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Physicians Tailor Their Concierge Care Practices
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 FAMILY PRACTICE NEWS 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.
Not all medical services are provided by these types of practices, however. Dr. Levinson's retainer, for example, does not cover medical care. It pays for 24–7 access to him, “but even if they come to my office for a normal medical visit, I'd bill [their insurer] for medical care provided,” he said.
Initially, Dr. Serbin thought about participating in an insurance group, but Blue Cross/Blue Shield, the largest insurer in Pennsylvania “was not too excited about the concept.” So far, he's enjoyed the independence of having a retainer care practice. “It makes it a lot easier to do referrals,” as a lot of health plans have discontinued referrals for pediatric subspecialists, he said.
Dr. Bliss said he encourages all of his patients to carry a high deductible insurance if they can afford it, at the very least. Those who can't afford insurance can often be included in hospital compassionate care programs.
“We are also working with insurers, encouraging them to create products that carve out primary care so that patients can contract directly with their primary care physician and maintain less expensive coverage for the unlikely but potentially catastrophic costs covered by insurance,” he explained.
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 FAMILY PRACTICE NEWS 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.
Not all medical services are provided by these types of practices, however. Dr. Levinson's retainer, for example, does not cover medical care. It pays for 24–7 access to him, “but even if they come to my office for a normal medical visit, I'd bill [their insurer] for medical care provided,” he said.
Initially, Dr. Serbin thought about participating in an insurance group, but Blue Cross/Blue Shield, the largest insurer in Pennsylvania “was not too excited about the concept.” So far, he's enjoyed the independence of having a retainer care practice. “It makes it a lot easier to do referrals,” as a lot of health plans have discontinued referrals for pediatric subspecialists, he said.
Dr. Bliss said he encourages all of his patients to carry a high deductible insurance if they can afford it, at the very least. Those who can't afford insurance can often be included in hospital compassionate care programs.
“We are also working with insurers, encouraging them to create products that carve out primary care so that patients can contract directly with their primary care physician and maintain less expensive coverage for the unlikely but potentially catastrophic costs covered by insurance,” he explained.
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 FAMILY PRACTICE NEWS 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.
Not all medical services are provided by these types of practices, however. Dr. Levinson's retainer, for example, does not cover medical care. It pays for 24–7 access to him, “but even if they come to my office for a normal medical visit, I'd bill [their insurer] for medical care provided,” he said.
Initially, Dr. Serbin thought about participating in an insurance group, but Blue Cross/Blue Shield, the largest insurer in Pennsylvania “was not too excited about the concept.” So far, he's enjoyed the independence of having a retainer care practice. “It makes it a lot easier to do referrals,” as a lot of health plans have discontinued referrals for pediatric subspecialists, he said.
Dr. Bliss said he encourages all of his patients to carry a high deductible insurance if they can afford it, at the very least. Those who can't afford insurance can often be included in hospital compassionate care programs.
“We are also working with insurers, encouraging them to create products that carve out primary care so that patients can contract directly with their primary care physician and maintain less expensive coverage for the unlikely but potentially catastrophic costs covered by insurance,” he explained.
Policy & Practice
Elderly Lack Preventive Care
Many elderly Medicare patients fail to get routine preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. In analyzing six preventive services covered by Medicare (routine blood tests and eye examinations for diabetes patients; colon and breast cancer screening; and influenza and pneumococcal vaccinations), researchers found that half of eligible Medicare beneficiaries or fewer received the recommended care in 2001. Specifically, 48% and 56% of beneficiaries with diabetes received eye examinations and hemoglobin A1c tests, respectively; 47% of women aged 65–75 years received mammograms; and 47% of all beneficiaries received flu shots. However, Medicare patients cared for by board-certified physicians in larger practices treating fewer poor patients were the patients most likely to receive cancer screenings and other preventive care. The study appeared in the July 27 Journal of the American Medical Association.
Clinician's Guide to Alcoholism
Physicians have a new tool to help them identify and care for patients with heavy drinking and alcohol use disorders. About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about one in four currently has alcohol dependence problems that often go undetected in medical and mental health care settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a new guide called “Helping Patients Who Drink Too Much: A Clinician's Guide,” which offers guidance for conducting brief interventions and managing patient care. If a patient drinks heavily (five or more drinks in a day for men or four or more for women), the guide shows physicians how to look for symptoms of alcohol abuse or dependence. The guide is at
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. 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. There was also a trend toward less use of inexpensive drugs. The study was published in the August issue of The American Journal of Medicine.
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. When asked to comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Osteopathic Medical Concepts
Osteopathic terminology for the first time has been added to the latest version of the College of American Pathologists' Systematized Nomenclature of Medicine (SNOMED) clinical terms. The latest release incorporates more than 230 osteopathic medical concepts including procedures, diagnoses, and even subtle anatomic aberrations well known to osteopathic physicians. “The availability of the osteopathic medical content in SNOMED clinical terms represents an additional opportunity to make unique terminology available to national and international clinical and research audiences,” said Franklin R. Elevitch, M.D., chair of SNOMED International Authority. The American Osteopathic Association collaborated with SNOMED on the project to include the terminology.
Call to Action on Disability
The U.S. Surgeon General has issued his first-ever Call to Action on Disability. The report outlines goals for improving the lives of individuals with disabilities. Goals include increasing knowledge among health care professionals; providing them with tools to screen, diagnose, and treat the whole person with a disability with dignity; and increasing accessible health care and support services to promote independence for people with disabilities. “The reality is that for too long we provided lesser care to people with disabilities,” Surgeon General Richard H. Carmona said in a statement. “Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.” The document is available at
Elderly Lack Preventive Care
Many elderly Medicare patients fail to get routine preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. In analyzing six preventive services covered by Medicare (routine blood tests and eye examinations for diabetes patients; colon and breast cancer screening; and influenza and pneumococcal vaccinations), researchers found that half of eligible Medicare beneficiaries or fewer received the recommended care in 2001. Specifically, 48% and 56% of beneficiaries with diabetes received eye examinations and hemoglobin A1c tests, respectively; 47% of women aged 65–75 years received mammograms; and 47% of all beneficiaries received flu shots. However, Medicare patients cared for by board-certified physicians in larger practices treating fewer poor patients were the patients most likely to receive cancer screenings and other preventive care. The study appeared in the July 27 Journal of the American Medical Association.
Clinician's Guide to Alcoholism
Physicians have a new tool to help them identify and care for patients with heavy drinking and alcohol use disorders. About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about one in four currently has alcohol dependence problems that often go undetected in medical and mental health care settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a new guide called “Helping Patients Who Drink Too Much: A Clinician's Guide,” which offers guidance for conducting brief interventions and managing patient care. If a patient drinks heavily (five or more drinks in a day for men or four or more for women), the guide shows physicians how to look for symptoms of alcohol abuse or dependence. The guide is at
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. 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. There was also a trend toward less use of inexpensive drugs. The study was published in the August issue of The American Journal of Medicine.
