Jennifer Silverman

CHICAGO — A pharmacist's philosophy shouldn't get in the way of prescribing needed drugs to patients. That was one of conclusions that physicians reached while addressing controversial topics at the annual meeting of the American Medical Association's House of Delegates.

American Pharmaceutical Association (APhA) policy recognizes an individual pharmacist's right to exercise conscientious refusal to fill prescriptions. In committee debate and in full congress, physicians at the House of Delegates meeting expressed concern that pharmacists were exercising this provision to impede access to certain medications, including emergency contraceptives and psychotropic agents.

“What happens between the doctor and the patient is between doctor and patient,” Mary Frank, M.D., president of the American Academy of Family Physicians, told this newspaper. “What they decide has to have priority over the pharmacist's objections.”

Although the delegates didn't outwardly oppose the use of conscience clauses, they did call for legislation that would require individual pharmacists or pharmacy chains to either fill legally valid prescriptions or refer patients to an alternative dispensing pharmacy.

AMA Trustee Peter W. Carmel, M.D., promised that the AMA would work with the pharmacists' associations and state legislators “so that neither patients' health nor the patient-physician relationship is harmed by pharmacists' refusal to fill prescribed medications.”

The House also agreed that the AMA should lobby for state legislation that would allow physicians to dispense medication to their own patients if no pharmacist within a 30-mile radius is able and willing to dispense the medication. The APhA did not respond to requests for comment from this newspaper.

In other business, delegates addressed the challenges physicians face in balancing the increasing value of imaging tests with payers' efforts to restrict reimbursement.

Several resolutions were approved that directed the AMA to oppose any attempts to restrict such reimbursement based on physician specialty.

Some payers propose to reimburse only radiologists for imaging, a practice that other specialists believe is unfair, Bruce Scott, M.D., an otolaryngologist, said.

“The ob.gyns. are going to want to bill for ultrasound, and the cardiologists want to bill for their interpretation of slides,” he told this newspaper, adding that the bottom line is physicians should have the right to bill for a service they provide and are qualified to perform.

Balance billing was another topic addressed and measures were approved asking that the AMA prepare legislation that would allow physicians to balance bill regardless of the payer.

In the wake of pay for performance initiatives, “which are nothing but third party managers taking over,” balance billing would place patients back in control, enabling them to negotiate their own bills with their individual physicians, Jay Gregory, M.D., of the Oklahoma delegation, said during committee debate.

To address the Medicare physician fee schedule, delegates recommended that saving under Medicare Part A that could be attributed to better Part B care (for example, fewer inpatient complications, shorter lengths of stay, and fewer hospital readmissions) should be “credited” and flow to the Part B physician payment pool.

On another contentious issue—malpractice—delegates called on the AMA to explore federal legislation that would correct inadequate state medical liability laws while preserving state medical liability reforms that have proven effective.

The House of Delegates also commented on the aftermath of the Terry Schiavo case, voting to oppose legislation that would “presume to prescribe a patient's preferences for artificial hydration and nutrition in situations where the patient lacks decision-making capacity and an advance directive or living will.”

A number of resolutions called on schools to develop children's health programs, such as sun-protection policies in elementary schools.

Most delegates were in agreement with this resolution, although some concerns were raised that this might place undo burdens on teachers. Parents should be the adults in charge of applying sunscreen to their children, Peter Lavine, M.D., delegate to the Medical Society of the District of Columbia, said in committee proceedings.

Delegates rejected a provision to impose taxes on sugar-sweetened soft drinks. Instead, they approved policy urging public schools to promote the consumption and availability of nutritious beverages.

Reducing television watching would do more to curtail obesity in children than taxing soft drinks, Holly Wyatt, M.D., delegate to the Young Physicians Section for the Endocrine Society, said during committee debate.

Addressing general policies on obesity, the AMA urged physicians to incorporate body mass index BMI and waist circumference as a component measurement in routine adult examinations and BMI percentiles in children.

