Jennifer Silverman

WASHINGTON — Few Medicare beneficiaries are reporting access problems despite ongoing issues over physician payment, according to surveys released at a meeting of the Medicare Payment Advisory Commission.

In a telephone survey conducted by MedPAC last summer, researchers found that access to physicians for Medicare beneficiaries aged 65 years and over was the same as or better than for privately insured people aged 50–64 years. The survey included responses from 2,000 fee-for-service Medicare beneficiaries and 2,000 privately insured individuals.

The majority of Medicare beneficiaries reported few or no problems with respect to access to physicians in 2004.

According to the survey, 94% of Medicare beneficiaries and 91% of privately insured individuals reported few or no problems accessing care from specialists.

In each group, 88% of the respondents said that they had few problems finding a primary care physician, although both groups reported that they had more difficulty finding a new primary care physician than a specialist.

Access to care is a timely issue, as physicians face 5% annual cuts in their Medicare payments for the following 6 years, starting in 2006, unless a flaw in the reimbursement formula is fixed.

An ongoing concern is that physicians will cut back or cease their care of Medicare beneficiaries if their fees are further reduced.

“The MedPAC survey numbers clearly don't match up with the anecdotal evidence we've been hearing” about physicians scaling back on Medicare patients, said MedPAC Commissioner Alan Nelson, M.D.

“You can stress physicians only to a certain point before they can't take it anymore and start closing practices to Medicare patients,” he said, noting that these survey results show that point has not been reached.

Despite increasing reimbursement concerns, physicians continue to feel a responsibility to care for Medicare patients, he said.

This doesn't mean that physicians can tolerate a 5% cut in 2006 and that the numbers couldn't change overnight.

The findings also don't necessarily reflect what's happening in all areas of the country, he continued. “There may be local areas where physician access problems are more severe than what the national numbers say.”

In other results of the MedPAC survey, the percentage of Medicare beneficiaries who had minor problems finding a primary care physician actually dropped, from 18% in 2003 to 11% in 2004. But in another finding, Medicare beneficiaries listing primary care physician access as a “big” problem increased from 7% to 11% from 2003 to 2004.

“Does this mean we need to be concerned about the primary care physician?” MedPAC Commissioner Nancy-Ann DeParle asked.

MedPAC staffers responded that neither finding signified a specific trend, at least not yet, but that they would continue to track both issues.

On the issue of getting timely appointments, Medicare beneficiaries fared slightly better than the privately insured patients for routine care. And 73% of Medicare beneficiaries and 66% of privately insured individuals reported that they never had to delay an appointment. Only 2% of Medicare beneficiaries and 3% of privately insured individuals reported always experiencing a delay. “As expected for illness or injury, delays were more common for both groups,” said Cristina Boccuti, an analyst at MedPAC who presented the findings at the meeting.

Overall, 6% of Medicare beneficiaries and 11% of privately insured individuals thought they should have seen a doctor for a medical problem in the last year, but didn't.

Within this group, physician availability issues such as finding a doctor or getting an appointment time were the most common responses.

Another survey sponsored by the Centers for Medicare and Medicaid Services reported similar findings on access to care.

In that survey, more than 90% of fee-for-service beneficiaries reported no problems getting a personal physician since joining Medicare, or getting a specialist within 6 months.

The survey focused on Medicare fee-for-service beneficiaries in 11 market areas that were targeted by the 2001 Consumer Assessment of Health Plans-Fee-for-Service Survey as having the highest rates of reported physician access problems. CMS received about 3,300 completed surveys, an agency spokesman said.

“Even in these areas suspected of higher than average access problems, only a small percentage of beneficiaries had access problems attributed to physicians not taking new Medicare patients,” Ms. Boccuti said.

Access problems were more common among transitioning beneficiaries—those new to Medicare or recently disenrolled from the Medicare Advantage Plans, or new to the market area in general. These beneficiaries had more difficulties finding a personal doctor or specialist—“and in some respects that can be expected,” Ms. Boccuti said.

Ability to get timely appointments was a little more problematic in these areas, “but still not bad,” she said.

Of those surveyed, 73% reported that they always got an appointment as soon as they needed it, and 20% said they usually did.

“So that leaves 7% who reported that they sometimes or never were able to get timely appointments,” Ms. Boccuti noted at the meeting.

Ms. Boccuti said she expected to complete an access to care analysis for MedPAC's review in December. At that time, there should be more information on physician willingness to serve beneficiaries.

Medicare Payment Increases in 2005

According to the final Medicare physician fee schedule released by the Centers for Medicare and Medicaid Services, physicians would have seen a 3.3% cut in Medicare payments in 2005 if the Medicare Modernization Act (MMA) hadn't blocked that decrease. Instead, payments will increase by 1.5%.

In other MMA mandates, Medicare now will pay for a “Welcome to Medicare” physical and for cardiovascular and diabetes screening tests.

In addition to payment for the physical, physicians can bill and be paid separately for a screening electrocardiogram, and may also bill for a more extensive office visit at the same time as the physical, as long as the services are medically necessary.

The fee schedule also increases payments for vaccinations and other types of injections. For instance, payments for administering the flu vaccine will increase from $8 to $18.

These changes boost aggregate spending under the fee schedule from $53.1 billion in 2004 to $55.3 billion in 2005.

WASHINGTON — Few Medicare beneficiaries are reporting access problems despite ongoing issues over physician payment, according to surveys released at a meeting of the Medicare Payment Advisory Commission.

In a telephone survey conducted by MedPAC last summer, researchers found that access to physicians for Medicare beneficiaries aged 65 years and over was the same as or better than for privately insured people aged 50–64 years. The survey included responses from 2,000 fee-for-service Medicare beneficiaries and 2,000 privately insured individuals.

The majority of Medicare beneficiaries reported few or no problems with respect to access to physicians in 2004.

According to the survey, 94% of Medicare beneficiaries and 91% of privately insured individuals reported few or no problems accessing care from specialists.

In each group, 88% of the respondents said that they had few problems finding a primary care physician, although both groups reported that they had more difficulty finding a new primary care physician than a specialist.

Access to care is a timely issue, as physicians face 5% annual cuts in their Medicare payments for the following 6 years, starting in 2006, unless a flaw in the reimbursement formula is fixed.

An ongoing concern is that physicians will cut back or cease their care of Medicare beneficiaries if their fees are further reduced.

“The MedPAC survey numbers clearly don't match up with the anecdotal evidence we've been hearing” about physicians scaling back on Medicare patients, said MedPAC Commissioner Alan Nelson, M.D.

“You can stress physicians only to a certain point before they can't take it anymore and start closing practices to Medicare patients,” he said, noting that these survey results show that point has not been reached.

Despite increasing reimbursement concerns, physicians continue to feel a responsibility to care for Medicare patients, he said.

This doesn't mean that physicians can tolerate a 5% cut in 2006 and that the numbers couldn't change overnight.

The findings also don't necessarily reflect what's happening in all areas of the country, he continued. “There may be local areas where physician access problems are more severe than what the national numbers say.”

In other results of the MedPAC survey, the percentage of Medicare beneficiaries who had minor problems finding a primary care physician actually dropped, from 18% in 2003 to 11% in 2004. But in another finding, Medicare beneficiaries listing primary care physician access as a “big” problem increased from 7% to 11% from 2003 to 2004.

“Does this mean we need to be concerned about the primary care physician?” MedPAC Commissioner Nancy-Ann DeParle asked.

MedPAC staffers responded that neither finding signified a specific trend, at least not yet, but that they would continue to track both issues.

On the issue of getting timely appointments, Medicare beneficiaries fared slightly better than the privately insured patients for routine care. And 73% of Medicare beneficiaries and 66% of privately insured individuals reported that they never had to delay an appointment. Only 2% of Medicare beneficiaries and 3% of privately insured individuals reported always experiencing a delay. “As expected for illness or injury, delays were more common for both groups,” said Cristina Boccuti, an analyst at MedPAC who presented the findings at the meeting.

Overall, 6% of Medicare beneficiaries and 11% of privately insured individuals thought they should have seen a doctor for a medical problem in the last year, but didn't.

Within this group, physician availability issues such as finding a doctor or getting an appointment time were the most common responses.

Another survey sponsored by the Centers for Medicare and Medicaid Services reported similar findings on access to care.

In that survey, more than 90% of fee-for-service beneficiaries reported no problems getting a personal physician since joining Medicare, or getting a specialist within 6 months.

The survey focused on Medicare fee-for-service beneficiaries in 11 market areas that were targeted by the 2001 Consumer Assessment of Health Plans-Fee-for-Service Survey as having the highest rates of reported physician access problems. CMS received about 3,300 completed surveys, an agency spokesman said.

“Even in these areas suspected of higher than average access problems, only a small percentage of beneficiaries had access problems attributed to physicians not taking new Medicare patients,” Ms. Boccuti said.

Access problems were more common among transitioning beneficiaries—those new to Medicare or recently disenrolled from the Medicare Advantage Plans, or new to the market area in general. These beneficiaries had more difficulties finding a personal doctor or specialist—“and in some respects that can be expected,” Ms. Boccuti said.

Ability to get timely appointments was a little more problematic in these areas, “but still not bad,” she said.

Of those surveyed, 73% reported that they always got an appointment as soon as they needed it, and 20% said they usually did.

“So that leaves 7% who reported that they sometimes or never were able to get timely appointments,” Ms. Boccuti noted at the meeting.

Ms. Boccuti said she expected to complete an access to care analysis for MedPAC's review in December. At that time, there should be more information on physician willingness to serve beneficiaries.

Medicare Payment Increases in 2005

According to the final Medicare physician fee schedule released by the Centers for Medicare and Medicaid Services, physicians would have seen a 3.3% cut in Medicare payments in 2005 if the Medicare Modernization Act (MMA) hadn't blocked that decrease. Instead, payments will increase by 1.5%.

In other MMA mandates, Medicare now will pay for a “Welcome to Medicare” physical and for cardiovascular and diabetes screening tests.

In addition to payment for the physical, physicians can bill and be paid separately for a screening electrocardiogram, and may also bill for a more extensive office visit at the same time as the physical, as long as the services are medically necessary.

The fee schedule also increases payments for vaccinations and other types of injections. For instance, payments for administering the flu vaccine will increase from $8 to $18.

These changes boost aggregate spending under the fee schedule from $53.1 billion in 2004 to $55.3 billion in 2005.

WASHINGTON — Few Medicare beneficiaries are reporting access problems despite ongoing issues over physician payment, according to surveys released at a meeting of the Medicare Payment Advisory Commission.

In a telephone survey conducted by MedPAC last summer, researchers found that access to physicians for Medicare beneficiaries aged 65 years and over was the same as or better than for privately insured people aged 50–64 years. The survey included responses from 2,000 fee-for-service Medicare beneficiaries and 2,000 privately insured individuals.

The majority of Medicare beneficiaries reported few or no problems with respect to access to physicians in 2004.

