Jennifer Silverman

WASHINGTON — The Centers for Medicare and Medicaid Services should not institute the 4.3% decrease proposed in the 2006 physician fee schedule, a federal advisory panel recommended.

As it works to fix the sustainable growth rate, CMS should, instead, adopt the Medicare Payment Advisory Commission's recent recommendation to increase payments by 2.7% to keep pace with the cost of care, the Practicing Physicians Advisory Council recommended.

The council meets quarterly to advise the Department of Health and Human Services on proposed changes in Medicare regulations and carrier manual instructions related to physicians' services.

MedPAC advises Congress in a similar manner.

Physician reimbursements under Medicare will be cut 26% over the next 6 years unless the sustainable growth rate (SGR) formula is changed. Although the PPAC recommendation calls on CMS to take action, only Congress has the statutory authority to fix the formula.

The average physician facing these cuts "is stuck," Ronald Castellanos, M.D., PPAC chairman, told CMS officials who presented a summary of the proposed fee schedule at the meeting. Reduced Medicare payments have forced some physicians to do ancillary procedures in their offices to make up for the losses, he said.

Leroy Sprang, M.D., an ob.gyn. who was recently named to the panel, said he's seen at least a dozen ob.gyns. in his area of Evanston, Ill., leave the profession due to the pressures of medical malpractice combined with reduced Medicare payments. While they don't deal with older patients as much as do other primary care physicians, some ob.gyn. practices have stopped seeing Medicare patients, he said.

In another avenue for addressing low physician reimbursement, the PPAC asked CMS for a report on whether Medicare Part B drugs could be removed retrospectively, using an administrative methodology. The council asked that the report be ready in time for its December meeting.

"We've been talking about this for the past 2 years," said PPAC member Gregory Przybylski, M.D. The question is whether CMS could do this administratively by a certain date, he said.

Testifying before the panel, Ardis Hoven, M.D., who spoke on behalf of the American Medical Association, said the AMA was confident of CMS' authority to remove the drugs. "Drugs are not paid under the Medicare physician fee schedule, and it is illogical to include them in calculating the SGR," Dr. Hoven said in her testimony. If CMS adopted a revised definition of "physicians' services" that excludes drugs, it could revise its SGR calculations going back to 1996 using its revised definition, although the revisions would affect payment updates in future years, she said.

Leslie Norwalk, CMS deputy administrator, conceded that Congress needed to institute a more rational approach to physician payments.

Addressing other possible options, HHS' Office of Inspector General may take another look at "gainsharing," an arrangement where physicians could suggest ways to improve care, and receive a portion of the cost savings achieved when their ideas are implemented. "The OIG has permitted physicians to engage in this, but only with respect to supplies, not specifically to medical savings," Ms. Norwalk said.

Congress has looked at some ideas where physicians could share in hospital savings, for instance, "without it being a kickback violation," she told the panel.

CMS also has the ability to change payment systems statutorily through its practice group demonstration projects, Ms. Norwalk said. Several projects are currently testing pay-for-performance systems.

For the first time, Congress, MedPAC, CMS, PPAC, and all of the medical specialties are in agreement about something: that the SGR is flawed, Dr. Castellanos said. For that reason, "maybe something constructive can come out of this."

WASHINGTON — The Centers for Medicare and Medicaid Services should not institute the 4.3% decrease proposed in the 2006 physician fee schedule, a federal advisory panel recommended.

As it works to fix the sustainable growth rate, CMS should, instead, adopt the Medicare Payment Advisory Commission's recent recommendation to increase payments by 2.7% to keep pace with the cost of care, the Practicing Physicians Advisory Council recommended.

The council meets quarterly to advise the Department of Health and Human Services on proposed changes in Medicare regulations and carrier manual instructions related to physicians' services.

MedPAC advises Congress in a similar manner.

Physician reimbursements under Medicare will be cut 26% over the next 6 years unless the sustainable growth rate (SGR) formula is changed. Although the PPAC recommendation calls on CMS to take action, only Congress has the statutory authority to fix the formula.

The average physician facing these cuts "is stuck," Ronald Castellanos, M.D., PPAC chairman, told CMS officials who presented a summary of the proposed fee schedule at the meeting. Reduced Medicare payments have forced some physicians to do ancillary procedures in their offices to make up for the losses, he said.

Leroy Sprang, M.D., an ob.gyn. who was recently named to the panel, said he's seen at least a dozen ob.gyns. in his area of Evanston, Ill., leave the profession due to the pressures of medical malpractice combined with reduced Medicare payments. While they don't deal with older patients as much as do other primary care physicians, some ob.gyn. practices have stopped seeing Medicare patients, he said.

In another avenue for addressing low physician reimbursement, the PPAC asked CMS for a report on whether Medicare Part B drugs could be removed retrospectively, using an administrative methodology. The council asked that the report be ready in time for its December meeting.

"We've been talking about this for the past 2 years," said PPAC member Gregory Przybylski, M.D. The question is whether CMS could do this administratively by a certain date, he said.

Testifying before the panel, Ardis Hoven, M.D., who spoke on behalf of the American Medical Association, said the AMA was confident of CMS' authority to remove the drugs. "Drugs are not paid under the Medicare physician fee schedule, and it is illogical to include them in calculating the SGR," Dr. Hoven said in her testimony. If CMS adopted a revised definition of "physicians' services" that excludes drugs, it could revise its SGR calculations going back to 1996 using its revised definition, although the revisions would affect payment updates in future years, she said.

Leslie Norwalk, CMS deputy administrator, conceded that Congress needed to institute a more rational approach to physician payments.

Addressing other possible options, HHS' Office of Inspector General may take another look at "gainsharing," an arrangement where physicians could suggest ways to improve care, and receive a portion of the cost savings achieved when their ideas are implemented. "The OIG has permitted physicians to engage in this, but only with respect to supplies, not specifically to medical savings," Ms. Norwalk said.

Congress has looked at some ideas where physicians could share in hospital savings, for instance, "without it being a kickback violation," she told the panel.

CMS also has the ability to change payment systems statutorily through its practice group demonstration projects, Ms. Norwalk said. Several projects are currently testing pay-for-performance systems.

For the first time, Congress, MedPAC, CMS, PPAC, and all of the medical specialties are in agreement about something: that the SGR is flawed, Dr. Castellanos said. For that reason, "maybe something constructive can come out of this."

WASHINGTON — The Centers for Medicare and Medicaid Services should not institute the 4.3% decrease proposed in the 2006 physician fee schedule, a federal advisory panel recommended.

As it works to fix the sustainable growth rate, CMS should, instead, adopt the Medicare Payment Advisory Commission's recent recommendation to increase payments by 2.7% to keep pace with the cost of care, the Practicing Physicians Advisory Council recommended.

The council meets quarterly to advise the Department of Health and Human Services on proposed changes in Medicare regulations and carrier manual instructions related to physicians' services.

MedPAC advises Congress in a similar manner.

Physician reimbursements under Medicare will be cut 26% over the next 6 years unless the sustainable growth rate (SGR) formula is changed. Although the PPAC recommendation calls on CMS to take action, only Congress has the statutory authority to fix the formula.

The average physician facing these cuts "is stuck," Ronald Castellanos, M.D., PPAC chairman, told CMS officials who presented a summary of the proposed fee schedule at the meeting. Reduced Medicare payments have forced some physicians to do ancillary procedures in their offices to make up for the losses, he said.

Leroy Sprang, M.D., an ob.gyn. who was recently named to the panel, said he's seen at least a dozen ob.gyns. in his area of Evanston, Ill., leave the profession due to the pressures of medical malpractice combined with reduced Medicare payments. While they don't deal with older patients as much as do other primary care physicians, some ob.gyn. practices have stopped seeing Medicare patients, he said.

In another avenue for addressing low physician reimbursement, the PPAC asked CMS for a report on whether Medicare Part B drugs could be removed retrospectively, using an administrative methodology. The council asked that the report be ready in time for its December meeting.

"We've been talking about this for the past 2 years," said PPAC member Gregory Przybylski, M.D. The question is whether CMS could do this administratively by a certain date, he said.

Testifying before the panel, Ardis Hoven, M.D., who spoke on behalf of the American Medical Association, said the AMA was confident of CMS' authority to remove the drugs. "Drugs are not paid under the Medicare physician fee schedule, and it is illogical to include them in calculating the SGR," Dr. Hoven said in her testimony. If CMS adopted a revised definition of "physicians' services" that excludes drugs, it could revise its SGR calculations going back to 1996 using its revised definition, although the revisions would affect payment updates in future years, she said.

Leslie Norwalk, CMS deputy administrator, conceded that Congress needed to institute a more rational approach to physician payments.

Addressing other possible options, HHS' Office of Inspector General may take another look at "gainsharing," an arrangement where physicians could suggest ways to improve care, and receive a portion of the cost savings achieved when their ideas are implemented. "The OIG has permitted physicians to engage in this, but only with respect to supplies, not specifically to medical savings," Ms. Norwalk said.

Congress has looked at some ideas where physicians could share in hospital savings, for instance, "without it being a kickback violation," she told the panel.

CMS also has the ability to change payment systems statutorily through its practice group demonstration projects, Ms. Norwalk said. Several projects are currently testing pay-for-performance systems.

For the first time, Congress, MedPAC, CMS, PPAC, and all of the medical specialties are in agreement about something: that the SGR is flawed, Dr. Castellanos said. For that reason, "maybe something constructive can come out of this."

A new Medicare program to start next year will take some of the gamble—and administrative hassles—out of providing injectable drugs to patients.

The arrangement, known as the Medicare Competitive Acquisition Program for Part B Drugs and Biologicals, "provides an important alternative method of drug acquisition for rheumatologists and other physicians for whom the [current] payment methodology is burdensome and, in some cases, does not cover their acquisition costs for drugs," Joseph Flood, M.D., government affairs committee chair of the American College of Rheumatology (ACR), told this newspaper.

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

Given fluctuations in what distributors and manufacturers charge for the drugs, however, in some cases Medicare's reimbursement can fall short of what the drugs actually cost.

Physicians who elect to participate in the competitive acquisition program will obtain drugs from a preselected list of vendors, and these vendors will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. At this point, it's not clear how many vendors will be participating in the program, but all will have to meet certain quality, program integrity, financial stability, and service standards.

Once a year, physicians who provide health care for Medicare beneficiaries will have the option of electing to participate in the program and at that point select a vendor to be their primary drug source. All physician participants will continue to submit procedural claims to Medicare for the cost of administering the agents.

Having fewer administrative and financial burdens should free doctors "to focus more on providing treatments for their patients," Centers for Medicare and Medicaid Services (CMS) administrator Mark McClellan, M.D., said in a statement.

Taking physicians out of the drug administration's financial chain should help insulate them from price fluctuations that can occur under the current system, a CMS spokeswoman noted in an interview. While it's true that physicians may miss out on profits if acquisition costs from the supplier are less than the average sales price, physicians can also take a hit if the acquisition costs exceed that price, she explained.

Officials at ACR praised the fact that the competitive acquisition program wasn't created exclusively for oncologists. "All physicians participating in Medicare have the opportunity to participate" in this voluntary program, according to a statement from the law firm Patton Boggs L.L.P., the government affairs representative for the ACR.

Physicians who decide not to participate in the new program may continue to purchase drugs directly from the suppliers. "We support our members' right to choose the method of drug acquisition and payment that makes the most sense for their particular practice," Dr. Flood said.

The American Society of Clinical Oncology (ASCO) lobbied for the competitive bidding process to be available for all drugs, "and CMS went pretty far down that road" in order to meet that request, Joseph S. Bailes, M.D., cochair of the government relations council for ASCO, said in an interview.

One drawback of the program is that for vendors and CMS to have enough time to reconcile claims data—and thus for vendors to get paid—physicians have just 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. That quick turnaround time may prove to be too challenging for some rheumatology practices. Individual providers should seriously consider whether they have the staff resources to meet that deadline before enrolling in the program.

Noting that "14 days was too short a period of time" for practices to process the claims, Dr. Bailes said that ASCO and the ACR tried but failed to convince CMS to extend the deadline to 30 business days.

Another possible wrinkle, Dr. Bailes noted, may occur because vendors can elect not to ship a drug if the patient has not met some of the copay obligations. "This could raise a problem," he said.

Drug distributors themselves don't seem comfortable with the idea of collecting deductibles and coinsurance from the beneficiaries. "Distributors typically do not have direct patient contact," Scott Melville, senior vice president of government relations at the Healthcare Distribution Management Association, a trade group representing full-service drug distributors, wrote in comments on the proposed rule to the new bidding process.

