Jennifer Silverman

Challenges of Running a Practice

Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Twenty-six percent of physicians who respondented described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” said medical practice management specialist J. Max Reiboldt in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.

Payments for the Elderly

U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted for only 12% of personal health care spending in that year.

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, who is the 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,” Mr. Reeb reported 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.

Guidance on Inpatient Status

To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.

Historic Fraud Case in Missouri

In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.

Malpractice: No. 3 Issue for Voters

Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.

Challenges of Running a Practice

Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Twenty-six percent of physicians who respondented described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” said medical practice management specialist J. Max Reiboldt in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.

Payments for the Elderly

U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted for only 12% of personal health care spending in that year.

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, who is the 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,” Mr. Reeb reported 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.

Guidance on Inpatient Status

To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.

Historic Fraud Case in Missouri

In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.

Malpractice: No. 3 Issue for Voters

Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.

Challenges of Running a Practice

Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Twenty-six percent of physicians who respondented described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” said medical practice management specialist J. Max Reiboldt in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.

Payments for the Elderly

U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted for only 12% of personal health care spending in that year.

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, who is the 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,” Mr. Reeb reported 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.

Guidance on Inpatient Status

To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.

Historic Fraud Case in Missouri

In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.

Malpractice: No. 3 Issue for Voters

Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.

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

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

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

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

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

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

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

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

Delegates 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. The percentage of nonrenewals in AMA membership 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.

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

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

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

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

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

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

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

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

Delegates 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. The percentage of nonrenewals in AMA membership 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.

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

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

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

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

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

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

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

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

Delegates 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. The percentage of nonrenewals in AMA membership 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.

Inpatient medicine is becoming a victim of its own success. Hospitalist programs are being set up faster than physicians can join them, and recruiters around the country are rushing to fill the empty slots.

In a recent survey of 3,000 hospitals, the American Hospital Association found that at least 1,200 had hospitalist programs, employing a total of 10,000 physicians. Because not all hospitals in the country were surveyed, the Society of Hospital Medicine (SHM) believes the number of programs could be as high as 1,800.

Hospitalists “have proved that they can provide better care and reduce medical errors, and reduce length of stay and resource costs,” and that's why they are popular right now, Larry Wellikson, M.D., SHM's chief executive officer, said in an interview.

Hospitalist programs often fail to appreciate how fast the workload can grow, said John Nelson, M.D., director of the hospitalist program at Overlake Hospital Medical Center, Bellevue, Wash.

“Every time we think we have enough doctors, the work expands and before we know it, we're looking for more,” Dr. Nelson told this newspaper.

The Overlake program, established in the spring of 2000, has grown from four to eight hospitalists and is in the process of recruiting two or three more. “Initial volume of new patient referrals was about 5 per day, and it has now grown to about 11.5 new referrals per day,” he said. He expects the program's work volume will continue to grow to the point that it will need 12-15 physicians within the next 5 years.

Almost every hospital in the country is trying to build a hospitalist program, Dr. Wellikson said. But if every one of the 5,000 hospitals acquires one, it's a certainty that there won't be enough physicians to fill available positions. This is because only a finite number of internists and pediatricians–the specialties to which most hospitalists belong–are coming out of residencies, he said.

Physicians aren't leaving other types of practices quickly enough to fill slots in hospitalist programs.

“Right now it is a seller's market,” observed Robert Wachter, M.D., chief of the medical service and director of the hospitalist group at the University of California, San Francisco. “Programs are going to have to think about how to create attractive jobs and keep excellent hospitalists if they have been able to hire them.”

Andrea Kloehn, vice president for Medstaff National Medical Staffing, a physician placement firm in Durham, N.C., said that in the last year, her firm has doubled its efforts to recruit hospitalists.

Medstaff has increased its recruiting staff to help with demand, as well as its direct mailing, advertising, and other efforts to reach out to physicians, Ms. Kloehn told this newspaper.

David Joyce, president of Delphi Healthcare Partners, a consulting and contract medical management firm in Durham, N.C., said that they too have been “overwhelmed” with requests from hospitals and hospitalist groups to fill positions, even on a temporary basis.