According to the survey, 94% of Medicare beneficiaries and 91% of privately insured individuals reported few or no problems accessing care from specialists.

In each group, 88% of the respondents said that they had few problems finding a primary care physician, although both groups reported that they had more difficulty finding a new primary care physician than a specialist.

Access to care is a timely issue, as physicians face 5% annual cuts in their Medicare payments for the following 6 years, starting in 2006, unless a flaw in the reimbursement formula is fixed.

An ongoing concern is that physicians will cut back or cease their care of Medicare beneficiaries if their fees are further reduced.

“The MedPAC survey numbers clearly don't match up with the anecdotal evidence we've been hearing” about physicians scaling back on Medicare patients, said MedPAC Commissioner Alan Nelson, M.D.

“You can stress physicians only to a certain point before they can't take it anymore and start closing practices to Medicare patients,” he said, noting that these survey results show that point has not been reached.

Despite increasing reimbursement concerns, physicians continue to feel a responsibility to care for Medicare patients, he said.

This doesn't mean that physicians can tolerate a 5% cut in 2006 and that the numbers couldn't change overnight.

The findings also don't necessarily reflect what's happening in all areas of the country, he continued. “There may be local areas where physician access problems are more severe than what the national numbers say.”

In other results of the MedPAC survey, the percentage of Medicare beneficiaries who had minor problems finding a primary care physician actually dropped, from 18% in 2003 to 11% in 2004. But in another finding, Medicare beneficiaries listing primary care physician access as a “big” problem increased from 7% to 11% from 2003 to 2004.

“Does this mean we need to be concerned about the primary care physician?” MedPAC Commissioner Nancy-Ann DeParle asked.

MedPAC staffers responded that neither finding signified a specific trend, at least not yet, but that they would continue to track both issues.

On the issue of getting timely appointments, Medicare beneficiaries fared slightly better than the privately insured patients for routine care. And 73% of Medicare beneficiaries and 66% of privately insured individuals reported that they never had to delay an appointment. Only 2% of Medicare beneficiaries and 3% of privately insured individuals reported always experiencing a delay. “As expected for illness or injury, delays were more common for both groups,” said Cristina Boccuti, an analyst at MedPAC who presented the findings at the meeting.

Overall, 6% of Medicare beneficiaries and 11% of privately insured individuals thought they should have seen a doctor for a medical problem in the last year, but didn't.

Within this group, physician availability issues such as finding a doctor or getting an appointment time were the most common responses.

Another survey sponsored by the Centers for Medicare and Medicaid Services reported similar findings on access to care.

In that survey, more than 90% of fee-for-service beneficiaries reported no problems getting a personal physician since joining Medicare, or getting a specialist within 6 months.

The survey focused on Medicare fee-for-service beneficiaries in 11 market areas that were targeted by the 2001 Consumer Assessment of Health Plans-Fee-for-Service Survey as having the highest rates of reported physician access problems. CMS received about 3,300 completed surveys, an agency spokesman said.

“Even in these areas suspected of higher than average access problems, only a small percentage of beneficiaries had access problems attributed to physicians not taking new Medicare patients,” Ms. Boccuti said.

Access problems were more common among transitioning beneficiaries—those new to Medicare or recently disenrolled from the Medicare Advantage Plans, or new to the market area in general. These beneficiaries had more difficulties finding a personal doctor or specialist—“and in some respects that can be expected,” Ms. Boccuti said.

Ability to get timely appointments was a little more problematic in these areas, “but still not bad,” she said.

Of those surveyed, 73% reported that they always got an appointment as soon as they needed it, and 20% said they usually did.

“So that leaves 7% who reported that they sometimes or never were able to get timely appointments,” Ms. Boccuti noted at the meeting.

Ms. Boccuti said she expected to complete an access to care analysis for MedPAC's review in December. At that time, there should be more information on physician willingness to serve beneficiaries.

Medicare Payment Increases in 2005

According to the final Medicare physician fee schedule released by the Centers for Medicare and Medicaid Services, physicians would have seen a 3.3% cut in Medicare payments in 2005 if the Medicare Modernization Act (MMA) hadn't blocked that decrease. Instead, payments will increase by 1.5%.

In other MMA mandates, Medicare now will pay for a “Welcome to Medicare” physical and for cardiovascular and diabetes screening tests.

In addition to payment for the physical, physicians can bill and be paid separately for a screening electrocardiogram, and may also bill for a more extensive office visit at the same time as the physical, as long as the services are medically necessary.

The fee schedule also increases payments for vaccinations and other types of injections. For instance, payments for administering the flu vaccine will increase from $8 to $18.

These changes boost aggregate spending under the fee schedule from $53.1 billion in 2004 to $55.3 billion in 2005.

ATLANTA — Delegates to the American Medical Association's 2004 interim meeting made a bold move to support prescription drug importation by wholesalers and pharmacies, provided that certain conditions were met to ensure patient safety.

“Prescription drugs should be available at the lowest price possible, and we must ensure quality and safety,” AMA Trustee Edward Langston, M.D., said at a press briefing following the vote.

The policy approved by the House of Delegates states that the drugs must be approved by the Food and Drug Administration and must be subject to reliable “track and trace” technology and a closed distribution chain. The policy was swiftly approved by the house after much discussion in committee.

The AMA also reaffirmed that it does not support personal importation of prescription drugs via the Internet until patient safety can be assured.

The policy urges the AMA to educate members regarding the risks and benefits associated with reimportation efforts.

“We're certainly gratified the AMA emphasized the need for safety” in its new policy, Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Association, told this newspaper. PhRMA, however, “remains convinced that importation is too riddled with problems to pursue.”

The AMA's position on patient safety and reimportation could change once it reviews a forthcoming report from a task force of the Department of Health and Human Services, the policy stated.

The issue is certain to come up in the House of Delegates again. In committee debate, Erich Garland, M.D., AMA delegate from the American Academy of Neurology, asked that the AMA look further into the cost discrepancy between Canada and other countries. Recently, “I was surprised to find that large insurance companies were reimbursing patients for medicines they got in other countries,” Dr. Garland said. “We shouldn't need to reimport medicine.”

Delegates approved several measures designed to address the influenza vaccine shortage, asking that physicians be allowed to form purchasing alliances for competitive purchasing of the vaccine comparable with large purchasers supplying pharmacy and grocery chain stores.

Language to study mechanisms to help the uninsured was also approved. Delegates in one instance broadened the scope of a board report, stipulating that federal legislation to authorize and fund state‐based demonstration projects should include—but not be limited to—implementing income‐related, refundable, and affordable tax credits.

In other actions, delegates voted to:

▸ Seek the replacement of the Medicare payment formula's sustainable growth rate with payment updates that reflect increases in the cost of medical practice.

▸ Pursue caps on noneconomic damages as a top priority in medical liability reform, with a request to the board of trustees to report efforts to reform the civil justice system, as part of its coalition‐building activities.

▸ Create model state legislation for physicians who testify in medical liability cases, emphasizing that they must meet statutory expert witness requirements, such as comparable education, training, and occupational experience in the same field as the defendant. “Junk science has no place in the courtroom,” said Donald Palmisano, M.D., AMA's immediate past president.

The stance on prescription drug importation provided the House of Delegates the opportunity to flex its political muscle at a time when the AMA is struggling with its identity and appeal to younger physicians.

Delegates heard the evidence for themselves in video clips of young participants in focus groups, and in new survey data, where only 11% of 800 physicians identified the AMA as a leadership body to which they could relate.

“Physicians simply aren't clear about who we are and what we do,” Michael Maves, M.D., the AMA's executive vice president, said during the meeting's opening session.

The survey reaffirmed a longtime trend that physicians prefer their specialty or state society to a broader umbrella organization. Only 19% of the survey participants thought the AMA increased opportunities for their voices to be heard on important issues, as opposed to specialty groups (49%) and state groups (30%), said Ajay Gupta, a principal at McKinsey & Co., a management consulting firm that conducted the survey and the focus groups.

Lack of confidence in the AMA has manifested in declining membership rolls. The percentage of nonrenewals in AMA membership has doubled from 10% to 20% over the past decade, with young, active physicians accounting for most of the decline, Mr. Gupta said.

ATLANTA — Delegates to the American Medical Association's 2004 interim meeting made a bold move to support prescription drug importation by wholesalers and pharmacies, provided that certain conditions were met to ensure patient safety.

“Prescription drugs should be available at the lowest price possible, and we must ensure quality and safety,” AMA Trustee Edward Langston, M.D., said at a press briefing following the vote.

The policy approved by the House of Delegates states that the drugs must be approved by the Food and Drug Administration and must be subject to reliable “track and trace” technology and a closed distribution chain. The policy was swiftly approved by the house after much discussion in committee.

The AMA also reaffirmed that it does not support personal importation of prescription drugs via the Internet until patient safety can be assured.

The policy urges the AMA to educate members regarding the risks and benefits associated with reimportation efforts.

“We're certainly gratified the AMA emphasized the need for safety” in its new policy, Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Association, told this newspaper. PhRMA, however, “remains convinced that importation is too riddled with problems to pursue.”

The AMA's position on patient safety and reimportation could change once it reviews a forthcoming report from a task force of the Department of Health and Human Services, the policy stated.

The issue is certain to come up in the House of Delegates again. In committee debate, Erich Garland, M.D., AMA delegate from the American Academy of Neurology, asked that the AMA look further into the cost discrepancy between Canada and other countries. Recently, “I was surprised to find that large insurance companies were reimbursing patients for medicines they got in other countries,” Dr. Garland said. “We shouldn't need to reimport medicine.”

Delegates approved several measures designed to address the influenza vaccine shortage, asking that physicians be allowed to form purchasing alliances for competitive purchasing of the vaccine comparable with large purchasers supplying pharmacy and grocery chain stores.

Language to study mechanisms to help the uninsured was also approved. Delegates in one instance broadened the scope of a board report, stipulating that federal legislation to authorize and fund state‐based demonstration projects should include—but not be limited to—implementing income‐related, refundable, and affordable tax credits.

In other actions, delegates voted to:

▸ Seek the replacement of the Medicare payment formula's sustainable growth rate with payment updates that reflect increases in the cost of medical practice.

▸ Pursue caps on noneconomic damages as a top priority in medical liability reform, with a request to the board of trustees to report efforts to reform the civil justice system, as part of its coalition‐building activities.

▸ Create model state legislation for physicians who testify in medical liability cases, emphasizing that they must meet statutory expert witness requirements, such as comparable education, training, and occupational experience in the same field as the defendant. “Junk science has no place in the courtroom,” said Donald Palmisano, M.D., AMA's immediate past president.

The stance on prescription drug importation provided the House of Delegates the opportunity to flex its political muscle at a time when the AMA is struggling with its identity and appeal to younger physicians.

Delegates heard the evidence for themselves in video clips of young participants in focus groups, and in new survey data, where only 11% of 800 physicians identified the AMA as a leadership body to which they could relate.