Medicare beneficiaries may have difficulty keeping track of their coinsurance amounts, "and they may not be inclined to pay a vendor with whom they only have an impersonal business relationship," Mr. Melville cautioned.

The trade group did not comment directly upon the competitive acquisition program.

The interim rule creating the new program took effect in June, although CMS will be seeking additional comments until Sept. 6. The agency plans to receive bids from vendors later this summer and award contracts in early fall, in anticipation of starting the program in 2006.

For more information about the competitive acquisition program, go to www.cms.hhs.gov/providers/drugs/compbid

A new Medicare program to start next year will take some of the gamble—and administrative hassles—out of providing injectable drugs to patients.

The arrangement, known as the Medicare Competitive Acquisition Program for Part B Drugs and Biologicals, "provides an important alternative method of drug acquisition for rheumatologists and other physicians for whom the [current] payment methodology is burdensome and, in some cases, does not cover their acquisition costs for drugs," Joseph Flood, M.D., government affairs committee chair of the American College of Rheumatology (ACR), told this newspaper.

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

Given fluctuations in what distributors and manufacturers charge for the drugs, however, in some cases Medicare's reimbursement can fall short of what the drugs actually cost.

Physicians who elect to participate in the competitive acquisition program will obtain drugs from a preselected list of vendors, and these vendors will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. At this point, it's not clear how many vendors will be participating in the program, but all will have to meet certain quality, program integrity, financial stability, and service standards.

Once a year, physicians who provide health care for Medicare beneficiaries will have the option of electing to participate in the program and at that point select a vendor to be their primary drug source. All physician participants will continue to submit procedural claims to Medicare for the cost of administering the agents.

Having fewer administrative and financial burdens should free doctors "to focus more on providing treatments for their patients," Centers for Medicare and Medicaid Services (CMS) administrator Mark McClellan, M.D., said in a statement.

Taking physicians out of the drug administration's financial chain should help insulate them from price fluctuations that can occur under the current system, a CMS spokeswoman noted in an interview. While it's true that physicians may miss out on profits if acquisition costs from the supplier are less than the average sales price, physicians can also take a hit if the acquisition costs exceed that price, she explained.

Officials at ACR praised the fact that the competitive acquisition program wasn't created exclusively for oncologists. "All physicians participating in Medicare have the opportunity to participate" in this voluntary program, according to a statement from the law firm Patton Boggs L.L.P., the government affairs representative for the ACR.

Physicians who decide not to participate in the new program may continue to purchase drugs directly from the suppliers. "We support our members' right to choose the method of drug acquisition and payment that makes the most sense for their particular practice," Dr. Flood said.

The American Society of Clinical Oncology (ASCO) lobbied for the competitive bidding process to be available for all drugs, "and CMS went pretty far down that road" in order to meet that request, Joseph S. Bailes, M.D., cochair of the government relations council for ASCO, said in an interview.

One drawback of the program is that for vendors and CMS to have enough time to reconcile claims data—and thus for vendors to get paid—physicians have just 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. That quick turnaround time may prove to be too challenging for some rheumatology practices. Individual providers should seriously consider whether they have the staff resources to meet that deadline before enrolling in the program.

Noting that "14 days was too short a period of time" for practices to process the claims, Dr. Bailes said that ASCO and the ACR tried but failed to convince CMS to extend the deadline to 30 business days.

Another possible wrinkle, Dr. Bailes noted, may occur because vendors can elect not to ship a drug if the patient has not met some of the copay obligations. "This could raise a problem," he said.

Drug distributors themselves don't seem comfortable with the idea of collecting deductibles and coinsurance from the beneficiaries. "Distributors typically do not have direct patient contact," Scott Melville, senior vice president of government relations at the Healthcare Distribution Management Association, a trade group representing full-service drug distributors, wrote in comments on the proposed rule to the new bidding process.

Medicare beneficiaries may have difficulty keeping track of their coinsurance amounts, "and they may not be inclined to pay a vendor with whom they only have an impersonal business relationship," Mr. Melville cautioned.

The trade group did not comment directly upon the competitive acquisition program.

The interim rule creating the new program took effect in June, although CMS will be seeking additional comments until Sept. 6. The agency plans to receive bids from vendors later this summer and award contracts in early fall, in anticipation of starting the program in 2006.

For more information about the competitive acquisition program, go to www.cms.hhs.gov/providers/drugs/compbid

A new Medicare program to start next year will take some of the gamble—and administrative hassles—out of providing injectable drugs to patients.

The arrangement, known as the Medicare Competitive Acquisition Program for Part B Drugs and Biologicals, "provides an important alternative method of drug acquisition for rheumatologists and other physicians for whom the [current] payment methodology is burdensome and, in some cases, does not cover their acquisition costs for drugs," Joseph Flood, M.D., government affairs committee chair of the American College of Rheumatology (ACR), told this newspaper.

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

Given fluctuations in what distributors and manufacturers charge for the drugs, however, in some cases Medicare's reimbursement can fall short of what the drugs actually cost.

Physicians who elect to participate in the competitive acquisition program will obtain drugs from a preselected list of vendors, and these vendors will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. At this point, it's not clear how many vendors will be participating in the program, but all will have to meet certain quality, program integrity, financial stability, and service standards.

Once a year, physicians who provide health care for Medicare beneficiaries will have the option of electing to participate in the program and at that point select a vendor to be their primary drug source. All physician participants will continue to submit procedural claims to Medicare for the cost of administering the agents.

Having fewer administrative and financial burdens should free doctors "to focus more on providing treatments for their patients," Centers for Medicare and Medicaid Services (CMS) administrator Mark McClellan, M.D., said in a statement.

Taking physicians out of the drug administration's financial chain should help insulate them from price fluctuations that can occur under the current system, a CMS spokeswoman noted in an interview. While it's true that physicians may miss out on profits if acquisition costs from the supplier are less than the average sales price, physicians can also take a hit if the acquisition costs exceed that price, she explained.

Officials at ACR praised the fact that the competitive acquisition program wasn't created exclusively for oncologists. "All physicians participating in Medicare have the opportunity to participate" in this voluntary program, according to a statement from the law firm Patton Boggs L.L.P., the government affairs representative for the ACR.

Physicians who decide not to participate in the new program may continue to purchase drugs directly from the suppliers. "We support our members' right to choose the method of drug acquisition and payment that makes the most sense for their particular practice," Dr. Flood said.

The American Society of Clinical Oncology (ASCO) lobbied for the competitive bidding process to be available for all drugs, "and CMS went pretty far down that road" in order to meet that request, Joseph S. Bailes, M.D., cochair of the government relations council for ASCO, said in an interview.

One drawback of the program is that for vendors and CMS to have enough time to reconcile claims data—and thus for vendors to get paid—physicians have just 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. That quick turnaround time may prove to be too challenging for some rheumatology practices. Individual providers should seriously consider whether they have the staff resources to meet that deadline before enrolling in the program.

Noting that "14 days was too short a period of time" for practices to process the claims, Dr. Bailes said that ASCO and the ACR tried but failed to convince CMS to extend the deadline to 30 business days.

Another possible wrinkle, Dr. Bailes noted, may occur because vendors can elect not to ship a drug if the patient has not met some of the copay obligations. "This could raise a problem," he said.

Drug distributors themselves don't seem comfortable with the idea of collecting deductibles and coinsurance from the beneficiaries. "Distributors typically do not have direct patient contact," Scott Melville, senior vice president of government relations at the Healthcare Distribution Management Association, a trade group representing full-service drug distributors, wrote in comments on the proposed rule to the new bidding process.

Medicare beneficiaries may have difficulty keeping track of their coinsurance amounts, "and they may not be inclined to pay a vendor with whom they only have an impersonal business relationship," Mr. Melville cautioned.

The trade group did not comment directly upon the competitive acquisition program.

The interim rule creating the new program took effect in June, although CMS will be seeking additional comments until Sept. 6. The agency plans to receive bids from vendors later this summer and award contracts in early fall, in anticipation of starting the program in 2006.

For more information about the competitive acquisition program, go to www.cms.hhs.gov/providers/drugs/compbid

Any legislative approach to fixing Medicare's sustainable growth rate system "would be prohibitively expensive," according to House Ways and Means Chair Bill Thomas (R-Calif.).

Attaining a permanent fix is possible, however, provided that Congress and the Bush administration work on efforts to combine administrative and legislative actions, Rep. Thomas and Nancy L. Johnson (R-Conn.), health subcommittee chair, wrote in a letter to Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services.

The proposal is one of several ideas floating in Congress that seek to fix the Medicare physician fee schedule, as physicians face a looming 4.3% cut to their reimbursement in 2006. CMS actuaries project negative payment updates of minus 5% annually for 7 years, beginning in 2006, if the flawed sustainable growth rate (SGR) is not corrected.

CMS could do its part by removing prescription drug expenditures from the baseline of the SGR, something it should have the authority to do, the letter suggested. Because drugs aren't reimbursed under the fee schedule, it's illogical to include them in the expenditure total when calculating the schedule's update.

The agency should also account for the costs of new and expanded Medicare benefits, which are included in the SGR calculation, the letter stated.

On a legislative fix, Rep. Thomas wrote that "the time is ripe" to tie physician payments to quality performance. CMS demonstration projects on performance-based payments in Medicare "will provide us with the experience we need to design appropriate rewards for delivering quality care," he wrote.

At press time, Rep. Johnson was prepping to introduce a pay-for-performance bill that would repeal the SGR and base future updates for physician payments on the Medicare Economic Index (MEI).

At a recent hearing, Dr. McClellan informed Rep. Johnson that such a measure could come at a high cost: specifically, that MEI-based increases would be $183 billion over 10 years.

CMS in the meantime is working hard to remove Part B drugs from the formula, although the procedure "presents difficult legal issues that we haven't yet been able to solve." It also would not solve the entire problem, as positive updates would not take place for several years, regardless of whether CMS removed drugs prospectively or retrospectively, his testimony indicated.

Leaders on the Senate Finance Committee have since introduced a pay-for-performance bill, although it may not get the same kind of support from physician groups as the forthcoming Johnson bill.

Applying the notion that Medicare should attain better "value" for its money, the bill from Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.) proposes to link a small portion of physician Medicare payments to reporting of quality data and demonstrated progress against quality and efficiency measures. The measures would focus on health care processes, structures, outcomes, patient experience of care, efficiency, and use of health information technology.

Participation in the program would be voluntary. However, those choosing not to report quality data would receive a reduced payment update.

Unlike the Johnson proposal, however, the Senate bill fails to include a fix to the SGR, Mary Frank, M.D., president of the American Academy of Family Physicians, said in a statement. Instead, the legislation "attempts to improve the payment system to physicians without attempting to stem the declining Medicare reimbursement rate."

Physicians could face lower Medicare payments and additional costs under such requirements, Dr. Frank said. While it might increase doctors' costs in order to meet and report specific care standards, the bill "doesn't help them obtain the technology to do so," she said. Without the technology to participate in the bill's proposed reporting system, physicians' reimbursement will be cut even further, hindering their ability to afford the technology. "Sound like a vicious cycle? It is," she said.

The outcome is family physicians may be forced to close their doors to Medicare beneficiaries, Dr. Frank said.

In addition, "tons of implementation questions" aren't broached in this bill, Michele Johnson, senior governmental relations representative of the Medical Group Management Association, told this newspaper.

"Right now, there are no evidence-based, valid scientific measures of efficiency, unless you're talking about clinical measures," Ms. Johnson said. It's unclear how such measures would be developed under the legislation, and how people would physically report these quality measures.

In a summary of the bill, the authors explained that they didn't address the sustainable growth rate because they wanted to limit provisions to quality improvement, value-based purchasing, and health information technology. However, "sense of the Senate" language (nonbinding language that accompanied the bill) did acknowledge that the negative physician update needed to be addressed, based on the "unsustainable" nature of the SGR.

If any language from Grassley-Baucus is approved, "it will probably be inserted into 'end of the year must pass legislation,' along with an SGR fix," Ms. Johnson stated. Standing alone, the bill is too risky on the Senate floor because it would provide Democrats with the opportunity to reopen the Medicare Modernization Act.

"They could introduce amendments stating that the government could negotiate prices with the pharmaceutical companies. The Republicans don't want that," she said.

Any legislative approach to fixing Medicare's sustainable growth rate system "would be prohibitively expensive," according to House Ways and Means Chair Bill Thomas (R-Calif.).

Attaining a permanent fix is possible, however, provided that Congress and the Bush administration work on efforts to combine administrative and legislative actions, Rep. Thomas and Nancy L. Johnson (R-Conn.), health subcommittee chair, wrote in a letter to Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services.

