Jennifer Silverman

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 U.S. 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 physician 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% 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 Medicare's spending growth for power wheelchairs, the Government Accountability Office found. Medicare spending for the wheelchairs rose more than fourfold from 1999 to 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, but it has not revised its 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, 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. 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. The vaccine doses will physically remain in the U.S. Strategic National Stockpile, but will be available for use by the WHO in the event of an emergency. The global stockpile is designed to help those countries that have no smallpox vaccine and are not prepared to respond to an outbreak of the disease. The global stockpile will only be used if at least one case of smallpox is confirmed in the human population. U.S. government officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical stockpile of vaccine in Geneva and a virtual global stockpile of pledged vaccine stocks 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 U.S. 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 physician 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% 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 Medicare's spending growth for power wheelchairs, the Government Accountability Office found. Medicare spending for the wheelchairs rose more than fourfold from 1999 to 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, but it has not revised its 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, 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. 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. The vaccine doses will physically remain in the U.S. Strategic National Stockpile, but will be available for use by the WHO in the event of an emergency. The global stockpile is designed to help those countries that have no smallpox vaccine and are not prepared to respond to an outbreak of the disease. The global stockpile will only be used if at least one case of smallpox is confirmed in the human population. U.S. government officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical stockpile of vaccine in Geneva and a virtual global stockpile of pledged vaccine stocks 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 U.S. 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 physician 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% 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 Medicare's spending growth for power wheelchairs, the Government Accountability Office found. Medicare spending for the wheelchairs rose more than fourfold from 1999 to 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, but it has not revised its 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, 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. 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. The vaccine doses will physically remain in the U.S. Strategic National Stockpile, but will be available for use by the WHO in the event of an emergency. The global stockpile is designed to help those countries that have no smallpox vaccine and are not prepared to respond to an outbreak of the disease. The global stockpile will only be used if at least one case of smallpox is confirmed in the human population. U.S. government officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical stockpile of vaccine in Geneva and a virtual global stockpile of pledged vaccine stocks around the world.

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for 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 under the Medicare Modernization Act of 2003, is expected to reach about 180,000 fee-for-service Medicare beneficiaries with chronic health conditions such as complex diabetes or heart failure.

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

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

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions got the contract for 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.

The ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson. The company “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 this newspaper.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the firm “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.” Slated to begin in June or September, the pilot test includes a chronic care management fee to recognize the time and effort involved in the initiative, he said. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans.”

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, Mr. Doherty said. “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.

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.

Primary Care Has Room to Improve

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

Care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records,” he said at a healthy policy meeting last November.

Management of these patients usually relies on symptoms and lab results, not long-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 white paper cited studies from the Institute of Medicine, Rand Corp., and CMS, showing that care for the chronically ill 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 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 under the Medicare Modernization Act of 2003, is expected to reach about 180,000 fee-for-service Medicare beneficiaries with chronic health conditions such as complex diabetes or heart failure.

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

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

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions got the contract for 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.

The ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson. The company “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 this newspaper.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the firm “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.” Slated to begin in June or September, the pilot test includes a chronic care management fee to recognize the time and effort involved in the initiative, he said. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans.”

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, Mr. Doherty said. “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.

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.

Primary Care Has Room to Improve

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

Care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records,” he said at a healthy policy meeting last November.

Management of these patients usually relies on symptoms and lab results, not long-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 white paper cited studies from the Institute of Medicine, Rand Corp., and CMS, showing that care for the chronically ill 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 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 under the Medicare Modernization Act of 2003, is expected to reach about 180,000 fee-for-service Medicare beneficiaries with chronic health conditions such as complex diabetes or heart failure.

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

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

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions got the contract for 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.

The ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson. The company “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 this newspaper.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the firm “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.” Slated to begin in June or September, the pilot test includes a chronic care management fee to recognize the time and effort involved in the initiative, he said. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans.”

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, Mr. Doherty said. “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.

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.

Primary Care Has Room to Improve

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

Care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records,” he said at a healthy policy meeting last November.

Management of these patients usually relies on symptoms and lab results, not long-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 white paper cited studies from the Institute of Medicine, Rand Corp., and CMS, showing that care for the chronically ill 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.

Medicare is investigating ways to help its beneficiaries quit smoking.

The Centers for Medicare and Medicaid Services proposed to extend smoking cessation coverage to beneficiaries who smoke and have been diagnosed with a smoking-related disease—or who are taking certain drugs whose metabolism is affected by tobacco use.

The hope is that Medicare's decision to pay for smoking cessation counseling "will encourage and help seniors quit smoking once and for all," Ronald Davis, M.D., trustee to the American Medical Association, said in a statement.

Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the Centers for Disease Control and Prevention. More than 9% of those aged 65 years and older smoke cigarettes.

The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.

The proposed coverage decision specifically applies to patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, weak bones, or blood clots—diseases that account for the bulk of Medicare spending, according to the CMS.

Beneficiaries are also eligible for the counseling if they take medications whose effectiveness is complicated by smoking, including insulins, and medicines for high blood pressure, seizures, blood clots, or depression.

Minimal counseling is already covered at each evaluation and management visit for beneficiaries. Beyond that, Medicare is proposing to cover two cessation attempts per year. "Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit covering up to eight sessions in a 12-month period," the proposal stated.

The CMS estimates the program will cost $11 million annually, a number it expects will be offset by fewer hospitalizations and health problems related to smoking.

In addition to heart disease, emphysema, and stroke, seniors who smoke cigarettes are also more likely to develop problems associated with older age, such as hip fractures, eye cataracts, and facial skin wrinkles, Dr. Davis said.

Seniors who try to quit smoking are 50% more likely to succeed than other age groups, and those who quit can reduce their risk of death from heart disease to that of nonsmokers within several years of quitting, he added.

In a statement, CMS Administrator Mark McClellan, M.D., encouraged smokers on Medicare who were starting to experience heart or lung problems, or high blood pressure "to take advantage of this new help—and more is coming." The agency noted that Medicare's upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.

The American Lung Association supported the effort but had concerns that comparable benefits weren't available to younger patients.

The group "applauds anything that will help anyone stop smoking," spokeswoman Diane Maple told this newspaper. However, a recent study showed that only 10% of employer-sponsored health plans cover smoking cessation programs that combine medications with counseling, she said. "There are a lot of people out there who are not eligible for Medicare and won't get these types of benefits from their personal health plans."

The association hopes that private plans will take a cue from Medicare and develop similar programs in the future, she said.

Medicare is investigating ways to help its beneficiaries quit smoking.

The Centers for Medicare and Medicaid Services proposed to extend smoking cessation coverage to beneficiaries who smoke and have been diagnosed with a smoking-related disease—or who are taking certain drugs whose metabolism is affected by tobacco use.