Although some of the openings can be attributed to understaffing in the new programs, other programs are experiencing natural turnover, and need replacements, Mr. Joyce said.

Ms. Kloehn noted that small and midsized community hospitals seem to be experiencing the most rapid growth in hospitalist programs right now.

These hospitals serve the areas that face the biggest challenges in recruitment, said Ron Greeno, M.D., a hospitalist and chief medical officer of Cogent Healthcare, Irvine, Calif., a hospitalist company. New York City has lots of training programs and young people who want to live there, so filling positions poses less of a challenge. But “there are some smaller communities that do not have training programs that may take several months to recruit candidates,” he said.

Dr. Nelson said he considers himself fortunate, since Bellevue, Wash., is an attractive place to live, “and people are generally willing to relocate here.” His program also benefits from the fact that potential candidates for hospitalist positions graduate each year from two internal medicine training programs that are located 15 minutes from the hospital.

Hospitals may go through some initial difficulty in getting positions filled for new and expanding programs, but it's unlikely that any will fail or shut down because of it, Ms. Kloehn said. Hiring locum tenens hospitalists may be one solution to help fill the gaps in hospitalist programs.

“Locum tenens physicians allow a program to get started sooner rather than later,” she said. Often, if a hospital has two of its four positions filled, “the program can get started with the locum tenens firm providing the other two physicians temporarily, while allowing more time for recruitment of permanent physicians.”

Eventually, these positions will fill up as the profession grows and matures, Dr. Wellikson predicted. “Since most hospitalists tend to be in their late 30s when they start, many people will only be in midcareer 10 years from now.” n

Inpatient medicine is becoming a victim of its own success. Hospitalist programs are being set up faster than physicians can join them, and recruiters around the country are rushing to fill the empty slots.

In a recent survey of 3,000 hospitals, the American Hospital Association found that at least 1,200 had hospitalist programs, employing a total of 10,000 physicians. Because not all hospitals in the country were surveyed, the Society of Hospital Medicine (SHM) believes the number of programs could be as high as 1,800.

Hospitalists “have proved that they can provide better care and reduce medical errors, and reduce length of stay and resource costs,” and that's why they are popular right now, Larry Wellikson, M.D., SHM's chief executive officer, said in an interview.

Hospitalist programs often fail to appreciate how fast the workload can grow, said John Nelson, M.D., director of the hospitalist program at Overlake Hospital Medical Center, Bellevue, Wash.

“Every time we think we have enough doctors, the work expands and before we know it, we're looking for more,” Dr. Nelson told this newspaper.

The Overlake program, established in the spring of 2000, has grown from four to eight hospitalists and is in the process of recruiting two or three more. “Initial volume of new patient referrals was about 5 per day, and it has now grown to about 11.5 new referrals per day,” he said. He expects the program's work volume will continue to grow to the point that it will need 12-15 physicians within the next 5 years.

Almost every hospital in the country is trying to build a hospitalist program, Dr. Wellikson said. But if every one of the 5,000 hospitals acquires one, it's a certainty that there won't be enough physicians to fill available positions. This is because only a finite number of internists and pediatricians–the specialties to which most hospitalists belong–are coming out of residencies, he said.

Physicians aren't leaving other types of practices quickly enough to fill slots in hospitalist programs.

“Right now it is a seller's market,” observed Robert Wachter, M.D., chief of the medical service and director of the hospitalist group at the University of California, San Francisco. “Programs are going to have to think about how to create attractive jobs and keep excellent hospitalists if they have been able to hire them.”

Andrea Kloehn, vice president for Medstaff National Medical Staffing, a physician placement firm in Durham, N.C., said that in the last year, her firm has doubled its efforts to recruit hospitalists.

Medstaff has increased its recruiting staff to help with demand, as well as its direct mailing, advertising, and other efforts to reach out to physicians, Ms. Kloehn told this newspaper.