In addition, the resolution called on the AMA to develop a school health advocacy agenda that includes funding for physical activity programs.

CHICAGO — A pharmacist's philosophy shouldn't get in the way of prescribing needed drugs to patients. That was one of conclusions that physicians reached while addressing controversial topics at the annual meeting of the American Medical Association's House of Delegates.

American Pharmaceutical Association (APhA) policy recognizes an individual pharmacist's right to exercise conscientious refusal to fill prescriptions. In committee debate and in full congress, physicians at the House of Delegates meeting expressed concern that pharmacists were exercising this provision to impede access to certain medications, including emergency contraceptives and psychotropic agents.

“What happens between the doctor and the patient is between doctor and patient,” Mary Frank, M.D., president of the American Academy of Family Physicians, told this newspaper. “What they decide has to have priority over the pharmacist's objections.”

Although the delegates didn't outwardly oppose the use of conscience clauses, they did call for legislation that would require individual pharmacists or pharmacy chains to either fill legally valid prescriptions or refer patients to an alternative dispensing pharmacy.

AMA Trustee Peter W. Carmel, M.D., promised that the AMA would work with the pharmacists' associations and state legislators “so that neither patients' health nor the patient-physician relationship is harmed by pharmacists' refusal to fill prescribed medications.”

The House also agreed that the AMA should lobby for state legislation that would allow physicians to dispense medication to their own patients if no pharmacist within a 30-mile radius is able and willing to dispense the medication. The APhA did not respond to requests for comment from this newspaper.

In other business, delegates addressed the challenges physicians face in balancing the increasing value of imaging tests with payers' efforts to restrict reimbursement.

Several resolutions were approved that directed the AMA to oppose any attempts to restrict such reimbursement based on physician specialty.

Some payers propose to reimburse only radiologists for imaging, a practice that other specialists believe is unfair, Bruce Scott, M.D., an otolaryngologist, said.

“The ob.gyns. are going to want to bill for ultrasound, and the cardiologists want to bill for their interpretation of slides,” he told this newspaper, adding that the bottom line is physicians should have the right to bill for a service they provide and are qualified to perform.

Balance billing was another topic addressed and measures were approved asking that the AMA prepare legislation that would allow physicians to balance bill regardless of the payer.

In the wake of pay for performance initiatives, “which are nothing but third party managers taking over,” balance billing would place patients back in control, enabling them to negotiate their own bills with their individual physicians, Jay Gregory, M.D., of the Oklahoma delegation, said during committee debate.

To address the Medicare physician fee schedule, delegates recommended that saving under Medicare Part A that could be attributed to better Part B care (for example, fewer inpatient complications, shorter lengths of stay, and fewer hospital readmissions) should be “credited” and flow to the Part B physician payment pool.

On another contentious issue—malpractice—delegates called on the AMA to explore federal legislation that would correct inadequate state medical liability laws while preserving state medical liability reforms that have proven effective.

The House of Delegates also commented on the aftermath of the Terry Schiavo case, voting to oppose legislation that would “presume to prescribe a patient's preferences for artificial hydration and nutrition in situations where the patient lacks decision-making capacity and an advance directive or living will.”

A number of resolutions called on schools to develop children's health programs, such as sun-protection policies in elementary schools.

Most delegates were in agreement with this resolution, although some concerns were raised that this might place undo burdens on teachers. Parents should be the adults in charge of applying sunscreen to their children, Peter Lavine, M.D., delegate to the Medical Society of the District of Columbia, said in committee proceedings.

Delegates rejected a provision to impose taxes on sugar-sweetened soft drinks. Instead, they approved policy urging public schools to promote the consumption and availability of nutritious beverages.

Reducing television watching would do more to curtail obesity in children than taxing soft drinks, Holly Wyatt, M.D., delegate to the Young Physicians Section for the Endocrine Society, said during committee debate.

Addressing general policies on obesity, the AMA urged physicians to incorporate body mass index BMI and waist circumference as a component measurement in routine adult examinations and BMI percentiles in children.