The hope is that Medicare's decision to pay for smoking cessation counseling "will encourage and help seniors quit smoking once and for all," Ronald Davis, M.D., trustee to the American Medical Association, said in a statement.

Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the Centers for Disease Control and Prevention. More than 9% of those aged 65 years and older smoke cigarettes.

The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.

The proposed coverage decision specifically applies to patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, weak bones, or blood clots—diseases that account for the bulk of Medicare spending, according to the CMS.

Beneficiaries are also eligible for the counseling if they take medications whose effectiveness is complicated by smoking, including insulins, and medicines for high blood pressure, seizures, blood clots, or depression.

Minimal counseling is already covered at each evaluation and management visit for beneficiaries. Beyond that, Medicare is proposing to cover two cessation attempts per year. "Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit covering up to eight sessions in a 12-month period," the proposal stated.

The CMS estimates the program will cost $11 million annually, a number it expects will be offset by fewer hospitalizations and health problems related to smoking.

In addition to heart disease, emphysema, and stroke, seniors who smoke cigarettes are also more likely to develop problems associated with older age, such as hip fractures, eye cataracts, and facial skin wrinkles, Dr. Davis said.

Seniors who try to quit smoking are 50% more likely to succeed than other age groups, and those who quit can reduce their risk of death from heart disease to that of nonsmokers within several years of quitting, he added.

In a statement, CMS Administrator Mark McClellan, M.D., encouraged smokers on Medicare who were starting to experience heart or lung problems, or high blood pressure "to take advantage of this new help—and more is coming." The agency noted that Medicare's upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.

The American Lung Association supported the effort but had concerns that comparable benefits weren't available to younger patients.

The group "applauds anything that will help anyone stop smoking," spokeswoman Diane Maple told this newspaper. However, a recent study showed that only 10% of employer-sponsored health plans cover smoking cessation programs that combine medications with counseling, she said. "There are a lot of people out there who are not eligible for Medicare and won't get these types of benefits from their personal health plans."

The association hopes that private plans will take a cue from Medicare and develop similar programs in the future, she said.

Medicare is investigating ways to help its beneficiaries quit smoking.

The Centers for Medicare and Medicaid Services proposed to extend smoking cessation coverage to beneficiaries who smoke and have been diagnosed with a smoking-related disease—or who are taking certain drugs whose metabolism is affected by tobacco use.

The hope is that Medicare's decision to pay for smoking cessation counseling "will encourage and help seniors quit smoking once and for all," Ronald Davis, M.D., trustee to the American Medical Association, said in a statement.

Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the Centers for Disease Control and Prevention. More than 9% of those aged 65 years and older smoke cigarettes.

The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.

The proposed coverage decision specifically applies to patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, weak bones, or blood clots—diseases that account for the bulk of Medicare spending, according to the CMS.

Beneficiaries are also eligible for the counseling if they take medications whose effectiveness is complicated by smoking, including insulins, and medicines for high blood pressure, seizures, blood clots, or depression.

Minimal counseling is already covered at each evaluation and management visit for beneficiaries. Beyond that, Medicare is proposing to cover two cessation attempts per year. "Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit covering up to eight sessions in a 12-month period," the proposal stated.

The CMS estimates the program will cost $11 million annually, a number it expects will be offset by fewer hospitalizations and health problems related to smoking.

In addition to heart disease, emphysema, and stroke, seniors who smoke cigarettes are also more likely to develop problems associated with older age, such as hip fractures, eye cataracts, and facial skin wrinkles, Dr. Davis said.

Seniors who try to quit smoking are 50% more likely to succeed than other age groups, and those who quit can reduce their risk of death from heart disease to that of nonsmokers within several years of quitting, he added.

In a statement, CMS Administrator Mark McClellan, M.D., encouraged smokers on Medicare who were starting to experience heart or lung problems, or high blood pressure "to take advantage of this new help—and more is coming." The agency noted that Medicare's upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.

The American Lung Association supported the effort but had concerns that comparable benefits weren't available to younger patients.

The group "applauds anything that will help anyone stop smoking," spokeswoman Diane Maple told this newspaper. However, a recent study showed that only 10% of employer-sponsored health plans cover smoking cessation programs that combine medications with counseling, she said. "There are a lot of people out there who are not eligible for Medicare and won't get these types of benefits from their personal health plans."

The association hopes that private plans will take a cue from Medicare and develop similar programs in the future, she said.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. “We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down,” commented Mark McClellan, M.D., CMS administrator. “We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly.”

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. Although the price is right, these alternative treatments “may be of questionable value,” said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

Treating Men's Depression

Improving primary care treatment for depression might help narrow the “gender gap” that leaves a greater proportion of depressed men untreated, according to a study from the Rand Corp. For their study, researchers assigned 46 primary care practices nationwide to provide either usual care for depression or to provide an improved treatment regimen that educated providers and patients about available depression treatment. Among practices that used an improvement program, rates of depression treatment increased for both sexes, but some treatment approaches increased care for men more than for women. “The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States,” the researchers said.

Bioterrorism Preparedness Update

States have made progress in protecting Americans from a bioterrorist attack, but they still have a long way to go, a report from Trust for America's Health (TFAH) concluded. Nearly 60% of states do not have adequate numbers of laboratory scientists to test for anthrax or the plague in the event of a suspected outbreak, and two-thirds do not electronically track disease outbreak information by national standards, making early warning of disease threats difficult. In addition, only six states are adequately prepared to distribute vaccines and antidotes in an emergency. Although planning for a flu pandemic has improved, 20 states still do not have publicly available response plans in place. To improve bioterrorism and public health preparedness, TFAH, a nonprofit, nonpartisan organization that focuses on disease prevention, recommended a systematic review of preparedness gaps, conducting practice drills to assess capabilities and vulnerabilities, and limiting liability to encourage vaccine development and protect health care workers.

Concern About Iodide Stockpile

The Department of Health and Human Services needs to do more to ensure an adequate stockpile of potassium iodide (KI) in case of an accident or attack involving a nuclear power plant, Rep. Edward J. Markey (D-Mass.) said in a letter to HHS. Rep. Markey sponsored an amendment to the Bioterrorism Act directing HHS to make KI available to state and local governments for distribution to anyone living within 20 miles of a nuclear power plant. “I am deeply disappointed by the continued delays in implementing this program,” Rep. Markey wrote. He noted that after the Chernobyl nuclear accident, numerous thyroid cancers occurred in Belarusian children, but none occurred in Polish children, because Poland quickly administered KI. The American Thyroid Association also criticized HHS, charging that the draft guidelines HHS issued to deal with the problem “interfere with, rather than assist and encourage, states and localities in obtaining KI as a preparedness measure.”