David Joyce, president of Delphi Healthcare Partners, a consulting and contract medical management firm in Durham, N.C., said that they too have been “overwhelmed” with requests from hospitals and hospitalist groups to fill positions, even on a temporary basis.

Although some of the openings can be attributed to understaffing in the new programs, other programs are experiencing natural turnover, and need replacements, Mr. Joyce said.

Ms. Kloehn noted that small and midsized community hospitals seem to be experiencing the most rapid growth in hospitalist programs right now.

These hospitals serve the areas that face the biggest challenges in recruitment, said Ron Greeno, M.D., a hospitalist and chief medical officer of Cogent Healthcare, Irvine, Calif., a hospitalist company. New York City has lots of training programs and young people who want to live there, so filling positions poses less of a challenge. But “there are some smaller communities that do not have training programs that may take several months to recruit candidates,” he said.

Dr. Nelson said he considers himself fortunate, since Bellevue, Wash., is an attractive place to live, “and people are generally willing to relocate here.” His program also benefits from the fact that potential candidates for hospitalist positions graduate each year from two internal medicine training programs that are located 15 minutes from the hospital.

Hospitals may go through some initial difficulty in getting positions filled for new and expanding programs, but it's unlikely that any will fail or shut down because of it, Ms. Kloehn said. Hiring locum tenens hospitalists may be one solution to help fill the gaps in hospitalist programs.

“Locum tenens physicians allow a program to get started sooner rather than later,” she said. Often, if a hospital has two of its four positions filled, “the program can get started with the locum tenens firm providing the other two physicians temporarily, while allowing more time for recruitment of permanent physicians.”

Eventually, these positions will fill up as the profession grows and matures, Dr. Wellikson predicted. “Since most hospitalists tend to be in their late 30s when they start, many people will only be in midcareer 10 years from now.” n

Inpatient medicine is becoming a victim of its own success. Hospitalist programs are being set up faster than physicians can join them, and recruiters around the country are rushing to fill the empty slots.

In a recent survey of 3,000 hospitals, the American Hospital Association found that at least 1,200 had hospitalist programs, employing a total of 10,000 physicians. Because not all hospitals in the country were surveyed, the Society of Hospital Medicine (SHM) believes the number of programs could be as high as 1,800.

Hospitalists “have proved that they can provide better care and reduce medical errors, and reduce length of stay and resource costs,” and that's why they are popular right now, Larry Wellikson, M.D., SHM's chief executive officer, said in an interview.

Hospitalist programs often fail to appreciate how fast the workload can grow, said John Nelson, M.D., director of the hospitalist program at Overlake Hospital Medical Center, Bellevue, Wash.

“Every time we think we have enough doctors, the work expands and before we know it, we're looking for more,” Dr. Nelson told this newspaper.

The Overlake program, established in the spring of 2000, has grown from four to eight hospitalists and is in the process of recruiting two or three more. “Initial volume of new patient referrals was about 5 per day, and it has now grown to about 11.5 new referrals per day,” he said. He expects the program's work volume will continue to grow to the point that it will need 12-15 physicians within the next 5 years.

Almost every hospital in the country is trying to build a hospitalist program, Dr. Wellikson said. But if every one of the 5,000 hospitals acquires one, it's a certainty that there won't be enough physicians to fill available positions. This is because only a finite number of internists and pediatricians–the specialties to which most hospitalists belong–are coming out of residencies, he said.

Physicians aren't leaving other types of practices quickly enough to fill slots in hospitalist programs.

“Right now it is a seller's market,” observed Robert Wachter, M.D., chief of the medical service and director of the hospitalist group at the University of California, San Francisco. “Programs are going to have to think about how to create attractive jobs and keep excellent hospitalists if they have been able to hire them.”

Andrea Kloehn, vice president for Medstaff National Medical Staffing, a physician placement firm in Durham, N.C., said that in the last year, her firm has doubled its efforts to recruit hospitalists.

Medstaff has increased its recruiting staff to help with demand, as well as its direct mailing, advertising, and other efforts to reach out to physicians, Ms. Kloehn told this newspaper.