“Physicians simply aren't clear about who we are and what we do,” Michael Maves, M.D., the AMA's executive vice president, said during the meeting's opening session.

The survey reaffirmed a longtime trend that physicians prefer their specialty or state society to a broader umbrella organization. Only 19% of the survey participants thought the AMA increased opportunities for their voices to be heard on important issues, as opposed to specialty groups (49%) and state groups (30%), said Ajay Gupta, a principal at McKinsey & Co., a management consulting firm that conducted the survey and the focus groups.

Lack of confidence in the AMA has manifested in declining membership rolls. The percentage of nonrenewals in AMA membership has doubled from 10% to 20% over the past decade, with young, active physicians accounting for most of the decline, Mr. Gupta said.

ATLANTA — Delegates to the American Medical Association's 2004 interim meeting made a bold move to support prescription drug importation by wholesalers and pharmacies, provided that certain conditions were met to ensure patient safety.

“Prescription drugs should be available at the lowest price possible, and we must ensure quality and safety,” AMA Trustee Edward Langston, M.D., said at a press briefing following the vote.

The policy approved by the House of Delegates states that the drugs must be approved by the Food and Drug Administration and must be subject to reliable “track and trace” technology and a closed distribution chain. The policy was swiftly approved by the house after much discussion in committee.

The AMA also reaffirmed that it does not support personal importation of prescription drugs via the Internet until patient safety can be assured.

The policy urges the AMA to educate members regarding the risks and benefits associated with reimportation efforts.

“We're certainly gratified the AMA emphasized the need for safety” in its new policy, Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Association, told this newspaper. PhRMA, however, “remains convinced that importation is too riddled with problems to pursue.”

The AMA's position on patient safety and reimportation could change once it reviews a forthcoming report from a task force of the Department of Health and Human Services, the policy stated.

The issue is certain to come up in the House of Delegates again. In committee debate, Erich Garland, M.D., AMA delegate from the American Academy of Neurology, asked that the AMA look further into the cost discrepancy between Canada and other countries. Recently, “I was surprised to find that large insurance companies were reimbursing patients for medicines they got in other countries,” Dr. Garland said. “We shouldn't need to reimport medicine.”

Delegates approved several measures designed to address the influenza vaccine shortage, asking that physicians be allowed to form purchasing alliances for competitive purchasing of the vaccine comparable with large purchasers supplying pharmacy and grocery chain stores.

Language to study mechanisms to help the uninsured was also approved. Delegates in one instance broadened the scope of a board report, stipulating that federal legislation to authorize and fund state‐based demonstration projects should include—but not be limited to—implementing income‐related, refundable, and affordable tax credits.

In other actions, delegates voted to:

▸ Seek the replacement of the Medicare payment formula's sustainable growth rate with payment updates that reflect increases in the cost of medical practice.

▸ Pursue caps on noneconomic damages as a top priority in medical liability reform, with a request to the board of trustees to report efforts to reform the civil justice system, as part of its coalition‐building activities.

▸ Create model state legislation for physicians who testify in medical liability cases, emphasizing that they must meet statutory expert witness requirements, such as comparable education, training, and occupational experience in the same field as the defendant. “Junk science has no place in the courtroom,” said Donald Palmisano, M.D., AMA's immediate past president.

The stance on prescription drug importation provided the House of Delegates the opportunity to flex its political muscle at a time when the AMA is struggling with its identity and appeal to younger physicians.

Delegates heard the evidence for themselves in video clips of young participants in focus groups, and in new survey data, where only 11% of 800 physicians identified the AMA as a leadership body to which they could relate.

“Physicians simply aren't clear about who we are and what we do,” Michael Maves, M.D., the AMA's executive vice president, said during the meeting's opening session.

The survey reaffirmed a longtime trend that physicians prefer their specialty or state society to a broader umbrella organization. Only 19% of the survey participants thought the AMA increased opportunities for their voices to be heard on important issues, as opposed to specialty groups (49%) and state groups (30%), said Ajay Gupta, a principal at McKinsey & Co., a management consulting firm that conducted the survey and the focus groups.

Lack of confidence in the AMA has manifested in declining membership rolls. The percentage of nonrenewals in AMA membership has doubled from 10% to 20% over the past decade, with young, active physicians accounting for most of the decline, Mr. Gupta said.

Many of 519 teens aged 15–17 years surveyed revealed a gap between what they think they know and what they really know about contraception.

Although teens seem to trust oral contraceptives for pregnancy prevention, nearly one in five surveyed thought newer hormonal methods, such as the patch or the ring, were not very effective at pregnancy prevention—or didn't know how effective they were.

More than one in four didn't know oral contraceptives offer no protection against sexually transmitted diseases. And a majority in the survey by the Henry J. Kaiser Family Foundation mistook the diaphragm and cervical cap as preventive of STD.

Many of 519 teens aged 15–17 years surveyed revealed a gap between what they think they know and what they really know about contraception.

Although teens seem to trust oral contraceptives for pregnancy prevention, nearly one in five surveyed thought newer hormonal methods, such as the patch or the ring, were not very effective at pregnancy prevention—or didn't know how effective they were.

More than one in four didn't know oral contraceptives offer no protection against sexually transmitted diseases. And a majority in the survey by the Henry J. Kaiser Family Foundation mistook the diaphragm and cervical cap as preventive of STD.

Many of 519 teens aged 15–17 years surveyed revealed a gap between what they think they know and what they really know about contraception.

Although teens seem to trust oral contraceptives for pregnancy prevention, nearly one in five surveyed thought newer hormonal methods, such as the patch or the ring, were not very effective at pregnancy prevention—or didn't know how effective they were.

More than one in four didn't know oral contraceptives offer no protection against sexually transmitted diseases. And a majority in the survey by the Henry J. Kaiser Family Foundation mistook the diaphragm and cervical cap as preventive of STD.

Boost in SCHIP Funds

Help is on the way for states facing empty children's health care budgets. The Department of Health and Human Services is redistributing $643 million in unspent 2002 funds for the State Children's Health Insurance Program. “I am very pleased that we can take action to prevent any loss or break in coverage because program funds weren't being used by states that need them the most,” said Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services. Twenty-eight states will be getting supplemental funds under this action. Without it, five states—Arizona, Minnesota, Mississippi, New Jersey, and Rhode Island—would have run out of federal funding for their SCHIP programs, according to HHS. Even with the redistribution, Dr. McClellan said he expected to complete fiscal year 2005 with more than $5 billion in unspent federal matching funds.

Compensation for Vaccine Injuries

The National Vaccine Injury Compensation program (VICP) will now cover injuries related to the hepatitis A vaccine. Hepatitis A is the most common type of hepatitis reported in the United States, and causes an estimated 125,000–200,000 cases per year. The vaccine is recommended for children in certain states and high-incidence communities, in addition to people with chronic diseases or for those traveling to countries where the disease is common. Most people who receive the hepatitis A vaccine don't experience serious problems. However, those who believe they've been injured by the vaccine must file a claim within 3 years of the first symptom of the vaccine injury or within 2 years of the vaccine-related death, but not more than 4 years after the start of the first symptom of the vaccine-related injury from which the death occurred. Administered by the Health Resources and Services Administration, the VICP program provides financial compensation to eligible individuals thought to be injured by vaccines.

Responsible Food Marketing

The Center for Science in the Public Interest wants supermarkets, media outlets, and schools to change the way “junk food” is marketed to children. The public interest group has issued guidelines calling on companies not to market low-nutrition drinks like sodas, sports drinks, and sweetened iced teas to children. Further, foods marketed to children should have reasonable portion sizes, and provide some basic nutrients. “What we're really asking is that marketers act responsibly and not urge kids to eat foods that could harm their health,” said Margo G. Wootan, CSPI's nutrition policy director. CSPI's guidelines were sent to supermarkets, major food companies, chain restaurants, television networks and stations, movie studios, and children's magazines. Meanwhile, the National Automatic Merchandising Association released its own initiative to fight childhood obesity, promoting a color-coded snack food rating system in school vending machines.

Secondhand Smoke Campaign

In another campaign to improve children's health, the American Legacy Foundation is asking parents to create smoke-free environments for their families. According to the Foundation's research, more than 13 million children in the United States are breathing secondhand smoke in their homes, resulting in serious health implications. In 82% of the cases where a young person lives with a smoker, that smoker is a parent. In television and radio public service announcements, the campaign urges parents to keep their homes and cars smoke-free and refrain from smoking around children. The foundation is based in Washington and develops programs that address the health effects of tobacco use. A previous foundation report found that a small reduction in tobacco smoke exposure would result in fewer low-birth- weight babies and fewer cases of asthma and ear infections.

Medicaid's Benefits to the States

An annual fiscal survey of the states failed to examine the benefit of Medicaid to the states' economies, according to Families USA. The report released by the National Governors Association (NGA) and the National Association of State Budget Officers indicated that state spending for Medicaid, including federal funds, has surpassed state spending on primary and secondary education. Yet in examining state general fund expenditures, states spent more than twice as much on education than they did on Medicaid. “When analyzing the NGA survey's findings on Medicaid, it is important to count the economic benefit that Medicaid holds for states,” said Families USA Executive Director Ron Pollack. “A recent Families USA study found that on average every $1 million invested in Medicaid by states generates nearly 34 jobs, $1.2 million in wages, and $3.3 million in business activity,” he added.

Boost in SCHIP Funds

Help is on the way for states facing empty children's health care budgets. The Department of Health and Human Services is redistributing $643 million in unspent 2002 funds for the State Children's Health Insurance Program. “I am very pleased that we can take action to prevent any loss or break in coverage because program funds weren't being used by states that need them the most,” said Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services. Twenty-eight states will be getting supplemental funds under this action. Without it, five states—Arizona, Minnesota, Mississippi, New Jersey, and Rhode Island—would have run out of federal funding for their SCHIP programs, according to HHS. Even with the redistribution, Dr. McClellan said he expected to complete fiscal year 2005 with more than $5 billion in unspent federal matching funds.

Compensation for Vaccine Injuries

The National Vaccine Injury Compensation program (VICP) will now cover injuries related to the hepatitis A vaccine. Hepatitis A is the most common type of hepatitis reported in the United States, and causes an estimated 125,000–200,000 cases per year. The vaccine is recommended for children in certain states and high-incidence communities, in addition to people with chronic diseases or for those traveling to countries where the disease is common. Most people who receive the hepatitis A vaccine don't experience serious problems. However, those who believe they've been injured by the vaccine must file a claim within 3 years of the first symptom of the vaccine injury or within 2 years of the vaccine-related death, but not more than 4 years after the start of the first symptom of the vaccine-related injury from which the death occurred. Administered by the Health Resources and Services Administration, the VICP program provides financial compensation to eligible individuals thought to be injured by vaccines.