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. When asked to comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Osteopathic Medical Concepts
Osteopathic terminology for the first time has been added to the latest version of the College of American Pathologists' Systematized Nomenclature of Medicine (SNOMED) clinical terms. The latest release incorporates more than 230 osteopathic medical concepts including procedures, diagnoses, and even subtle anatomic aberrations well known to osteopathic physicians. “The availability of the osteopathic medical content in SNOMED clinical terms represents an additional opportunity to make unique terminology available to national and international clinical and research audiences,” said Franklin R. Elevitch, M.D., chair of SNOMED International Authority. The American Osteopathic Association collaborated with SNOMED on the project to include the terminology.
Call to Action on Disability
The U.S. Surgeon General has issued his first-ever Call to Action on Disability. The report outlines goals for improving the lives of individuals with disabilities. Goals include increasing knowledge among health care professionals; providing them with tools to screen, diagnose, and treat the whole person with a disability with dignity; and increasing accessible health care and support services to promote independence for people with disabilities. “The reality is that for too long we provided lesser care to people with disabilities,” Surgeon General Richard H. Carmona said in a statement. “Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.” The document is available at
Elderly Lack Preventive Care
Many elderly Medicare patients fail to get routine preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. In analyzing six preventive services covered by Medicare (routine blood tests and eye examinations for diabetes patients; colon and breast cancer screening; and influenza and pneumococcal vaccinations), researchers found that half of eligible Medicare beneficiaries or fewer received the recommended care in 2001. Specifically, 48% and 56% of beneficiaries with diabetes received eye examinations and hemoglobin A1c tests, respectively; 47% of women aged 65–75 years received mammograms; and 47% of all beneficiaries received flu shots. However, Medicare patients cared for by board-certified physicians in larger practices treating fewer poor patients were the patients most likely to receive cancer screenings and other preventive care. The study appeared in the July 27 Journal of the American Medical Association.
Clinician's Guide to Alcoholism
Physicians have a new tool to help them identify and care for patients with heavy drinking and alcohol use disorders. About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about one in four currently has alcohol dependence problems that often go undetected in medical and mental health care settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a new guide called “Helping Patients Who Drink Too Much: A Clinician's Guide,” which offers guidance for conducting brief interventions and managing patient care. If a patient drinks heavily (five or more drinks in a day for men or four or more for women), the guide shows physicians how to look for symptoms of alcohol abuse or dependence. The guide is at
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. 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. There was also a trend toward less use of inexpensive drugs. The study was published in the August issue of The American Journal of Medicine.
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. When asked to comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Osteopathic Medical Concepts
Osteopathic terminology for the first time has been added to the latest version of the College of American Pathologists' Systematized Nomenclature of Medicine (SNOMED) clinical terms. The latest release incorporates more than 230 osteopathic medical concepts including procedures, diagnoses, and even subtle anatomic aberrations well known to osteopathic physicians. “The availability of the osteopathic medical content in SNOMED clinical terms represents an additional opportunity to make unique terminology available to national and international clinical and research audiences,” said Franklin R. Elevitch, M.D., chair of SNOMED International Authority. The American Osteopathic Association collaborated with SNOMED on the project to include the terminology.
Call to Action on Disability
The U.S. Surgeon General has issued his first-ever Call to Action on Disability. The report outlines goals for improving the lives of individuals with disabilities. Goals include increasing knowledge among health care professionals; providing them with tools to screen, diagnose, and treat the whole person with a disability with dignity; and increasing accessible health care and support services to promote independence for people with disabilities. “The reality is that for too long we provided lesser care to people with disabilities,” Surgeon General Richard H. Carmona said in a statement. “Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.” The document is available at
Congress Floats Medicare Payment Formula Fixes
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 Rep. 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 (CMS).
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,” Dr. McClellan said. 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.
In addition, he cautioned Rep. Johnson's subcommittee that removal of drugs would increase beneficiary premiums.
Physician groups offered support for this legislative approach at the hearing. “We're committed to improving quality of care, but to make further quality improvements physicians must be adequately reimbursed for treating Medicare patients,” John H. Armstrong, trustee to the American Medical Association, testified.
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 legislation 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 has no fix for 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, for example, might 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.
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 Rep. 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 (CMS).
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,” Dr. McClellan said. 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.
In addition, he cautioned Rep. Johnson's subcommittee that removal of drugs would increase beneficiary premiums.
Physician groups offered support for this legislative approach at the hearing. “We're committed to improving quality of care, but to make further quality improvements physicians must be adequately reimbursed for treating Medicare patients,” John H. Armstrong, trustee to the American Medical Association, testified.
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 legislation 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 has no fix for 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, for example, might 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.
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 Rep. 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 (CMS).
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,” Dr. McClellan said. 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.
In addition, he cautioned Rep. Johnson's subcommittee that removal of drugs would increase beneficiary premiums.
Physician groups offered support for this legislative approach at the hearing. “We're committed to improving quality of care, but to make further quality improvements physicians must be adequately reimbursed for treating Medicare patients,” John H. Armstrong, trustee to the American Medical Association, testified.
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 legislation 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 has no fix for 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, for example, might 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.
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.
Policy & Practice
Elderly Lack Preventive Care
Many elderly Medicare patients fail to get routine preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. In analyzing six preventive services covered by Medicare (routine blood tests and eye examinations for diabetes patients; colon and breast cancer screening; and influenza and pneumococcal vaccinations), researchers found that half of eligible Medicare beneficiaries or fewer received the recommended care in 2001. Specifically, 48% and 56% of beneficiaries with diabetes received eye examinations and hemoglobin A1c tests, respectively; 47% of women aged 65–75 years received mammograms; and 47% of all beneficiaries received flu shots. Medicare patients cared for by board-certified physicians in larger practices treating fewer poor patients were the most likely to receive cancer screenings and other preventive care. The study appeared in the July 27 Journal of the American Medical Association.
Clinician's Guide to Alcoholism
Physicians have a new tool to help them identify and care for patients with heavy drinking and alcohol use disorders, About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about one in four currently has alcohol dependence problems that often go undetected in medical and mental health care settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a new guide called “Helping Patients Who Drink Too Much: A Clinician's Guide,” which offers guidance for conducting brief interventions and managing patient care. If a patient drinks heavily (five or more drinks in a day for men or four or more for women), the guide shows physicians how to look for symptoms of alcohol abuse or dependence. The guide is available at
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. 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. There was also a trend toward less use of inexpensive drugs. The study was published in the August issue of The American Journal of Medicine.
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. When asked to comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Osteopathic Medical Concepts
Osteopathic terminology for the first time has been added to the latest version of the College of American Pathologists' Systematized Nomenclature of Medicine (SNOMED) clinical terms. The latest release incorporates more than 230 osteopathic medical concepts including procedures, diagnoses, and even subtle anatomic aberrations well known to osteopathic physicians. “The availability of the osteopathic medical content in SNOMED clinical terms represents an additional opportunity to make unique terminology available to national and international clinical and research audiences,” said Franklin R. Elevitch, M.D., chair of SNOMED International Authority. The American Osteopathic Association collaborated with SNOMED on the project to include the terminology.