David Joyce, president of Delphi Healthcare Partners, a consulting and contract medical management firm in Durham, N.C., said that they too have been “overwhelmed” with requests from hospitals and hospitalist groups to fill positions, even on a temporary basis.

Although some of the openings can be attributed to understaffing in the new programs, other programs are experiencing natural turnover, and need replacements, Mr. Joyce said.

Ms. Kloehn noted that small and midsized community hospitals seem to be experiencing the most rapid growth in hospitalist programs right now.

These hospitals serve the areas that face the biggest challenges in recruitment, said Ron Greeno, M.D., a hospitalist and chief medical officer of Cogent Healthcare, Irvine, Calif., a hospitalist company. New York City has lots of training programs and young people who want to live there, so filling positions poses less of a challenge. But “there are some smaller communities that do not have training programs that may take several months to recruit candidates,” he said.

Dr. Nelson said he considers himself fortunate, since Bellevue, Wash., is an attractive place to live, “and people are generally willing to relocate here.” His program also benefits from the fact that potential candidates for hospitalist positions graduate each year from two internal medicine training programs that are located 15 minutes from the hospital.

Hospitals may go through some initial difficulty in getting positions filled for new and expanding programs, but it's unlikely that any will fail or shut down because of it, Ms. Kloehn said. Hiring locum tenens hospitalists may be one solution to help fill the gaps in hospitalist programs.

“Locum tenens physicians allow a program to get started sooner rather than later,” she said. Often, if a hospital has two of its four positions filled, “the program can get started with the locum tenens firm providing the other two physicians temporarily, while allowing more time for recruitment of permanent physicians.”

Eventually, these positions will fill up as the profession grows and matures, Dr. Wellikson predicted. “Since most hospitalists tend to be in their late 30s when they start, many people will only be in midcareer 10 years from now.” n

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 a closed distribution chain and reliable “track and trace” technology. The policy was swiftly approved by the house after much discussion in committee.

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

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

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

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

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

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

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

In other actions, delegates voted to:

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

▸ Pursue caps on noneconomic damages as a top priority in 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 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 trend that physicians prefer specialty or state societies 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.

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.

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 a closed distribution chain and reliable “track and trace” technology. The policy was swiftly approved by the house after much discussion in committee.

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

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

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

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

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

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

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

In other actions, delegates voted to:

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

▸ Pursue caps on noneconomic damages as a top priority in 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 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 trend that physicians prefer specialty or state societies 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.

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.

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 a closed distribution chain and reliable “track and trace” technology. The policy was swiftly approved by the house after much discussion in committee.

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

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

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

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

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

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

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

In other actions, delegates voted to:

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

▸ Pursue caps on noneconomic damages as a top priority in 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 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 trend that physicians prefer specialty or state societies 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.

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.

Challenges of Running a Practice

Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Of the physicians who respondented, 26% described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” medical practice management specialist J. Max Reiboldt said in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.

Payments for the Elderly

U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted only for 12% of personal health care spending in that year.

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, who is the 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,” Mr. Reeb reported 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.

Guidance on Inpatient Status

To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.

Historic Fraud Case in Missouri

In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.

Malpractice: No. 3 Issue for Voters

Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37%), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.

Challenges of Running a Practice

Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Of the physicians who respondented, 26% described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” medical practice management specialist J. Max Reiboldt said in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.

Payments for the Elderly

U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted only for 12% of personal health care spending in that year.

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, who is the 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,” Mr. Reeb reported 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.

Guidance on Inpatient Status

To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.

Historic Fraud Case in Missouri

In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.

Malpractice: No. 3 Issue for Voters

Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37%), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.

Challenges of Running a Practice

Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Of the physicians who respondented, 26% described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” medical practice management specialist J. Max Reiboldt said in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.

Payments for the Elderly

U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted only for 12% of personal health care spending in that year.

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, who is the 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,” Mr. Reeb reported 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.

Guidance on Inpatient Status

To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.

Historic Fraud Case in Missouri

In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.