Responsible Food Marketing

The Center for Science in the Public Interest wants supermarkets, media outlets, and schools to change the way “junk food” is marketed to children. The public interest group has issued guidelines calling on companies not to market low-nutrition drinks like sodas, sports drinks, and sweetened iced teas to children. Further, foods marketed to children should have reasonable portion sizes, and provide some basic nutrients. “What we're really asking is that marketers act responsibly and not urge kids to eat foods that could harm their health,” said Margo G. Wootan, CSPI's nutrition policy director. CSPI's guidelines were sent to supermarkets, major food companies, chain restaurants, television networks and stations, movie studios, and children's magazines. Meanwhile, the National Automatic Merchandising Association released its own initiative to fight childhood obesity, promoting a color-coded snack food rating system in school vending machines.

Secondhand Smoke Campaign

In another campaign to improve children's health, the American Legacy Foundation is asking parents to create smoke-free environments for their families. According to the Foundation's research, more than 13 million children in the United States are breathing secondhand smoke in their homes, resulting in serious health implications. In 82% of the cases where a young person lives with a smoker, that smoker is a parent. In television and radio public service announcements, the campaign urges parents to keep their homes and cars smoke-free and refrain from smoking around children. The foundation is based in Washington and develops programs that address the health effects of tobacco use. A previous foundation report found that a small reduction in tobacco smoke exposure would result in fewer low-birth- weight babies and fewer cases of asthma and ear infections.

Medicaid's Benefits to the States

An annual fiscal survey of the states failed to examine the benefit of Medicaid to the states' economies, according to Families USA. The report released by the National Governors Association (NGA) and the National Association of State Budget Officers indicated that state spending for Medicaid, including federal funds, has surpassed state spending on primary and secondary education. Yet in examining state general fund expenditures, states spent more than twice as much on education than they did on Medicaid. “When analyzing the NGA survey's findings on Medicaid, it is important to count the economic benefit that Medicaid holds for states,” said Families USA Executive Director Ron Pollack. “A recent Families USA study found that on average every $1 million invested in Medicaid by states generates nearly 34 jobs, $1.2 million in wages, and $3.3 million in business activity,” he added.

Boost in SCHIP Funds

Help is on the way for states facing empty children's health care budgets. The Department of Health and Human Services is redistributing $643 million in unspent 2002 funds for the State Children's Health Insurance Program. “I am very pleased that we can take action to prevent any loss or break in coverage because program funds weren't being used by states that need them the most,” said Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services. Twenty-eight states will be getting supplemental funds under this action. Without it, five states—Arizona, Minnesota, Mississippi, New Jersey, and Rhode Island—would have run out of federal funding for their SCHIP programs, according to HHS. Even with the redistribution, Dr. McClellan said he expected to complete fiscal year 2005 with more than $5 billion in unspent federal matching funds.

Compensation for Vaccine Injuries

The National Vaccine Injury Compensation program (VICP) will now cover injuries related to the hepatitis A vaccine. Hepatitis A is the most common type of hepatitis reported in the United States, and causes an estimated 125,000–200,000 cases per year. The vaccine is recommended for children in certain states and high-incidence communities, in addition to people with chronic diseases or for those traveling to countries where the disease is common. Most people who receive the hepatitis A vaccine don't experience serious problems. However, those who believe they've been injured by the vaccine must file a claim within 3 years of the first symptom of the vaccine injury or within 2 years of the vaccine-related death, but not more than 4 years after the start of the first symptom of the vaccine-related injury from which the death occurred. Administered by the Health Resources and Services Administration, the VICP program provides financial compensation to eligible individuals thought to be injured by vaccines.

Responsible Food Marketing

The Center for Science in the Public Interest wants supermarkets, media outlets, and schools to change the way “junk food” is marketed to children. The public interest group has issued guidelines calling on companies not to market low-nutrition drinks like sodas, sports drinks, and sweetened iced teas to children. Further, foods marketed to children should have reasonable portion sizes, and provide some basic nutrients. “What we're really asking is that marketers act responsibly and not urge kids to eat foods that could harm their health,” said Margo G. Wootan, CSPI's nutrition policy director. CSPI's guidelines were sent to supermarkets, major food companies, chain restaurants, television networks and stations, movie studios, and children's magazines. Meanwhile, the National Automatic Merchandising Association released its own initiative to fight childhood obesity, promoting a color-coded snack food rating system in school vending machines.

Secondhand Smoke Campaign

In another campaign to improve children's health, the American Legacy Foundation is asking parents to create smoke-free environments for their families. According to the Foundation's research, more than 13 million children in the United States are breathing secondhand smoke in their homes, resulting in serious health implications. In 82% of the cases where a young person lives with a smoker, that smoker is a parent. In television and radio public service announcements, the campaign urges parents to keep their homes and cars smoke-free and refrain from smoking around children. The foundation is based in Washington and develops programs that address the health effects of tobacco use. A previous foundation report found that a small reduction in tobacco smoke exposure would result in fewer low-birth- weight babies and fewer cases of asthma and ear infections.

Medicaid's Benefits to the States

An annual fiscal survey of the states failed to examine the benefit of Medicaid to the states' economies, according to Families USA. The report released by the National Governors Association (NGA) and the National Association of State Budget Officers indicated that state spending for Medicaid, including federal funds, has surpassed state spending on primary and secondary education. Yet in examining state general fund expenditures, states spent more than twice as much on education than they did on Medicaid. “When analyzing the NGA survey's findings on Medicaid, it is important to count the economic benefit that Medicaid holds for states,” said Families USA Executive Director Ron Pollack. “A recent Families USA study found that on average every $1 million invested in Medicaid by states generates nearly 34 jobs, $1.2 million in wages, and $3.3 million in business activity,” he added.

WASHINGTON — Physicians should be reimbursed retroactively for any payment miscalculations that occurred under Medicare's new system to reimburse for in-office infusions, the Practicing Physicians Advisory Council recommended.

The “average sales price” (ASP) is something federal regulators “are concocting, and they don't know how accurate it's going to be,” said PPAC member Barbara L. McAneny, M.D., an oncologist from Albuquerque, N.M., who drew up the council's recommendation.

The Centers for Medicare and Medicaid Services should establish a correction factor for each quarter it updates pricing on the ASP, to prevent physicians from treating patients at a loss or being put in the position of denying treatment, she said. PPAC is an independent panel that advises CMS on physician payment issues.

The ASP was authorized by the Medicare Modernization Act of 2003, replacing the former system of overpayments for drugs and underpayments for their administration. The intent was to make fair payments for both services.

This year and next, Medicare will pay physicians the ASP plus 6%, although in 2006, physicians will have the option of obtaining the drugs directly from a supplier selected by Medicare through a competitive bidding process.

CMS officials told the panel that the agency would update pricing for the ASP on a quarterly basis. Dr. McAneny countered that this wouldn't allow for any mistakes in pricing made along the way.

“Suppose the ASP is set at $60 for a drug, but you can only purchase that drug for $100,” she later said in an interview. This means physicians would be getting paid only $60 for that drug from January through April—and losing $40 every time they administer the drug.

CMS might be able to correct the price on April 1, but that doesn't compensate for the losses physicians incurred over the first quarter of the year, Dr. McAneny said. As a result, the agency may end up getting complaints from half the physicians in the country about the cost of a drug. By putting in a correction mechanism, the agency can make the change retroactive, she said.

A report from the Government Accountability Office indicated that physicians may not get shortchanged under the ASP. Medicare payments for cancer drugs may decline next year, but payments are actually expected to exceed physicians' costs by 6% on average, the GAO found. The American Society of Clinical Oncology responded that the study underreported some costs and the report's methodology was flawed.

“GAO has always said that everything's going to be fine” with the ASP, Dr. Mc-Aneny said. Nevertheless, “we need a plan B in case they're wrong.”

The ASP replaces the average wholesale price, a number that drug makers had been giving to the government for each drug administered. Medicare in the past paid physicians 95% of the average wholesale price for in-office administration of a drug to a Medicare beneficiary; however, the physician was not paid an administration fee.

The ASP system comes with mixed benefits: Physicians now will get paid an administration fee but they won't be getting paid as much for the drugs themselves as they were under the average wholesale price system.

PPAC also requested that physicians be allowed Internet access to a list of drugs that CMS compiled by manufacturer to determine ASP. “This will be very helpful to the physician community—not just oncology—but for everybody who wants to purchase drugs … under the average selling price, and [to] know who they can purchase these drugs from,” Dr. McAneny said.

WASHINGTON — Physicians should be reimbursed retroactively for any payment miscalculations that occurred under Medicare's new system to reimburse for in-office infusions, the Practicing Physicians Advisory Council recommended.

The “average sales price” (ASP) is something federal regulators “are concocting, and they don't know how accurate it's going to be,” said PPAC member Barbara L. McAneny, M.D., an oncologist from Albuquerque, N.M., who drew up the council's recommendation.

The Centers for Medicare and Medicaid Services should establish a correction factor for each quarter it updates pricing on the ASP, to prevent physicians from treating patients at a loss or being put in the position of denying treatment, she said. PPAC is an independent panel that advises CMS on physician payment issues.

The ASP was authorized by the Medicare Modernization Act of 2003, replacing the former system of overpayments for drugs and underpayments for their administration. The intent was to make fair payments for both services.

This year and next, Medicare will pay physicians the ASP plus 6%, although in 2006, physicians will have the option of obtaining the drugs directly from a supplier selected by Medicare through a competitive bidding process.

CMS officials told the panel that the agency would update pricing for the ASP on a quarterly basis. Dr. McAneny countered that this wouldn't allow for any mistakes in pricing made along the way.

“Suppose the ASP is set at $60 for a drug, but you can only purchase that drug for $100,” she later said in an interview. This means physicians would be getting paid only $60 for that drug from January through April—and losing $40 every time they administer the drug.

CMS might be able to correct the price on April 1, but that doesn't compensate for the losses physicians incurred over the first quarter of the year, Dr. McAneny said. As a result, the agency may end up getting complaints from half the physicians in the country about the cost of a drug. By putting in a correction mechanism, the agency can make the change retroactive, she said.

A report from the Government Accountability Office indicated that physicians may not get shortchanged under the ASP. Medicare payments for cancer drugs may decline next year, but payments are actually expected to exceed physicians' costs by 6% on average, the GAO found. The American Society of Clinical Oncology responded that the study underreported some costs and the report's methodology was flawed.

“GAO has always said that everything's going to be fine” with the ASP, Dr. Mc-Aneny said. Nevertheless, “we need a plan B in case they're wrong.”

The ASP replaces the average wholesale price, a number that drug makers had been giving to the government for each drug administered. Medicare in the past paid physicians 95% of the average wholesale price for in-office administration of a drug to a Medicare beneficiary; however, the physician was not paid an administration fee.

The ASP system comes with mixed benefits: Physicians now will get paid an administration fee but they won't be getting paid as much for the drugs themselves as they were under the average wholesale price system.