Call to Action on Disability
The U.S. Surgeon General has issued his first-ever Call to Action on Disability. The report outlines goals for improving the lives of individuals with disabilities. Goals include increasing knowledge among health care professionals; providing them with tools to screen, diagnose, and treat the whole person with a disability with dignity; and increasing accessible health care and support services to promote independence for people with disabilities. “The reality is that for too long we provided lesser care to people with disabilities,” Surgeon General Richard H. Carmona said in a statement. “Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.” The document is available at
Elderly Lack Preventive Care
Many elderly Medicare patients fail to get routine preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. In analyzing six preventive services covered by Medicare (routine blood tests and eye examinations for diabetes patients; colon and breast cancer screening; and influenza and pneumococcal vaccinations), researchers found that half of eligible Medicare beneficiaries or fewer received the recommended care in 2001. Specifically, 48% and 56% of beneficiaries with diabetes received eye examinations and hemoglobin A1c tests, respectively; 47% of women aged 65–75 years received mammograms; and 47% of all beneficiaries received flu shots. Medicare patients cared for by board-certified physicians in larger practices treating fewer poor patients were the most likely to receive cancer screenings and other preventive care. The study appeared in the July 27 Journal of the American Medical Association.
Clinician's Guide to Alcoholism
Physicians have a new tool to help them identify and care for patients with heavy drinking and alcohol use disorders, About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about one in four currently has alcohol dependence problems that often go undetected in medical and mental health care settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a new guide called “Helping Patients Who Drink Too Much: A Clinician's Guide,” which offers guidance for conducting brief interventions and managing patient care. If a patient drinks heavily (five or more drinks in a day for men or four or more for women), the guide shows physicians how to look for symptoms of alcohol abuse or dependence. The guide is available at
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. 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. There was also a trend toward less use of inexpensive drugs. The study was published in the August issue of The American Journal of Medicine.
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. When asked to comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Osteopathic Medical Concepts
Osteopathic terminology for the first time has been added to the latest version of the College of American Pathologists' Systematized Nomenclature of Medicine (SNOMED) clinical terms. The latest release incorporates more than 230 osteopathic medical concepts including procedures, diagnoses, and even subtle anatomic aberrations well known to osteopathic physicians. “The availability of the osteopathic medical content in SNOMED clinical terms represents an additional opportunity to make unique terminology available to national and international clinical and research audiences,” said Franklin R. Elevitch, M.D., chair of SNOMED International Authority. The American Osteopathic Association collaborated with SNOMED on the project to include the terminology.
Call to Action on Disability
The U.S. Surgeon General has issued his first-ever Call to Action on Disability. The report outlines goals for improving the lives of individuals with disabilities. Goals include increasing knowledge among health care professionals; providing them with tools to screen, diagnose, and treat the whole person with a disability with dignity; and increasing accessible health care and support services to promote independence for people with disabilities. “The reality is that for too long we provided lesser care to people with disabilities,” Surgeon General Richard H. Carmona said in a statement. “Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.” The document is available at
Elderly Lack Preventive Care
Many elderly Medicare patients fail to get routine preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center. In analyzing six preventive services covered by Medicare (routine blood tests and eye examinations for diabetes patients; colon and breast cancer screening; and influenza and pneumococcal vaccinations), researchers found that half of eligible Medicare beneficiaries or fewer received the recommended care in 2001. Specifically, 48% and 56% of beneficiaries with diabetes received eye examinations and hemoglobin A1c tests, respectively; 47% of women aged 65–75 years received mammograms; and 47% of all beneficiaries received flu shots. Medicare patients cared for by board-certified physicians in larger practices treating fewer poor patients were the most likely to receive cancer screenings and other preventive care. The study appeared in the July 27 Journal of the American Medical Association.
Clinician's Guide to Alcoholism
Physicians have a new tool to help them identify and care for patients with heavy drinking and alcohol use disorders, About 3 in 10 U.S. adults drink at levels that increase their risk for physical, mental health, and social problems. Of these heavy drinkers, about one in four currently has alcohol dependence problems that often go undetected in medical and mental health care settings. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently released a new guide called “Helping Patients Who Drink Too Much: A Clinician's Guide,” which offers guidance for conducting brief interventions and managing patient care. If a patient drinks heavily (five or more drinks in a day for men or four or more for women), the guide shows physicians how to look for symptoms of alcohol abuse or dependence. The guide is available at
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. 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. There was also a trend toward less use of inexpensive drugs. The study was published in the August issue of The American Journal of Medicine.
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. When asked to comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Osteopathic Medical Concepts
Osteopathic terminology for the first time has been added to the latest version of the College of American Pathologists' Systematized Nomenclature of Medicine (SNOMED) clinical terms. The latest release incorporates more than 230 osteopathic medical concepts including procedures, diagnoses, and even subtle anatomic aberrations well known to osteopathic physicians. “The availability of the osteopathic medical content in SNOMED clinical terms represents an additional opportunity to make unique terminology available to national and international clinical and research audiences,” said Franklin R. Elevitch, M.D., chair of SNOMED International Authority. The American Osteopathic Association collaborated with SNOMED on the project to include the terminology.
Call to Action on Disability
The U.S. Surgeon General has issued his first-ever Call to Action on Disability. The report outlines goals for improving the lives of individuals with disabilities. Goals include increasing knowledge among health care professionals; providing them with tools to screen, diagnose, and treat the whole person with a disability with dignity; and increasing accessible health care and support services to promote independence for people with disabilities. “The reality is that for too long we provided lesser care to people with disabilities,” Surgeon General Richard H. Carmona said in a statement. “Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.” The document is available at
Loss of Health Insurance Leaves Children at Risk
For parents, losing employer-based health insurance means their children could be uninsured for long periods of time, the American Academy of Pediatrics reported.
Among an estimated 3 million children whose parents lose employer-based insurance annually, 75% subsequently become uninsured, and almost a million remain uninsured for a year or longer.
Theoretically, families have options when this happens, such as COBRA, individually purchased private insurance, or enrollment in Medicaid or the State Children's Health Insurance Program (SCHIP).
“But the reality is that COBRA and private coverage are mostly unaffordable to low- and moderate-income families,” and parents may not know about Medicaid and SCHIP or face enrollment barriers, such as cumbersome applications and waiting periods, according to the AAP.
Among those children who become uninsured, only one in eight will enroll in public programs, whereas 1 in 30 will obtain nonemployer-based private coverage. The results were based on more than 18,000 records of children obtained from Medical Expenditure Panel Survey data, from 1996 to 2001.
For parents, losing employer-based health insurance means their children could be uninsured for long periods of time, the American Academy of Pediatrics reported.
Among an estimated 3 million children whose parents lose employer-based insurance annually, 75% subsequently become uninsured, and almost a million remain uninsured for a year or longer.
Theoretically, families have options when this happens, such as COBRA, individually purchased private insurance, or enrollment in Medicaid or the State Children's Health Insurance Program (SCHIP).
“But the reality is that COBRA and private coverage are mostly unaffordable to low- and moderate-income families,” and parents may not know about Medicaid and SCHIP or face enrollment barriers, such as cumbersome applications and waiting periods, according to the AAP.
Among those children who become uninsured, only one in eight will enroll in public programs, whereas 1 in 30 will obtain nonemployer-based private coverage. The results were based on more than 18,000 records of children obtained from Medical Expenditure Panel Survey data, from 1996 to 2001.
For parents, losing employer-based health insurance means their children could be uninsured for long periods of time, the American Academy of Pediatrics reported.