The proposal is one of several ideas floating in Congress that seek to fix the Medicare physician fee schedule, as physicians face a looming 4.3% cut to their reimbursement in 2006. CMS actuaries project negative payment updates of minus 5% annually for 7 years, beginning in 2006, if the flawed sustainable growth rate (SGR) is not corrected.

CMS could do its part by removing prescription drug expenditures from the baseline of the SGR, something it should have the authority to do, the letter suggested. Because drugs aren't reimbursed under the fee schedule, it's illogical to include them in the expenditure total when calculating the schedule's update.

The agency should also account for the costs of new and expanded Medicare benefits, which are included in the SGR calculation, the letter stated.

On a legislative fix, Rep. Thomas wrote that "the time is ripe" to tie physician payments to quality performance. CMS demonstration projects on performance-based payments in Medicare "will provide us with the experience we need to design appropriate rewards for delivering quality care," he wrote.

At press time, Rep. Johnson was prepping to introduce a pay-for-performance bill that would repeal the SGR and base future updates for physician payments on the Medicare Economic Index (MEI).

At a recent hearing, Dr. McClellan informed Rep. Johnson that such a measure could come at a high cost: specifically, that MEI-based increases would be $183 billion over 10 years.

CMS in the meantime is working hard to remove Part B drugs from the formula, although the procedure "presents difficult legal issues that we haven't yet been able to solve." It also would not solve the entire problem, as positive updates would not take place for several years, regardless of whether CMS removed drugs prospectively or retrospectively, his testimony indicated.

Leaders on the Senate Finance Committee have since introduced a pay-for-performance bill, although it may not get the same kind of support from physician groups as the forthcoming Johnson bill.

Applying the notion that Medicare should attain better "value" for its money, the bill from Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.) proposes to link a small portion of physician Medicare payments to reporting of quality data and demonstrated progress against quality and efficiency measures. The measures would focus on health care processes, structures, outcomes, patient experience of care, efficiency, and use of health information technology.

Participation in the program would be voluntary. However, those choosing not to report quality data would receive a reduced payment update.

Unlike the Johnson proposal, however, the Senate bill fails to include a fix to the SGR, Mary Frank, M.D., president of the American Academy of Family Physicians, said in a statement. Instead, the legislation "attempts to improve the payment system to physicians without attempting to stem the declining Medicare reimbursement rate."

Physicians could face lower Medicare payments and additional costs under such requirements, Dr. Frank said. While it might increase doctors' costs in order to meet and report specific care standards, the bill "doesn't help them obtain the technology to do so," she said. Without the technology to participate in the bill's proposed reporting system, physicians' reimbursement will be cut even further, hindering their ability to afford the technology. "Sound like a vicious cycle? It is," she said.

The outcome is family physicians may be forced to close their doors to Medicare beneficiaries, Dr. Frank said.

In addition, "tons of implementation questions" aren't broached in this bill, Michele Johnson, senior governmental relations representative of the Medical Group Management Association, told this newspaper.

"Right now, there are no evidence-based, valid scientific measures of efficiency, unless you're talking about clinical measures," Ms. Johnson said. It's unclear how such measures would be developed under the legislation, and how people would physically report these quality measures.

In a summary of the bill, the authors explained that they didn't address the sustainable growth rate because they wanted to limit provisions to quality improvement, value-based purchasing, and health information technology. However, "sense of the Senate" language (nonbinding language that accompanied the bill) did acknowledge that the negative physician update needed to be addressed, based on the "unsustainable" nature of the SGR.

If any language from Grassley-Baucus is approved, "it will probably be inserted into 'end of the year must pass legislation,' along with an SGR fix," Ms. Johnson stated. Standing alone, the bill is too risky on the Senate floor because it would provide Democrats with the opportunity to reopen the Medicare Modernization Act.

"They could introduce amendments stating that the government could negotiate prices with the pharmaceutical companies. The Republicans don't want that," she said.

Any legislative approach to fixing Medicare's sustainable growth rate system "would be prohibitively expensive," according to House Ways and Means Chair Bill Thomas (R-Calif.).

Attaining a permanent fix is possible, however, provided that Congress and the Bush administration work on efforts to combine administrative and legislative actions, Rep. Thomas and Nancy L. Johnson (R-Conn.), health subcommittee chair, wrote in a letter to Mark McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services.

The proposal is one of several ideas floating in Congress that seek to fix the Medicare physician fee schedule, as physicians face a looming 4.3% cut to their reimbursement in 2006. CMS actuaries project negative payment updates of minus 5% annually for 7 years, beginning in 2006, if the flawed sustainable growth rate (SGR) is not corrected.

CMS could do its part by removing prescription drug expenditures from the baseline of the SGR, something it should have the authority to do, the letter suggested. Because drugs aren't reimbursed under the fee schedule, it's illogical to include them in the expenditure total when calculating the schedule's update.

The agency should also account for the costs of new and expanded Medicare benefits, which are included in the SGR calculation, the letter stated.

On a legislative fix, Rep. Thomas wrote that "the time is ripe" to tie physician payments to quality performance. CMS demonstration projects on performance-based payments in Medicare "will provide us with the experience we need to design appropriate rewards for delivering quality care," he wrote.

At press time, Rep. Johnson was prepping to introduce a pay-for-performance bill that would repeal the SGR and base future updates for physician payments on the Medicare Economic Index (MEI).

At a recent hearing, Dr. McClellan informed Rep. Johnson that such a measure could come at a high cost: specifically, that MEI-based increases would be $183 billion over 10 years.

CMS in the meantime is working hard to remove Part B drugs from the formula, although the procedure "presents difficult legal issues that we haven't yet been able to solve." It also would not solve the entire problem, as positive updates would not take place for several years, regardless of whether CMS removed drugs prospectively or retrospectively, his testimony indicated.

Leaders on the Senate Finance Committee have since introduced a pay-for-performance bill, although it may not get the same kind of support from physician groups as the forthcoming Johnson bill.

Applying the notion that Medicare should attain better "value" for its money, the bill from Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.) proposes to link a small portion of physician Medicare payments to reporting of quality data and demonstrated progress against quality and efficiency measures. The measures would focus on health care processes, structures, outcomes, patient experience of care, efficiency, and use of health information technology.

Participation in the program would be voluntary. However, those choosing not to report quality data would receive a reduced payment update.

Unlike the Johnson proposal, however, the Senate bill fails to include a fix to the SGR, Mary Frank, M.D., president of the American Academy of Family Physicians, said in a statement. Instead, the legislation "attempts to improve the payment system to physicians without attempting to stem the declining Medicare reimbursement rate."

Physicians could face lower Medicare payments and additional costs under such requirements, Dr. Frank said. While it might increase doctors' costs in order to meet and report specific care standards, the bill "doesn't help them obtain the technology to do so," she said. Without the technology to participate in the bill's proposed reporting system, physicians' reimbursement will be cut even further, hindering their ability to afford the technology. "Sound like a vicious cycle? It is," she said.

The outcome is family physicians may be forced to close their doors to Medicare beneficiaries, Dr. Frank said.

In addition, "tons of implementation questions" aren't broached in this bill, Michele Johnson, senior governmental relations representative of the Medical Group Management Association, told this newspaper.

"Right now, there are no evidence-based, valid scientific measures of efficiency, unless you're talking about clinical measures," Ms. Johnson said. It's unclear how such measures would be developed under the legislation, and how people would physically report these quality measures.

In a summary of the bill, the authors explained that they didn't address the sustainable growth rate because they wanted to limit provisions to quality improvement, value-based purchasing, and health information technology. However, "sense of the Senate" language (nonbinding language that accompanied the bill) did acknowledge that the negative physician update needed to be addressed, based on the "unsustainable" nature of the SGR.

If any language from Grassley-Baucus is approved, "it will probably be inserted into 'end of the year must pass legislation,' along with an SGR fix," Ms. Johnson stated. Standing alone, the bill is too risky on the Senate floor because it would provide Democrats with the opportunity to reopen the Medicare Modernization Act.

"They could introduce amendments stating that the government could negotiate prices with the pharmaceutical companies. The Republicans don't want that," she said.

Merck Loses First Vioxx Case

A jury in Texas last month awarded $253 million to the widow of a man who died after taking Vioxx (rofecoxib). The plaintiff charged that the drug maker Merck & Co. failed to warn physicians about the danger posed by Vioxx, that the drug was improperly designed, and that the company's negligence caused the death of the plaintiff's husband, Robert Ernst. Merck executives plan to appeal the verdict on the grounds that the jury was allowed to hear testimony that was both irrelevant and not based on reliable science, the company said. “While we are disappointed with the verdict, this decision should be put in its appropriate context,” Kenneth C. Frazier, Merck's senior vice president and general counsel, said in a statement. “This is the first of many trials. Each case has a different set of facts. Regardless of the outcome in this single case, the fact remains that plaintiffs have a significant legal burden in proving causation.” The award included $24 million in actual damages and $229 million in punitive damages. But the punitive damages could be reduced to about $2 million, according to Merck, since punitive damages are limited under Texas law.

Chronic Care Pilots

Medicare is launching chronic care pilot projects this year aimed at improving care for people with heart failure and diabetes. The program, called Medicare Health Support, will provide free, voluntary services to about 160,000 Medicare fee-for-service beneficiaries for 3 years. Participating patients will get access to nurse coaches; reminders about preventive care needs; prescription drug counseling; home visits and intensive care management, when needed; and home monitoring equipment to track health status. At press time, eight areas had been selected for the program: Maryland, Oklahoma, Western Pennsylvania, Mississippi, Northwest Georgia, Chicago, Central Florida, and the District of Columbia. “Because early intervention is tremendously important in treating chronic illnesses, we are providing beneficiaries additional tools to help them manage their health more effectively and avoid preventable complications,” Health and Human Services Secretary Mike Leavitt said in a statement.

Uninsured Demographics

Although they make up only 15% of the U.S. population, Hispanics comprise nearly 29% of the uninsured in that population, according to the 2004 Medical Expenditure Panel Survey (MEPS) findings from the Agency for Healthcare Research and Quality. More than one in three Hispanics is uninsured, and 25% are covered by public health insurance. In addition, Hispanics constitute 36% of all uninsured children under 18. “These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics,” said AHRQ Director Carolyn M. Clancy, M.D. In other findings, white non-Hispanics made up 65% of the U.S. population and almost 50% of the uninsured. About one in seven whites was uninsured, and 10% had only public insurance. Black non-Hispanics made up almost 13% of the population and almost 15% of the uninsured. Young adults aged 19–24 years were at greatest risk of being uninsured, with 35% having no insurance coverage for the first part of 2004. The report noted the lack of coverage was worst for young Hispanic adults, with 56% uninsured.

When the Price Isn't Right

Brand name pharmaceutical prices continue to increase, far exceeding the rate of general inflation in 2005, according to an AARP “Rx Watchdog Report.” More than one-half of the drugs in the sample, 110 of 195, had increases in manufacturer price during the period from Dec. 31, 2004, through March 31, 2005. Taking into account price increases in recent years, the report estimated that a typical older American (who takes three prescription drugs) is likely to have experienced an increase, on average, in the cost of therapy from the year 2000 through March 31, 2005, of $866.16 if the drugs are brand name products used to treat chronic conditions and the full price increases were passed along to the consumer. “We are very disappointed that brand name manufacturers have failed to keep their price increases in line with inflation,” said AARP's CEO William Novelli, who promised to educate older consumers on how best to find affordable drugs that suit their needs.

Meth Crisis Continues

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the past year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” Valerie Brown, chair of the association's membership committee, said in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed to combat the methamphetamine epidemic.”

Merck Loses First Vioxx Case

A jury in Texas last month awarded $253 million to the widow of a man who died after taking Vioxx (rofecoxib). The plaintiff charged that the drug maker Merck & Co. failed to warn physicians about the danger posed by Vioxx, that the drug was improperly designed, and that the company's negligence caused the death of the plaintiff's husband, Robert Ernst. Merck executives plan to appeal the verdict on the grounds that the jury was allowed to hear testimony that was both irrelevant and not based on reliable science, the company said. “While we are disappointed with the verdict, this decision should be put in its appropriate context,” Kenneth C. Frazier, Merck's senior vice president and general counsel, said in a statement. “This is the first of many trials. Each case has a different set of facts. Regardless of the outcome in this single case, the fact remains that plaintiffs have a significant legal burden in proving causation.” The award included $24 million in actual damages and $229 million in punitive damages. But the punitive damages could be reduced to about $2 million, according to Merck, since punitive damages are limited under Texas law.