In addition, the resolution called on the AMA to develop a school health advocacy agenda that includes funding for physical activity programs.

CHICAGO — A pharmacist's philosophy shouldn't get in the way of prescribing needed drugs to patients. That was one of conclusions that physicians reached while addressing controversial topics at the annual meeting of the American Medical Association's House of Delegates.

American Pharmaceutical Association (APhA) policy recognizes an individual pharmacist's right to exercise conscientious refusal to fill prescriptions. In committee debate and in full congress, physicians at the House of Delegates meeting expressed concern that pharmacists were exercising this provision to impede access to certain medications, including emergency contraceptives and psychotropic agents.

“What happens between the doctor and the patient is between doctor and patient,” Mary Frank, M.D., president of the American Academy of Family Physicians, told this newspaper. “What they decide has to have priority over the pharmacist's objections.”

Although the delegates didn't outwardly oppose the use of conscience clauses, they did call for legislation that would require individual pharmacists or pharmacy chains to either fill legally valid prescriptions or refer patients to an alternative dispensing pharmacy.

AMA Trustee Peter W. Carmel, M.D., promised that the AMA would work with the pharmacists' associations and state legislators “so that neither patients' health nor the patient-physician relationship is harmed by pharmacists' refusal to fill prescribed medications.”

The House also agreed that the AMA should lobby for state legislation that would allow physicians to dispense medication to their own patients if no pharmacist within a 30-mile radius is able and willing to dispense the medication. The APhA did not respond to requests for comment from this newspaper.

In other business, delegates addressed the challenges physicians face in balancing the increasing value of imaging tests with payers' efforts to restrict reimbursement.

Several resolutions were approved that directed the AMA to oppose any attempts to restrict such reimbursement based on physician specialty.

Some payers propose to reimburse only radiologists for imaging, a practice that other specialists believe is unfair, Bruce Scott, M.D., an otolaryngologist, said.

“The ob.gyns. are going to want to bill for ultrasound, and the cardiologists want to bill for their interpretation of slides,” he told this newspaper, adding that the bottom line is physicians should have the right to bill for a service they provide and are qualified to perform.

Balance billing was another topic addressed and measures were approved asking that the AMA prepare legislation that would allow physicians to balance bill regardless of the payer.

In the wake of pay for performance initiatives, “which are nothing but third party managers taking over,” balance billing would place patients back in control, enabling them to negotiate their own bills with their individual physicians, Jay Gregory, M.D., of the Oklahoma delegation, said during committee debate.

To address the Medicare physician fee schedule, delegates recommended that saving under Medicare Part A that could be attributed to better Part B care (for example, fewer inpatient complications, shorter lengths of stay, and fewer hospital readmissions) should be “credited” and flow to the Part B physician payment pool.

On another contentious issue—malpractice—delegates called on the AMA to explore federal legislation that would correct inadequate state medical liability laws while preserving state medical liability reforms that have proven effective.

The House of Delegates also commented on the aftermath of the Terry Schiavo case, voting to oppose legislation that would “presume to prescribe a patient's preferences for artificial hydration and nutrition in situations where the patient lacks decision-making capacity and an advance directive or living will.”

A number of resolutions called on schools to develop children's health programs, such as sun-protection policies in elementary schools.

Most delegates were in agreement with this resolution, although some concerns were raised that this might place undo burdens on teachers. Parents should be the adults in charge of applying sunscreen to their children, Peter Lavine, M.D., delegate to the Medical Society of the District of Columbia, said in committee proceedings.

Delegates rejected a provision to impose taxes on sugar-sweetened soft drinks. Instead, they approved policy urging public schools to promote the consumption and availability of nutritious beverages.

Reducing television watching would do more to curtail obesity in children than taxing soft drinks, Holly Wyatt, M.D., delegate to the Young Physicians Section for the Endocrine Society, said during committee debate.

Addressing general policies on obesity, the AMA urged physicians to incorporate body mass index BMI and waist circumference as a component measurement in routine adult examinations and BMI percentiles in children.