No Global Cloning Ban

The United Nations could not come to a consensus to approve a global ban on all forms of human cloning. The United States and Costa Rica had led an effort to ban all cloning, including so-called therapeutic cloning, but the treaty did not draw enough support. But groups such as the Coalition for the Advancement of Medical Research have urged the United Nations to reject a wide-ranging ban that would apply to cloning that could aid in medical research and the development of therapies. “We're very gratified that the U.N. has backed away from an overreaching treaty that could harm medical research and hinder possible cures for millions throughout the world,” Daniel Perry, president of the coalition, said in a statement.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. “We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down,” commented Mark McClellan, M.D., CMS administrator. “We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly.”

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. Although the price is right, these alternative treatments “may be of questionable value,” said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

Treating Men's Depression

Improving primary care treatment for depression might help narrow the “gender gap” that leaves a greater proportion of depressed men untreated, according to a study from the Rand Corp. For their study, researchers assigned 46 primary care practices nationwide to provide either usual care for depression or to provide an improved treatment regimen that educated providers and patients about available depression treatment. Among practices that used an improvement program, rates of depression treatment increased for both sexes, but some treatment approaches increased care for men more than for women. “The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States,” the researchers said.

Bioterrorism Preparedness Update

States have made progress in protecting Americans from a bioterrorist attack, but they still have a long way to go, a report from Trust for America's Health (TFAH) concluded. Nearly 60% of states do not have adequate numbers of laboratory scientists to test for anthrax or the plague in the event of a suspected outbreak, and two-thirds do not electronically track disease outbreak information by national standards, making early warning of disease threats difficult. In addition, only six states are adequately prepared to distribute vaccines and antidotes in an emergency. Although planning for a flu pandemic has improved, 20 states still do not have publicly available response plans in place. To improve bioterrorism and public health preparedness, TFAH, a nonprofit, nonpartisan organization that focuses on disease prevention, recommended a systematic review of preparedness gaps, conducting practice drills to assess capabilities and vulnerabilities, and limiting liability to encourage vaccine development and protect health care workers.

Concern About Iodide Stockpile

The Department of Health and Human Services needs to do more to ensure an adequate stockpile of potassium iodide (KI) in case of an accident or attack involving a nuclear power plant, Rep. Edward J. Markey (D-Mass.) said in a letter to HHS. Rep. Markey sponsored an amendment to the Bioterrorism Act directing HHS to make KI available to state and local governments for distribution to anyone living within 20 miles of a nuclear power plant. “I am deeply disappointed by the continued delays in implementing this program,” Rep. Markey wrote. He noted that after the Chernobyl nuclear accident, numerous thyroid cancers occurred in Belarusian children, but none occurred in Polish children, because Poland quickly administered KI. The American Thyroid Association also criticized HHS, charging that the draft guidelines HHS issued to deal with the problem “interfere with, rather than assist and encourage, states and localities in obtaining KI as a preparedness measure.”

No Global Cloning Ban

The United Nations could not come to a consensus to approve a global ban on all forms of human cloning. The United States and Costa Rica had led an effort to ban all cloning, including so-called therapeutic cloning, but the treaty did not draw enough support. But groups such as the Coalition for the Advancement of Medical Research have urged the United Nations to reject a wide-ranging ban that would apply to cloning that could aid in medical research and the development of therapies. “We're very gratified that the U.N. has backed away from an overreaching treaty that could harm medical research and hinder possible cures for millions throughout the world,” Daniel Perry, president of the coalition, said in a statement.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. “We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down,” commented Mark McClellan, M.D., CMS administrator. “We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly.”

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. Although the price is right, these alternative treatments “may be of questionable value,” said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

Treating Men's Depression

Improving primary care treatment for depression might help narrow the “gender gap” that leaves a greater proportion of depressed men untreated, according to a study from the Rand Corp. For their study, researchers assigned 46 primary care practices nationwide to provide either usual care for depression or to provide an improved treatment regimen that educated providers and patients about available depression treatment. Among practices that used an improvement program, rates of depression treatment increased for both sexes, but some treatment approaches increased care for men more than for women. “The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States,” the researchers said.

Bioterrorism Preparedness Update

States have made progress in protecting Americans from a bioterrorist attack, but they still have a long way to go, a report from Trust for America's Health (TFAH) concluded. Nearly 60% of states do not have adequate numbers of laboratory scientists to test for anthrax or the plague in the event of a suspected outbreak, and two-thirds do not electronically track disease outbreak information by national standards, making early warning of disease threats difficult. In addition, only six states are adequately prepared to distribute vaccines and antidotes in an emergency. Although planning for a flu pandemic has improved, 20 states still do not have publicly available response plans in place. To improve bioterrorism and public health preparedness, TFAH, a nonprofit, nonpartisan organization that focuses on disease prevention, recommended a systematic review of preparedness gaps, conducting practice drills to assess capabilities and vulnerabilities, and limiting liability to encourage vaccine development and protect health care workers.

Concern About Iodide Stockpile

The Department of Health and Human Services needs to do more to ensure an adequate stockpile of potassium iodide (KI) in case of an accident or attack involving a nuclear power plant, Rep. Edward J. Markey (D-Mass.) said in a letter to HHS. Rep. Markey sponsored an amendment to the Bioterrorism Act directing HHS to make KI available to state and local governments for distribution to anyone living within 20 miles of a nuclear power plant. “I am deeply disappointed by the continued delays in implementing this program,” Rep. Markey wrote. He noted that after the Chernobyl nuclear accident, numerous thyroid cancers occurred in Belarusian children, but none occurred in Polish children, because Poland quickly administered KI. The American Thyroid Association also criticized HHS, charging that the draft guidelines HHS issued to deal with the problem “interfere with, rather than assist and encourage, states and localities in obtaining KI as a preparedness measure.”

No Global Cloning Ban

The United Nations could not come to a consensus to approve a global ban on all forms of human cloning. The United States and Costa Rica had led an effort to ban all cloning, including so-called therapeutic cloning, but the treaty did not draw enough support. But groups such as the Coalition for the Advancement of Medical Research have urged the United Nations to reject a wide-ranging ban that would apply to cloning that could aid in medical research and the development of therapies. “We're very gratified that the U.N. has backed away from an overreaching treaty that could harm medical research and hinder possible cures for millions throughout the world,” Daniel Perry, president of the coalition, said in a statement.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. “We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down,” commented Mark McClellan, M.D., CMS administrator. “We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly.”

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to complementary and alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. Although the price is right, these alternative treatments “may be of questionable value,” said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

Treating Men's Depression

Improving primary care treatment for depression might help narrow the “gender gap” that leaves a greater proportion of depressed men untreated, according to a study from the Rand Corp. Researchers assigned 46 primary care practices to provide either usual care for depression or an improved treatment regimen that educated providers and patients about available depression treatment. Among practices that used an improvement program, rates of depression treatment increased for both sexes, but some treatment approaches increased care for men more than for women. “The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States,” the researchers said.