Chronic Care Pilots

Medicare is launching chronic care pilot projects this year aimed at improving care for people with heart failure and diabetes. The program, called Medicare Health Support, will provide free, voluntary services to about 160,000 Medicare fee-for-service beneficiaries for 3 years. Participating patients will get access to nurse coaches; reminders about preventive care needs; prescription drug counseling; home visits and intensive care management, when needed; and home monitoring equipment to track health status. At press time, eight areas had been selected for the program: Maryland, Oklahoma, Western Pennsylvania, Mississippi, Northwest Georgia, Chicago, Central Florida, and the District of Columbia. “Because early intervention is tremendously important in treating chronic illnesses, we are providing beneficiaries additional tools to help them manage their health more effectively and avoid preventable complications,” Health and Human Services Secretary Mike Leavitt said in a statement.

Uninsured Demographics

Although they make up only 15% of the U.S. population, Hispanics comprise nearly 29% of the uninsured in that population, according to the 2004 Medical Expenditure Panel Survey (MEPS) findings from the Agency for Healthcare Research and Quality. More than one in three Hispanics is uninsured, and 25% are covered by public health insurance. In addition, Hispanics constitute 36% of all uninsured children under 18. “These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics,” said AHRQ Director Carolyn M. Clancy, M.D. In other findings, white non-Hispanics made up 65% of the U.S. population and almost 50% of the uninsured. About one in seven whites was uninsured, and 10% had only public insurance. Black non-Hispanics made up almost 13% of the population and almost 15% of the uninsured. Young adults aged 19–24 years were at greatest risk of being uninsured, with 35% having no insurance coverage for the first part of 2004. The report noted the lack of coverage was worst for young Hispanic adults, with 56% uninsured.

When the Price Isn't Right

Brand name pharmaceutical prices continue to increase, far exceeding the rate of general inflation in 2005, according to an AARP “Rx Watchdog Report.” More than one-half of the drugs in the sample, 110 of 195, had increases in manufacturer price during the period from Dec. 31, 2004, through March 31, 2005. Taking into account price increases in recent years, the report estimated that a typical older American (who takes three prescription drugs) is likely to have experienced an increase, on average, in the cost of therapy from the year 2000 through March 31, 2005, of $866.16 if the drugs are brand name products used to treat chronic conditions and the full price increases were passed along to the consumer. “We are very disappointed that brand name manufacturers have failed to keep their price increases in line with inflation,” said AARP's CEO William Novelli, who promised to educate older consumers on how best to find affordable drugs that suit their needs.

Meth Crisis Continues

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the past year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” Valerie Brown, chair of the association's membership committee, said in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed to combat the methamphetamine epidemic.”

Merck Loses First Vioxx Case

A jury in Texas last month awarded $253 million to the widow of a man who died after taking Vioxx (rofecoxib). The plaintiff charged that the drug maker Merck & Co. failed to warn physicians about the danger posed by Vioxx, that the drug was improperly designed, and that the company's negligence caused the death of the plaintiff's husband, Robert Ernst. Merck executives plan to appeal the verdict on the grounds that the jury was allowed to hear testimony that was both irrelevant and not based on reliable science, the company said. “While we are disappointed with the verdict, this decision should be put in its appropriate context,” Kenneth C. Frazier, Merck's senior vice president and general counsel, said in a statement. “This is the first of many trials. Each case has a different set of facts. Regardless of the outcome in this single case, the fact remains that plaintiffs have a significant legal burden in proving causation.” The award included $24 million in actual damages and $229 million in punitive damages. But the punitive damages could be reduced to about $2 million, according to Merck, since punitive damages are limited under Texas law.

Chronic Care Pilots

Medicare is launching chronic care pilot projects this year aimed at improving care for people with heart failure and diabetes. The program, called Medicare Health Support, will provide free, voluntary services to about 160,000 Medicare fee-for-service beneficiaries for 3 years. Participating patients will get access to nurse coaches; reminders about preventive care needs; prescription drug counseling; home visits and intensive care management, when needed; and home monitoring equipment to track health status. At press time, eight areas had been selected for the program: Maryland, Oklahoma, Western Pennsylvania, Mississippi, Northwest Georgia, Chicago, Central Florida, and the District of Columbia. “Because early intervention is tremendously important in treating chronic illnesses, we are providing beneficiaries additional tools to help them manage their health more effectively and avoid preventable complications,” Health and Human Services Secretary Mike Leavitt said in a statement.

Uninsured Demographics

Although they make up only 15% of the U.S. population, Hispanics comprise nearly 29% of the uninsured in that population, according to the 2004 Medical Expenditure Panel Survey (MEPS) findings from the Agency for Healthcare Research and Quality. More than one in three Hispanics is uninsured, and 25% are covered by public health insurance. In addition, Hispanics constitute 36% of all uninsured children under 18. “These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics,” said AHRQ Director Carolyn M. Clancy, M.D. In other findings, white non-Hispanics made up 65% of the U.S. population and almost 50% of the uninsured. About one in seven whites was uninsured, and 10% had only public insurance. Black non-Hispanics made up almost 13% of the population and almost 15% of the uninsured. Young adults aged 19–24 years were at greatest risk of being uninsured, with 35% having no insurance coverage for the first part of 2004. The report noted the lack of coverage was worst for young Hispanic adults, with 56% uninsured.

When the Price Isn't Right

Brand name pharmaceutical prices continue to increase, far exceeding the rate of general inflation in 2005, according to an AARP “Rx Watchdog Report.” More than one-half of the drugs in the sample, 110 of 195, had increases in manufacturer price during the period from Dec. 31, 2004, through March 31, 2005. Taking into account price increases in recent years, the report estimated that a typical older American (who takes three prescription drugs) is likely to have experienced an increase, on average, in the cost of therapy from the year 2000 through March 31, 2005, of $866.16 if the drugs are brand name products used to treat chronic conditions and the full price increases were passed along to the consumer. “We are very disappointed that brand name manufacturers have failed to keep their price increases in line with inflation,” said AARP's CEO William Novelli, who promised to educate older consumers on how best to find affordable drugs that suit their needs.

Meth Crisis Continues

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the past year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” Valerie Brown, chair of the association's membership committee, said in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed to combat the methamphetamine epidemic.”

A new Medicare program to start next year will take some of the gamble—and administrative hassles—out of providing injectable drugs to patients.

The arrangement, known as the Medicare Competitive Acquisition Program for Part B Drugs and Biologicals, “provides an important alternative method of drug acquisition for rheumatologists and other physicians for whom the [current] payment methodology is burdensome and, in some cases, does not cover their acquisition costs for drugs,” Joseph Flood, M.D., government affairs committee chair of the American College of Rheumatology (ACR), told this newspaper.

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

Given fluctuations in what distributors and manufacturers charge for the drugs, however, in some cases Medicare's reimbursement can fall short of what the drugs actually cost.

Physicians who elect to participate in the competitive acquisition program will obtain drugs from a preselected list of vendors, and these vendors will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. At this point, it's not clear how many vendors will be participating in the program, but all will have to meet certain quality, program integrity, financial stability, and service standards.

Once a year, physicians who provide health care for Medicare beneficiaries will have the option of electing to participate in the program and at that point select a vendor to be their primary drug source. All physician participants will continue to submit procedural claims to Medicare for the cost of administering the agents. (For a list of the rheumatology-associated drugs included under the program, see box.)

Having fewer administrative and financial burdens should free doctors “to focus more on providing treatments for their patients,” Centers for Medicare and Medicaid Services (CMS) administrator Mark McClellan, M.D., said in a statement.

Taking physicians out of the drug administration's financial chain should help insulate them from price fluctuations that can occur under the current system, a CMS spokeswoman noted in an interview. While it's true that physicians may miss out on profits if acquisition costs from the supplier are less than the average sales price, physicians can also take a hit if the acquisition costs exceed that price, she explained.

Officials at ACR praised the fact that the competitive acquisition program wasn't created exclusively for oncologists. “All physicians participating in Medicare have the opportunity to participate” in this voluntary program, according to a statement from the law firm Patton Boggs L.L.P., the government affairs representative for the ACR.

Physicians who decide not to participate in the new program may continue to purchase drugs directly from the suppliers. “We support our members' right to choose the method of drug acquisition and payment that makes the most sense for their particular practice,” Dr. Flood said.

The American Society of Clinical Oncology (ASCO) lobbied for the competitive bidding process to be available for all drugs, “and CMS went pretty far down that road” to meet that request, Joseph S. Bailes, M.D., cochair of the government relations council for ASCO, said in an interview.

One drawback of the program is that for vendors and CMS to have enough time to reconcile claims data—and thus for vendors to get paid—physicians have just 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. That quick turnaround time may prove to be too challenging for some physician practices. Individual providers should seriously consider whether they have the staff resources to meet that deadline before enrolling in the program.

Noting that “14 days was too short a period of time” for practices to process the claims, Dr. Bailes said that ASCO and the ACR tried but failed to convince CMS to extend the deadline to 30 business days.

Another possible wrinkle, Dr. Bailes noted, may occur because vendors can elect not to ship a drug if the patient has not met some of the copay obligations. “This could raise a problem,” he said.

Drug distributors themselves don't seem comfortable with the idea of collecting deductibles and coinsurance from the beneficiaries. “Distributors typically do not have direct patient contact,” Scott Melville, senior vice president of government relations at the Healthcare Distribution Management Association, a trade group representing full-service drug distributors, wrote in comments on the proposed rule to the new bidding process.

Medicare beneficiaries may have difficulty keeping track of their coinsurance amounts, “and they may not be inclined to pay a vendor with whom they only have an impersonal business relationship,” Mr. Melville cautioned.

The trade group did not make any comments directly on the competitive acquisition program.

The interim rule creating the new program took effect in June, although CMS will be seeking additional comments until Sept. 6. The agency plans to receive bids from vendors later this summer and award contracts in early fall, in anticipation of starting the program in 2006.

For more information about the competitive acquisition program, go to www.cms.hhs.gov/providers/drugs/compbid

A Look at the Covered Drugs

More than 180 drugs billed incident to a physician's service and paid for under Part B of Medicare will be part of the competitive acquisition program. These agents account for 85% of all Medicare spending on physician-injectable drugs and include agents commonly administered by rheumatologists, such as:

▸ Cyclophosphamide (both lyophilized and nonlyophilized).

▸ Hylan G-F 20 (for intraarticular injection).

▸ Infliximab (injection).

▸ Methylprednisolone acetate (injection).

▸ Methylprednisolone sodium succinate (injection).

The new program will not apply to drugs included in the new prescription drug benefit under Medicare Part D, nor will it apply to drugs that are self-administered by the patient through a device such as a nebulizer or to certain other drugs, such as intravenous immunoglobulin, immunosuppressants, and hemophilia blood-clotting factor.

A new Medicare program to start next year will take some of the gamble—and administrative hassles—out of providing injectable drugs to patients.

The arrangement, known as the Medicare Competitive Acquisition Program for Part B Drugs and Biologicals, “provides an important alternative method of drug acquisition for rheumatologists and other physicians for whom the [current] payment methodology is burdensome and, in some cases, does not cover their acquisition costs for drugs,” Joseph Flood, M.D., government affairs committee chair of the American College of Rheumatology (ACR), told this newspaper.

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

Given fluctuations in what distributors and manufacturers charge for the drugs, however, in some cases Medicare's reimbursement can fall short of what the drugs actually cost.

Physicians who elect to participate in the competitive acquisition program will obtain drugs from a preselected list of vendors, and these vendors will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. At this point, it's not clear how many vendors will be participating in the program, but all will have to meet certain quality, program integrity, financial stability, and service standards.

Once a year, physicians who provide health care for Medicare beneficiaries will have the option of electing to participate in the program and at that point select a vendor to be their primary drug source. All physician participants will continue to submit procedural claims to Medicare for the cost of administering the agents. (For a list of the rheumatology-associated drugs included under the program, see box.)

Having fewer administrative and financial burdens should free doctors “to focus more on providing treatments for their patients,” Centers for Medicare and Medicaid Services (CMS) administrator Mark McClellan, M.D., said in a statement.

Taking physicians out of the drug administration's financial chain should help insulate them from price fluctuations that can occur under the current system, a CMS spokeswoman noted in an interview. While it's true that physicians may miss out on profits if acquisition costs from the supplier are less than the average sales price, physicians can also take a hit if the acquisition costs exceed that price, she explained.

Officials at ACR praised the fact that the competitive acquisition program wasn't created exclusively for oncologists. “All physicians participating in Medicare have the opportunity to participate” in this voluntary program, according to a statement from the law firm Patton Boggs L.L.P., the government affairs representative for the ACR.

Physicians who decide not to participate in the new program may continue to purchase drugs directly from the suppliers. “We support our members' right to choose the method of drug acquisition and payment that makes the most sense for their particular practice,” Dr. Flood said.