In addition, the resolution called on the AMA to develop a school health advocacy agenda that includes funding for physical activity programs.

Dozing Doctors Endure

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

More Options Versus Saving Costs

Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

Underinsured Statistics

A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.

The Ongoing 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. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for 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.”

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures. In addition, the group would like to see coverage made more uniform around the country since Medicare coverage decisions for weight-loss surgery are generally decided regionally. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.

Dozing Doctors Endure

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

More Options Versus Saving Costs

Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

Underinsured Statistics

A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.

The Ongoing 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. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for 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.”

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures. In addition, the group would like to see coverage made more uniform around the country since Medicare coverage decisions for weight-loss surgery are generally decided regionally. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.

Dozing Doctors Endure

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

More Options Versus Saving Costs

Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

Underinsured Statistics

A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.

The Ongoing 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. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for 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.”

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures. In addition, the group would like to see coverage made more uniform around the country since Medicare coverage decisions for weight-loss surgery are generally decided regionally. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.

WASHINGTON — Medicare intends to use performance measures to monitor cost, quality, and access issues related to the new prescription drug benefit, a research analyst said during a meeting of the Medicare Payment Advisory Commission.

But Medicare has not yet “determined what those measures will be and how they will be used,” said MedPAC analyst Cristina Boccuti. The Centers for Medicare and Medicaid Services will be collecting a large amount of data on the new drug benefit—or Medicare Part D—including drug utilization and plan benefit information, to construct these performance measures, Ms. Boccuti said. In addition to the agency's need for the data, “congressional agencies will need Part D data to report to the Congress on the impact of the drug benefit on cost, quality, and access,” she added.

MedPAC commissioners recommended that the Health and Human Services department establish a process for the timely delivery of these data to interested parties. Individuals, employers, and government agencies currently use performance measures to evaluate how well health plans and pharmacy benefit managers manage drug benefits, Ms. Boccuti said.

To identify how policy makers could use these measures to monitor the Part D program, MedPAC convened a panel of 11 experts representing health plans, pharmacy benefits managers (PBMs), employers, pharmacies, consumers, quality assurance organizations, and researchers. The panel analyzed measures such as cost control, access and quality assurance, benefit administration and management, and enrollee satisfaction.

Based on the panel's findings, CMS plans to collect data on the following:

▸ Dispensing fees, generic dispensing rates, aggregate rebates, drug claims, and drug spending by plans and beneficiaries.

▸ Pharmacy networks, formularies (including prior authorization and exceptions), appeals rates, and drug utilization.

▸ Claims processing, including plans' out-of-pocket calculations.

▸ Beneficiary satisfaction, grievances, call center operations, and disenrollment rates.

Measures to track beneficiary satisfaction—such as member satisfaction surveys and performance of customer service call centers—are common types of performance guarantees that health plans and PBMs offer to their clients, she said. CMS plans to conduct its own consumer satisfaction surveys to provide comparative plan information to beneficiaries for making enrollment decisions. Also, plans will submit data on grievances filed, and call center performance measures such as abandonment rates and hold times.

MedPAC commissioner Nancy-Ann DeParle, a health care consultant in Washington and former head of CMs' predecessor agency (the Health Care Financing Administration), asked whether CMS would be looking at these data at a physician level, in terms of who did the prescribing. “In our pay-for-performance discussions around physicians, [MedPAC indicated that] it would be useful to have this.” Ms. Boccuti noted that there is a prescriber code associated with each drug.

On the issue of collecting cost data, Ms. DeParle said that she wondered whether CMS would be able to assess whether particular plans were getting a “good deal” on the drugs they purchased. “Will they know by drug?” she asked. The agency will be collecting data on actual drugs and the spending associated with those drugs, “so there will be the ability to track how much was paid at the point of sale,” she said.

WASHINGTON — Medicare intends to use performance measures to monitor cost, quality, and access issues related to the new prescription drug benefit, a research analyst said during a meeting of the Medicare Payment Advisory Commission.