Bioterrorism Preparedness Update

States have made progress in protecting Americans from a bioterrorism, but they have a long way to go, a report from Trust for America's Health (TFAH) concluded. Nearly 60% of states do not have adequate numbers of laboratory scientists to test for anthrax or the plague in the event of a suspected outbreak, and two-thirds do not electronically track disease outbreak information by national standards, making early warning difficult. Only six states are adequately prepared to distribute vaccines and antidotes in an emergency. Although planning for a flu pandemic has improved, 20 states still do not have publicly available response plans. To improve preparedness, TFAH, a nonprofit, nonpartisan organization that focuses on disease prevention, recommended a systematic review of preparedness gaps, conducting practice drills to assess capabilities and vulnerabilities, and limiting liability to encourage vaccine development and protect health care workers.

Concern About the Iodide Stockpile

The Department of Health and Human Services needs to do more to ensure an adequate stockpile of potassium iodide (KI) in case of an accident or attack involving a nuclear power plant, Rep. Edward J. Markey (D-Mass.) said in a letter to HHS. Rep. Markey sponsored an amendment to the Bioterrorism Act directing HHS to make KI available to state and local governments for distribution to anyone living within 20 miles of a nuclear power plant. “I am deeply disappointed by the continued delays in implementing this program,” Rep. Markey wrote. He noted that after the Chernobyl nuclear accident, numerous thyroid cancers occurred in Belarusian children, but none occurred in Polish children, because Poland quickly administered KI. The American Thyroid Association also criticized HHS, charging that the draft guidelines HHS issued to deal with the problem “interfere with, rather than assist and encourage, states and localities in obtaining KI as a preparedness measure.”

No Global Cloning Ban

The United Nations could not come to a consensus to approve a global ban on all forms of human cloning. The United States and Costa Rica had led an effort to ban all cloning, including so-called therapeutic cloning, but the treaty did not draw enough support. But groups such as the Coalition for the Advancement of Medical Research have urged the United Nations to reject a wide-ranging ban that would apply to cloning that could aid in medical research and the development of therapies. “We're very gratified that the U.N. has backed away from an overreaching treaty that could harm medical research and hinder possible cures for millions throughout the world,” Daniel Perry, president of the coalition, said in a statement.

Doctors Bilked in Insurance Scam

The U.S. Department of Justice has frozen over $500 million in bank and investment accounts that department officials say represent booty from a fraudulent tax avoidance scheme. The department issued a temporary restraining order against xélan Inc. and related entities. Federal officials alleged that the company, based in San Diego, advised thousands of doctors and other medical professionals to place their income in various tax schemes involving supposed “supplemental insurance products” or improper charitable deductions. The Internal Revenue Service estimates that the 4,000 doctors who participated may owe as much as $420 million in taxes, interest, and penalties. A temporary receiver has been named to guard assets and handle claims; doctors who want to file a claim or get information on the case should contact the receiver, William “Biff” Leonard, at [email protected] or by calling 702-262-9322.

Group Pays $1.8 Million Settlement

Temple University Physicians has agreed to pay almost $1.9 million to settle civil charges arising from an investigation into the group's Medicare Part B billing practices. HHS audited Medicare Part B claims submitted by the group between July 1995 and July 1996 and concluded that the group lacked sufficient documentation to support some claims, and that some of the claims represented a greater level of service than was actually provided. “Through this settlement we are protecting the integrity of the Medicare system on which our senior citizens depend for their critical health care coverage,” Patrick Meehan, U.S. Attorney for the Eastern District of Pennsylvania, said in a statement on behalf of HHS. Temple University Physicians denies both the government's allegations and any liability relating to them.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. “We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down,” commented Mark McClellan, M.D., CMS administrator. “We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly.”

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to complementary and alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. Although the price is right, these alternative treatments “may be of questionable value,” said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

Treating Men's Depression

Improving primary care treatment for depression might help narrow the “gender gap” that leaves a greater proportion of depressed men untreated, according to a study from the Rand Corp. Researchers assigned 46 primary care practices to provide either usual care for depression or an improved treatment regimen that educated providers and patients about available depression treatment. Among practices that used an improvement program, rates of depression treatment increased for both sexes, but some treatment approaches increased care for men more than for women. “The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States,” the researchers said.

Bioterrorism Preparedness Update

States have made progress in protecting Americans from a bioterrorism, but they have a long way to go, a report from Trust for America's Health (TFAH) concluded. Nearly 60% of states do not have adequate numbers of laboratory scientists to test for anthrax or the plague in the event of a suspected outbreak, and two-thirds do not electronically track disease outbreak information by national standards, making early warning difficult. Only six states are adequately prepared to distribute vaccines and antidotes in an emergency. Although planning for a flu pandemic has improved, 20 states still do not have publicly available response plans. To improve preparedness, TFAH, a nonprofit, nonpartisan organization that focuses on disease prevention, recommended a systematic review of preparedness gaps, conducting practice drills to assess capabilities and vulnerabilities, and limiting liability to encourage vaccine development and protect health care workers.

Concern About the Iodide Stockpile

The Department of Health and Human Services needs to do more to ensure an adequate stockpile of potassium iodide (KI) in case of an accident or attack involving a nuclear power plant, Rep. Edward J. Markey (D-Mass.) said in a letter to HHS. Rep. Markey sponsored an amendment to the Bioterrorism Act directing HHS to make KI available to state and local governments for distribution to anyone living within 20 miles of a nuclear power plant. “I am deeply disappointed by the continued delays in implementing this program,” Rep. Markey wrote. He noted that after the Chernobyl nuclear accident, numerous thyroid cancers occurred in Belarusian children, but none occurred in Polish children, because Poland quickly administered KI. The American Thyroid Association also criticized HHS, charging that the draft guidelines HHS issued to deal with the problem “interfere with, rather than assist and encourage, states and localities in obtaining KI as a preparedness measure.”

No Global Cloning Ban

The United Nations could not come to a consensus to approve a global ban on all forms of human cloning. The United States and Costa Rica had led an effort to ban all cloning, including so-called therapeutic cloning, but the treaty did not draw enough support. But groups such as the Coalition for the Advancement of Medical Research have urged the United Nations to reject a wide-ranging ban that would apply to cloning that could aid in medical research and the development of therapies. “We're very gratified that the U.N. has backed away from an overreaching treaty that could harm medical research and hinder possible cures for millions throughout the world,” Daniel Perry, president of the coalition, said in a statement.