The American Society of Clinical Oncology (ASCO) lobbied for the competitive bidding process to be available for all drugs, “and CMS went pretty far down that road” to meet that request, Joseph S. Bailes, M.D., cochair of the government relations council for ASCO, said in an interview.

One drawback of the program is that for vendors and CMS to have enough time to reconcile claims data—and thus for vendors to get paid—physicians have just 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. That quick turnaround time may prove to be too challenging for some physician practices. Individual providers should seriously consider whether they have the staff resources to meet that deadline before enrolling in the program.

Noting that “14 days was too short a period of time” for practices to process the claims, Dr. Bailes said that ASCO and the ACR tried but failed to convince CMS to extend the deadline to 30 business days.

Another possible wrinkle, Dr. Bailes noted, may occur because vendors can elect not to ship a drug if the patient has not met some of the copay obligations. “This could raise a problem,” he said.

Drug distributors themselves don't seem comfortable with the idea of collecting deductibles and coinsurance from the beneficiaries. “Distributors typically do not have direct patient contact,” Scott Melville, senior vice president of government relations at the Healthcare Distribution Management Association, a trade group representing full-service drug distributors, wrote in comments on the proposed rule to the new bidding process.

Medicare beneficiaries may have difficulty keeping track of their coinsurance amounts, “and they may not be inclined to pay a vendor with whom they only have an impersonal business relationship,” Mr. Melville cautioned.

The trade group did not make any comments directly on the competitive acquisition program.

The interim rule creating the new program took effect in June, although CMS will be seeking additional comments until Sept. 6. The agency plans to receive bids from vendors later this summer and award contracts in early fall, in anticipation of starting the program in 2006.

For more information about the competitive acquisition program, go to www.cms.hhs.gov/providers/drugs/compbid

A Look at the Covered Drugs

More than 180 drugs billed incident to a physician's service and paid for under Part B of Medicare will be part of the competitive acquisition program. These agents account for 85% of all Medicare spending on physician-injectable drugs and include agents commonly administered by rheumatologists, such as:

▸ Cyclophosphamide (both lyophilized and nonlyophilized).

▸ Hylan G-F 20 (for intraarticular injection).

▸ Infliximab (injection).

▸ Methylprednisolone acetate (injection).

▸ Methylprednisolone sodium succinate (injection).

The new program will not apply to drugs included in the new prescription drug benefit under Medicare Part D, nor will it apply to drugs that are self-administered by the patient through a device such as a nebulizer or to certain other drugs, such as intravenous immunoglobulin, immunosuppressants, and hemophilia blood-clotting factor.

A new Medicare program to start next year will take some of the gamble—and administrative hassles—out of providing injectable drugs to patients.

The arrangement, known as the Medicare Competitive Acquisition Program for Part B Drugs and Biologicals, “provides an important alternative method of drug acquisition for rheumatologists and other physicians for whom the [current] payment methodology is burdensome and, in some cases, does not cover their acquisition costs for drugs,” Joseph Flood, M.D., government affairs committee chair of the American College of Rheumatology (ACR), told this newspaper.

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

Given fluctuations in what distributors and manufacturers charge for the drugs, however, in some cases Medicare's reimbursement can fall short of what the drugs actually cost.

Physicians who elect to participate in the competitive acquisition program will obtain drugs from a preselected list of vendors, and these vendors will take on the responsibility of billing Medicare for the drugs and collecting coinsurance or deductibles from patients. At this point, it's not clear how many vendors will be participating in the program, but all will have to meet certain quality, program integrity, financial stability, and service standards.

Once a year, physicians who provide health care for Medicare beneficiaries will have the option of electing to participate in the program and at that point select a vendor to be their primary drug source. All physician participants will continue to submit procedural claims to Medicare for the cost of administering the agents. (For a list of the rheumatology-associated drugs included under the program, see box.)

Having fewer administrative and financial burdens should free doctors “to focus more on providing treatments for their patients,” Centers for Medicare and Medicaid Services (CMS) administrator Mark McClellan, M.D., said in a statement.

Taking physicians out of the drug administration's financial chain should help insulate them from price fluctuations that can occur under the current system, a CMS spokeswoman noted in an interview. While it's true that physicians may miss out on profits if acquisition costs from the supplier are less than the average sales price, physicians can also take a hit if the acquisition costs exceed that price, she explained.

Officials at ACR praised the fact that the competitive acquisition program wasn't created exclusively for oncologists. “All physicians participating in Medicare have the opportunity to participate” in this voluntary program, according to a statement from the law firm Patton Boggs L.L.P., the government affairs representative for the ACR.

Physicians who decide not to participate in the new program may continue to purchase drugs directly from the suppliers. “We support our members' right to choose the method of drug acquisition and payment that makes the most sense for their particular practice,” Dr. Flood said.

The American Society of Clinical Oncology (ASCO) lobbied for the competitive bidding process to be available for all drugs, “and CMS went pretty far down that road” to meet that request, Joseph S. Bailes, M.D., cochair of the government relations council for ASCO, said in an interview.

One drawback of the program is that for vendors and CMS to have enough time to reconcile claims data—and thus for vendors to get paid—physicians have just 14 days to submit to Medicare carriers procedural claims, including all necessary codes, for the administration of the drugs. That quick turnaround time may prove to be too challenging for some physician practices. Individual providers should seriously consider whether they have the staff resources to meet that deadline before enrolling in the program.

Noting that “14 days was too short a period of time” for practices to process the claims, Dr. Bailes said that ASCO and the ACR tried but failed to convince CMS to extend the deadline to 30 business days.

Another possible wrinkle, Dr. Bailes noted, may occur because vendors can elect not to ship a drug if the patient has not met some of the copay obligations. “This could raise a problem,” he said.

Drug distributors themselves don't seem comfortable with the idea of collecting deductibles and coinsurance from the beneficiaries. “Distributors typically do not have direct patient contact,” Scott Melville, senior vice president of government relations at the Healthcare Distribution Management Association, a trade group representing full-service drug distributors, wrote in comments on the proposed rule to the new bidding process.

Medicare beneficiaries may have difficulty keeping track of their coinsurance amounts, “and they may not be inclined to pay a vendor with whom they only have an impersonal business relationship,” Mr. Melville cautioned.

The trade group did not make any comments directly on the competitive acquisition program.

The interim rule creating the new program took effect in June, although CMS will be seeking additional comments until Sept. 6. The agency plans to receive bids from vendors later this summer and award contracts in early fall, in anticipation of starting the program in 2006.

For more information about the competitive acquisition program, go to www.cms.hhs.gov/providers/drugs/compbid

A Look at the Covered Drugs

More than 180 drugs billed incident to a physician's service and paid for under Part B of Medicare will be part of the competitive acquisition program. These agents account for 85% of all Medicare spending on physician-injectable drugs and include agents commonly administered by rheumatologists, such as:

▸ Cyclophosphamide (both lyophilized and nonlyophilized).

▸ Hylan G-F 20 (for intraarticular injection).

▸ Infliximab (injection).

▸ Methylprednisolone acetate (injection).

▸ Methylprednisolone sodium succinate (injection).

The new program will not apply to drugs included in the new prescription drug benefit under Medicare Part D, nor will it apply to drugs that are self-administered by the patient through a device such as a nebulizer or to certain other drugs, such as intravenous immunoglobulin, immunosuppressants, and hemophilia blood-clotting factor.

Merck Loses First Vioxx Lawsuit

A jury in Texas last month awarded $253 million to the widow of a man who died after taking Vioxx (rofecoxib). The plaintiff charged that the drug maker Merck & Co. failed to warn physicians about the danger posed by Vioxx, that the drug was improperly designed, and that the company's negligence caused the death of the plaintiff's husband, Robert Ernst. Merck executives plan to appeal the verdict on the grounds that the jury was allowed to hear testimony that was both irrelevant and not based on reliable science, the company said. “While we are disappointed with the verdict, this decision should be put in its appropriate context,” Kenneth C. Frazier, Merck's senior vice president and general counsel, said in a statement. “This is the first of many trials. Each case has a different set of facts. Regardless of the outcome in this single case, the fact remains that plaintiffs have a significant legal burden in proving causation.” The award included $24 million in actual damages and $229 million in punitive damages. But the punitive damages could be reduced to about $2 million, according to Merck, since punitive damages are limited under Texas law.

Chronic Care Pilot Projects

Medicare is launching chronic care pilot projects this year aimed at improving care for people with heart failure and diabetes. The program, called Medicare Health Support, will provide free, voluntary services to about 160,000 Medicare fee-for-service beneficiaries for 3 years. Participating patients will get access to nurse coaches; reminders about preventive care needs; prescription drug counseling; home visits and intensive care management, when needed; and home monitoring equipment to track health status. At press time, eight areas had been selected for the program: Maryland, Oklahoma, Western Pennsylvania, Mississippi, Northwest Georgia, Chicago, Central Florida, and the District of Columbia. “Because early intervention is tremendously important in treating chronic illnesses, we are providing beneficiaries additional tools to help them manage their health more effectively and avoid preventable complications,” Health and Human Services Secretary Mike Leavitt said in a statement.

Demographics of Uninsured

Although they make up only 15% of the U.S. population, Hispanics comprise nearly 29% of the uninsured in that population, according to the 2004 Medical Expenditure Panel Survey (MEPS) findings from the Agency for Healthcare Research and Quality. More than one in three Hispanics is uninsured, and 25% are covered by public health insurance. In addition, Hispanics constitute 36% of all uninsured children under 18. “These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics,” said AHRQ Director Carolyn M. Clancy, M.D. In other findings, white non-Hispanics made up 65% of the U.S. population and almost 50% of the uninsured. About one in seven whites was uninsured, and 10% had only public insurance. Black non-Hispanics made up almost 13% of the population and almost 15% of the uninsured. Young adults aged 19–24 were at greatest risk of being uninsured, with 35% having no insurance coverage for the first part of 2004. The report noted the lack of coverage was worst for young Hispanic adults, with 56% uninsured.

When the Price Isn't Right

Brand name pharmaceutical prices continue to increase, far exceeding the rate of general inflation in 2005, according to an AARP “Rx Watchdog Report.” More than one-half of the drugs in the sample, 110 of 195, had increases in manufacturer price during the period from Dec. 31, 2004, through March 31, 2005. Taking into account price increases in recent years, the report estimated that a typical older American (who takes three prescription drugs) is likely to have experienced an increase, on average, in the cost of therapy from the year 2000 through March 31, 2005, of $866.16 if the drugs are brand name products used to treat chronic conditions and the full price increases were passed along to the consumer. “We are very disappointed that brand name manufacturers have failed to keep their price increases in line with inflation,” said AARP's CEO William Novelli, who promised to educate older consumers on how best to find affordable drugs that suit their needs.

Methamphetamine Crisis

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the past year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” Valerie Brown, chair of the association's membership committee, said in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed to combat the methamphetamine epidemic.”

Merck Loses First Vioxx Lawsuit

A jury in Texas last month awarded $253 million to the widow of a man who died after taking Vioxx (rofecoxib). The plaintiff charged that the drug maker Merck & Co. failed to warn physicians about the danger posed by Vioxx, that the drug was improperly designed, and that the company's negligence caused the death of the plaintiff's husband, Robert Ernst. Merck executives plan to appeal the verdict on the grounds that the jury was allowed to hear testimony that was both irrelevant and not based on reliable science, the company said. “While we are disappointed with the verdict, this decision should be put in its appropriate context,” Kenneth C. Frazier, Merck's senior vice president and general counsel, said in a statement. “This is the first of many trials. Each case has a different set of facts. Regardless of the outcome in this single case, the fact remains that plaintiffs have a significant legal burden in proving causation.” The award included $24 million in actual damages and $229 million in punitive damages. But the punitive damages could be reduced to about $2 million, according to Merck, since punitive damages are limited under Texas law.

Chronic Care Pilot Projects

Medicare is launching chronic care pilot projects this year aimed at improving care for people with heart failure and diabetes. The program, called Medicare Health Support, will provide free, voluntary services to about 160,000 Medicare fee-for-service beneficiaries for 3 years. Participating patients will get access to nurse coaches; reminders about preventive care needs; prescription drug counseling; home visits and intensive care management, when needed; and home monitoring equipment to track health status. At press time, eight areas had been selected for the program: Maryland, Oklahoma, Western Pennsylvania, Mississippi, Northwest Georgia, Chicago, Central Florida, and the District of Columbia. “Because early intervention is tremendously important in treating chronic illnesses, we are providing beneficiaries additional tools to help them manage their health more effectively and avoid preventable complications,” Health and Human Services Secretary Mike Leavitt said in a statement.