But Medicare has not yet “determined what those measures will be and how they will be used,” said MedPAC analyst Cristina Boccuti. The Centers for Medicare and Medicaid Services will be collecting a large amount of data on the new drug benefit—or Medicare Part D—including drug utilization and plan benefit information, to construct these performance measures, Ms. Boccuti said. In addition to the agency's need for the data, “congressional agencies will need Part D data to report to the Congress on the impact of the drug benefit on cost, quality, and access,” she added.

MedPAC commissioners recommended that the Health and Human Services department establish a process for the timely delivery of these data to interested parties. Individuals, employers, and government agencies currently use performance measures to evaluate how well health plans and pharmacy benefit managers manage drug benefits, Ms. Boccuti said.

To identify how policy makers could use these measures to monitor the Part D program, MedPAC convened a panel of 11 experts representing health plans, pharmacy benefits managers (PBMs), employers, pharmacies, consumers, quality assurance organizations, and researchers. The panel analyzed measures such as cost control, access and quality assurance, benefit administration and management, and enrollee satisfaction.

Based on the panel's findings, CMS plans to collect data on the following:

▸ Dispensing fees, generic dispensing rates, aggregate rebates, drug claims, and drug spending by plans and beneficiaries.

▸ Pharmacy networks, formularies (including prior authorization and exceptions), appeals rates, and drug utilization.

▸ Claims processing, including plans' out-of-pocket calculations.

▸ Beneficiary satisfaction, grievances, call center operations, and disenrollment rates.

Measures to track beneficiary satisfaction—such as member satisfaction surveys and performance of customer service call centers—are common types of performance guarantees that health plans and PBMs offer to their clients, she said. CMS plans to conduct its own consumer satisfaction surveys to provide comparative plan information to beneficiaries for making enrollment decisions. Also, plans will submit data on grievances filed, and call center performance measures such as abandonment rates and hold times.

MedPAC commissioner Nancy-Ann DeParle, a health care consultant in Washington and former head of CMs' predecessor agency (the Health Care Financing Administration), asked whether CMS would be looking at these data at a physician level, in terms of who did the prescribing. “In our pay-for-performance discussions around physicians, [MedPAC indicated that] it would be useful to have this.” Ms. Boccuti noted that there is a prescriber code associated with each drug.

On the issue of collecting cost data, Ms. DeParle said that she wondered whether CMS would be able to assess whether particular plans were getting a “good deal” on the drugs they purchased. “Will they know by drug?” she asked. The agency will be collecting data on actual drugs and the spending associated with those drugs, “so there will be the ability to track how much was paid at the point of sale,” she said.

WASHINGTON — Medicare intends to use performance measures to monitor cost, quality, and access issues related to the new prescription drug benefit, a research analyst said during a meeting of the Medicare Payment Advisory Commission.

But Medicare has not yet “determined what those measures will be and how they will be used,” said MedPAC analyst Cristina Boccuti. The Centers for Medicare and Medicaid Services will be collecting a large amount of data on the new drug benefit—or Medicare Part D—including drug utilization and plan benefit information, to construct these performance measures, Ms. Boccuti said. In addition to the agency's need for the data, “congressional agencies will need Part D data to report to the Congress on the impact of the drug benefit on cost, quality, and access,” she added.

MedPAC commissioners recommended that the Health and Human Services department establish a process for the timely delivery of these data to interested parties. Individuals, employers, and government agencies currently use performance measures to evaluate how well health plans and pharmacy benefit managers manage drug benefits, Ms. Boccuti said.

To identify how policy makers could use these measures to monitor the Part D program, MedPAC convened a panel of 11 experts representing health plans, pharmacy benefits managers (PBMs), employers, pharmacies, consumers, quality assurance organizations, and researchers. The panel analyzed measures such as cost control, access and quality assurance, benefit administration and management, and enrollee satisfaction.