Among an estimated 3 million children whose parents lose employer-based insurance annually, 75% subsequently become uninsured, and almost a million remain uninsured for a year or longer.
Theoretically, families have options when this happens, such as COBRA, individually purchased private insurance, or enrollment in Medicaid or the State Children's Health Insurance Program (SCHIP).
“But the reality is that COBRA and private coverage are mostly unaffordable to low- and moderate-income families,” and parents may not know about Medicaid and SCHIP or face enrollment barriers, such as cumbersome applications and waiting periods, according to the AAP.
Among those children who become uninsured, only one in eight will enroll in public programs, whereas 1 in 30 will obtain nonemployer-based private coverage. The results were based on more than 18,000 records of children obtained from Medical Expenditure Panel Survey data, from 1996 to 2001.
CMS Calls for 4.3% Pay Reduction Next Year
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.
"These collaborations build on Medicare's performance-based payment demonstrations, value-based payment reforms implemented in the private sector, and especially promising measures and reform ideas from leading physician organizations," he said.
Physician organizations, in the meantime, called on Congress to reach some consensus on payment solutions.
The ACP, the American Medical Association, as well as other groups support pay-for-performance legislation (H.R. 3617) from Rep. Nancy Johnson (R-Conn.) that would repeal the SGR and would 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:
▸ 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.
"These collaborations build on Medicare's performance-based payment demonstrations, value-based payment reforms implemented in the private sector, and especially promising measures and reform ideas from leading physician organizations," he said.
Physician organizations, in the meantime, called on Congress to reach some consensus on payment solutions.
The ACP, the American Medical Association, as well as other groups support pay-for-performance legislation (H.R. 3617) from Rep. Nancy Johnson (R-Conn.) that would repeal the SGR and would 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:
▸ 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.
"These collaborations build on Medicare's performance-based payment demonstrations, value-based payment reforms implemented in the private sector, and especially promising measures and reform ideas from leading physician organizations," he said.
Physician organizations, in the meantime, called on Congress to reach some consensus on payment solutions.
The ACP, the American Medical Association, as well as other groups support pay-for-performance legislation (H.R. 3617) from Rep. Nancy Johnson (R-Conn.) that would repeal the SGR and would 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:
▸ 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.
AMA House Divided on Pay for Performance
CHICAGO — The American Medical Association's new policy on pay for performance will limit its ability to negotiate with Congress, several medical specialty society groups claim.
Tensions surfaced at the annual meeting of the AMA's House of Delegates, when delegates voted to oppose any private or federal initiative that did not meet AMA's new principles and guidelines on pay for performance. These and other provisions were contained in a report that established the AMA's principles as official policy.
"Let's face it, pay for performance is here," said AMA Secretary John Armstrong, M.D., who headed the organization's task force on the issue. These new policies will help the organization establish a leadership position on pay for performance, "so when programs are being developed, we have a voice to say: This is the way to do it, that they should not just be used as a tool to cut reimbursement."
However, not everyone agrees with such a hard-line approach. "To say that 'you better meet every single one of these principles and guidelines,' that's digging in your heels—and tying your hands," Mary Frank, M.D., president of the American Academy of Family Physicians, told this newspaper.
"There needs to be flexibility in dealing with Congress, and the AMA is not being flexible," said Ralph Hale, M.D., delegate from the American College of Obstetricians and Gynecologists.
"You don't want to tie the hands of the AMA" on pay-for-performance programs, Stuart Cohen, M.D., delegate from the American Academy of Pediatrics, said in an interview.
Bob Doherty, the senior vice president for governmental affairs and public policy for the American College of Physicians, observed that the AMA's actions might specifically limit its ability to support a pay-for-performance bill linked to fixing the Medicare physician fee schedule, "if the bill in question doesn't meet all of the conditions set by the House of Delegates."
The AMA in its proceedings had expressly decided not to link pay for performance with Medicare pay. "We think they're separate issues," John Nelson, M.D., the AMA's immediate past president, told this newspaper.
But whenever physician groups have brought up the payment fix—either with Centers for Medicare and Medicaid Services Administrator Mark McClellan, M.D., or with members of Congress—the suggestion has always been that "there's no way we were going to get a [sustainable growth rate] fix without there being some kind of a quid pro quo, that they were going to look at this issue in light of other things, such as pay for performance," Dr. Frank said.
The two issues were highlighted extensively in a letter sent by ACP, AAFP, AAP, and ACOG to Senate Majority Leader Bill Frist (R-Tenn.), outlining their own wish list for physician payment reforms.
Given the limitations of the actions by the AMA, "the ACP and the other groups felt we needed to go forward on our own and try to develop the best possible bill based on our own policies," Mr. Doherty said.
In the letter to Sen. Frist, the groups specified that they would support legislation that would provide positive updates to Medicare's physician fee schedule, and reverse cuts that would otherwise occur under the sustainable growth rate (SGR).
In other recommendations, the letter stated that:
▸ Physicians should receive additional payments for participating in performance measurements and reporting programs.
▸ Pay should increase proportionately, based on the types of care being measured, by the time and costs associated with documenting performance, and the level of health information technology acquired by the practice to support quality improvement.
▸ Physicians should not be penalized under the SGR for volume increases that may occur due to compliance with performance measures.
Dr. Frank clarified that the letter "was not a preemptive strike" against the AMA, that the groups had gotten word that the Senate Finance Committee was planning a hearing on pay for performance, and they wanted to weigh in on the issue.
"Although we had issues with the board report, we would have written to the Senate regardless of the AMA's actions," she said. The hope is the AMA will end up supporting these measures in the Frist letter, "but that is a judgment it will have to make" in the context of its own policy, Mr. Doherty added.
Representatives from the primary care groups stressed that they were not breaking ranks from the AMA, but that they wanted to continue negotiations with the organization on pay for performance. The bottom line is "the AMA does not speak for us as individual policy groups," said Donna Sweet, M.D., delegate from the ACP.
Considering that performance measures for pediatricians don't exist—with the exception of immunizations, "the pediatricians want to be involved as [lawmakers] go forward in developing quality measures," AAP's Dr. Cohen said.
Some delegates, such as James Bean, M.D., of the American Association of Neurological Surgeons, thought the AMA should stand by and defend its principles. "We shouldn't negotiate out of fear," he said during House of Delegates proceedings.
In an interview, Dr. Armstrong said the AMA would continue to work with the delegation's specialty groups, to make sure that all physicians were on the same page with pay for performance.
The internal battles over payments have erupted at a time when the AMA is testing new approaches to improve its public reputation and solidify its relationship with other physician groups. In the meeting's opening session, Gary Epstein, the AMA's chief marketing officer, urged delegates to transform their impassioned debates into a consensus process to help patients.
"Together we are stronger," he said, reciting one of the AMA's new mantras. "That's not debatable."
CHICAGO — The American Medical Association's new policy on pay for performance will limit its ability to negotiate with Congress, several medical specialty society groups claim.
Tensions surfaced at the annual meeting of the AMA's House of Delegates, when delegates voted to oppose any private or federal initiative that did not meet AMA's new principles and guidelines on pay for performance. These and other provisions were contained in a report that established the AMA's principles as official policy.