Doctors Bilked in Insurance Scam

The U.S. Department of Justice has frozen over $500 million in bank and investment accounts that department officials say represent booty from a fraudulent tax avoidance scheme. The department issued a temporary restraining order against xélan Inc. and related entities. Federal officials alleged that the company, based in San Diego, advised thousands of doctors and other medical professionals to place their income in various tax schemes involving supposed “supplemental insurance products” or improper charitable deductions. The Internal Revenue Service estimates that the 4,000 doctors who participated may owe as much as $420 million in taxes, interest, and penalties. A temporary receiver has been named to guard assets and handle claims; doctors who want to file a claim or get information on the case should contact the receiver, William “Biff” Leonard, at [email protected] or by calling 702-262-9322.

Group Pays $1.8 Million Settlement

Temple University Physicians has agreed to pay almost $1.9 million to settle civil charges arising from an investigation into the group's Medicare Part B billing practices. HHS audited Medicare Part B claims submitted by the group between July 1995 and July 1996 and concluded that the group lacked sufficient documentation to support some claims, and that some of the claims represented a greater level of service than was actually provided. “Through this settlement we are protecting the integrity of the Medicare system on which our senior citizens depend for their critical health care coverage,” Patrick Meehan, U.S. Attorney for the Eastern District of Pennsylvania, said in a statement on behalf of HHS. Temple University Physicians denies both the government's allegations and any liability relating to them.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. “We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down,” commented Mark McClellan, M.D., CMS administrator. “We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly.”

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to complementary and alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. Although the price is right, these alternative treatments “may be of questionable value,” said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

Treating Men's Depression

Improving primary care treatment for depression might help narrow the “gender gap” that leaves a greater proportion of depressed men untreated, according to a study from the Rand Corp. Researchers assigned 46 primary care practices to provide either usual care for depression or an improved treatment regimen that educated providers and patients about available depression treatment. Among practices that used an improvement program, rates of depression treatment increased for both sexes, but some treatment approaches increased care for men more than for women. “The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States,” the researchers said.

Bioterrorism Preparedness Update

States have made progress in protecting Americans from a bioterrorism, but they have a long way to go, a report from Trust for America's Health (TFAH) concluded. Nearly 60% of states do not have adequate numbers of laboratory scientists to test for anthrax or the plague in the event of a suspected outbreak, and two-thirds do not electronically track disease outbreak information by national standards, making early warning difficult. Only six states are adequately prepared to distribute vaccines and antidotes in an emergency. Although planning for a flu pandemic has improved, 20 states still do not have publicly available response plans. To improve preparedness, TFAH, a nonprofit, nonpartisan organization that focuses on disease prevention, recommended a systematic review of preparedness gaps, conducting practice drills to assess capabilities and vulnerabilities, and limiting liability to encourage vaccine development and protect health care workers.

Concern About the Iodide Stockpile

The Department of Health and Human Services needs to do more to ensure an adequate stockpile of potassium iodide (KI) in case of an accident or attack involving a nuclear power plant, Rep. Edward J. Markey (D-Mass.) said in a letter to HHS. Rep. Markey sponsored an amendment to the Bioterrorism Act directing HHS to make KI available to state and local governments for distribution to anyone living within 20 miles of a nuclear power plant. “I am deeply disappointed by the continued delays in implementing this program,” Rep. Markey wrote. He noted that after the Chernobyl nuclear accident, numerous thyroid cancers occurred in Belarusian children, but none occurred in Polish children, because Poland quickly administered KI. The American Thyroid Association also criticized HHS, charging that the draft guidelines HHS issued to deal with the problem “interfere with, rather than assist and encourage, states and localities in obtaining KI as a preparedness measure.”

No Global Cloning Ban

The United Nations could not come to a consensus to approve a global ban on all forms of human cloning. The United States and Costa Rica had led an effort to ban all cloning, including so-called therapeutic cloning, but the treaty did not draw enough support. But groups such as the Coalition for the Advancement of Medical Research have urged the United Nations to reject a wide-ranging ban that would apply to cloning that could aid in medical research and the development of therapies. “We're very gratified that the U.N. has backed away from an overreaching treaty that could harm medical research and hinder possible cures for millions throughout the world,” Daniel Perry, president of the coalition, said in a statement.

Doctors Bilked in Insurance Scam

The U.S. Department of Justice has frozen over $500 million in bank and investment accounts that department officials say represent booty from a fraudulent tax avoidance scheme. The department issued a temporary restraining order against xélan Inc. and related entities. Federal officials alleged that the company, based in San Diego, advised thousands of doctors and other medical professionals to place their income in various tax schemes involving supposed “supplemental insurance products” or improper charitable deductions. The Internal Revenue Service estimates that the 4,000 doctors who participated may owe as much as $420 million in taxes, interest, and penalties. A temporary receiver has been named to guard assets and handle claims; doctors who want to file a claim or get information on the case should contact the receiver, William “Biff” Leonard, at [email protected] or by calling 702-262-9322.

Group Pays $1.8 Million Settlement

Temple University Physicians has agreed to pay almost $1.9 million to settle civil charges arising from an investigation into the group's Medicare Part B billing practices. HHS audited Medicare Part B claims submitted by the group between July 1995 and July 1996 and concluded that the group lacked sufficient documentation to support some claims, and that some of the claims represented a greater level of service than was actually provided. “Through this settlement we are protecting the integrity of the Medicare system on which our senior citizens depend for their critical health care coverage,” Patrick Meehan, U.S. Attorney for the Eastern District of Pennsylvania, said in a statement on behalf of HHS. Temple University Physicians denies both the government's allegations and any liability relating to them.

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 recommendation.

For that reason, 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 explained in an interview. This would mean that physicians would get 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 that 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 place a correction mechanism, CMS could make the change retroactive, Dr. McAneny 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, according to the GAO report.

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. McAneny 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 commented.

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 recommendation.

For that reason, 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 explained in an interview. This would mean that physicians would get 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 that 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 place a correction mechanism, CMS could make the change retroactive, Dr. McAneny 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, according to the GAO report.

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. McAneny 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 commented.

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 recommendation.

For that reason, 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 explained in an interview. This would mean that physicians would get 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 that 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 place a correction mechanism, CMS could make the change retroactive, Dr. McAneny 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, according to the GAO report.

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. McAneny 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 commented.

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 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,” 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.

Seven of the 13 states 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,” she said.

Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to those 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 has a special status under Medicaid, as it's 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,” Ms. Gold said.

In 2001, the most recent year for which data are available, 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 sexually transmitted diseases 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 during the briefing.

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, New 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 in the meantime continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

A Snapshot of 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 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 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,” 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.

Seven of the 13 states 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,” she said.

Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to those 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 has a special status under Medicaid, as it's 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,” Ms. Gold said.

In 2001, the most recent year for which data are available, 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 sexually transmitted diseases 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 during the briefing.

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, New 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 in the meantime continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

A Snapshot of 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 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 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,” 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.

Seven of the 13 states 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,” she said.

Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to those 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 has a special status under Medicaid, as it's 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,” Ms. Gold said.