Malpractice: No. 3 Issue for Voters

Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37%), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.

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 are 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, said Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Association. PhRMA, however, “remains convinced that importation is too riddled with problems to pursue.”

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

The issue is certain to come up in the House of Delegates again. In committee debate, Erich Garland, M.D., AMA delegate from the American Academy of Neurology, urged the AMA to look 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,” he 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 are 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, said Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Association. PhRMA, however, “remains convinced that importation is too riddled with problems to pursue.”

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

The issue is certain to come up in the House of Delegates again. In committee debate, Erich Garland, M.D., AMA delegate from the American Academy of Neurology, urged the AMA to look 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,” he 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 are 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, said Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers Association. PhRMA, however, “remains convinced that importation is too riddled with problems to pursue.”

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

The issue is certain to come up in the House of Delegates again. In committee debate, Erich Garland, M.D., AMA delegate from the American Academy of Neurology, urged the AMA to look 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,” he 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.

Federal investigators are targeting physicians who help Internet sites sell drugs to buyers without legitimate prescriptions.

"The Internet has brought drug dealers from the back alleys directly into every American home wired for e-mail and the World Wide Web," Karen Tandy, administrator of the Drug Enforcement Administration, recently testified before the Senate Governmental Affairs Permanent Subcommittee on Investigations.

Such Web sites are heavily advertised through spam e-mail and on the Web, selling as much as $50 million annually per site in some cases, the DEA estimates.

Web sites, such as Medexplorer.comLegalMedsOnline.com

Physicians associated with such Web sites typically have a business relationship with a pharmacy and almost never have a valid doctor-patient relationship under accepted medical practices, Ms. Tandy said. "Acting together, the physician and pharmacist dispense controlled substances [to those] without a legitimate medical need, resulting in widespread self-medication over the Internet.

Often the physician will ask the patient only three or four questions before prescribing the drug, Michael Schaff, a lawyer specializing in health care and corporate law in Woodbridge, N.J., said in an interview. To Mr. Schaff, it's illogical how a physician could make a diagnosis without seeing the patient.

To date, Justice Department investigations have discovered 14 deaths or overdoses and 15 people who have entered addiction rehabilitation or sustained injuries from drugs obtained illegally over the Internet, Ms. Tandy said.

The Government Accountability Office, in its analysis of drugs from 68 Web sites around the world, found that some Internet pharmacies pose safety risks for consumers and have unreliable business practices. While some in the United States and Canada required the patient to provide a doctor's prescription, other sites provided prescriptions based on their own medical questionnaire or had no prescription requirement.

Doctors not involved in Internet pharmacies face another threat: They have no way to know how many Web sites a patient might be using to obtain drugs, said James Saxton, chair of the healthcare liability and litigation practice group of the American Health Lawyers Association. From a medical liability perspective, "this is a disaster waiting to happen," he said.

More than 90 active investigations involving the diversion of pharmaceutical controlled substances over the Internet are underway, covering 537 Web sites, Ms. Tandy said. In the current fiscal year, the DEA has shut down 25 Internet pharmacy organizations and seized $3.3 million and 3.2 million dosage units. "Eleven million dollars is pending forfeiture," she said.

The Food and Drug Administration also has been investigating Internet pharmacies and referring cases for criminal prosecution and initiating civil enforcement actions against online sellers of drugs and other FDA-related products, John M. Taylor, FDA's associate commissioner for regulatory affairs, testified at the Senate hearing.

A number of state laws regulate the practice of pharmacy and medicine to protect patients from harm resulting from the use of unsafe drugs and the improper practice of medicine and pharmacy, Mr. Taylor said, adding that the statutes may not have enough teeth to efficiently regulate online pharmacies. In addition, many states have not yet fully determined how to address the issues that arise from online prescribing. As a result, the attempt to stop some physicians and online pharmacies from issuing prescriptions without an exam aren't always successful.

Other testimony before the Senate investigations panel addressed what Internet portals are doing to crack down on illegal Internet pharmacies.