"Let's face it, pay for performance is here," said AMA Secretary John Armstrong, M.D., who headed the organization's task force on the issue. These new policies will help the organization establish a leadership position on pay for performance, "so when programs are being developed, we have a voice to say: This is the way to do it, that they should not just be used as a tool to cut reimbursement."
However, not everyone agrees with such a hard-line approach. "To say that 'you better meet every single one of these principles and guidelines,' that's digging in your heels—and tying your hands," Mary Frank, M.D., president of the American Academy of Family Physicians, told this newspaper.
"There needs to be flexibility in dealing with Congress, and the AMA is not being flexible," said Ralph Hale, M.D., delegate from the American College of Obstetricians and Gynecologists.
"You don't want to tie the hands of the AMA" on pay-for-performance programs, Stuart Cohen, M.D., delegate from the American Academy of Pediatrics, said in an interview.
Bob Doherty, the senior vice president for governmental affairs and public policy for the American College of Physicians, observed that the AMA's actions might specifically limit its ability to support a pay-for-performance bill linked to fixing the Medicare physician fee schedule, "if the bill in question doesn't meet all of the conditions set by the House of Delegates."
The AMA in its proceedings had expressly decided not to link pay for performance with Medicare pay. "We think they're separate issues," John Nelson, M.D., the AMA's immediate past president, told this newspaper.
But whenever physician groups have brought up the payment fix—either with Centers for Medicare and Medicaid Services Administrator Mark McClellan, M.D., or with members of Congress—the suggestion has always been that "there's no way we were going to get a [sustainable growth rate] fix without there being some kind of a quid pro quo, that they were going to look at this issue in light of other things, such as pay for performance," Dr. Frank said.
The two issues were highlighted extensively in a letter sent by ACP, AAFP, AAP, and ACOG to Senate Majority Leader Bill Frist (R-Tenn.), outlining their own wish list for physician payment reforms.
Given the limitations of the actions by the AMA, "the ACP and the other groups felt we needed to go forward on our own and try to develop the best possible bill based on our own policies," Mr. Doherty said.
In the letter to Sen. Frist, the groups specified that they would support legislation that would provide positive updates to Medicare's physician fee schedule, and reverse cuts that would otherwise occur under the sustainable growth rate (SGR).
In other recommendations, the letter stated that:
▸ Physicians should receive additional payments for participating in performance measurements and reporting programs.
▸ Pay should increase proportionately, based on the types of care being measured, by the time and costs associated with documenting performance, and the level of health information technology acquired by the practice to support quality improvement.
▸ Physicians should not be penalized under the SGR for volume increases that may occur due to compliance with performance measures.
Dr. Frank clarified that the letter "was not a preemptive strike" against the AMA, that the groups had gotten word that the Senate Finance Committee was planning a hearing on pay for performance, and they wanted to weigh in on the issue.
"Although we had issues with the board report, we would have written to the Senate regardless of the AMA's actions," she said. The hope is the AMA will end up supporting these measures in the Frist letter, "but that is a judgment it will have to make" in the context of its own policy, Mr. Doherty added.
Representatives from the primary care groups stressed that they were not breaking ranks from the AMA, but that they wanted to continue negotiations with the organization on pay for performance. The bottom line is "the AMA does not speak for us as individual policy groups," said Donna Sweet, M.D., delegate from the ACP.
Considering that performance measures for pediatricians don't exist—with the exception of immunizations, "the pediatricians want to be involved as [lawmakers] go forward in developing quality measures," AAP's Dr. Cohen said.
Some delegates, such as James Bean, M.D., of the American Association of Neurological Surgeons, thought the AMA should stand by and defend its principles. "We shouldn't negotiate out of fear," he said during House of Delegates proceedings.
In an interview, Dr. Armstrong said the AMA would continue to work with the delegation's specialty groups, to make sure that all physicians were on the same page with pay for performance.
The internal battles over payments have erupted at a time when the AMA is testing new approaches to improve its public reputation and solidify its relationship with other physician groups. In the meeting's opening session, Gary Epstein, the AMA's chief marketing officer, urged delegates to transform their impassioned debates into a consensus process to help patients.
"Together we are stronger," he said, reciting one of the AMA's new mantras. "That's not debatable."
CHICAGO — The American Medical Association's new policy on pay for performance will limit its ability to negotiate with Congress, several medical specialty society groups claim.
Tensions surfaced at the annual meeting of the AMA's House of Delegates, when delegates voted to oppose any private or federal initiative that did not meet AMA's new principles and guidelines on pay for performance. These and other provisions were contained in a report that established the AMA's principles as official policy.
"Let's face it, pay for performance is here," said AMA Secretary John Armstrong, M.D., who headed the organization's task force on the issue. These new policies will help the organization establish a leadership position on pay for performance, "so when programs are being developed, we have a voice to say: This is the way to do it, that they should not just be used as a tool to cut reimbursement."
However, not everyone agrees with such a hard-line approach. "To say that 'you better meet every single one of these principles and guidelines,' that's digging in your heels—and tying your hands," Mary Frank, M.D., president of the American Academy of Family Physicians, told this newspaper.
"There needs to be flexibility in dealing with Congress, and the AMA is not being flexible," said Ralph Hale, M.D., delegate from the American College of Obstetricians and Gynecologists.
"You don't want to tie the hands of the AMA" on pay-for-performance programs, Stuart Cohen, M.D., delegate from the American Academy of Pediatrics, said in an interview.
Bob Doherty, the senior vice president for governmental affairs and public policy for the American College of Physicians, observed that the AMA's actions might specifically limit its ability to support a pay-for-performance bill linked to fixing the Medicare physician fee schedule, "if the bill in question doesn't meet all of the conditions set by the House of Delegates."
The AMA in its proceedings had expressly decided not to link pay for performance with Medicare pay. "We think they're separate issues," John Nelson, M.D., the AMA's immediate past president, told this newspaper.
But whenever physician groups have brought up the payment fix—either with Centers for Medicare and Medicaid Services Administrator Mark McClellan, M.D., or with members of Congress—the suggestion has always been that "there's no way we were going to get a [sustainable growth rate] fix without there being some kind of a quid pro quo, that they were going to look at this issue in light of other things, such as pay for performance," Dr. Frank said.
The two issues were highlighted extensively in a letter sent by ACP, AAFP, AAP, and ACOG to Senate Majority Leader Bill Frist (R-Tenn.), outlining their own wish list for physician payment reforms.
Given the limitations of the actions by the AMA, "the ACP and the other groups felt we needed to go forward on our own and try to develop the best possible bill based on our own policies," Mr. Doherty said.
In the letter to Sen. Frist, the groups specified that they would support legislation that would provide positive updates to Medicare's physician fee schedule, and reverse cuts that would otherwise occur under the sustainable growth rate (SGR).
In other recommendations, the letter stated that:
▸ Physicians should receive additional payments for participating in performance measurements and reporting programs.
▸ Pay should increase proportionately, based on the types of care being measured, by the time and costs associated with documenting performance, and the level of health information technology acquired by the practice to support quality improvement.
▸ Physicians should not be penalized under the SGR for volume increases that may occur due to compliance with performance measures.
Dr. Frank clarified that the letter "was not a preemptive strike" against the AMA, that the groups had gotten word that the Senate Finance Committee was planning a hearing on pay for performance, and they wanted to weigh in on the issue.