Demographics of Uninsured

Although they make up only 15% of the U.S. population, Hispanics comprise nearly 29% of the uninsured in that population, according to the 2004 Medical Expenditure Panel Survey (MEPS) findings from the Agency for Healthcare Research and Quality. More than one in three Hispanics is uninsured, and 25% are covered by public health insurance. In addition, Hispanics constitute 36% of all uninsured children under 18. “These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics,” said AHRQ Director Carolyn M. Clancy, M.D. In other findings, white non-Hispanics made up 65% of the U.S. population and almost 50% of the uninsured. About one in seven whites was uninsured, and 10% had only public insurance. Black non-Hispanics made up almost 13% of the population and almost 15% of the uninsured. Young adults aged 19–24 were at greatest risk of being uninsured, with 35% having no insurance coverage for the first part of 2004. The report noted the lack of coverage was worst for young Hispanic adults, with 56% uninsured.

When the Price Isn't Right

Brand name pharmaceutical prices continue to increase, far exceeding the rate of general inflation in 2005, according to an AARP “Rx Watchdog Report.” More than one-half of the drugs in the sample, 110 of 195, had increases in manufacturer price during the period from Dec. 31, 2004, through March 31, 2005. Taking into account price increases in recent years, the report estimated that a typical older American (who takes three prescription drugs) is likely to have experienced an increase, on average, in the cost of therapy from the year 2000 through March 31, 2005, of $866.16 if the drugs are brand name products used to treat chronic conditions and the full price increases were passed along to the consumer. “We are very disappointed that brand name manufacturers have failed to keep their price increases in line with inflation,” said AARP's CEO William Novelli, who promised to educate older consumers on how best to find affordable drugs that suit their needs.

Methamphetamine Crisis

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the past year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” Valerie Brown, chair of the association's membership committee, said in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed to combat the methamphetamine epidemic.”

Merck Loses First Vioxx Lawsuit

A jury in Texas last month awarded $253 million to the widow of a man who died after taking Vioxx (rofecoxib). The plaintiff charged that the drug maker Merck & Co. failed to warn physicians about the danger posed by Vioxx, that the drug was improperly designed, and that the company's negligence caused the death of the plaintiff's husband, Robert Ernst. Merck executives plan to appeal the verdict on the grounds that the jury was allowed to hear testimony that was both irrelevant and not based on reliable science, the company said. “While we are disappointed with the verdict, this decision should be put in its appropriate context,” Kenneth C. Frazier, Merck's senior vice president and general counsel, said in a statement. “This is the first of many trials. Each case has a different set of facts. Regardless of the outcome in this single case, the fact remains that plaintiffs have a significant legal burden in proving causation.” The award included $24 million in actual damages and $229 million in punitive damages. But the punitive damages could be reduced to about $2 million, according to Merck, since punitive damages are limited under Texas law.

Chronic Care Pilot Projects

Medicare is launching chronic care pilot projects this year aimed at improving care for people with heart failure and diabetes. The program, called Medicare Health Support, will provide free, voluntary services to about 160,000 Medicare fee-for-service beneficiaries for 3 years. Participating patients will get access to nurse coaches; reminders about preventive care needs; prescription drug counseling; home visits and intensive care management, when needed; and home monitoring equipment to track health status. At press time, eight areas had been selected for the program: Maryland, Oklahoma, Western Pennsylvania, Mississippi, Northwest Georgia, Chicago, Central Florida, and the District of Columbia. “Because early intervention is tremendously important in treating chronic illnesses, we are providing beneficiaries additional tools to help them manage their health more effectively and avoid preventable complications,” Health and Human Services Secretary Mike Leavitt said in a statement.

Demographics of Uninsured

Although they make up only 15% of the U.S. population, Hispanics comprise nearly 29% of the uninsured in that population, according to the 2004 Medical Expenditure Panel Survey (MEPS) findings from the Agency for Healthcare Research and Quality. More than one in three Hispanics is uninsured, and 25% are covered by public health insurance. In addition, Hispanics constitute 36% of all uninsured children under 18. “These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics,” said AHRQ Director Carolyn M. Clancy, M.D. In other findings, white non-Hispanics made up 65% of the U.S. population and almost 50% of the uninsured. About one in seven whites was uninsured, and 10% had only public insurance. Black non-Hispanics made up almost 13% of the population and almost 15% of the uninsured. Young adults aged 19–24 were at greatest risk of being uninsured, with 35% having no insurance coverage for the first part of 2004. The report noted the lack of coverage was worst for young Hispanic adults, with 56% uninsured.

When the Price Isn't Right

Brand name pharmaceutical prices continue to increase, far exceeding the rate of general inflation in 2005, according to an AARP “Rx Watchdog Report.” More than one-half of the drugs in the sample, 110 of 195, had increases in manufacturer price during the period from Dec. 31, 2004, through March 31, 2005. Taking into account price increases in recent years, the report estimated that a typical older American (who takes three prescription drugs) is likely to have experienced an increase, on average, in the cost of therapy from the year 2000 through March 31, 2005, of $866.16 if the drugs are brand name products used to treat chronic conditions and the full price increases were passed along to the consumer. “We are very disappointed that brand name manufacturers have failed to keep their price increases in line with inflation,” said AARP's CEO William Novelli, who promised to educate older consumers on how best to find affordable drugs that suit their needs.

Methamphetamine Crisis

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the past year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” Valerie Brown, chair of the association's membership committee, said in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed to combat the methamphetamine epidemic.”

Physicians face a 4.3% cut to Medicare reimbursements next year unless Congress takes action to change the sustainable growth rate formula.

The reduction was announced in a proposed rule that would update payment rates and revise payment policies under the program's fee schedule. The Centers for Medicare and Medicaid Services is expected to pay approximately $56.5 billion to 875,000 physicians and other health care professionals in 2006, according to the proposed rule.

“The payment reduction shows the need for more effective ways to pay physicians that help them improve quality and avoid unnecessary costs,” CMS Administrator Mark McClellan, M.D., said in a statement.

The agency will accept comments on the proposal until Sept. 30, and publish a final rule later this year.

Physician reimbursements under Medicare will be cut 26% over the next 6 years unless the SGR [sustainable growth rate] formula is changed. The American Medical Association recently reported that 38% of physicians will no longer be able to accept new Medicare patients if the first of these cuts begins on Jan. 1.

The proposed rule “confirms the need for Congress and the administration to take prompt action to avert the upcoming 4.3% cut from the SGR. This means that the CMS needs to do its part by removing drugs from the SGR formula,” Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians, said in an interview.

At a recent hearing of the House Ways and Means subcommittee on health, Dr. McClellan cautioned that removing Part B drugs from the formula would not solve the entire problem, as positive updates would not take place for several years, regardless of whether CMS removed drugs prospectively or retrospectively. In addition, the removal of these drugs would increase beneficiary premiums.

The agency is working with members of Congress, physician organizations, and other health care stakeholders on ways to improve physician payment without adding to overall Medicare costs, Dr. McClellan said in a statement.

Physician organizations, in the meantime, called on Congress to reach some consensus on payment solutions. The ACP, the American Medical Association and other groups support pay-for-performance legislation (H.R. 3617) from Rep. Nancy Johnson (R-Conn.) that would repeal the SGR and base future updates for physician payments on the Medicare Economic Index (MEI).

This bill differs fundamentally from S. 1356, legislation introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.), which also proposes to link payments to reporting of quality data and demonstrated progress against quality and efficiency measures, but contains no SGR fix.

At press time, Brian Schubert, a spokesman for Rep. Johnson said the congresswoman would be “working very hard on the issue and talking with colleagues … in the hopes of maintaining quality access to care for seniors within Medicare.”

Other topics addressed in the proposed rule include:

▸ Expanding a benefit for glaucoma screening to Hispanic Americans aged 65 and older.

This population was named specifically because it is at high risk for the disease. Currently, Medicare covers screening only for patients with diabetes, those with family history of glaucoma, and African Americans age 50 and over.

▸ Revising the methodology used to account for the costs of running a physician's practice.

▸ Refining payment adjustments for the malpractice costs associated with specific services.

Joyce Frieden, associate editor for Practice Trends, contributed to this report.

Physicians face a 4.3% cut to Medicare reimbursements next year unless Congress takes action to change the sustainable growth rate formula.

The reduction was announced in a proposed rule that would update payment rates and revise payment policies under the program's fee schedule. The Centers for Medicare and Medicaid Services is expected to pay approximately $56.5 billion to 875,000 physicians and other health care professionals in 2006, according to the proposed rule.

“The payment reduction shows the need for more effective ways to pay physicians that help them improve quality and avoid unnecessary costs,” CMS Administrator Mark McClellan, M.D., said in a statement.

The agency will accept comments on the proposal until Sept. 30, and publish a final rule later this year.

Physician reimbursements under Medicare will be cut 26% over the next 6 years unless the SGR [sustainable growth rate] formula is changed. The American Medical Association recently reported that 38% of physicians will no longer be able to accept new Medicare patients if the first of these cuts begins on Jan. 1.

The proposed rule “confirms the need for Congress and the administration to take prompt action to avert the upcoming 4.3% cut from the SGR. This means that the CMS needs to do its part by removing drugs from the SGR formula,” Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians, said in an interview.

At a recent hearing of the House Ways and Means subcommittee on health, Dr. McClellan cautioned that removing Part B drugs from the formula would not solve the entire problem, as positive updates would not take place for several years, regardless of whether CMS removed drugs prospectively or retrospectively. In addition, the removal of these drugs would increase beneficiary premiums.

The agency is working with members of Congress, physician organizations, and other health care stakeholders on ways to improve physician payment without adding to overall Medicare costs, Dr. McClellan said in a statement.

Physician organizations, in the meantime, called on Congress to reach some consensus on payment solutions. The ACP, the American Medical Association and other groups support pay-for-performance legislation (H.R. 3617) from Rep. Nancy Johnson (R-Conn.) that would repeal the SGR and base future updates for physician payments on the Medicare Economic Index (MEI).

This bill differs fundamentally from S. 1356, legislation introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.), which also proposes to link payments to reporting of quality data and demonstrated progress against quality and efficiency measures, but contains no SGR fix.

At press time, Brian Schubert, a spokesman for Rep. Johnson said the congresswoman would be “working very hard on the issue and talking with colleagues … in the hopes of maintaining quality access to care for seniors within Medicare.”

Other topics addressed in the proposed rule include:

▸ Expanding a benefit for glaucoma screening to Hispanic Americans aged 65 and older.

This population was named specifically because it is at high risk for the disease. Currently, Medicare covers screening only for patients with diabetes, those with family history of glaucoma, and African Americans age 50 and over.

▸ Revising the methodology used to account for the costs of running a physician's practice.

▸ Refining payment adjustments for the malpractice costs associated with specific services.

Joyce Frieden, associate editor for Practice Trends, contributed to this report.

Physicians face a 4.3% cut to Medicare reimbursements next year unless Congress takes action to change the sustainable growth rate formula.

The reduction was announced in a proposed rule that would update payment rates and revise payment policies under the program's fee schedule. The Centers for Medicare and Medicaid Services is expected to pay approximately $56.5 billion to 875,000 physicians and other health care professionals in 2006, according to the proposed rule.

“The payment reduction shows the need for more effective ways to pay physicians that help them improve quality and avoid unnecessary costs,” CMS Administrator Mark McClellan, M.D., said in a statement.

The agency will accept comments on the proposal until Sept. 30, and publish a final rule later this year.

Physician reimbursements under Medicare will be cut 26% over the next 6 years unless the SGR [sustainable growth rate] formula is changed. The American Medical Association recently reported that 38% of physicians will no longer be able to accept new Medicare patients if the first of these cuts begins on Jan. 1.

The proposed rule “confirms the need for Congress and the administration to take prompt action to avert the upcoming 4.3% cut from the SGR. This means that the CMS needs to do its part by removing drugs from the SGR formula,” Bob Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians, said in an interview.

At a recent hearing of the House Ways and Means subcommittee on health, Dr. McClellan cautioned that removing Part B drugs from the formula would not solve the entire problem, as positive updates would not take place for several years, regardless of whether CMS removed drugs prospectively or retrospectively. In addition, the removal of these drugs would increase beneficiary premiums.

The agency is working with members of Congress, physician organizations, and other health care stakeholders on ways to improve physician payment without adding to overall Medicare costs, Dr. McClellan said in a statement.

Physician organizations, in the meantime, called on Congress to reach some consensus on payment solutions. The ACP, the American Medical Association and other groups support pay-for-performance legislation (H.R. 3617) from Rep. Nancy Johnson (R-Conn.) that would repeal the SGR and base future updates for physician payments on the Medicare Economic Index (MEI).