Representatives from Yahoo! Inc. and Google Inc. described their efforts to ensure that their advertisers engage in best practices approved by the National Community Pharmacists Association. Both online providers use SquareTrade, an online trust infrastructure company that verifies that the online pharmacy and its pharmacist are appropriately licensed.

Yahoo! specifically prohibits online pharmacies from advertising FDA schedule II drugs, testified John Scheibel, Yahoo's vice president for public policy.

The DEA is also working with search engines and Internet service providers to warn consumers about dangerous drugs. "We have also established a link to the DEA's homepage to allow citizens to report suspicious Internet pharmacies," Ms. Tandy said.

For the law to fully catch up with the Internet, Congress should enact legislation that would set parameters for all of the states on how to legally administer these drugs online, suggested Rose Hager, a health care lawyer with Kathleen L. DeBruhl & Associates LLC in New Orleans.

Internet pharmacies will be around for some time, she said. "You won't be able to stop it."

Mr. Saxton agreed, but noted that a multimillion-dollar verdict against a Web site and its participants could have a chilling effect on this type of activity

Liability Risk Is Only a Click Away

Physicians caught in Internet prescribing activities that result in patient injury face a number of liability scenarios.

Those who prescribe over the Internet could be sued for malpractice "if you're prescribing medication for someone who [doesn't] need it," Ms. Hager told this newspaper.

Malpractice actions may also come up if a physician licensed in one state prescribes the wrong drug to a patient in another state, she said. The trick with these cases, however, is, "Where do you sue that physician? Normally you would sue in the state where the patient got hurt," but the seamless world of Internet prescribing makes it much harder to prosecute someone.

To settle the jurisdiction issue, lawyers in some states might begin suing physicians under a tort action, which relates to any action that harms someone else, she said. The argument would be, "You prescribed medication; you harmed my client," she said.

But if drugs are prescribed in another jurisdiction, the physician could conceivably be accused of practicing without a license, which in some states is the basis for a claim of punitive damages, she said.

Federal investigators are targeting physicians who help Internet sites sell drugs to buyers without legitimate prescriptions.

"The Internet has brought drug dealers from the back alleys directly into every American home wired for e-mail and the World Wide Web," Karen Tandy, administrator of the Drug Enforcement Administration, recently testified before the Senate Governmental Affairs Permanent Subcommittee on Investigations.

Such Web sites are heavily advertised through spam e-mail and on the Web, selling as much as $50 million annually per site in some cases, the DEA estimates.

Web sites, such as Medexplorer.comLegalMedsOnline.com

Physicians associated with such Web sites typically have a business relationship with a pharmacy and almost never have a valid doctor-patient relationship under accepted medical practices, Ms. Tandy said. "Acting together, the physician and pharmacist dispense controlled substances [to those] without a legitimate medical need, resulting in widespread self-medication over the Internet.

Often the physician will ask the patient only three or four questions before prescribing the drug, Michael Schaff, a lawyer specializing in health care and corporate law in Woodbridge, N.J., said in an interview. To Mr. Schaff, it's illogical how a physician could make a diagnosis without seeing the patient.

To date, Justice Department investigations have discovered 14 deaths or overdoses and 15 people who have entered addiction rehabilitation or sustained injuries from drugs obtained illegally over the Internet, Ms. Tandy said.

The Government Accountability Office, in its analysis of drugs from 68 Web sites around the world, found that some Internet pharmacies pose safety risks for consumers and have unreliable business practices. While some in the United States and Canada required the patient to provide a doctor's prescription, other sites provided prescriptions based on their own medical questionnaire or had no prescription requirement.

Doctors not involved in Internet pharmacies face another threat: They have no way to know how many Web sites a patient might be using to obtain drugs, said James Saxton, chair of the healthcare liability and litigation practice group of the American Health Lawyers Association. From a medical liability perspective, "this is a disaster waiting to happen," he said.

