House members, including Rep. Patrick Kennedy (D-R.I.) and Rep. Tim Murphy (R-Pa.), who have cosponsored legislation encouraging the use of health information technology. Issues on the top of the PAC's agenda this year include medical liability reform and a fix to the physician pay formula, according to PAC board member Jim King, M.D., a family physician in Selmer, Tenn. He said that before the PAC was established, the AAFP had hit the limit on what it could accomplish politically. “The PAC takes us to a different level in the political game,” Dr. King said. The establishment of PACs within medicine seems to be a growing trend: In 2004, the internal medicine community formed the ACP Services PAC, which was very active during the 2004 election season.

No Free Lunch

Among the many exhibits showcasing pharmaceuticals and technology products at this year's AAFP meeting was one exhibit devoted to urging physicians not to accept free gifts from pharmaceutical reps. No Free Lunch is a group of physicians and other health care providers who say that the promotional efforts of drug companies are unduly influencing physicians. The issue is “much bigger than pens and gifts,” said Paul Bergeron, M.D., an internist based in Portsmouth, N.H., who participated in an ethics panel discussion at the American College of Physicians meeting earlier this year. If the pharmaceutical company offers something that benefits patients, such as compliance programs free of charge, that's okay, he said. “What we should not be taking are things that personally benefit the physician. If they pay me $1,000 to talk about a drug at a conference, that's not appropriate.”

Health Care Rankings

Health care quality improved markedly in many key areas in 2004, but only about 21.5% of the industry now reports publicly on its performance, according to the National Committee for Quality Assurance (NCQA) annual State of Health Care Quality report. Among the 289 commercial health plans that reported their data, average performance improved on 18 of 22 clinical measures although Medicare and Medicaid plans reported smaller gains. Improvements in measures related to high blood pressure control were made in 2004, (up 4.6 points to 66.8%) along with cholesterol control for people with diabetes (up 4.4 points to 64.8%). Fewer patients are enrolled in plans that publicly report their data, due largely to shifting enrollment patterns, the NCQA reported. Enrollment in preferred provider organizations and consumer-directed health plans is up sharply. With few exceptions, these plans tend not to measure or report on their performance. “Today we see a lot of health plans that aren't measuring anything. The right response as a consumer to these plans is simply, don't buy them,” said NCQA President Margaret E. O'Kane. “The new mantra for health care purchasers needs to be, 'show us your data.' Why trust your family's health to an organization that operates behind closed doors?” As many as 67,000 deaths have been prevented to date as a result of improvements recorded over the past 6 years.

von Eschenbach to FDA

Andrew C. von Eschenbach, M.D., has been named acting commissioner of the Food and Drug Administration, following the resignation of Lester Crawford, D.V.M., Ph.D. Dr. von Eschenbach served as head of the National Cancer Institute prior to his appointment. “As a practicing physician and research scientist, I share in the critical mission of this agency in protecting and promoting the health of the American people,” he said in a statement. Dr. Crawford had a 30-year career with the agency, serving as its deputy commissioner and director of the Center for Veterinary Medicine, among other posts. “It is time at the age of 67, to step aside,” he said. In a statement, Michael Jacobson, executive director of the Center for Science in the Public Interest said CSPI would “miss Dr. Crawford for his openness, despite various policy disagreements. He was one of the only FDA commissioners who had substantive experience with food safety.”

Public Health Unpreparedness

Many local public health agencies are ill-prepared to learn about and respond to naturally occurring outbreaks of deadly infectious diseases or acts of bioterrorism, a test by the RAND Corporation has found. To conduct the test, researchers posed as local physicians who were reporting fictitious cases of botulism, anthrax, smallpox, bubonic plague, and other diseases to 19 public health agencies in 18 states nationwide. (Agency directors agreed in advance to participate in the test, but did not tell their staff members.) In one case, after listening to a description of the classic symptoms of bubonic plague, a public health worker advised the caller not to worry because no similar cases had been reported. Another caller who reported a botulism case was told: “You're right; it does sound like botulism. I wouldn't worry too much if I were you.” The article appears in the Aug. 30 online edition of Health Affairs.