In 2001, the most recent year for which data are available, 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 sexually transmitted diseases 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 during the briefing.

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, New 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 in the meantime continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

A Snapshot of 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.”

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 said.

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 backed another controversial issue—specialty hospitals—when they approved a board report encouraging competition among health facilities as a means of promoting high quality, cost-effective care. The report also opposed efforts to extend a federal 18-month moratorium on physician referrals to specialty hospitals in which they have an ownership interest.

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.

▸ Support federal funding of comprehensive sex education programs that stress the importance of abstinence in preventing unwanted pregnancies and sexually transmitted diseases, and that also teach about contraception and safer sex.

▸ 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 and specialty hospitals 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.

In addition, “the AMA is not getting credit from physicians for the advocacy work it does,” said Ajay Gupta, a principal at McKinsey & Co., a management consulting firm that conducted the survey and the focus groups.

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%). In comparing current member penetration, the AMA “was fifth in the wallet behind specialty, state, and county societies,” Mr. Gupta said.

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 last decade, with young, active physicians accounting for most of the decline. “That amounts to 430,000 physicians who are no longer members,” Mr. Gupta said.

AMA could conceivably boost its membership by focusing on medical society activists and “positive” society supporters, two groups of physicians that embrace the idea of society medicine, Mr. Gupta suggested. About 290,000 physicians represent these “joiner” segments, though most are mature physicians, not young ones, he said.

“Joiners” have “a remarkably uniform view of what they want us to deliver: focused advocacy on priority issues, opportunities for involvement, and communications about progress and results,” Dr. Maves said.

Targeting residents should be a key strategy, said Brooke Bible, the medical student representative to the AMA's political action committee. While the AMA enjoys an excellent student constituency, “the residency period—where people get tired, jaded, or busy—is where we lose members.”

The campaign begins in 2005, using surveys, town meetings, and other grassroots activities to connect with physicians, Gary Epstein, the AMA's new chief marketing officer, said in an interview. Patients in particular have always supported the AMA's charge, “and we need to leverage that” as a resource, he 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 said.

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 backed another controversial issue—specialty hospitals—when they approved a board report encouraging competition among health facilities as a means of promoting high quality, cost-effective care. The report also opposed efforts to extend a federal 18-month moratorium on physician referrals to specialty hospitals in which they have an ownership interest.

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.

▸ Support federal funding of comprehensive sex education programs that stress the importance of abstinence in preventing unwanted pregnancies and sexually transmitted diseases, and that also teach about contraception and safer sex.

▸ 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 and specialty hospitals 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.

In addition, “the AMA is not getting credit from physicians for the advocacy work it does,” said Ajay Gupta, a principal at McKinsey & Co., a management consulting firm that conducted the survey and the focus groups.

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%). In comparing current member penetration, the AMA “was fifth in the wallet behind specialty, state, and county societies,” Mr. Gupta said.

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 last decade, with young, active physicians accounting for most of the decline. “That amounts to 430,000 physicians who are no longer members,” Mr. Gupta said.

AMA could conceivably boost its membership by focusing on medical society activists and “positive” society supporters, two groups of physicians that embrace the idea of society medicine, Mr. Gupta suggested. About 290,000 physicians represent these “joiner” segments, though most are mature physicians, not young ones, he said.

“Joiners” have “a remarkably uniform view of what they want us to deliver: focused advocacy on priority issues, opportunities for involvement, and communications about progress and results,” Dr. Maves said.

Targeting residents should be a key strategy, said Brooke Bible, the medical student representative to the AMA's political action committee. While the AMA enjoys an excellent student constituency, “the residency period—where people get tired, jaded, or busy—is where we lose members.”

The campaign begins in 2005, using surveys, town meetings, and other grassroots activities to connect with physicians, Gary Epstein, the AMA's new chief marketing officer, said in an interview. Patients in particular have always supported the AMA's charge, “and we need to leverage that” as a resource, he 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 said.

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 backed another controversial issue—specialty hospitals—when they approved a board report encouraging competition among health facilities as a means of promoting high quality, cost-effective care. The report also opposed efforts to extend a federal 18-month moratorium on physician referrals to specialty hospitals in which they have an ownership interest.

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.

▸ Support federal funding of comprehensive sex education programs that stress the importance of abstinence in preventing unwanted pregnancies and sexually transmitted diseases, and that also teach about contraception and safer sex.

▸ 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 and specialty hospitals 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.

In addition, “the AMA is not getting credit from physicians for the advocacy work it does,” said Ajay Gupta, a principal at McKinsey & Co., a management consulting firm that conducted the survey and the focus groups.

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%). In comparing current member penetration, the AMA “was fifth in the wallet behind specialty, state, and county societies,” Mr. Gupta said.

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 last decade, with young, active physicians accounting for most of the decline. “That amounts to 430,000 physicians who are no longer members,” Mr. Gupta said.

AMA could conceivably boost its membership by focusing on medical society activists and “positive” society supporters, two groups of physicians that embrace the idea of society medicine, Mr. Gupta suggested. About 290,000 physicians represent these “joiner” segments, though most are mature physicians, not young ones, he said.

“Joiners” have “a remarkably uniform view of what they want us to deliver: focused advocacy on priority issues, opportunities for involvement, and communications about progress and results,” Dr. Maves said.

Targeting residents should be a key strategy, said Brooke Bible, the medical student representative to the AMA's political action committee. While the AMA enjoys an excellent student constituency, “the residency period—where people get tired, jaded, or busy—is where we lose members.”

The campaign begins in 2005, using surveys, town meetings, and other grassroots activities to connect with physicians, Gary Epstein, the AMA's new chief marketing officer, said in an interview. Patients in particular have always supported the AMA's charge, “and we need to leverage that” as a resource, he said.

Influenza Update

Federal health officials are applauding the progress made in the first year of vaccinating children between the ages of 6 months and 23 months. As of mid-December, nearly 37% of children in that age group had received the vaccine, according to Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention. “We're considering this a very excellent coverage rate for the first year out,” Dr. Gerberding said at a press conference on the influenza vaccine. Dr. Gerberding also addressed charges that officials at the Health and Human Services Department had inappropriately used state immunization grant funds to purchase additional nonpediatric influenza vaccine from GlaxoSmithKline in Germany. The money was taken from there, Dr. Gerberding said, because it was the only money available at the time, and it was important to close the deal to procure more vaccine quickly. She added that the children's vaccine money is only available for use by states annually through the end of the calendar year and that $14 million still remained in the fund during the final days of December.