"Although we had issues with the board report, we would have written to the Senate regardless of the AMA's actions," she said. The hope is the AMA will end up supporting these measures in the Frist letter, "but that is a judgment it will have to make" in the context of its own policy, Mr. Doherty added.
Representatives from the primary care groups stressed that they were not breaking ranks from the AMA, but that they wanted to continue negotiations with the organization on pay for performance. The bottom line is "the AMA does not speak for us as individual policy groups," said Donna Sweet, M.D., delegate from the ACP.
Considering that performance measures for pediatricians don't exist—with the exception of immunizations, "the pediatricians want to be involved as [lawmakers] go forward in developing quality measures," AAP's Dr. Cohen said.
Some delegates, such as James Bean, M.D., of the American Association of Neurological Surgeons, thought the AMA should stand by and defend its principles. "We shouldn't negotiate out of fear," he said during House of Delegates proceedings.
In an interview, Dr. Armstrong said the AMA would continue to work with the delegation's specialty groups, to make sure that all physicians were on the same page with pay for performance.
The internal battles over payments have erupted at a time when the AMA is testing new approaches to improve its public reputation and solidify its relationship with other physician groups. In the meeting's opening session, Gary Epstein, the AMA's chief marketing officer, urged delegates to transform their impassioned debates into a consensus process to help patients.
"Together we are stronger," he said, reciting one of the AMA's new mantras. "That's not debatable."
Congress Floats Plan to Fix Medicare Physician Fee Schedule
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 plan is one of several 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 told Rep. Johnson such a measure could come at a high cost: that is, MEI-based increases would be $183 billion over 10 years.
CMS, meanwhile, is working 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.
In addition, he cautioned Rep. Johnson's subcommittee that removal of drugs would increase beneficiary premiums.
Physicians groups offered support for this legislative approach at the hearing. “We're committed to improving quality of care, but to make further quality improvements physicians must be adequately reimbursed for treating Medicare patients,” John H. Armstrong, trustee to the American Medical Association, testified.
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 would be voluntary, but those choosing not to report quality data would receive a reduced payment update.
Unlike the Johnson proposal, 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.
The outcome is family physicians may be forced to drop Medicare beneficiaries, Dr. Frank said. In addition, “tons of implementation questions” aren't broached in this bill, said Michele Johnson, senior governmental relations representative of the Medical Group Management Association.
“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 said 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.
Primary care groups had lobbied Senate Majority Leader Bill Frist (R-Tenn.) for a pay-for-performance bill that would provide positive updates to Medicare's physician fee schedule, as well as reverse cuts that would otherwise occur under the SGR.
If any language from Grassley-Baucus is approved, “it will probably be inserted into end of the year must-pass legislation,” Ms. Johnson said. Standing alone, the bill is too risky on the Senate floor because it would give Democrats an opportunity to reopen the Medicare Modernization Act. “The Republicans don't want that.”
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 plan is one of several 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 told Rep. Johnson such a measure could come at a high cost: that is, MEI-based increases would be $183 billion over 10 years.
CMS, meanwhile, is working 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.
In addition, he cautioned Rep. Johnson's subcommittee that removal of drugs would increase beneficiary premiums.
Physicians groups offered support for this legislative approach at the hearing. “We're committed to improving quality of care, but to make further quality improvements physicians must be adequately reimbursed for treating Medicare patients,” John H. Armstrong, trustee to the American Medical Association, testified.
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 would be voluntary, but those choosing not to report quality data would receive a reduced payment update.
Unlike the Johnson proposal, 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.
The outcome is family physicians may be forced to drop Medicare beneficiaries, Dr. Frank said. In addition, “tons of implementation questions” aren't broached in this bill, said Michele Johnson, senior governmental relations representative of the Medical Group Management Association.
“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 said 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.
Primary care groups had lobbied Senate Majority Leader Bill Frist (R-Tenn.) for a pay-for-performance bill that would provide positive updates to Medicare's physician fee schedule, as well as reverse cuts that would otherwise occur under the SGR.
If any language from Grassley-Baucus is approved, “it will probably be inserted into end of the year must-pass legislation,” Ms. Johnson said. Standing alone, the bill is too risky on the Senate floor because it would give Democrats an opportunity to reopen the Medicare Modernization Act. “The Republicans don't want that.”
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 plan is one of several 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 told Rep. Johnson such a measure could come at a high cost: that is, MEI-based increases would be $183 billion over 10 years.
CMS, meanwhile, is working 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.
In addition, he cautioned Rep. Johnson's subcommittee that removal of drugs would increase beneficiary premiums.
Physicians groups offered support for this legislative approach at the hearing. “We're committed to improving quality of care, but to make further quality improvements physicians must be adequately reimbursed for treating Medicare patients,” John H. Armstrong, trustee to the American Medical Association, testified.
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 would be voluntary, but those choosing not to report quality data would receive a reduced payment update.
Unlike the Johnson proposal, 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.
The outcome is family physicians may be forced to drop Medicare beneficiaries, Dr. Frank said. In addition, “tons of implementation questions” aren't broached in this bill, said Michele Johnson, senior governmental relations representative of the Medical Group Management Association.
“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 said 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.
Primary care groups had lobbied Senate Majority Leader Bill Frist (R-Tenn.) for a pay-for-performance bill that would provide positive updates to Medicare's physician fee schedule, as well as reverse cuts that would otherwise occur under the SGR.
If any language from Grassley-Baucus is approved, “it will probably be inserted into end of the year must-pass legislation,” Ms. Johnson said. Standing alone, the bill is too risky on the Senate floor because it would give Democrats an opportunity to reopen the Medicare Modernization Act. “The Republicans don't want that.”
Policy & Practice
Bill Would Repeal SGR
Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medcaid Services, 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. Her bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for participating in performance measurement.
No More Caps in Wisconsin
The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.
Information Technology Deficit
Most Medicare fee-for-service outpatient visits in 2001 were to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that 57% of Medicare outpatient visits were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions. While half those visits were to physicians using IT to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower, falling to 9% for electronic prescribing. While access to “wired” practices was low for all beneficiaries, HSC found there were few differences in access between sicker and healthier beneficiaries.
Air Travel With Medical Oxygen
As of last month, the Federal Aviation Administration began allowing people with respiratory disease to bring their own portable oxygen concentrators on board commercial flights. While pleased with the ruling, the American Thoracic Society's President Peter D. Wagner, M.D., expressed concerns that the rule allows but does not require airlines to let passengers use portable oxygen concentrators. The Department of Transportation should use its regulatory authority under the Air Carrier Access Act to ensure portable oxygen concentrators can be used on all commercial passenger planes, he said.
Widespread Ethics Problems
More than 40 employees at the National Institutes of Health were found to have violated the agency's conflict of interest rules, according to the House Energy and Commerce Committee. Last year, the Committee identified a sample of 81 NIH scientists who were hired by drug companies between 1999 and 2004 but whose activities were not listed in NIH reports to the Committee. An NIH review, which was reported to the Energy and Commerce Committee, cleared 37 of the scientists but found that 44 had violated one or more of the NIH rules, including reporting income on financial disclosure forms, taking personal leave to do private work, and seeking prior approval for consulting arrangements. Of the 44, 36 are still employed at NIH and have been referred for possible disciplinary action, and 9 of the 36 are facing investigation of possible criminal violations by the Health and Human Services Office of Inspector General. After months of congressional hearings on possible financial conflicts of interest by NIH employees, the agency issued an interim final regulation earlier this year that tightens restrictions on outside consulting arrangements with industry.