More than 90 active investigations involving the diversion of pharmaceutical controlled substances over the Internet are underway, covering 537 Web sites, Ms. Tandy said. In the current fiscal year, the DEA has shut down 25 Internet pharmacy organizations and seized $3.3 million and 3.2 million dosage units. "Eleven million dollars is pending forfeiture," she said.

The Food and Drug Administration also has been investigating Internet pharmacies and referring cases for criminal prosecution and initiating civil enforcement actions against online sellers of drugs and other FDA-related products, John M. Taylor, FDA's associate commissioner for regulatory affairs, testified at the Senate hearing.

A number of state laws regulate the practice of pharmacy and medicine to protect patients from harm resulting from the use of unsafe drugs and the improper practice of medicine and pharmacy, Mr. Taylor said, adding that the statutes may not have enough teeth to efficiently regulate online pharmacies. In addition, many states have not yet fully determined how to address the issues that arise from online prescribing. As a result, the attempt to stop some physicians and online pharmacies from issuing prescriptions without an exam aren't always successful.

Other testimony before the Senate investigations panel addressed what Internet portals are doing to crack down on illegal Internet pharmacies.

Representatives from Yahoo! Inc. and Google Inc. described their efforts to ensure that their advertisers engage in best practices approved by the National Community Pharmacists Association. Both online providers use SquareTrade, an online trust infrastructure company that verifies that the online pharmacy and its pharmacist are appropriately licensed.

Yahoo! specifically prohibits online pharmacies from advertising FDA schedule II drugs, testified John Scheibel, Yahoo's vice president for public policy.

The DEA is also working with search engines and Internet service providers to warn consumers about dangerous drugs. "We have also established a link to the DEA's homepage to allow citizens to report suspicious Internet pharmacies," Ms. Tandy said.

For the law to fully catch up with the Internet, Congress should enact legislation that would set parameters for all of the states on how to legally administer these drugs online, suggested Rose Hager, a health care lawyer with Kathleen L. DeBruhl & Associates LLC in New Orleans.

Internet pharmacies will be around for some time, she said. "You won't be able to stop it."

Mr. Saxton agreed, but noted that a multimillion-dollar verdict against a Web site and its participants could have a chilling effect on this type of activity

Liability Risk Is Only a Click Away

Physicians caught in Internet prescribing activities that result in patient injury face a number of liability scenarios.

Those who prescribe over the Internet could be sued for malpractice "if you're prescribing medication for someone who [doesn't] need it," Ms. Hager told this newspaper.

Malpractice actions may also come up if a physician licensed in one state prescribes the wrong drug to a patient in another state, she said. The trick with these cases, however, is, "Where do you sue that physician? Normally you would sue in the state where the patient got hurt," but the seamless world of Internet prescribing makes it much harder to prosecute someone.

To settle the jurisdiction issue, lawyers in some states might begin suing physicians under a tort action, which relates to any action that harms someone else, she said. The argument would be, "You prescribed medication; you harmed my client," she said.

But if drugs are prescribed in another jurisdiction, the physician could conceivably be accused of practicing without a license, which in some states is the basis for a claim of punitive damages, she said.

Federal investigators are targeting physicians who help Internet sites sell drugs to buyers without legitimate prescriptions.

"The Internet has brought drug dealers from the back alleys directly into every American home wired for e-mail and the World Wide Web," Karen Tandy, administrator of the Drug Enforcement Administration, recently testified before the Senate Governmental Affairs Permanent Subcommittee on Investigations.

Such Web sites are heavily advertised through spam e-mail and on the Web, selling as much as $50 million annually per site in some cases, the DEA estimates.

Web sites, such as Medexplorer.comLegalMedsOnline.com

Physicians associated with such Web sites typically have a business relationship with a pharmacy and almost never have a valid doctor-patient relationship under accepted medical practices, Ms. Tandy said. "Acting together, the physician and pharmacist dispense controlled substances [to those] without a legitimate medical need, resulting in widespread self-medication over the Internet.

Often the physician will ask the patient only three or four questions before prescribing the drug, Michael Schaff, a lawyer specializing in health care and corporate law in Woodbridge, N.J., said in an interview. To Mr. Schaff, it's illogical how a physician could make a diagnosis without seeing the patient.