Teens Delaying Sexual Activity

Sexual activity among younger teenagers declined significantly between 1995 and 2002, while use of contraception increased, according to a study by the Centers for Disease Control and Prevention. Among never-married teenage girls aged 15-17 years, 30% of those surveyed in 2002 had ever had intercourse, compared with 38% in 1995. Among boys who were the same age, the percentage dropped from 43% in 1995 to 31% in 2002. The numbers were more mixed among teens aged 18-19; the percentage of boys in that group who had ever had sex dropped from 75% to 64%, but the percentage among the girls actually went from 68% to 69%. More than three-quarters used contraception when they began having intercourse. “More teenagers are avoiding or postponing sexual activity, which can lead to sexually transmitted diseases, unwanted pregnancy, or emotional and societal responsibilities for which they are not prepared,” according to a statement by the Department of Health and Human Services.

Abstinence Education Evaluated

Federally funded abstinence-only education programs contain errors and misinformation on the effectiveness of condoms, the risks of abortion, and the transmission of disease, according to a recent report from Rep. Henry Waxman (D-Calif.). The report reviewed school-based sex education curricula used by federally funded programs. For example, one curriculum states that data do not support the claim that condoms help prevent the spread of sexually-transmitted diseases. In another case, a curriculum states that 5%-10% of women who undergo abortions will become sterile. “Serious and pervasive problems with the accuracy of abstinence-only curricula may help explain why these programs have not been shown to protect adolescents from sexually transmitted diseases and why youth who pledge abstinence are significantly less likely to make informed choices about precautions when they do have sex,” the report said.

Fewer Children Are Smoking

Smoking among preteens is down—but the majority of children who do smoke are getting cigarettes from people they know, a national survey indicated, according to a research presented in the American Journal of Preventive Medicine (Am. J. Prev. Med. 2004; 27:267-76). The survey polled 58,911 children from grades 8 through 12, between 1997 and 2002. During this time period, the number of eighth graders who smoked every day dropped from 8.3% to 4.8%. Among 10th graders, the smoking rate dropped from 18.3% to 9.6%, while among 12th graders it fell from 23.3% to 14.5%. The number of kids smoking occasionally also dropped in all grades. There's a greater perception among children that cigarettes are dangerous, and there's more peer disapproval, said Lloyd D. Johnston, Ph.D., lead researcher of the report. Yet 65% of the children in each grade said they had friends or relatives who bought them cigarettes.

AMA Tackles Children's Issues

The American Medical Association approved several measures at its 2004 interim meeting to protect the health and welfare of children.

Among the measures were one to encourage the development of a strong adolescent immunization program in the United States and one to support legislation that would prevent the over-the-counter sale of dextromethorphan products to individuals under the age of 18.

In a statement, the AMA opposed NASCAR's decision to advertise hard-liquor brands. In a national poll conducted by Reducing Underage Drinking Through Coalitions Initiative, “63% of respondents agreed that marketing hard liquor on racecars sends the wrong message to children and teens about drinking and driving,” said AMA President-elect J. Edward Hill, M.D.

Medicaid Prescription Drug Charges

The Medicaid program is being overcharged for prescription drugs, George M. Reeb testified to the House Energy and Commerce subcommittee on oversight and investigations. Mr. Reeb, assistant inspector general for the Centers for Medicare and Medicaid Audits at the Department of Health and Human Services, said part of the problem is that states vary greatly in the reimbursement amounts they set for prescription drugs.

For example, “based on state data, we estimated that, overall, Medicaid could have saved as much as $86.7 million in fiscal year 2001 if all 42 states had reimbursed at the same price as the lowest paying state for each of the drugs reviewed,” he said in his testimony.

Among his recommendations is that states be provided with enhanced access to accurate wholesale pricing information and adopt other strategies to contain costs.

Influenza Update

Federal health officials are applauding the progress made in the first year of vaccinating children between the ages of 6 months and 23 months. As of mid-December, nearly 37% of children in that age group had received the vaccine, according to Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention. “We're considering this a very excellent coverage rate for the first year out,” Dr. Gerberding said at a press conference on the influenza vaccine. Dr. Gerberding also addressed charges that officials at the Health and Human Services Department had inappropriately used state immunization grant funds to purchase additional nonpediatric influenza vaccine from GlaxoSmithKline in Germany. The money was taken from there, Dr. Gerberding said, because it was the only money available at the time, and it was important to close the deal to procure more vaccine quickly. She added that the children's vaccine money is only available for use by states annually through the end of the calendar year and that $14 million still remained in the fund during the final days of December.

Teens Delaying Sexual Activity

Sexual activity among younger teenagers declined significantly between 1995 and 2002, while use of contraception increased, according to a study by the Centers for Disease Control and Prevention. Among never-married teenage girls aged 15-17 years, 30% of those surveyed in 2002 had ever had intercourse, compared with 38% in 1995. Among boys who were the same age, the percentage dropped from 43% in 1995 to 31% in 2002. The numbers were more mixed among teens aged 18-19; the percentage of boys in that group who had ever had sex dropped from 75% to 64%, but the percentage among the girls actually went from 68% to 69%. More than three-quarters used contraception when they began having intercourse. “More teenagers are avoiding or postponing sexual activity, which can lead to sexually transmitted diseases, unwanted pregnancy, or emotional and societal responsibilities for which they are not prepared,” according to a statement by the Department of Health and Human Services.

Abstinence Education Evaluated

Federally funded abstinence-only education programs contain errors and misinformation on the effectiveness of condoms, the risks of abortion, and the transmission of disease, according to a recent report from Rep. Henry Waxman (D-Calif.). The report reviewed school-based sex education curricula used by federally funded programs. For example, one curriculum states that data do not support the claim that condoms help prevent the spread of sexually-transmitted diseases. In another case, a curriculum states that 5%-10% of women who undergo abortions will become sterile. “Serious and pervasive problems with the accuracy of abstinence-only curricula may help explain why these programs have not been shown to protect adolescents from sexually transmitted diseases and why youth who pledge abstinence are significantly less likely to make informed choices about precautions when they do have sex,” the report said.

Fewer Children Are Smoking

Smoking among preteens is down—but the majority of children who do smoke are getting cigarettes from people they know, a national survey indicated, according to a research presented in the American Journal of Preventive Medicine (Am. J. Prev. Med. 2004; 27:267-76). The survey polled 58,911 children from grades 8 through 12, between 1997 and 2002. During this time period, the number of eighth graders who smoked every day dropped from 8.3% to 4.8%. Among 10th graders, the smoking rate dropped from 18.3% to 9.6%, while among 12th graders it fell from 23.3% to 14.5%. The number of kids smoking occasionally also dropped in all grades. There's a greater perception among children that cigarettes are dangerous, and there's more peer disapproval, said Lloyd D. Johnston, Ph.D., lead researcher of the report. Yet 65% of the children in each grade said they had friends or relatives who bought them cigarettes.

AMA Tackles Children's Issues

The American Medical Association approved several measures at its 2004 interim meeting to protect the health and welfare of children.