This bill differs fundamentally from S. 1356, legislation introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.), which also proposes to link payments to reporting of quality data and demonstrated progress against quality and efficiency measures, but contains no SGR fix.

At press time, Brian Schubert, a spokesman for Rep. Johnson said the congresswoman would be “working very hard on the issue and talking with colleagues … in the hopes of maintaining quality access to care for seniors within Medicare.”

Other topics addressed in the proposed rule include:

▸ Expanding a benefit for glaucoma screening to Hispanic Americans aged 65 and older.

This population was named specifically because it is at high risk for the disease. Currently, Medicare covers screening only for patients with diabetes, those with family history of glaucoma, and African Americans age 50 and over.

▸ Revising the methodology used to account for the costs of running a physician's practice.

▸ Refining payment adjustments for the malpractice costs associated with specific services.

Joyce Frieden, associate editor for Practice Trends, contributed to this report.

Garrison Bliss, M.D., doesn't believe that so-called concierge care has to involve a $4,000 yearly fee.

The Seattle internist charged patients only $65 a month when he opened his practice in Washington state in 1997—one of the first practices in the country to adopt the concierge care model. His current monthly fee is $85. Patients who receive medical services don't get a bill and neither do their insurance companies, he said.

Traditionally associated with high fees and a limited and wealthy patient base, concierge care—now often called “retainer care”—is morphing into a number of different types of practices, according to Matthew Wynia, M.D., an internist and director of the American Medical Association's Institute for Ethics. So many different types of retainer care have emerged that the trade association for concierge care practices changed its name to “the Society for Innovative Medical Practice Design,” he said.

There is a misconception that retainer care is elitist, that patients don't want to pay for it, and that it's something they can't afford, said Marcy Zwelling-Aamot, M.D., an internist who runs a retainer practice in Long Beach, Calif. The 460 patients who belong to her “choice care” program pay a $1,500 yearly fee—but can pay it in monthly installments. “That's less than what they pay for car insurance, a little more than $100 a month,” she said in an interview.

For patients who cannot afford the retainer, she provides free care in exchange for volunteer work at a 501(c)3 organization such as a cancer foundation. “It really is a nice exchange. Some of my patients have gotten really involved in the volunteer work—one who was volunteering at the hospital called me and said she wanted to work there.”

About 10% of her patients take part in the program.

Dr. Bliss also cares for indigent patients. Those who can't pay the monthly fee fill out a form indicating what fee they can afford. “Whatever their answer is, that's the price they pay,” he said.

From the start, he assumed that 10%–15% of his patients would be indigent, he said.

“If every doctor had 10%–15% of their practices with people who couldn't afford it, that would go a very long way toward solving the problem” of the poor getting health care, he said. Plus, there would be no government programs to supervise the practice, no insurance costs, and no billing involved.

Some retainer practices cater to specific segments of the population. John Levinson, M.D., a cardiologist at Massachusetts General Hospital in Boston, runs a “hybrid” hospital/office-based practice that includes both retainer and nonretainer patients.

“The way my day works is I drive to the hospital at 5 in the morning, see my inpatients until 8 a.m., then have a regular office day,” where he sees patients that are on Medicaid and other types of insurance, and his retainer patients. At the end of the day, he goes back to the hospital to check on in his inpatients.

There are two groups of patients within the small group of 40 retainer patients he sees. Most see Dr. Levinson as their primary care physician. However, a smaller group sees him for cardiac care only. “Some—about 25—use me for primary and cardiology care, and the others are just cardiology patients.”

Those who want comprehensive care pay a higher retainer fee than the cardiology only patients, he said. He would not disclose the fee.

Pediatrician Scott Serbin, M.D., who established a retainer practice for children in December 2004, decided to “tier” his fees based on the age of the child.

Some physicians who spoke with this newspaper said they doubted that any type of retainer medicine would become a major trend.

“It doesn't bode well for medicine, and it smacks of elitism, but in its defense, it is what America has pushed some doctors into doing,” Charles Scott, M.D., a pediatrician in Medford, N.J., said in an interview.

“Without a doubt [retainer] physicians know that there are ethical dilemmas associated with their practices, that colleagues are really scrutinizing them for their ethics,” Dr. Wynia said.

In a recent survey of 83 retainer practices, he found that retainer physicians reported better quality of care and fewer hassles, but they also saw fewer minorities and Medicaid patients, and fewer patients with chronic illnesses than regular practices.

The physician's role “is to provide 24/7 access for our patients—all patients, whether they're on Medicaid, have special health care needs, etc. That's what the medical home is all about,” said Garry Gardner, M.D., a pediatrician in Darien, Ill.

Dr. Zwelling-Aamot, who is trained in emergency medicine, said her patients are not compromised by her “round the clock” hours. Her office is next to the hospital, and she always carries her electronic medical records with her. She uses a variety of specialists in the area to cover for her.

This is how medicine used to work, when physicians volunteered at the local hospitals and free clinics, she said.

Garrison Bliss, M.D., doesn't believe that so-called concierge care has to involve a $4,000 yearly fee.

The Seattle internist charged patients only $65 a month when he opened his practice in Washington state in 1997—one of the first practices in the country to adopt the concierge care model. His current monthly fee is $85. Patients who receive medical services don't get a bill and neither do their insurance companies, he said.

Traditionally associated with high fees and a limited and wealthy patient base, concierge care—now often called “retainer care”—is morphing into a number of different types of practices, according to Matthew Wynia, M.D., an internist and director of the American Medical Association's Institute for Ethics. So many different types of retainer care have emerged that the trade association for concierge care practices changed its name to “the Society for Innovative Medical Practice Design,” he said.

There is a misconception that retainer care is elitist, that patients don't want to pay for it, and that it's something they can't afford, said Marcy Zwelling-Aamot, M.D., an internist who runs a retainer practice in Long Beach, Calif. The 460 patients who belong to her “choice care” program pay a $1,500 yearly fee—but can pay it in monthly installments. “That's less than what they pay for car insurance, a little more than $100 a month,” she said in an interview.

For patients who cannot afford the retainer, she provides free care in exchange for volunteer work at a 501(c)3 organization such as a cancer foundation. “It really is a nice exchange. Some of my patients have gotten really involved in the volunteer work—one who was volunteering at the hospital called me and said she wanted to work there.”

About 10% of her patients take part in the program.

Dr. Bliss also cares for indigent patients. Those who can't pay the monthly fee fill out a form indicating what fee they can afford. “Whatever their answer is, that's the price they pay,” he said.

From the start, he assumed that 10%–15% of his patients would be indigent, he said.

“If every doctor had 10%–15% of their practices with people who couldn't afford it, that would go a very long way toward solving the problem” of the poor getting health care, he said. Plus, there would be no government programs to supervise the practice, no insurance costs, and no billing involved.

Some retainer practices cater to specific segments of the population. John Levinson, M.D., a cardiologist at Massachusetts General Hospital in Boston, runs a “hybrid” hospital/office-based practice that includes both retainer and nonretainer patients.

“The way my day works is I drive to the hospital at 5 in the morning, see my inpatients until 8 a.m., then have a regular office day,” where he sees patients that are on Medicaid and other types of insurance, and his retainer patients. At the end of the day, he goes back to the hospital to check on in his inpatients.

There are two groups of patients within the small group of 40 retainer patients he sees. Most see Dr. Levinson as their primary care physician. However, a smaller group sees him for cardiac care only. “Some—about 25—use me for primary and cardiology care, and the others are just cardiology patients.”

Those who want comprehensive care pay a higher retainer fee than the cardiology only patients, he said. He would not disclose the fee.

Pediatrician Scott Serbin, M.D., who established a retainer practice for children in December 2004, decided to “tier” his fees based on the age of the child.

Some physicians who spoke with this newspaper said they doubted that any type of retainer medicine would become a major trend.

“It doesn't bode well for medicine, and it smacks of elitism, but in its defense, it is what America has pushed some doctors into doing,” Charles Scott, M.D., a pediatrician in Medford, N.J., said in an interview.

“Without a doubt [retainer] physicians know that there are ethical dilemmas associated with their practices, that colleagues are really scrutinizing them for their ethics,” Dr. Wynia said.

In a recent survey of 83 retainer practices, he found that retainer physicians reported better quality of care and fewer hassles, but they also saw fewer minorities and Medicaid patients, and fewer patients with chronic illnesses than regular practices.

The physician's role “is to provide 24/7 access for our patients—all patients, whether they're on Medicaid, have special health care needs, etc. That's what the medical home is all about,” said Garry Gardner, M.D., a pediatrician in Darien, Ill.

Dr. Zwelling-Aamot, who is trained in emergency medicine, said her patients are not compromised by her “round the clock” hours. Her office is next to the hospital, and she always carries her electronic medical records with her. She uses a variety of specialists in the area to cover for her.

This is how medicine used to work, when physicians volunteered at the local hospitals and free clinics, she said.

Garrison Bliss, M.D., doesn't believe that so-called concierge care has to involve a $4,000 yearly fee.

The Seattle internist charged patients only $65 a month when he opened his practice in Washington state in 1997—one of the first practices in the country to adopt the concierge care model. His current monthly fee is $85. Patients who receive medical services don't get a bill and neither do their insurance companies, he said.

Traditionally associated with high fees and a limited and wealthy patient base, concierge care—now often called “retainer care”—is morphing into a number of different types of practices, according to Matthew Wynia, M.D., an internist and director of the American Medical Association's Institute for Ethics. So many different types of retainer care have emerged that the trade association for concierge care practices changed its name to “the Society for Innovative Medical Practice Design,” he said.

There is a misconception that retainer care is elitist, that patients don't want to pay for it, and that it's something they can't afford, said Marcy Zwelling-Aamot, M.D., an internist who runs a retainer practice in Long Beach, Calif. The 460 patients who belong to her “choice care” program pay a $1,500 yearly fee—but can pay it in monthly installments. “That's less than what they pay for car insurance, a little more than $100 a month,” she said in an interview.

For patients who cannot afford the retainer, she provides free care in exchange for volunteer work at a 501(c)3 organization such as a cancer foundation. “It really is a nice exchange. Some of my patients have gotten really involved in the volunteer work—one who was volunteering at the hospital called me and said she wanted to work there.”

About 10% of her patients take part in the program.

Dr. Bliss also cares for indigent patients. Those who can't pay the monthly fee fill out a form indicating what fee they can afford. “Whatever their answer is, that's the price they pay,” he said.

From the start, he assumed that 10%–15% of his patients would be indigent, he said.

“If every doctor had 10%–15% of their practices with people who couldn't afford it, that would go a very long way toward solving the problem” of the poor getting health care, he said. Plus, there would be no government programs to supervise the practice, no insurance costs, and no billing involved.

Some retainer practices cater to specific segments of the population. John Levinson, M.D., a cardiologist at Massachusetts General Hospital in Boston, runs a “hybrid” hospital/office-based practice that includes both retainer and nonretainer patients.

“The way my day works is I drive to the hospital at 5 in the morning, see my inpatients until 8 a.m., then have a regular office day,” where he sees patients that are on Medicaid and other types of insurance, and his retainer patients. At the end of the day, he goes back to the hospital to check on in his inpatients.

There are two groups of patients within the small group of 40 retainer patients he sees. Most see Dr. Levinson as their primary care physician. However, a smaller group sees him for cardiac care only. “Some—about 25—use me for primary and cardiology care, and the others are just cardiology patients.”

Those who want comprehensive care pay a higher retainer fee than the cardiology only patients, he said. He would not disclose the fee.

Pediatrician Scott Serbin, M.D., who established a retainer practice for children in December 2004, decided to “tier” his fees based on the age of the child.

Some physicians who spoke with this newspaper said they doubted that any type of retainer medicine would become a major trend.

“It doesn't bode well for medicine, and it smacks of elitism, but in its defense, it is what America has pushed some doctors into doing,” Charles Scott, M.D., a pediatrician in Medford, N.J., said in an interview.

“Without a doubt [retainer] physicians know that there are ethical dilemmas associated with their practices, that colleagues are really scrutinizing them for their ethics,” Dr. Wynia said.

In a recent survey of 83 retainer practices, he found that retainer physicians reported better quality of care and fewer hassles, but they also saw fewer minorities and Medicaid patients, and fewer patients with chronic illnesses than regular practices.

The physician's role “is to provide 24/7 access for our patients—all patients, whether they're on Medicaid, have special health care needs, etc. That's what the medical home is all about,” said Garry Gardner, M.D., a pediatrician in Darien, Ill.

Dr. Zwelling-Aamot, who is trained in emergency medicine, said her patients are not compromised by her “round the clock” hours. Her office is next to the hospital, and she always carries her electronic medical records with her. She uses a variety of specialists in the area to cover for her.