To date, Justice Department investigations have discovered 14 deaths or overdoses and 15 people who have entered addiction rehabilitation or sustained injuries from drugs obtained illegally over the Internet, Ms. Tandy said.

The Government Accountability Office, in its analysis of drugs from 68 Web sites around the world, found that some Internet pharmacies pose safety risks for consumers and have unreliable business practices. While some in the United States and Canada required the patient to provide a doctor's prescription, other sites provided prescriptions based on their own medical questionnaire or had no prescription requirement.

Doctors not involved in Internet pharmacies face another threat: They have no way to know how many Web sites a patient might be using to obtain drugs, said James Saxton, chair of the healthcare liability and litigation practice group of the American Health Lawyers Association. From a medical liability perspective, "this is a disaster waiting to happen," he said.

More than 90 active investigations involving the diversion of pharmaceutical controlled substances over the Internet are underway, covering 537 Web sites, Ms. Tandy said. In the current fiscal year, the DEA has shut down 25 Internet pharmacy organizations and seized $3.3 million and 3.2 million dosage units. "Eleven million dollars is pending forfeiture," she said.

The Food and Drug Administration also has been investigating Internet pharmacies and referring cases for criminal prosecution and initiating civil enforcement actions against online sellers of drugs and other FDA-related products, John M. Taylor, FDA's associate commissioner for regulatory affairs, testified at the Senate hearing.

A number of state laws regulate the practice of pharmacy and medicine to protect patients from harm resulting from the use of unsafe drugs and the improper practice of medicine and pharmacy, Mr. Taylor said, adding that the statutes may not have enough teeth to efficiently regulate online pharmacies. In addition, many states have not yet fully determined how to address the issues that arise from online prescribing. As a result, the attempt to stop some physicians and online pharmacies from issuing prescriptions without an exam aren't always successful.

Other testimony before the Senate investigations panel addressed what Internet portals are doing to crack down on illegal Internet pharmacies.

Representatives from Yahoo! Inc. and Google Inc. described their efforts to ensure that their advertisers engage in best practices approved by the National Community Pharmacists Association. Both online providers use SquareTrade, an online trust infrastructure company that verifies that the online pharmacy and its pharmacist are appropriately licensed.

Yahoo! specifically prohibits online pharmacies from advertising FDA schedule II drugs, testified John Scheibel, Yahoo's vice president for public policy.

The DEA is also working with search engines and Internet service providers to warn consumers about dangerous drugs. "We have also established a link to the DEA's homepage to allow citizens to report suspicious Internet pharmacies," Ms. Tandy said.

For the law to fully catch up with the Internet, Congress should enact legislation that would set parameters for all of the states on how to legally administer these drugs online, suggested Rose Hager, a health care lawyer with Kathleen L. DeBruhl & Associates LLC in New Orleans.

Internet pharmacies will be around for some time, she said. "You won't be able to stop it."

Mr. Saxton agreed, but noted that a multimillion-dollar verdict against a Web site and its participants could have a chilling effect on this type of activity

Liability Risk Is Only a Click Away

Physicians caught in Internet prescribing activities that result in patient injury face a number of liability scenarios.

Those who prescribe over the Internet could be sued for malpractice "if you're prescribing medication for someone who [doesn't] need it," Ms. Hager told this newspaper.

Malpractice actions may also come up if a physician licensed in one state prescribes the wrong drug to a patient in another state, she said. The trick with these cases, however, is, "Where do you sue that physician? Normally you would sue in the state where the patient got hurt," but the seamless world of Internet prescribing makes it much harder to prosecute someone.

To settle the jurisdiction issue, lawyers in some states might begin suing physicians under a tort action, which relates to any action that harms someone else, she said. The argument would be, "You prescribed medication; you harmed my client," she said.

But if drugs are prescribed in another jurisdiction, the physician could conceivably be accused of practicing without a license, which in some states is the basis for a claim of punitive damages, she said.