Among the measures were one to encourage the development of a strong adolescent immunization program in the United States and one to support legislation that would prevent the over-the-counter sale of dextromethorphan products to individuals under the age of 18.

In a statement, the AMA opposed NASCAR's decision to advertise hard-liquor brands. In a national poll conducted by Reducing Underage Drinking Through Coalitions Initiative, “63% of respondents agreed that marketing hard liquor on racecars sends the wrong message to children and teens about drinking and driving,” said AMA President-elect J. Edward Hill, M.D.

Medicaid Prescription Drug Charges

The Medicaid program is being overcharged for prescription drugs, George M. Reeb testified to the House Energy and Commerce subcommittee on oversight and investigations. Mr. Reeb, assistant inspector general for the Centers for Medicare and Medicaid Audits at the Department of Health and Human Services, said part of the problem is that states vary greatly in the reimbursement amounts they set for prescription drugs.

For example, “based on state data, we estimated that, overall, Medicaid could have saved as much as $86.7 million in fiscal year 2001 if all 42 states had reimbursed at the same price as the lowest paying state for each of the drugs reviewed,” he said in his testimony.

Among his recommendations is that states be provided with enhanced access to accurate wholesale pricing information and adopt other strategies to contain costs.

Influenza Update

Federal health officials are applauding the progress made in the first year of vaccinating children between the ages of 6 months and 23 months. As of mid-December, nearly 37% of children in that age group had received the vaccine, according to Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention. “We're considering this a very excellent coverage rate for the first year out,” Dr. Gerberding said at a press conference on the influenza vaccine. Dr. Gerberding also addressed charges that officials at the Health and Human Services Department had inappropriately used state immunization grant funds to purchase additional nonpediatric influenza vaccine from GlaxoSmithKline in Germany. The money was taken from there, Dr. Gerberding said, because it was the only money available at the time, and it was important to close the deal to procure more vaccine quickly. She added that the children's vaccine money is only available for use by states annually through the end of the calendar year and that $14 million still remained in the fund during the final days of December.

Teens Delaying Sexual Activity

Sexual activity among younger teenagers declined significantly between 1995 and 2002, while use of contraception increased, according to a study by the Centers for Disease Control and Prevention. Among never-married teenage girls aged 15-17 years, 30% of those surveyed in 2002 had ever had intercourse, compared with 38% in 1995. Among boys who were the same age, the percentage dropped from 43% in 1995 to 31% in 2002. The numbers were more mixed among teens aged 18-19; the percentage of boys in that group who had ever had sex dropped from 75% to 64%, but the percentage among the girls actually went from 68% to 69%. More than three-quarters used contraception when they began having intercourse. “More teenagers are avoiding or postponing sexual activity, which can lead to sexually transmitted diseases, unwanted pregnancy, or emotional and societal responsibilities for which they are not prepared,” according to a statement by the Department of Health and Human Services.

Abstinence Education Evaluated

Federally funded abstinence-only education programs contain errors and misinformation on the effectiveness of condoms, the risks of abortion, and the transmission of disease, according to a recent report from Rep. Henry Waxman (D-Calif.). The report reviewed school-based sex education curricula used by federally funded programs. For example, one curriculum states that data do not support the claim that condoms help prevent the spread of sexually-transmitted diseases. In another case, a curriculum states that 5%-10% of women who undergo abortions will become sterile. “Serious and pervasive problems with the accuracy of abstinence-only curricula may help explain why these programs have not been shown to protect adolescents from sexually transmitted diseases and why youth who pledge abstinence are significantly less likely to make informed choices about precautions when they do have sex,” the report said.

Fewer Children Are Smoking

Smoking among preteens is down—but the majority of children who do smoke are getting cigarettes from people they know, a national survey indicated, according to a research presented in the American Journal of Preventive Medicine (Am. J. Prev. Med. 2004; 27:267-76). The survey polled 58,911 children from grades 8 through 12, between 1997 and 2002. During this time period, the number of eighth graders who smoked every day dropped from 8.3% to 4.8%. Among 10th graders, the smoking rate dropped from 18.3% to 9.6%, while among 12th graders it fell from 23.3% to 14.5%. The number of kids smoking occasionally also dropped in all grades. There's a greater perception among children that cigarettes are dangerous, and there's more peer disapproval, said Lloyd D. Johnston, Ph.D., lead researcher of the report. Yet 65% of the children in each grade said they had friends or relatives who bought them cigarettes.

AMA Tackles Children's Issues

The American Medical Association approved several measures at its 2004 interim meeting to protect the health and welfare of children.

Among the measures were one to encourage the development of a strong adolescent immunization program in the United States and one to support legislation that would prevent the over-the-counter sale of dextromethorphan products to individuals under the age of 18.

In a statement, the AMA opposed NASCAR's decision to advertise hard-liquor brands. In a national poll conducted by Reducing Underage Drinking Through Coalitions Initiative, “63% of respondents agreed that marketing hard liquor on racecars sends the wrong message to children and teens about drinking and driving,” said AMA President-elect J. Edward Hill, M.D.

Medicaid Prescription Drug Charges

The Medicaid program is being overcharged for prescription drugs, George M. Reeb testified to the House Energy and Commerce subcommittee on oversight and investigations. Mr. Reeb, assistant inspector general for the Centers for Medicare and Medicaid Audits at the Department of Health and Human Services, said part of the problem is that states vary greatly in the reimbursement amounts they set for prescription drugs.

For example, “based on state data, we estimated that, overall, Medicaid could have saved as much as $86.7 million in fiscal year 2001 if all 42 states had reimbursed at the same price as the lowest paying state for each of the drugs reviewed,” he said in his testimony.

Among his recommendations is that states be provided with enhanced access to accurate wholesale pricing information and adopt other strategies to contain costs.

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 this 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. In 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% 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.

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 did not. 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. 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 surveys that had been completed, 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.

Medicare Changes For the New Year

At press time, the Centers for Medicare and Medicaid Services released the final Medicare physician fee schedule.

For this year, physicians would have seen a 3.3% cut in Medicare payments if the Medicare Modernization Act hadn't blocked that decrease and, instead, increased payments 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 this 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. In 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% 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.

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 did not. 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. 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 surveys that had been completed, 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.

Medicare Changes For the New Year

At press time, the Centers for Medicare and Medicaid Services released the final Medicare physician fee schedule.

For this year, physicians would have seen a 3.3% cut in Medicare payments if the Medicare Modernization Act hadn't blocked that decrease and, instead, increased payments 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 this 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. In 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% 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.

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 did not. 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. 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 surveys that had been completed, 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.

Medicare Changes For the New Year

At press time, the Centers for Medicare and Medicaid Services released the final Medicare physician fee schedule.

For this year, physicians would have seen a 3.3% cut in Medicare payments if the Medicare Modernization Act hadn't blocked that decrease and, instead, increased payments 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.