Jennifer Lubell

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

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

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

Under the CAP, the only thing the physician has to do is purchase the drugs from the preselected vendors.

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

This system will inevitably work against the patients who need therapy but have no money and the physicians who treat them, said Barbara McAneny, M.D., a member of the PPAC and an oncologist, who proposed the recommendation. If the patient is unemployed, “there is no way to make that copay,” she said.

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

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

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

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

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

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

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

In other PPAC recommendations:

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

▸ CAP vendor prices should not be included in the calculation of the ASP. The inclusion is duplicative and unfair to physicians not participating in the CAP, the PPAC determined. Given that the CMS has recognized the increased cost of dispensing drugs by pharmacies and has added 2% of the average sales price to cover pharmacy overhead costs under the ASP, the PPAC recommended that the CMS “treat physicians equally” and add 2% for physicians using the ASP + 6% and a dispensing fee for physicians using the CAP.

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

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

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

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

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

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

Under the CAP, the only thing the physician has to do is purchase the drugs from the preselected vendors.

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

This system will inevitably work against the patients who need therapy but have no money and the physicians who treat them, said Barbara McAneny, M.D., a member of the PPAC and an oncologist, who proposed the recommendation. If the patient is unemployed, “there is no way to make that copay,” she said.

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

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

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

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

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

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

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

In other PPAC recommendations:

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

▸ CAP vendor prices should not be included in the calculation of the ASP. The inclusion is duplicative and unfair to physicians not participating in the CAP, the PPAC determined. Given that the CMS has recognized the increased cost of dispensing drugs by pharmacies and has added 2% of the average sales price to cover pharmacy overhead costs under the ASP, the PPAC recommended that the CMS “treat physicians equally” and add 2% for physicians using the ASP + 6% and a dispensing fee for physicians using the CAP.

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

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

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

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

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

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

Under the CAP, the only thing the physician has to do is purchase the drugs from the preselected vendors.

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

This system will inevitably work against the patients who need therapy but have no money and the physicians who treat them, said Barbara McAneny, M.D., a member of the PPAC and an oncologist, who proposed the recommendation. If the patient is unemployed, “there is no way to make that copay,” she said.

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

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

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

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

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

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

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

In other PPAC recommendations:

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

▸ CAP vendor prices should not be included in the calculation of the ASP. The inclusion is duplicative and unfair to physicians not participating in the CAP, the PPAC determined. Given that the CMS has recognized the increased cost of dispensing drugs by pharmacies and has added 2% of the average sales price to cover pharmacy overhead costs under the ASP, the PPAC recommended that the CMS “treat physicians equally” and add 2% for physicians using the ASP + 6% and a dispensing fee for physicians using the CAP.

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

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

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

HHS Buys More Avian Flu Vaccine

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

Managing Finances a Challenge

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

Humana Settles Class Action Suit

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

Public Favors EHRs

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

Pinpointing Side Effects

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

Voters Doubt Congress on Access

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

HHS Buys More Avian Flu Vaccine

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

Managing Finances a Challenge

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

Humana Settles Class Action Suit

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

Public Favors EHRs

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

Pinpointing Side Effects

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

Voters Doubt Congress on Access

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

HHS Buys More Avian Flu Vaccine

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

Managing Finances a Challenge

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

Humana Settles Class Action Suit

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

Public Favors EHRs

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

Pinpointing Side Effects

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

Voters Doubt Congress on Access

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

WASHINGTON — 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 a 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 added. 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, 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 the 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, according to Rep. Deal.

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 a 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 added. 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, 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 the 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, according to Rep. Deal.

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 a 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 added. 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, 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 the 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, according to Rep. Deal.

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.

Pediatric neurologist Carmela Tardo, M.D., director of the epilepsy center at New Orleans' Children's Hospital, didn't return to the city for nearly 6 weeks after Hurricane Katrina made landfall in late August.

“[In early October] we were given the go-ahead to return to Children's Hospital … which fortunately was located in an area uptown and did not flood,” Dr. Tardo, a clinical professor of neurology at Louisiana State University, said in an interview.

During those weeks in limbo, Children's Hospital stayed busy, opening up a temporary corporate office and an outpatient clinic in Baton Rouge 2 weeks after the hurricane. Another clinic was established in Lafayette. “We've had to adapt by becoming more mobile,” said Dr. Tardo.

Both of these facilities will remain in operation.

For now, the hospital in New Orleans is nowhere near full capacity, she said. “We had maybe 35 patients yesterday, where we normally would have 150. We're very pleased we're getting things [back to normal]. But many of our patients may not be here anymore.”