PPAC also requested that physicians be allowed Internet access to a list of drugs that CMS compiled by manufacturer to determine ASP. “This will be very helpful to the physician community—not just oncology—but for everybody who wants to purchase drugs … under the average selling price, and [to] know who they can purchase these drugs from,” Dr. McAneny said.

WASHINGTON — Physicians should be reimbursed retroactively for any payment miscalculations that occurred under Medicare's new system to reimburse for in-office infusions, the Practicing Physicians Advisory Council recommended.

The “average sales price” (ASP) is something federal regulators “are concocting, and they don't know how accurate it's going to be,” said PPAC member Barbara L. McAneny, M.D., an oncologist from Albuquerque, N.M., who drew up the council's recommendation.

The Centers for Medicare and Medicaid Services should establish a correction factor for each quarter it updates pricing on the ASP, to prevent physicians from treating patients at a loss or being put in the position of denying treatment, she said. PPAC is an independent panel that advises CMS on physician payment issues.

The ASP was authorized by the Medicare Modernization Act of 2003, replacing the former system of overpayments for drugs and underpayments for their administration. The intent was to make fair payments for both services.

This year and next, Medicare will pay physicians the ASP plus 6%, although in 2006, physicians will have the option of obtaining the drugs directly from a supplier selected by Medicare through a competitive bidding process.

CMS officials told the panel that the agency would update pricing for the ASP on a quarterly basis. Dr. McAneny countered that this wouldn't allow for any mistakes in pricing made along the way.

“Suppose the ASP is set at $60 for a drug, but you can only purchase that drug for $100,” she later said in an interview. This means physicians would be getting paid only $60 for that drug from January through April—and losing $40 every time they administer the drug.

CMS might be able to correct the price on April 1, but that doesn't compensate for the losses physicians incurred over the first quarter of the year, Dr. McAneny said. As a result, the agency may end up getting complaints from half the physicians in the country about the cost of a drug. By putting in a correction mechanism, the agency can make the change retroactive, she said.

A report from the Government Accountability Office indicated that physicians may not get shortchanged under the ASP. Medicare payments for cancer drugs may decline next year, but payments are actually expected to exceed physicians' costs by 6% on average, the GAO found. The American Society of Clinical Oncology responded that the study underreported some costs and the report's methodology was flawed.

“GAO has always said that everything's going to be fine” with the ASP, Dr. Mc-Aneny said. Nevertheless, “we need a plan B in case they're wrong.”

The ASP replaces the average wholesale price, a number that drug makers had been giving to the government for each drug administered. Medicare in the past paid physicians 95% of the average wholesale price for in-office administration of a drug to a Medicare beneficiary; however, the physician was not paid an administration fee.

The ASP system comes with mixed benefits: Physicians now will get paid an administration fee but they won't be getting paid as much for the drugs themselves as they were under the average wholesale price system.

PPAC also requested that physicians be allowed Internet access to a list of drugs that CMS compiled by manufacturer to determine ASP. “This will be very helpful to the physician community—not just oncology—but for everybody who wants to purchase drugs … under the average selling price, and [to] know who they can purchase these drugs from,” Dr. McAneny said.

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for its beneficiaries.

Primary care groups are collaborating with health care contractors to test a model of care that supports the physician's role in managing chronic disease.

The voluntary Medicare Chronic Care Improvement Program, a demonstration project created as part of the Medicare Modernization Act of 2003, is expected to reach approximately 180,000 fee-for-service Medicare beneficiaries with multiple chronic health conditions.

Not all the details have been worked out, but the American College of Physicians and other primary groups plan to work with two health care contractors “to find out how these models will work in the context of the project,” Robert Doherty, ACP's senior vice president for governmental affairs and public policy, said in an interview.

Developed by Edward H. Wagner, M.D., an internist and epidemiologist, the chronic care model features an evidence-based team approach and physician incentives for improved care. It also emphasizes information technology and online, real-time clinical decision support.

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions was awarded a contract in Mississippi. Those companies were the only two that proposed the physician-guided, patient-centered model of care in their bids to Medicare, Mr. Doherty said.

Three physician groups—the ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson on its project. McKesson “is doing all the ground work on the project, but all three physician groups will serve as subcontractors,” Mary Frank, M.D., AAFP president, told FAMILY PRACTICE NEWS.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the company “wanted to test a model that supports and enables the physician's care plan and strengthens the relationship between chronically ill patients and their doctors.”

The McKesson test includes a chronic care management fee to recognize the time and effort involved in this initiative, Dr. Wadhwa said in an interview. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans,” he said. The project is expected to begin in June or September.

That CMS awarded the contracts is a sign the agency was willing to look at the model's effectiveness, Mr. Doherty said.

Testing only parts of it, however, “won't give the model the full evaluation that's ultimately needed,” he added. For that reason, the ACP plans to submit a white paper to Congress, outlining a more ambitious request to test the model in its entirety in a separate demonstration project.

Most bidders in Medicare's chronic care demonstration project are large health care organizations. “We believe there should be a larger demonstration, to take the full components developed by Dr. Wagner” and test their effectiveness in smaller physician practices, Mr. Doherty said.

The ACP will be submitting the model along with a series of proposals that address broader payment issues for physicians. “Our sense is, we may need additional authority to test the model—that Congress should enact legislation to allow CMS to launch another demonstration project to allow full evaluation of the model,” Mr. Doherty said.

The AAFP in the meantime has decided not to wait for the Medicare project's outcome to begin using Dr. Wagner's model in physician practices.

“The academy decided a year ago that we would teach Dr. Wagner's model to our members through continuing medical education and lectures,” Dr. Frank said. The AAFP is in the process of finalizing an educational tool kit to help physicians integrate the model into practice.

Management of chronic disease is just one element of the AAFP's new model of family medicine and part of its Future of Family Medicine project, Dr. Frank explained. Ultimately, the goal is to integrate patients into this model of care, so they can enhance their role as part of the care team, she said.

Primary Care = Chronic Care

Primary care doctors have not been proactive in ensuring regular interactions with their chronically ill patients, according to Dr. Wagner.

At a health policy conference last November, he asserted that the care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records.”

Management of these patients usually relies on symptoms and lab results—not longer-term disease control and prevention. “Most patients are receiving rushed admonitions to shape up, not counseling and supportive interventions that work,” said Dr. Wagner, who directs Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation.

The ACP's white paper cited several studies from the Institute of Medicine, Rand Corp., and CMS, indicating that care for chronically ill patients was fragmented and costly because of a lack of coordination under fee-for-service. This makes the large-scale testing of a patient-centered chronic care model “crucial to the health system's viability.”

Key elements of Dr. Wagner's model include:

▸ Mobilizing community resources to meet patient needs—for example, encouraging patients to participate in effective community programs.

▸ Reorganizing the health care system to encourage open and systematic handling of errors and quality problems to improve care and providing incentives to improve quality of care.

▸ Empowering and preparing patients to manage their health and health care, emphasizing the patient's central role in managing their health.

▸ Ensuring the delivery of effective clinical care and self-management support, such as providing clinical case management services for complex patients and giving care that patients understand and that fits with their cultural backgrounds.

▸ Promoting clinical care that's consistent with scientific evidence and patient preferences, embedding evidence-based guidelines into daily clinical practice.

▸ Organizing patient and population data to facilitate care, such as identifying subpopulations for proactive care, and sharing information with patients and providers to coordinate care.

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for its beneficiaries.

Primary care groups are collaborating with health care contractors to test a model of care that supports the physician's role in managing chronic disease.

The voluntary Medicare Chronic Care Improvement Program, a demonstration project created as part of the Medicare Modernization Act of 2003, is expected to reach approximately 180,000 fee-for-service Medicare beneficiaries with multiple chronic health conditions.

Not all the details have been worked out, but the American College of Physicians and other primary groups plan to work with two health care contractors “to find out how these models will work in the context of the project,” Robert Doherty, ACP's senior vice president for governmental affairs and public policy, said in an interview.

Developed by Edward H. Wagner, M.D., an internist and epidemiologist, the chronic care model features an evidence-based team approach and physician incentives for improved care. It also emphasizes information technology and online, real-time clinical decision support.

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions was awarded a contract in Mississippi. Those companies were the only two that proposed the physician-guided, patient-centered model of care in their bids to Medicare, Mr. Doherty said.

Three physician groups—the ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson on its project. McKesson “is doing all the ground work on the project, but all three physician groups will serve as subcontractors,” Mary Frank, M.D., AAFP president, told FAMILY PRACTICE NEWS.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the company “wanted to test a model that supports and enables the physician's care plan and strengthens the relationship between chronically ill patients and their doctors.”

The McKesson test includes a chronic care management fee to recognize the time and effort involved in this initiative, Dr. Wadhwa said in an interview. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans,” he said. The project is expected to begin in June or September.

That CMS awarded the contracts is a sign the agency was willing to look at the model's effectiveness, Mr. Doherty said.

Testing only parts of it, however, “won't give the model the full evaluation that's ultimately needed,” he added. For that reason, the ACP plans to submit a white paper to Congress, outlining a more ambitious request to test the model in its entirety in a separate demonstration project.

Most bidders in Medicare's chronic care demonstration project are large health care organizations. “We believe there should be a larger demonstration, to take the full components developed by Dr. Wagner” and test their effectiveness in smaller physician practices, Mr. Doherty said.

The ACP will be submitting the model along with a series of proposals that address broader payment issues for physicians. “Our sense is, we may need additional authority to test the model—that Congress should enact legislation to allow CMS to launch another demonstration project to allow full evaluation of the model,” Mr. Doherty said.

The AAFP in the meantime has decided not to wait for the Medicare project's outcome to begin using Dr. Wagner's model in physician practices.

“The academy decided a year ago that we would teach Dr. Wagner's model to our members through continuing medical education and lectures,” Dr. Frank said. The AAFP is in the process of finalizing an educational tool kit to help physicians integrate the model into practice.

Management of chronic disease is just one element of the AAFP's new model of family medicine and part of its Future of Family Medicine project, Dr. Frank explained. Ultimately, the goal is to integrate patients into this model of care, so they can enhance their role as part of the care team, she said.

Primary Care = Chronic Care

Primary care doctors have not been proactive in ensuring regular interactions with their chronically ill patients, according to Dr. Wagner.

At a health policy conference last November, he asserted that the care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records.”

Management of these patients usually relies on symptoms and lab results—not longer-term disease control and prevention. “Most patients are receiving rushed admonitions to shape up, not counseling and supportive interventions that work,” said Dr. Wagner, who directs Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation.

The ACP's white paper cited several studies from the Institute of Medicine, Rand Corp., and CMS, indicating that care for chronically ill patients was fragmented and costly because of a lack of coordination under fee-for-service. This makes the large-scale testing of a patient-centered chronic care model “crucial to the health system's viability.”

Key elements of Dr. Wagner's model include:

▸ Mobilizing community resources to meet patient needs—for example, encouraging patients to participate in effective community programs.