Soft Drink Wars
The Center for Science in the Public Interest is targeting the public's consumption of soft drinks, something the group labels as “liquid poison.” Carbonated soft drinks are the single biggest source of calories in the American diet—and frequent consumption is a likely contributor to overweight and obesity, the group stated. In a petition, CSPI called on the Food and Drug Administration to require a series of rotating health notices on containers of all nondiet soft drinks (carbonated and noncarbonated) that contain more than 13 g of refined sugars per 12 ounces. In a statement, Susan Neely, president and chief executive officer of the American Beverage Association, thought the CSPI's proposed warning labels on soft drinks patronized consumers and lacked common sense. “Even skim milk and thousands of other food products could potentially fit into a CSPI labeling scheme because of the sugars contained in those products,” she said.
Bill Would Repeal SGR
Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medcaid Services, 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. Her bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for participating in performance measurement.
No More Caps in Wisconsin
The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.
Information Technology Deficit
Most Medicare fee-for-service outpatient visits in 2001 were to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that 57% of Medicare outpatient visits were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions. While half those visits were to physicians using IT to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower, falling to 9% for electronic prescribing. While access to “wired” practices was low for all beneficiaries, HSC found there were few differences in access between sicker and healthier beneficiaries.
Air Travel With Medical Oxygen
As of last month, the Federal Aviation Administration began allowing people with respiratory disease to bring their own portable oxygen concentrators on board commercial flights. While pleased with the ruling, the American Thoracic Society's President Peter D. Wagner, M.D., expressed concerns that the rule allows but does not require airlines to let passengers use portable oxygen concentrators. The Department of Transportation should use its regulatory authority under the Air Carrier Access Act to ensure portable oxygen concentrators can be used on all commercial passenger planes, he said.
Widespread Ethics Problems
More than 40 employees at the National Institutes of Health were found to have violated the agency's conflict of interest rules, according to the House Energy and Commerce Committee. Last year, the Committee identified a sample of 81 NIH scientists who were hired by drug companies between 1999 and 2004 but whose activities were not listed in NIH reports to the Committee. An NIH review, which was reported to the Energy and Commerce Committee, cleared 37 of the scientists but found that 44 had violated one or more of the NIH rules, including reporting income on financial disclosure forms, taking personal leave to do private work, and seeking prior approval for consulting arrangements. Of the 44, 36 are still employed at NIH and have been referred for possible disciplinary action, and 9 of the 36 are facing investigation of possible criminal violations by the Health and Human Services Office of Inspector General. After months of congressional hearings on possible financial conflicts of interest by NIH employees, the agency issued an interim final regulation earlier this year that tightens restrictions on outside consulting arrangements with industry.
Soft Drink Wars
The Center for Science in the Public Interest is targeting the public's consumption of soft drinks, something the group labels as “liquid poison.” Carbonated soft drinks are the single biggest source of calories in the American diet—and frequent consumption is a likely contributor to overweight and obesity, the group stated. In a petition, CSPI called on the Food and Drug Administration to require a series of rotating health notices on containers of all nondiet soft drinks (carbonated and noncarbonated) that contain more than 13 g of refined sugars per 12 ounces. In a statement, Susan Neely, president and chief executive officer of the American Beverage Association, thought the CSPI's proposed warning labels on soft drinks patronized consumers and lacked common sense. “Even skim milk and thousands of other food products could potentially fit into a CSPI labeling scheme because of the sugars contained in those products,” she said.
Bill Would Repeal SGR
Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medcaid Services, 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. Her bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for participating in performance measurement.
No More Caps in Wisconsin
The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.
Information Technology Deficit
Most Medicare fee-for-service outpatient visits in 2001 were to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that 57% of Medicare outpatient visits were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions. While half those visits were to physicians using IT to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower, falling to 9% for electronic prescribing. While access to “wired” practices was low for all beneficiaries, HSC found there were few differences in access between sicker and healthier beneficiaries.
Air Travel With Medical Oxygen
As of last month, the Federal Aviation Administration began allowing people with respiratory disease to bring their own portable oxygen concentrators on board commercial flights. While pleased with the ruling, the American Thoracic Society's President Peter D. Wagner, M.D., expressed concerns that the rule allows but does not require airlines to let passengers use portable oxygen concentrators. The Department of Transportation should use its regulatory authority under the Air Carrier Access Act to ensure portable oxygen concentrators can be used on all commercial passenger planes, he said.
Widespread Ethics Problems
More than 40 employees at the National Institutes of Health were found to have violated the agency's conflict of interest rules, according to the House Energy and Commerce Committee. Last year, the Committee identified a sample of 81 NIH scientists who were hired by drug companies between 1999 and 2004 but whose activities were not listed in NIH reports to the Committee. An NIH review, which was reported to the Energy and Commerce Committee, cleared 37 of the scientists but found that 44 had violated one or more of the NIH rules, including reporting income on financial disclosure forms, taking personal leave to do private work, and seeking prior approval for consulting arrangements. Of the 44, 36 are still employed at NIH and have been referred for possible disciplinary action, and 9 of the 36 are facing investigation of possible criminal violations by the Health and Human Services Office of Inspector General. After months of congressional hearings on possible financial conflicts of interest by NIH employees, the agency issued an interim final regulation earlier this year that tightens restrictions on outside consulting arrangements with industry.
Soft Drink Wars
The Center for Science in the Public Interest is targeting the public's consumption of soft drinks, something the group labels as “liquid poison.” Carbonated soft drinks are the single biggest source of calories in the American diet—and frequent consumption is a likely contributor to overweight and obesity, the group stated. In a petition, CSPI called on the Food and Drug Administration to require a series of rotating health notices on containers of all nondiet soft drinks (carbonated and noncarbonated) that contain more than 13 g of refined sugars per 12 ounces. In a statement, Susan Neely, president and chief executive officer of the American Beverage Association, thought the CSPI's proposed warning labels on soft drinks patronized consumers and lacked common sense. “Even skim milk and thousands of other food products could potentially fit into a CSPI labeling scheme because of the sugars contained in those products,” she said.
Policy & Practice
Bill Would Repeal SGR
Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medcaid Services, 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. Her bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for participating in performance measurement.
No More Caps in Wisconsin
The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.
Air Travel With Medical Oxygen
Starting this month, the Federal Aviation Administration is allowing people with respiratory disease to bring their own portable oxygen concentrators on board commercial flights. Although pleased with the ruling, the American Thoracic Society's President Peter D. Wagner, M.D., expressed concerns that the rule allows but does not require airlines to let passengers use portable oxygen concentrators. The Department of Transportation should use its regulatory authority under the Air Carrier Access Act to ensure portable oxygen concentrators can be used on all commercial passenger planes, he said.