Faculty at LSU had dispersed “everywhere” after Hurricane Katrina—to Alabama, California, Georgia, or South Carolina—said Dr. Tardo. Evacuating the city before the hurricane hit, Dr. Tardo had stayed in Houston before temporarily relocating to Baton Rouge for a few weeks, then finally moving back home. “During this period, the seven pediatric neurologists, all LSU faculty, were in touch with each other through e-mail and phone calls,” she said. All have since returned to Louisiana to practice medicine.

Michael Happel, M.D., a neurologist who lost his practice in New Orleans, is trying to reestablish his practice and build up his referral base in a new area.

His home in Metairie, La., survived, but the private practice in Chalmette, in Orleans Parish, flooded, he said in an interview. The rented office “looks like the inside of a toilet bowl,” he said. Fortunately, his paper records escaped the flooding—they were being stored at a nearby office on the 10th floor. “I know some physicians who lost 20 years of records,” said Dr. Happel.

Whenever he needs his records, however, he has to hike up those 10 floors to carry down sometimes as much as 100 pounds of documents at a time. “I've been relocating records for patients, who are asking them to be forwarded to another doctor.”

Dr. Happel's private practice is part of a group of eight neurologists that share overhead and jointly negotiate managed care contracts. At press time, Dr. Happel is living in his home and commuting to one of the group's offices in Covington, La., on the north shore of Lake Pontchartrain. “My average monthly [patient] volume is 5%–10% of what it once was,” he said, referring to his current patient base. For now, he sees about 3–5 patients a day.

“I'm pretty much living day to day,” said Dr. Happel, who's looking to open a new practice in Metairie, to replace the one in Chalmette, and has applied for hospital privileges in that area. “I'm committed to trying to stay [in Louisiana] and make it work, but it's difficult,” he said.

Nancy 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 New Orleans East—are not operational anymore. Furthermore, the population I used to see is not there anymore.”

If group practices felt the impact of the hurricanes, “the worst toll has been with physicians in individual practices, who have lost their house and practice,” Dr. Tardo commented.

Some physicians are considering a more permanent relocation. Otolaryngologist Michael 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,” said internist and infectious disease specialist Michael Hill, M.D.

Telephone service has been spotty in some areas, and it's been difficult for patients to navigate around the New Orleans area and get care, Dr. Hill said. His practice is trying to communicate with patients through newspaper ads and its Internet site, “which has updated where we are.” At press time he was working at his group 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.

6,000 Physicians Displaced in Gulf Coast Region

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 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.

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.

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 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.”

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 a large number of calls for physicians to extend their contracts in their locum tenens jobs for as long as 6 months.

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.

Pediatric neurologist Carmela Tardo, M.D., director of the epilepsy center at New Orleans' Children's Hospital, didn't return to the city for nearly 6 weeks after Hurricane Katrina made landfall in late August.

“[In early October] we were given the go-ahead to return to Children's Hospital … which fortunately was located in an area uptown and did not flood,” Dr. Tardo, a clinical professor of neurology at Louisiana State University, said in an interview.

During those weeks in limbo, Children's Hospital stayed busy, opening up a temporary corporate office and an outpatient clinic in Baton Rouge 2 weeks after the hurricane. Another clinic was established in Lafayette. “We've had to adapt by becoming more mobile,” said Dr. Tardo.

Both of these facilities will remain in operation.

For now, the hospital in New Orleans is nowhere near full capacity, she said. “We had maybe 35 patients yesterday, where we normally would have 150. We're very pleased we're getting things [back to normal]. But many of our patients may not be here anymore.”

Faculty at LSU had dispersed “everywhere” after Hurricane Katrina—to Alabama, California, Georgia, or South Carolina—said Dr. Tardo. Evacuating the city before the hurricane hit, Dr. Tardo had stayed in Houston before temporarily relocating to Baton Rouge for a few weeks, then finally moving back home. “During this period, the seven pediatric neurologists, all LSU faculty, were in touch with each other through e-mail and phone calls,” she said. All have since returned to Louisiana to practice medicine.

Michael Happel, M.D., a neurologist who lost his practice in New Orleans, is trying to reestablish his practice and build up his referral base in a new area.

His home in Metairie, La., survived, but the private practice in Chalmette, in Orleans Parish, flooded, he said in an interview. The rented office “looks like the inside of a toilet bowl,” he said. Fortunately, his paper records escaped the flooding—they were being stored at a nearby office on the 10th floor. “I know some physicians who lost 20 years of records,” said Dr. Happel.

Whenever he needs his records, however, he has to hike up those 10 floors to carry down sometimes as much as 100 pounds of documents at a time. “I've been relocating records for patients, who are asking them to be forwarded to another doctor.”

Dr. Happel's private practice is part of a group of eight neurologists that share overhead and jointly negotiate managed care contracts. At press time, Dr. Happel is living in his home and commuting to one of the group's offices in Covington, La., on the north shore of Lake Pontchartrain. “My average monthly [patient] volume is 5%–10% of what it once was,” he said, referring to his current patient base. For now, he sees about 3–5 patients a day.