▸ Reorganizing the health care system to encourage open and systematic handling of errors and quality problems to improve care and providing incentives to improve quality of care.

▸ Empowering and preparing patients to manage their health and health care, emphasizing the patient's central role in managing their health.

▸ Ensuring the delivery of effective clinical care and self-management support, such as providing clinical case management services for complex patients and giving care that patients understand and that fits with their cultural backgrounds.

▸ Promoting clinical care that's consistent with scientific evidence and patient preferences, embedding evidence-based guidelines into daily clinical practice.

▸ Organizing patient and population data to facilitate care, such as identifying subpopulations for proactive care, and sharing information with patients and providers to coordinate care.

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for its beneficiaries.

Primary care groups are collaborating with health care contractors to test a model of care that supports the physician's role in managing chronic disease.

The voluntary Medicare Chronic Care Improvement Program, a demonstration project created as part of the Medicare Modernization Act of 2003, is expected to reach approximately 180,000 fee-for-service Medicare beneficiaries with multiple chronic health conditions.

Not all the details have been worked out, but the American College of Physicians and other primary groups plan to work with two health care contractors “to find out how these models will work in the context of the project,” Robert Doherty, ACP's senior vice president for governmental affairs and public policy, said in an interview.

Developed by Edward H. Wagner, M.D., an internist and epidemiologist, the chronic care model features an evidence-based team approach and physician incentives for improved care. It also emphasizes information technology and online, real-time clinical decision support.

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions was awarded a contract in Mississippi. Those companies were the only two that proposed the physician-guided, patient-centered model of care in their bids to Medicare, Mr. Doherty said.

Three physician groups—the ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson on its project. McKesson “is doing all the ground work on the project, but all three physician groups will serve as subcontractors,” Mary Frank, M.D., AAFP president, told FAMILY PRACTICE NEWS.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the company “wanted to test a model that supports and enables the physician's care plan and strengthens the relationship between chronically ill patients and their doctors.”

The McKesson test includes a chronic care management fee to recognize the time and effort involved in this initiative, Dr. Wadhwa said in an interview. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans,” he said. The project is expected to begin in June or September.

That CMS awarded the contracts is a sign the agency was willing to look at the model's effectiveness, Mr. Doherty said.

Testing only parts of it, however, “won't give the model the full evaluation that's ultimately needed,” he added. For that reason, the ACP plans to submit a white paper to Congress, outlining a more ambitious request to test the model in its entirety in a separate demonstration project.

Most bidders in Medicare's chronic care demonstration project are large health care organizations. “We believe there should be a larger demonstration, to take the full components developed by Dr. Wagner” and test their effectiveness in smaller physician practices, Mr. Doherty said.

The ACP will be submitting the model along with a series of proposals that address broader payment issues for physicians. “Our sense is, we may need additional authority to test the model—that Congress should enact legislation to allow CMS to launch another demonstration project to allow full evaluation of the model,” Mr. Doherty said.

The AAFP in the meantime has decided not to wait for the Medicare project's outcome to begin using Dr. Wagner's model in physician practices.

“The academy decided a year ago that we would teach Dr. Wagner's model to our members through continuing medical education and lectures,” Dr. Frank said. The AAFP is in the process of finalizing an educational tool kit to help physicians integrate the model into practice.

Management of chronic disease is just one element of the AAFP's new model of family medicine and part of its Future of Family Medicine project, Dr. Frank explained. Ultimately, the goal is to integrate patients into this model of care, so they can enhance their role as part of the care team, she said.

Primary Care = Chronic Care

Primary care doctors have not been proactive in ensuring regular interactions with their chronically ill patients, according to Dr. Wagner.

At a health policy conference last November, he asserted that the care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records.”

Management of these patients usually relies on symptoms and lab results—not longer-term disease control and prevention. “Most patients are receiving rushed admonitions to shape up, not counseling and supportive interventions that work,” said Dr. Wagner, who directs Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation.

The ACP's white paper cited several studies from the Institute of Medicine, Rand Corp., and CMS, indicating that care for chronically ill patients was fragmented and costly because of a lack of coordination under fee-for-service. This makes the large-scale testing of a patient-centered chronic care model “crucial to the health system's viability.”

Key elements of Dr. Wagner's model include:

▸ Mobilizing community resources to meet patient needs—for example, encouraging patients to participate in effective community programs.

▸ Reorganizing the health care system to encourage open and systematic handling of errors and quality problems to improve care and providing incentives to improve quality of care.

▸ Empowering and preparing patients to manage their health and health care, emphasizing the patient's central role in managing their health.

▸ Ensuring the delivery of effective clinical care and self-management support, such as providing clinical case management services for complex patients and giving care that patients understand and that fits with their cultural backgrounds.

▸ Promoting clinical care that's consistent with scientific evidence and patient preferences, embedding evidence-based guidelines into daily clinical practice.

▸ Organizing patient and population data to facilitate care, such as identifying subpopulations for proactive care, and sharing information with patients and providers to coordinate care.

Portable Health Plans

Patients can take their health insurance coverage with them when they change or lose a job, under the final regulations that implement the last piece of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). According to a statement by the Health and Human Services Department, it is important that American workers, who often change jobs several times in the course of their lives are able to respond to the modern workplace without having to fear for their health insurance. The regulations allow greater portability and availability of group health coverage during a time of job transition, setting limits on preexisting condition exclusions that could be imposed, and requiring group health plans and insurance issuers to offer “special enrollment” to certain patients who lose eligibility for other group health coverage or health insurance, or to otherwise eligible new dependents. The regulation goes into effect for plan years starting on or after July 1.

Computer Entries Lead to Errors

Automation isn't necessarily a foolproof way to improve patient safety and reduce medical errors, a report from the United States Pharmacopeia (USP) found. Computer entry errors were the fourth leading cause of medication errors according to MEDMARX, USP's national medication error reporting system. These errors have steadily increased and represent about 12% of all MEDMARX records from 1999 through 2003. Performance deficits—where an otherwise qualified physicians makes a mistake—were the most frequently reported cause of errors. Distractions were the leading contributing factor, accounting for almost 57% of errors associated with computer entry. The report provided an analysis of 235,159 medication errors voluntarily reported by 570 hospitals and health care facilities nationwide.

Reduced Benefits for Retirees

Businesses are asking retirees to pay more for their health coverage as they struggle to control rising costs, the Kaiser Family Foundation reported. In the past year, 79% of firms increased their retirees' contributions for premiums, and 85% expect to do so in the coming year. In addition, 8% of employers surveyed eliminated subsidized health benefits for future retirees in 2004. For 2005, 11% said they are likely to terminate coverage for future retirees; however, 58% of said they were likely to continue offering prescription drug benefits and accept the tax-free subsidy created by the new Medicare law. The survey included responses from 333 large private-sector firms that offer retiree health benefits.

Spending for Power Wheelchairs

Federal safeguards did not go far enough to curb out-of-control spending growth for power wheelchairs under the Medicare program, the Government Accountability Office found. Medicare spending for the wheelchairs rose more than fourfold from 1999 through 2003, raising concerns that some of the payments may have been improper. Following the indictment of several power wheelchair suppliers in Texas who fraudulently billed Medicare, GAO was asked to examine earlier steps taken by the Centers for Medicare and Medicaid Services to respond to improper payments. CMS' contractors started informing the agency in 1997 about escalating spending for wheelchairs, and some started taking steps to respond to improper payments, yet the agency didn't assume an active role until 2003. Since then, CMS has worked to prevent fraudulent suppliers from entering the Medicare program, although it has not implemented a revised form to collect better information for power wheelchair claims reviews, the GAO found.

Medicaid's Benefits to the States

An annual fiscal survey of the states failed to examine the benefit of Medicaid to the states' economies, according to Families USA. The report released by the National Governors Association (NGA) and the National Association of State Budget Officers indicated that state spending for Medicaid, including federal funds, has surpassed state spending on primary and secondary education. Yet, state general fund expenditures show that states spent more than twice as much on education than they did on Medicaid. “When analyzing the NGA survey's findings on Medicaid, it is important to count the economic benefit that Medicaid holds for states,” said Families USA Executive Director Ron Pollack. “A recent Families USA study found that on average every $1 million invested in Medicaid by states generates nearly 34 jobs, $1.2 million in wages, and $3.3 million in business activity,” he added. During fiscal 2005, Medicaid is estimated to grow as much as 12% due in part to expiring federal fiscal relief. Long-term growth is expected to be 8%–9%, well above expected state revenue growth, the NGA's report said.

Global Smallpox Stockpile

The United States has pledged 20 million doses of smallpox vaccine toward the global stockpile managed by the World Health Organization (WHO). The vaccine doses will physically remain in the U.S. Strategic National Stockpile, but will be available for WHOuse in an emergency. The global stockpile is designed to help countries, especially developing ones, that have no vaccine and are not prepared to respond to a smallpox outbreak. The global stockpile will only be used if at least one human case of smallpox is confirmed. U.S. officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical vaccine stockpile in Geneva and a virtual global stockpile around the world.

Portable Health Plans

Patients can take their health insurance coverage with them when they change or lose a job, under the final regulations that implement the last piece of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). According to a statement by the Health and Human Services Department, it is important that American workers, who often change jobs several times in the course of their lives are able to respond to the modern workplace without having to fear for their health insurance. The regulations allow greater portability and availability of group health coverage during a time of job transition, setting limits on preexisting condition exclusions that could be imposed, and requiring group health plans and insurance issuers to offer “special enrollment” to certain patients who lose eligibility for other group health coverage or health insurance, or to otherwise eligible new dependents. The regulation goes into effect for plan years starting on or after July 1.

Computer Entries Lead to Errors

Automation isn't necessarily a foolproof way to improve patient safety and reduce medical errors, a report from the United States Pharmacopeia (USP) found. Computer entry errors were the fourth leading cause of medication errors according to MEDMARX, USP's national medication error reporting system. These errors have steadily increased and represent about 12% of all MEDMARX records from 1999 through 2003. Performance deficits—where an otherwise qualified physicians makes a mistake—were the most frequently reported cause of errors. Distractions were the leading contributing factor, accounting for almost 57% of errors associated with computer entry. The report provided an analysis of 235,159 medication errors voluntarily reported by 570 hospitals and health care facilities nationwide.

Reduced Benefits for Retirees

Businesses are asking retirees to pay more for their health coverage as they struggle to control rising costs, the Kaiser Family Foundation reported. In the past year, 79% of firms increased their retirees' contributions for premiums, and 85% expect to do so in the coming year. In addition, 8% of employers surveyed eliminated subsidized health benefits for future retirees in 2004. For 2005, 11% said they are likely to terminate coverage for future retirees; however, 58% of said they were likely to continue offering prescription drug benefits and accept the tax-free subsidy created by the new Medicare law. The survey included responses from 333 large private-sector firms that offer retiree health benefits.