This is how medicine used to work, when physicians volunteered at the local hospitals and free clinics, she said.

PHILADELPHIA — Noncompliance with physicians' orders “is a real problem” that costs the United States $100 billion annually and results in at least 125,000 deaths, said Reid Oetjen, director of graduate health services administration studies at the University of Central Florida.

At the annual conference of the Medical Group Management association, Dr. Oetjen said that there are three types of noncompliers:

▸ Unwitting noncompliers, who misunderstand their prescribed regimen or don't receive adequate information about the regimen. Language barriers and use of medical jargon may complicate matters. Sometimes, patients who receive bad news may not be able to process information presented to them.

▸ Unwilling noncompliers, who don't follow treatment orders because of economic, physical, or personal barriers—for example, a patient who can't afford a certain drug.

▸ Then there are the intelligent noncompliers, who make an intentional choice to alter their therapy without consulting their physician.

Physicians often overestimate the degree of correspondence between their orders and patient behavior, Mr. Oetjen said.

Compliance is problematic even with chronic or life-threatening conditions. A 2001 study of HIV protease inhibitor cocktails revealed that fewer than 50% of the patients took their antiretroviral medication correctly and on time. A too complex regimen was the source of the noncompliance among these patients.

PHILADELPHIA — Noncompliance with physicians' orders “is a real problem” that costs the United States $100 billion annually and results in at least 125,000 deaths, said Reid Oetjen, director of graduate health services administration studies at the University of Central Florida.

At the annual conference of the Medical Group Management association, Dr. Oetjen said that there are three types of noncompliers:

▸ Unwitting noncompliers, who misunderstand their prescribed regimen or don't receive adequate information about the regimen. Language barriers and use of medical jargon may complicate matters. Sometimes, patients who receive bad news may not be able to process information presented to them.

▸ Unwilling noncompliers, who don't follow treatment orders because of economic, physical, or personal barriers—for example, a patient who can't afford a certain drug.

▸ Then there are the intelligent noncompliers, who make an intentional choice to alter their therapy without consulting their physician.

Physicians often overestimate the degree of correspondence between their orders and patient behavior, Mr. Oetjen said.

Compliance is problematic even with chronic or life-threatening conditions. A 2001 study of HIV protease inhibitor cocktails revealed that fewer than 50% of the patients took their antiretroviral medication correctly and on time. A too complex regimen was the source of the noncompliance among these patients.

PHILADELPHIA — Noncompliance with physicians' orders “is a real problem” that costs the United States $100 billion annually and results in at least 125,000 deaths, said Reid Oetjen, director of graduate health services administration studies at the University of Central Florida.

At the annual conference of the Medical Group Management association, Dr. Oetjen said that there are three types of noncompliers:

▸ Unwitting noncompliers, who misunderstand their prescribed regimen or don't receive adequate information about the regimen. Language barriers and use of medical jargon may complicate matters. Sometimes, patients who receive bad news may not be able to process information presented to them.

▸ Unwilling noncompliers, who don't follow treatment orders because of economic, physical, or personal barriers—for example, a patient who can't afford a certain drug.

▸ Then there are the intelligent noncompliers, who make an intentional choice to alter their therapy without consulting their physician.

Physicians often overestimate the degree of correspondence between their orders and patient behavior, Mr. Oetjen said.

Compliance is problematic even with chronic or life-threatening conditions. A 2001 study of HIV protease inhibitor cocktails revealed that fewer than 50% of the patients took their antiretroviral medication correctly and on time. A too complex regimen was the source of the noncompliance among these patients.

Rise in Uninsured Children

One-third of the uninsured children in this country went without medical care for an entire year, according to “Going Without: America's Uninsured Children,” a report from the Robert Wood Johnson Foundation. By comparison, nearly 88% of insured children received care during the same period. In 17 populous states, about one in every three uninsured children received no medical care during the year. In 21 other states, the number was one in four. Even uninsured kids who received medical care didn't always see a physician when they needed one. Uninsured children were 10 times more likely not to receive the medical care they needed, compared with children who have insurance. The report was released during a kick-off event for the Covering Kids & Families campaign, a nationwide effort to enroll eligible children in public coverage programs during the back-to-school season.

Kids Shape Up

A new obesity-prevention initiative chartered by the American Diabetes Association aims to provide leadership and information “to help families and communities make improved nutrition and greater physical activity a priority, especially for children,” said Michael Jensen, M.D., president of a new organization called Shaping America's Health: Association for Weight Management and Obesity Prevention. The group plans to develop clinical guidelines and best practices for health care professionals working to help individuals better manage their weight, said Dr. Jensen, professor of medicine at the Mayo Clinic, Rochester, Minn. The new organization will incorporate the “Shaping America's Youth” program, a public-private partnership launched in 2003 in cooperation with the ADA, the Office of the Surgeon General, and other organizations.

Teen Driving

Although most recognize that the summer driving season is dangerous for teens, September is the third deadliest month for teen motor vehicle deaths, according to the National Highway Traffic Safety Administration. Of the 6,434 youth (involving ages 15–20) motor vehicle fatalities in 2000, July saw more deaths (644) than any other month, followed by June (600), September (590), and August (587), the agency said. “Per mile driven, teen drivers are more likely to be involved in a fatal crash than other drivers,” said Mary Pat McKay, M.D., and director of the Center for Injury Prevention and Control at the George Washington University Medical Center in Washington. “The increased risk for crashing results from a combination of inexperience and immaturity—particularly a tendency toward riskier behavior.”

The Meth Crisis Continues

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the last year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” said Valerie Brown, chair of the association's membership committee, in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed.”

Influence of Free Drug Samples

Readily accessible, free drug samples can influence the prescribing behavior of residents, according to a study from the University of Minnesota and Abbott Northwestern Hospital, in Minneapolis. Researchers observed 29 internal medicine residents over a 6-month period in an inner-city primary care clinic. After selecting drug classes where samples of heavily advertised drugs were provided to the clinic, and where lower-priced alternative formulations existed, the authors looked for prescribing differences between physicians who had access to free samples and those who had been randomized to a group that agreed not to use samples. “We found that resident physicians with access to drug samples in clinic were more likely to write new prescriptions for heavily advertised drugs and less likely to recommend over-the-counter drugs than their peers,” said lead author Richard F. Adair, M.D. The study was published in the August issue of the American Journal of Medicine.

Rise in Uninsured Children

One-third of the uninsured children in this country went without medical care for an entire year, according to “Going Without: America's Uninsured Children,” a report from the Robert Wood Johnson Foundation. By comparison, nearly 88% of insured children received care during the same period. In 17 populous states, about one in every three uninsured children received no medical care during the year. In 21 other states, the number was one in four. Even uninsured kids who received medical care didn't always see a physician when they needed one. Uninsured children were 10 times more likely not to receive the medical care they needed, compared with children who have insurance. The report was released during a kick-off event for the Covering Kids & Families campaign, a nationwide effort to enroll eligible children in public coverage programs during the back-to-school season.

Kids Shape Up

A new obesity-prevention initiative chartered by the American Diabetes Association aims to provide leadership and information “to help families and communities make improved nutrition and greater physical activity a priority, especially for children,” said Michael Jensen, M.D., president of a new organization called Shaping America's Health: Association for Weight Management and Obesity Prevention. The group plans to develop clinical guidelines and best practices for health care professionals working to help individuals better manage their weight, said Dr. Jensen, professor of medicine at the Mayo Clinic, Rochester, Minn. The new organization will incorporate the “Shaping America's Youth” program, a public-private partnership launched in 2003 in cooperation with the ADA, the Office of the Surgeon General, and other organizations.

Teen Driving

Although most recognize that the summer driving season is dangerous for teens, September is the third deadliest month for teen motor vehicle deaths, according to the National Highway Traffic Safety Administration. Of the 6,434 youth (involving ages 15–20) motor vehicle fatalities in 2000, July saw more deaths (644) than any other month, followed by June (600), September (590), and August (587), the agency said. “Per mile driven, teen drivers are more likely to be involved in a fatal crash than other drivers,” said Mary Pat McKay, M.D., and director of the Center for Injury Prevention and Control at the George Washington University Medical Center in Washington. “The increased risk for crashing results from a combination of inexperience and immaturity—particularly a tendency toward riskier behavior.”

The Meth Crisis Continues

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the last year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” said Valerie Brown, chair of the association's membership committee, in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed.”

Influence of Free Drug Samples

Readily accessible, free drug samples can influence the prescribing behavior of residents, according to a study from the University of Minnesota and Abbott Northwestern Hospital, in Minneapolis. Researchers observed 29 internal medicine residents over a 6-month period in an inner-city primary care clinic. After selecting drug classes where samples of heavily advertised drugs were provided to the clinic, and where lower-priced alternative formulations existed, the authors looked for prescribing differences between physicians who had access to free samples and those who had been randomized to a group that agreed not to use samples. “We found that resident physicians with access to drug samples in clinic were more likely to write new prescriptions for heavily advertised drugs and less likely to recommend over-the-counter drugs than their peers,” said lead author Richard F. Adair, M.D. The study was published in the August issue of the American Journal of Medicine.

Rise in Uninsured Children

One-third of the uninsured children in this country went without medical care for an entire year, according to “Going Without: America's Uninsured Children,” a report from the Robert Wood Johnson Foundation. By comparison, nearly 88% of insured children received care during the same period. In 17 populous states, about one in every three uninsured children received no medical care during the year. In 21 other states, the number was one in four. Even uninsured kids who received medical care didn't always see a physician when they needed one. Uninsured children were 10 times more likely not to receive the medical care they needed, compared with children who have insurance. The report was released during a kick-off event for the Covering Kids & Families campaign, a nationwide effort to enroll eligible children in public coverage programs during the back-to-school season.

Kids Shape Up

A new obesity-prevention initiative chartered by the American Diabetes Association aims to provide leadership and information “to help families and communities make improved nutrition and greater physical activity a priority, especially for children,” said Michael Jensen, M.D., president of a new organization called Shaping America's Health: Association for Weight Management and Obesity Prevention. The group plans to develop clinical guidelines and best practices for health care professionals working to help individuals better manage their weight, said Dr. Jensen, professor of medicine at the Mayo Clinic, Rochester, Minn. The new organization will incorporate the “Shaping America's Youth” program, a public-private partnership launched in 2003 in cooperation with the ADA, the Office of the Surgeon General, and other organizations.

Teen Driving

Although most recognize that the summer driving season is dangerous for teens, September is the third deadliest month for teen motor vehicle deaths, according to the National Highway Traffic Safety Administration. Of the 6,434 youth (involving ages 15–20) motor vehicle fatalities in 2000, July saw more deaths (644) than any other month, followed by June (600), September (590), and August (587), the agency said. “Per mile driven, teen drivers are more likely to be involved in a fatal crash than other drivers,” said Mary Pat McKay, M.D., and director of the Center for Injury Prevention and Control at the George Washington University Medical Center in Washington. “The increased risk for crashing results from a combination of inexperience and immaturity—particularly a tendency toward riskier behavior.”

The Meth Crisis Continues

The methamphetamine crisis has meant major problems for law enforcement and child welfare workers, according to two new surveys by the National Association of Counties. The first survey, which included responses from 500 local law enforcement agencies, found that 87% reported an increase in methamphetamine-related arrests beginning 3 years ago. More than half the counties said methamphetamine was their largest drug problem, with an estimated one-fifth of jail inmates incarcerated because of meth-related crimes. In the second survey, which involved child welfare officials in more than 300 counties, 40% of respondents reported increased out-of-home placements because of meth addiction in the last year, and nearly two-thirds of officials agreed that the nature of the meth-using parent increased the difficulty of family reunification. “As our surveys confirmed, methamphetamine abuse is a national drug crisis that requires national leadership,” said Valerie Brown, chair of the association's membership committee, in testimony to a House subcommittee. “A comprehensive and intergovernmental approach is needed.”

Influence of Free Drug Samples

Readily accessible, free drug samples can influence the prescribing behavior of residents, according to a study from the University of Minnesota and Abbott Northwestern Hospital, in Minneapolis. Researchers observed 29 internal medicine residents over a 6-month period in an inner-city primary care clinic. After selecting drug classes where samples of heavily advertised drugs were provided to the clinic, and where lower-priced alternative formulations existed, the authors looked for prescribing differences between physicians who had access to free samples and those who had been randomized to a group that agreed not to use samples. “We found that resident physicians with access to drug samples in clinic were more likely to write new prescriptions for heavily advertised drugs and less likely to recommend over-the-counter drugs than their peers,” said lead author Richard F. Adair, M.D. The study was published in the August issue of the American Journal of Medicine.