“I'm pretty much living day to day,” said Dr. Happel, who's looking to open a new practice in Metairie, to replace the one in Chalmette, and has applied for hospital privileges in that area. “I'm committed to trying to stay [in Louisiana] and make it work, but it's difficult,” he said.

Nancy 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 New Orleans East—are not operational anymore. Furthermore, the population I used to see is not there anymore.”

If group practices felt the impact of the hurricanes, “the worst toll has been with physicians in individual practices, who have lost their house and practice,” Dr. Tardo commented.

Some physicians are considering a more permanent relocation. Otolaryngologist Michael 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,” said internist and infectious disease specialist Michael Hill, M.D.

Telephone service has been spotty in some areas, and it's been difficult for patients to navigate around the New Orleans area and get care, Dr. Hill said. His practice is trying to communicate with patients through newspaper ads and its Internet site, “which has updated where we are.” At press time he was working at his group 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.

6,000 Physicians Displaced in Gulf Coast Region

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 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.

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.

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 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.”

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 a large number of calls for physicians to extend their contracts in their locum tenens jobs for as long as 6 months.

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.

Pediatric neurologist Carmela Tardo, M.D., director of the epilepsy center at New Orleans' Children's Hospital, didn't return to the city for nearly 6 weeks after Hurricane Katrina made landfall in late August.

“[In early October] we were given the go-ahead to return to Children's Hospital … which fortunately was located in an area uptown and did not flood,” Dr. Tardo, a clinical professor of neurology at Louisiana State University, said in an interview.

During those weeks in limbo, Children's Hospital stayed busy, opening up a temporary corporate office and an outpatient clinic in Baton Rouge 2 weeks after the hurricane. Another clinic was established in Lafayette. “We've had to adapt by becoming more mobile,” said Dr. Tardo.

Both of these facilities will remain in operation.

For now, the hospital in New Orleans is nowhere near full capacity, she said. “We had maybe 35 patients yesterday, where we normally would have 150. We're very pleased we're getting things [back to normal]. But many of our patients may not be here anymore.”

Faculty at LSU had dispersed “everywhere” after Hurricane Katrina—to Alabama, California, Georgia, or South Carolina—said Dr. Tardo. Evacuating the city before the hurricane hit, Dr. Tardo had stayed in Houston before temporarily relocating to Baton Rouge for a few weeks, then finally moving back home. “During this period, the seven pediatric neurologists, all LSU faculty, were in touch with each other through e-mail and phone calls,” she said. All have since returned to Louisiana to practice medicine.

Michael Happel, M.D., a neurologist who lost his practice in New Orleans, is trying to reestablish his practice and build up his referral base in a new area.

His home in Metairie, La., survived, but the private practice in Chalmette, in Orleans Parish, flooded, he said in an interview. The rented office “looks like the inside of a toilet bowl,” he said. Fortunately, his paper records escaped the flooding—they were being stored at a nearby office on the 10th floor. “I know some physicians who lost 20 years of records,” said Dr. Happel.

Whenever he needs his records, however, he has to hike up those 10 floors to carry down sometimes as much as 100 pounds of documents at a time. “I've been relocating records for patients, who are asking them to be forwarded to another doctor.”

Dr. Happel's private practice is part of a group of eight neurologists that share overhead and jointly negotiate managed care contracts. At press time, Dr. Happel is living in his home and commuting to one of the group's offices in Covington, La., on the north shore of Lake Pontchartrain. “My average monthly [patient] volume is 5%–10% of what it once was,” he said, referring to his current patient base. For now, he sees about 3–5 patients a day.

“I'm pretty much living day to day,” said Dr. Happel, who's looking to open a new practice in Metairie, to replace the one in Chalmette, and has applied for hospital privileges in that area. “I'm committed to trying to stay [in Louisiana] and make it work, but it's difficult,” he said.

Nancy 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 New Orleans East—are not operational anymore. Furthermore, the population I used to see is not there anymore.”

If group practices felt the impact of the hurricanes, “the worst toll has been with physicians in individual practices, who have lost their house and practice,” Dr. Tardo commented.

Some physicians are considering a more permanent relocation. Otolaryngologist Michael 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,” said internist and infectious disease specialist Michael Hill, M.D.

Telephone service has been spotty in some areas, and it's been difficult for patients to navigate around the New Orleans area and get care, Dr. Hill said. His practice is trying to communicate with patients through newspaper ads and its Internet site, “which has updated where we are.” At press time he was working at his group 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.

6,000 Physicians Displaced in Gulf Coast Region

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 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.

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.

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 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.”

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 a large number of calls for physicians to extend their contracts in their locum tenens jobs for as long as 6 months.

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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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

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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]

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.