Spending for Power Wheelchairs

Federal safeguards did not go far enough to curb out-of-control spending growth for power wheelchairs under the Medicare program, the Government Accountability Office found. Medicare spending for the wheelchairs rose more than fourfold from 1999 through 2003, raising concerns that some of the payments may have been improper. Following the indictment of several power wheelchair suppliers in Texas who fraudulently billed Medicare, GAO was asked to examine earlier steps taken by the Centers for Medicare and Medicaid Services to respond to improper payments. CMS' contractors started informing the agency in 1997 about escalating spending for wheelchairs, and some started taking steps to respond to improper payments, yet the agency didn't assume an active role until 2003. Since then, CMS has worked to prevent fraudulent suppliers from entering the Medicare program, although it has not implemented a revised form to collect better information for power wheelchair claims reviews, the GAO found.

Medicaid's Benefits to the States

An annual fiscal survey of the states failed to examine the benefit of Medicaid to the states' economies, according to Families USA. The report released by the National Governors Association (NGA) and the National Association of State Budget Officers indicated that state spending for Medicaid, including federal funds, has surpassed state spending on primary and secondary education. Yet, state general fund expenditures show that states spent more than twice as much on education than they did on Medicaid. “When analyzing the NGA survey's findings on Medicaid, it is important to count the economic benefit that Medicaid holds for states,” said Families USA Executive Director Ron Pollack. “A recent Families USA study found that on average every $1 million invested in Medicaid by states generates nearly 34 jobs, $1.2 million in wages, and $3.3 million in business activity,” he added. During fiscal 2005, Medicaid is estimated to grow as much as 12% due in part to expiring federal fiscal relief. Long-term growth is expected to be 8%–9%, well above expected state revenue growth, the NGA's report said.

Global Smallpox Stockpile

The United States has pledged 20 million doses of smallpox vaccine toward the global stockpile managed by the World Health Organization (WHO). The vaccine doses will physically remain in the U.S. Strategic National Stockpile, but will be available for WHOuse in an emergency. The global stockpile is designed to help countries, especially developing ones, that have no vaccine and are not prepared to respond to a smallpox outbreak. The global stockpile will only be used if at least one human case of smallpox is confirmed. U.S. officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical vaccine stockpile in Geneva and a virtual global stockpile around the world.

Portable Health Plans

Patients can take their health insurance coverage with them when they change or lose a job, under the final regulations that implement the last piece of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). According to a statement by the Health and Human Services Department, it is important that American workers, who often change jobs several times in the course of their lives are able to respond to the modern workplace without having to fear for their health insurance. The regulations allow greater portability and availability of group health coverage during a time of job transition, setting limits on preexisting condition exclusions that could be imposed, and requiring group health plans and insurance issuers to offer “special enrollment” to certain patients who lose eligibility for other group health coverage or health insurance, or to otherwise eligible new dependents. The regulation goes into effect for plan years starting on or after July 1.

Computer Entries Lead to Errors

Automation isn't necessarily a foolproof way to improve patient safety and reduce medical errors, a report from the United States Pharmacopeia (USP) found. Computer entry errors were the fourth leading cause of medication errors according to MEDMARX, USP's national medication error reporting system. These errors have steadily increased and represent about 12% of all MEDMARX records from 1999 through 2003. Performance deficits—where an otherwise qualified physicians makes a mistake—were the most frequently reported cause of errors. Distractions were the leading contributing factor, accounting for almost 57% of errors associated with computer entry. The report provided an analysis of 235,159 medication errors voluntarily reported by 570 hospitals and health care facilities nationwide.

Reduced Benefits for Retirees

Businesses are asking retirees to pay more for their health coverage as they struggle to control rising costs, the Kaiser Family Foundation reported. In the past year, 79% of firms increased their retirees' contributions for premiums, and 85% expect to do so in the coming year. In addition, 8% of employers surveyed eliminated subsidized health benefits for future retirees in 2004. For 2005, 11% said they are likely to terminate coverage for future retirees; however, 58% of said they were likely to continue offering prescription drug benefits and accept the tax-free subsidy created by the new Medicare law. The survey included responses from 333 large private-sector firms that offer retiree health benefits.

Spending for Power Wheelchairs

Federal safeguards did not go far enough to curb out-of-control spending growth for power wheelchairs under the Medicare program, the Government Accountability Office found. Medicare spending for the wheelchairs rose more than fourfold from 1999 through 2003, raising concerns that some of the payments may have been improper. Following the indictment of several power wheelchair suppliers in Texas who fraudulently billed Medicare, GAO was asked to examine earlier steps taken by the Centers for Medicare and Medicaid Services to respond to improper payments. CMS' contractors started informing the agency in 1997 about escalating spending for wheelchairs, and some started taking steps to respond to improper payments, yet the agency didn't assume an active role until 2003. Since then, CMS has worked to prevent fraudulent suppliers from entering the Medicare program, although it has not implemented a revised form to collect better information for power wheelchair claims reviews, the GAO found.

Medicaid's Benefits to the States

An annual fiscal survey of the states failed to examine the benefit of Medicaid to the states' economies, according to Families USA. The report released by the National Governors Association (NGA) and the National Association of State Budget Officers indicated that state spending for Medicaid, including federal funds, has surpassed state spending on primary and secondary education. Yet, state general fund expenditures show that states spent more than twice as much on education than they did on Medicaid. “When analyzing the NGA survey's findings on Medicaid, it is important to count the economic benefit that Medicaid holds for states,” said Families USA Executive Director Ron Pollack. “A recent Families USA study found that on average every $1 million invested in Medicaid by states generates nearly 34 jobs, $1.2 million in wages, and $3.3 million in business activity,” he added. During fiscal 2005, Medicaid is estimated to grow as much as 12% due in part to expiring federal fiscal relief. Long-term growth is expected to be 8%–9%, well above expected state revenue growth, the NGA's report said.

Global Smallpox Stockpile

The United States has pledged 20 million doses of smallpox vaccine toward the global stockpile managed by the World Health Organization (WHO). The vaccine doses will physically remain in the U.S. Strategic National Stockpile, but will be available for WHOuse in an emergency. The global stockpile is designed to help countries, especially developing ones, that have no vaccine and are not prepared to respond to a smallpox outbreak. The global stockpile will only be used if at least one human case of smallpox is confirmed. U.S. officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical vaccine stockpile in Geneva and a virtual global stockpile around the world.

WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving Medicaid dollars, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

One-third of all U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” said Rachel Gold, director of policy analysis at the Alan Guttmacher Institute.

Under one approach, 13 of the 21 states have extended eligibility for Medicaid family planning benefits to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.”

Illinois and Delaware went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.

Since starting these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, the most recent year for which there are data, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomy are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for sexually transmitted diseases are covered by Medicaid, but not always as family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.

Eligibility for maternity care has greatly increased because of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

Seventeen states continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

Snapshot: Women Medicaid Recipients

The vast majority of women on Medicaid are in their reproductive years, although they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.

“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.

Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.

“Forty percent of poor women are still uninsured,” Ms. Salganicoff said.

Nearly half of the women on Medicaid have children under the age of 18 in the household; one in five of these women are over the age of 65, and the remaining third don't have children in the household but often qualify based on a disability. Those without children or a disability may never qualify for the program “no matter how poor they get,” she said.

Although women of color are more likely to be low income, half of all women on Medicaid are white.

“Women on Medicaid are more than four times as likely to report their health as fair or poor,” because low-income people tend to have more health issues, Ms. Salganicoff said.

Medicaid covers half of the women in the United States with a permanent physical or mental impairment who live in a community setting. This percentage is even higher among institutionalized women—Medicaid pays for the care of nearly three-fourths of the residents in nursing homes.

Relatively new to Medicaid assistance are uninsured women with breast and cervical cancer, Ms. Salganicoff said. In 2000, treatment was extended as an optional Medicaid benefit for women screened under a program established by the Centers for Disease Control and Prevention in 1990, she said. “In California alone, 10,000 women got treatment under this program.”

WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving Medicaid dollars, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

One-third of all U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” said Rachel Gold, director of policy analysis at the Alan Guttmacher Institute.

Under one approach, 13 of the 21 states have extended eligibility for Medicaid family planning benefits to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.”

Illinois and Delaware went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.

Since starting these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, the most recent year for which there are data, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomy are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for sexually transmitted diseases are covered by Medicaid, but not always as family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.

Eligibility for maternity care has greatly increased because of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

Seventeen states continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

Snapshot: Women Medicaid Recipients

The vast majority of women on Medicaid are in their reproductive years, although they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.

“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.

Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.

“Forty percent of poor women are still uninsured,” Ms. Salganicoff said.

Nearly half of the women on Medicaid have children under the age of 18 in the household; one in five of these women are over the age of 65, and the remaining third don't have children in the household but often qualify based on a disability. Those without children or a disability may never qualify for the program “no matter how poor they get,” she said.

Although women of color are more likely to be low income, half of all women on Medicaid are white.

“Women on Medicaid are more than four times as likely to report their health as fair or poor,” because low-income people tend to have more health issues, Ms. Salganicoff said.

Medicaid covers half of the women in the United States with a permanent physical or mental impairment who live in a community setting. This percentage is even higher among institutionalized women—Medicaid pays for the care of nearly three-fourths of the residents in nursing homes.

Relatively new to Medicaid assistance are uninsured women with breast and cervical cancer, Ms. Salganicoff said. In 2000, treatment was extended as an optional Medicaid benefit for women screened under a program established by the Centers for Disease Control and Prevention in 1990, she said. “In California alone, 10,000 women got treatment under this program.”

WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving Medicaid dollars, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

One-third of all U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” said Rachel Gold, director of policy analysis at the Alan Guttmacher Institute.

Under one approach, 13 of the 21 states have extended eligibility for Medicaid family planning benefits to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.”

Illinois and Delaware went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.

Since starting these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, the most recent year for which there are data, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomy are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for sexually transmitted diseases are covered by Medicaid, but not always as family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.

Eligibility for maternity care has greatly increased because of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

Seventeen states continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

Snapshot: Women Medicaid Recipients

The vast majority of women on Medicaid are in their reproductive years, although they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.

“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.

Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.

“Forty percent of poor women are still uninsured,” Ms. Salganicoff said.

Nearly half of the women on Medicaid have children under the age of 18 in the household; one in five of these women are over the age of 65, and the remaining third don't have children in the household but often qualify based on a disability. Those without children or a disability may never qualify for the program “no matter how poor they get,” she said.

Although women of color are more likely to be low income, half of all women on Medicaid are white.

“Women on Medicaid are more than four times as likely to report their health as fair or poor,” because low-income people tend to have more health issues, Ms. Salganicoff said.

Medicaid covers half of the women in the United States with a permanent physical or mental impairment who live in a community setting. This percentage is even higher among institutionalized women—Medicaid pays for the care of nearly three-fourths of the residents in nursing homes.