Information Technology Deficit
Most Medicare fee-for-service outpatient visits in 2001 were to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that 57% Medicare outpatient visits were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions. Although half of those visits were to physicians using IT to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower, falling to 9% for electronic prescribing. Access to “wired” practices was low for all beneficiaries, but HSC found few differences in access between sicker and healthier beneficiaries.
Ethics Problems at the NIH
More than 40 employees at the National Institutes of Health were found to have violated the agency's conflict of interest rules, according to the House Energy and Commerce Committee. Last year, the Committee identified a sample of 81 NIH scientists who were hired by drug companies between 1999 and 2004 but whose activities were not listed in NIH reports to the Committee. An NIH review, which was reported to the Energy and Commerce Committee, cleared 37 of the scientists but found that 44 had violated one or more of the NIH rules including reporting income on financial disclosure forms, taking personal leave to do private work, and seeking prior approval for consulting arrangements. Of the 44 scientists, 36 are still employed at NIH and have been referred for possible disciplinary action, and 9 of the 36 are facing investigation of possible criminal violations by the Health and Human Services Office of Inspector General. After months of congressional hearings on possible financial conflicts of interest by NIH employees, NIH issued an interim final regulation earlier this year that tightens restrictions on outside consulting arrangements with industry.
Soft Drink Wars
The Center for Science in the Public Interest is targeting the public's consumption of soft drinks, something the group labels as “liquid poison.” Carbonated soft drinks are the single biggest source of calories in the American diet—and frequent consumption is a likely contributor to overweight and obesity, the group stated. In a petition, CSPI called on the Food and Drug Administration to require a series of rotating health notices on containers of all nondiet soft drinks (carbonated and noncarbonated) that contain more than 13 g of refined sugars per 12 ounces. In a statement, Susan Neely, president and chief executive officer of the American Beverage Association, said the CSPI's proposed warning labels on soft drinks patronized consumers and lacked common sense. “Even skim milk and thousands of other food products could potentially fit into a CSPI labeling scheme because of the sugars contained in those products,” she said.
Bill Would Repeal SGR
Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medcaid Services, 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. Her bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for participating in performance measurement.
No More Caps in Wisconsin
The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.
Air Travel With Medical Oxygen
Starting this month, the Federal Aviation Administration is allowing people with respiratory disease to bring their own portable oxygen concentrators on board commercial flights. Although pleased with the ruling, the American Thoracic Society's President Peter D. Wagner, M.D., expressed concerns that the rule allows but does not require airlines to let passengers use portable oxygen concentrators. The Department of Transportation should use its regulatory authority under the Air Carrier Access Act to ensure portable oxygen concentrators can be used on all commercial passenger planes, he said.
Information Technology Deficit
Most Medicare fee-for-service outpatient visits in 2001 were to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that 57% Medicare outpatient visits were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions. Although half of those visits were to physicians using IT to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower, falling to 9% for electronic prescribing. Access to “wired” practices was low for all beneficiaries, but HSC found few differences in access between sicker and healthier beneficiaries.
Ethics Problems at the NIH
More than 40 employees at the National Institutes of Health were found to have violated the agency's conflict of interest rules, according to the House Energy and Commerce Committee. Last year, the Committee identified a sample of 81 NIH scientists who were hired by drug companies between 1999 and 2004 but whose activities were not listed in NIH reports to the Committee. An NIH review, which was reported to the Energy and Commerce Committee, cleared 37 of the scientists but found that 44 had violated one or more of the NIH rules including reporting income on financial disclosure forms, taking personal leave to do private work, and seeking prior approval for consulting arrangements. Of the 44 scientists, 36 are still employed at NIH and have been referred for possible disciplinary action, and 9 of the 36 are facing investigation of possible criminal violations by the Health and Human Services Office of Inspector General. After months of congressional hearings on possible financial conflicts of interest by NIH employees, NIH issued an interim final regulation earlier this year that tightens restrictions on outside consulting arrangements with industry.
Soft Drink Wars
The Center for Science in the Public Interest is targeting the public's consumption of soft drinks, something the group labels as “liquid poison.” Carbonated soft drinks are the single biggest source of calories in the American diet—and frequent consumption is a likely contributor to overweight and obesity, the group stated. In a petition, CSPI called on the Food and Drug Administration to require a series of rotating health notices on containers of all nondiet soft drinks (carbonated and noncarbonated) that contain more than 13 g of refined sugars per 12 ounces. In a statement, Susan Neely, president and chief executive officer of the American Beverage Association, said the CSPI's proposed warning labels on soft drinks patronized consumers and lacked common sense. “Even skim milk and thousands of other food products could potentially fit into a CSPI labeling scheme because of the sugars contained in those products,” she said.
Bill Would Repeal SGR
Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medcaid Services, 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. Her bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for participating in performance measurement.
No More Caps in Wisconsin
The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.
Air Travel With Medical Oxygen
Starting this month, the Federal Aviation Administration is allowing people with respiratory disease to bring their own portable oxygen concentrators on board commercial flights. Although pleased with the ruling, the American Thoracic Society's President Peter D. Wagner, M.D., expressed concerns that the rule allows but does not require airlines to let passengers use portable oxygen concentrators. The Department of Transportation should use its regulatory authority under the Air Carrier Access Act to ensure portable oxygen concentrators can be used on all commercial passenger planes, he said.
Information Technology Deficit
Most Medicare fee-for-service outpatient visits in 2001 were to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that 57% Medicare outpatient visits were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions. Although half of those visits were to physicians using IT to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower, falling to 9% for electronic prescribing. Access to “wired” practices was low for all beneficiaries, but HSC found few differences in access between sicker and healthier beneficiaries.
Ethics Problems at the NIH
More than 40 employees at the National Institutes of Health were found to have violated the agency's conflict of interest rules, according to the House Energy and Commerce Committee. Last year, the Committee identified a sample of 81 NIH scientists who were hired by drug companies between 1999 and 2004 but whose activities were not listed in NIH reports to the Committee. An NIH review, which was reported to the Energy and Commerce Committee, cleared 37 of the scientists but found that 44 had violated one or more of the NIH rules including reporting income on financial disclosure forms, taking personal leave to do private work, and seeking prior approval for consulting arrangements. Of the 44 scientists, 36 are still employed at NIH and have been referred for possible disciplinary action, and 9 of the 36 are facing investigation of possible criminal violations by the Health and Human Services Office of Inspector General. After months of congressional hearings on possible financial conflicts of interest by NIH employees, NIH issued an interim final regulation earlier this year that tightens restrictions on outside consulting arrangements with industry.
Soft Drink Wars
The Center for Science in the Public Interest is targeting the public's consumption of soft drinks, something the group labels as “liquid poison.” Carbonated soft drinks are the single biggest source of calories in the American diet—and frequent consumption is a likely contributor to overweight and obesity, the group stated. In a petition, CSPI called on the Food and Drug Administration to require a series of rotating health notices on containers of all nondiet soft drinks (carbonated and noncarbonated) that contain more than 13 g of refined sugars per 12 ounces. In a statement, Susan Neely, president and chief executive officer of the American Beverage Association, said the CSPI's proposed warning labels on soft drinks patronized consumers and lacked common sense. “Even skim milk and thousands of other food products could potentially fit into a CSPI labeling scheme because of the sugars contained in those products,” she said.