Relatively new to Medicaid assistance are uninsured women with breast and cervical cancer, Ms. Salganicoff said. In 2000, treatment was extended as an optional Medicaid benefit for women screened under a program established by the Centers for Disease Control and Prevention in 1990, she said. “In California alone, 10,000 women got treatment under this program.”

Nearly one in five Food and Drug Administration scientists in a federal survey said they were pressured to approve or recommend approval for a drug despite reservations about its safety.

Half of the 400 scientists who participated in this 2002 survey by the Department of Health and Human Services' Office of Inspector General thought that scientific dissent was allowed to some extent. However, less than a third felt the work environment at FDA allowed wide leeway for differing scientific opinions related to new drug application decisions. Only 17% thought the agency had adequate procedures in place to address scientific disagreements.

Parts of the survey had originally been published in a 2003 OIG report on the effectiveness of the FDA's new drug review process. Two groups, the Union of Concerned Scientists and Public Employees for Environmental Responsibility, obtained the complete findings through the Freedom of Information Act process and recently released them to the public.

“The survey raises significant issues about drug safety and ongoing monitoring of adverse health impacts of drugs in the marketplace,” said Kathleen Rest, executive director of the Union for Concerned Scientists. “The scientists' concerns warrant further investigation as Congress reviews drug approval practices at FDA.”

An FDA spokeswoman did not respond to requests from this newspaper for a reaction to the survey results.

In other findings, 66% of respondents did not think FDA adequately monitored the safety of prescription drugs once they were on the market, and only 12% were completely confident that labeling decisions adequately addressed key safety concerns.

Almost 60% thought the 6 months allotted for a priority review of a drug was inadequate. The OIG in its 2003 report on the new drug application process had praised the agency for relying on expert scientific reviewers and for working collaboratively with sponsors. But even with these strengths, “workload pressures increasingly challenge the effectiveness of the review process,” the report said.

Nearly one in five Food and Drug Administration scientists in a federal survey said they were pressured to approve or recommend approval for a drug despite reservations about its safety.

Half of the 400 scientists who participated in this 2002 survey by the Department of Health and Human Services' Office of Inspector General thought that scientific dissent was allowed to some extent. However, less than a third felt the work environment at FDA allowed wide leeway for differing scientific opinions related to new drug application decisions. Only 17% thought the agency had adequate procedures in place to address scientific disagreements.

Parts of the survey had originally been published in a 2003 OIG report on the effectiveness of the FDA's new drug review process. Two groups, the Union of Concerned Scientists and Public Employees for Environmental Responsibility, obtained the complete findings through the Freedom of Information Act process and recently released them to the public.

“The survey raises significant issues about drug safety and ongoing monitoring of adverse health impacts of drugs in the marketplace,” said Kathleen Rest, executive director of the Union for Concerned Scientists. “The scientists' concerns warrant further investigation as Congress reviews drug approval practices at FDA.”

An FDA spokeswoman did not respond to requests from this newspaper for a reaction to the survey results.

In other findings, 66% of respondents did not think FDA adequately monitored the safety of prescription drugs once they were on the market, and only 12% were completely confident that labeling decisions adequately addressed key safety concerns.

Almost 60% thought the 6 months allotted for a priority review of a drug was inadequate. The OIG in its 2003 report on the new drug application process had praised the agency for relying on expert scientific reviewers and for working collaboratively with sponsors. But even with these strengths, “workload pressures increasingly challenge the effectiveness of the review process,” the report said.

Nearly one in five Food and Drug Administration scientists in a federal survey said they were pressured to approve or recommend approval for a drug despite reservations about its safety.

Half of the 400 scientists who participated in this 2002 survey by the Department of Health and Human Services' Office of Inspector General thought that scientific dissent was allowed to some extent. However, less than a third felt the work environment at FDA allowed wide leeway for differing scientific opinions related to new drug application decisions. Only 17% thought the agency had adequate procedures in place to address scientific disagreements.

Parts of the survey had originally been published in a 2003 OIG report on the effectiveness of the FDA's new drug review process. Two groups, the Union of Concerned Scientists and Public Employees for Environmental Responsibility, obtained the complete findings through the Freedom of Information Act process and recently released them to the public.

“The survey raises significant issues about drug safety and ongoing monitoring of adverse health impacts of drugs in the marketplace,” said Kathleen Rest, executive director of the Union for Concerned Scientists. “The scientists' concerns warrant further investigation as Congress reviews drug approval practices at FDA.”

An FDA spokeswoman did not respond to requests from this newspaper for a reaction to the survey results.

In other findings, 66% of respondents did not think FDA adequately monitored the safety of prescription drugs once they were on the market, and only 12% were completely confident that labeling decisions adequately addressed key safety concerns.

Almost 60% thought the 6 months allotted for a priority review of a drug was inadequate. The OIG in its 2003 report on the new drug application process had praised the agency for relying on expert scientific reviewers and for working collaboratively with sponsors. But even with these strengths, “workload pressures increasingly challenge the effectiveness of the review process,” the report said.

WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving money for the Medicaid program, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

This is encouraging news at a time when everyone's so concerned about budget cuts and, specifically, cuts to Medicaid, Rachel Gold, director of policy analysis at the Alan Guttmacher Institute, a health policy research organization in Washington, said during the briefing.

One-third of U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” Ms. Gold said.

Under one cost-saving approach, 13 of the 21 states have extended Medicaid eligibility for family planning to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing them with access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In authorizing these experimental eligibility expansions, the federal government requires that these programs remain budget neutral—“meaning they can't cost the government any more than what it would have spent in the absence of one of these programs,” Ms. Gold said.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.” Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.

Since the establishment of these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomies are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for STDs are covered by Medicaid, although they're not always considered family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.

Eligibility for maternity care has greatly increased because of a series of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

In the meantime, 17 states continue to use their own funds to provide abortion services to Medicaid enrollees, she said.

Snapshot of Women Who Get Medicaid

The vast majority of women on Medicaid are in their reproductive years, but they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.

“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.

Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.

“Forty percent of poor women are still uninsured,” Ms. Salganicoff said.

Nearly half of the women on Medicaid have children under the age of 18 in the household; 1 in 5 of these women are over the age of 65, and the remaining third don't have children in the household but often qualify based on a disability. Those without children or a disability may never qualify for the program “no matter how poor they get,” she said.

Although women of color are more likely to be low income, half of all women on Medicaid are white.

“Women on Medicaid are more than four times as likely to report their health as fair or poor,” because low-income people tend to have more health issues, Ms. Salganicoff said.

Medicaid covers half of the women in the United States with a permanent physical or mental impairment who live in a community setting. This percentage is even higher among institutionalized women—Medicaid pays for the care of nearly three-fourths of the residents in nursing homes.

Relatively new to Medicaid assistance are uninsured women with breast and cervical cancer, she said. In 2000, treatment was extended as an optional Medicaid benefit for women screened under a program established by the Centers for Disease Control and Prevention in 1990, she said. “In California alone, 10,000 women got treatment under this program.”

WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving money for the Medicaid program, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

This is encouraging news at a time when everyone's so concerned about budget cuts and, specifically, cuts to Medicaid, Rachel Gold, director of policy analysis at the Alan Guttmacher Institute, a health policy research organization in Washington, said during the briefing.

One-third of U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” Ms. Gold said.

Under one cost-saving approach, 13 of the 21 states have extended Medicaid eligibility for family planning to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing them with access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In authorizing these experimental eligibility expansions, the federal government requires that these programs remain budget neutral—“meaning they can't cost the government any more than what it would have spent in the absence of one of these programs,” Ms. Gold said.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.” Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.

Since the establishment of these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomies are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for STDs are covered by Medicaid, although they're not always considered family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.

Eligibility for maternity care has greatly increased because of a series of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

In the meantime, 17 states continue to use their own funds to provide abortion services to Medicaid enrollees, she said.

Snapshot of Women Who Get Medicaid

The vast majority of women on Medicaid are in their reproductive years, but they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.

“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.

Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.

“Forty percent of poor women are still uninsured,” Ms. Salganicoff said.

Nearly half of the women on Medicaid have children under the age of 18 in the household; 1 in 5 of these women are over the age of 65, and the remaining third don't have children in the household but often qualify based on a disability. Those without children or a disability may never qualify for the program “no matter how poor they get,” she said.

Although women of color are more likely to be low income, half of all women on Medicaid are white.

“Women on Medicaid are more than four times as likely to report their health as fair or poor,” because low-income people tend to have more health issues, Ms. Salganicoff said.

Medicaid covers half of the women in the United States with a permanent physical or mental impairment who live in a community setting. This percentage is even higher among institutionalized women—Medicaid pays for the care of nearly three-fourths of the residents in nursing homes.

Relatively new to Medicaid assistance are uninsured women with breast and cervical cancer, she said. In 2000, treatment was extended as an optional Medicaid benefit for women screened under a program established by the Centers for Disease Control and Prevention in 1990, she said. “In California alone, 10,000 women got treatment under this program.”

WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving money for the Medicaid program, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

This is encouraging news at a time when everyone's so concerned about budget cuts and, specifically, cuts to Medicaid, Rachel Gold, director of policy analysis at the Alan Guttmacher Institute, a health policy research organization in Washington, said during the briefing.

One-third of U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” Ms. Gold said.

Under one cost-saving approach, 13 of the 21 states have extended Medicaid eligibility for family planning to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing them with access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In authorizing these experimental eligibility expansions, the federal government requires that these programs remain budget neutral—“meaning they can't cost the government any more than what it would have spent in the absence of one of these programs,” Ms. Gold said.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.” Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.

Since the establishment of these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomies are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for STDs are covered by Medicaid, although they're not always considered family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.

Eligibility for maternity care has greatly increased because of a series of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

In the meantime, 17 states continue to use their own funds to provide abortion services to Medicaid enrollees, she said.

Snapshot of Women Who Get Medicaid

The vast majority of women on Medicaid are in their reproductive years, but they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.

“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.

Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.

“Forty percent of poor women are still uninsured,” Ms. Salganicoff said.

Nearly half of the women on Medicaid have children under the age of 18 in the household; 1 in 5 of these women are over the age of 65, and the remaining third don't have children in the household but often qualify based on a disability. Those without children or a disability may never qualify for the program “no matter how poor they get,” she said.

Although women of color are more likely to be low income, half of all women on Medicaid are white.

“Women on Medicaid are more than four times as likely to report their health as fair or poor,” because low-income people tend to have more health issues, Ms. Salganicoff said.

Medicaid covers half of the women in the United States with a permanent physical or mental impairment who live in a community setting. This percentage is even higher among institutionalized women—Medicaid pays for the care of nearly three-fourths of the residents in nursing homes.

Relatively new to Medicaid assistance are uninsured women with breast and cervical cancer, she said. In 2000, treatment was extended as an optional Medicaid benefit for women screened under a program established by the Centers for Disease Control and Prevention in 1990, she said. “In California alone, 10,000 women got treatment under this program.”