Based on the panel's findings, CMS plans to collect data on the following:

▸ Dispensing fees, generic dispensing rates, aggregate rebates, drug claims, and drug spending by plans and beneficiaries.

▸ Pharmacy networks, formularies (including prior authorization and exceptions), appeals rates, and drug utilization.

▸ Claims processing, including plans' out-of-pocket calculations.

▸ Beneficiary satisfaction, grievances, call center operations, and disenrollment rates.

Measures to track beneficiary satisfaction—such as member satisfaction surveys and performance of customer service call centers—are common types of performance guarantees that health plans and PBMs offer to their clients, she said. CMS plans to conduct its own consumer satisfaction surveys to provide comparative plan information to beneficiaries for making enrollment decisions. Also, plans will submit data on grievances filed, and call center performance measures such as abandonment rates and hold times.

MedPAC commissioner Nancy-Ann DeParle, a health care consultant in Washington and former head of CMs' predecessor agency (the Health Care Financing Administration), asked whether CMS would be looking at these data at a physician level, in terms of who did the prescribing. “In our pay-for-performance discussions around physicians, [MedPAC indicated that] it would be useful to have this.” Ms. Boccuti noted that there is a prescriber code associated with each drug.

On the issue of collecting cost data, Ms. DeParle said that she wondered whether CMS would be able to assess whether particular plans were getting a “good deal” on the drugs they purchased. “Will they know by drug?” she asked. The agency will be collecting data on actual drugs and the spending associated with those drugs, “so there will be the ability to track how much was paid at the point of sale,” she said.

Dozing Doctors

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is currently 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

More Options Versus Saving Costs

Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket medical costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures and to make coverage more uniform around the country, since Medicare coverage decisions for weight-loss surgery are generally decided from region to region. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

Underinsured Statistics

A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.

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 notes. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for 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.”

Dozing Doctors

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is currently 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

More Options Versus Saving Costs

Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket medical costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures and to make coverage more uniform around the country, since Medicare coverage decisions for weight-loss surgery are generally decided from region to region. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

Underinsured Statistics

A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.

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 notes. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for 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.”

Dozing Doctors

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is currently 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

More Options Versus Saving Costs

Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket medical costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures and to make coverage more uniform around the country, since Medicare coverage decisions for weight-loss surgery are generally decided from region to region. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

Underinsured Statistics

A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.

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 notes. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for 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.”

TBI Costs Almost $6 Billion Yearly

Traumatic brain injury was the most frequent cause of death in the hospital among Americans 44 years and younger, according to data from the Agency for Healthcare Research and Quality. More than 5,500 people in this age range died from traumatic brain injury (TBI) in 2002; most of these injuries were related to falls (38%) and motor vehicle accidents (35%). Another 8% of TBI cases involved being struck by or against something. Respiratory intubation and mechanical ventilation were among the most common procedures performed in TBI patients; those who had these procedures done had a 38% mortality, according to the researchers. The aggregate charge billed for all TBI patients nationwide was $5.8 billion.

Patients Allege Gambling Addiction

Patients in the United States and Canada have filed class action suits against Boehringer Ingelheim, maker of pramipexole dihydrochloride (Mirapex), claiming that the Parkinson's disease drug caused them to become gambling addicts. In Canada, lead plaintiff Gerard Schick of Midland, Ontario, alleged that whereas before taking the drug, he had gambled only infrequently and risked small sums of money, once he started taking Mirapex he gambled away more than $100,000, withdrew all available cash from his bank accounts, and mortgaged his house to pay for his addiction. “At no time … did Gerard Schick receive any warning about the risk of compulsive behavior and in particular an addiction to gambling that could result from the use of Mirapex,” notes the lawsuit, which seeks $3 million for each plaintiff and $50 million in punitive damages. Boehringer Ingelheim does not comment on pending litigation, a spokeswoman said.

Medicare AED Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all antiepileptic drugs (AED) on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released in early June, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in the AED group and five other categories—antidepressants, antipsychotics, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

U.S. Is High-Tech Imaging Champ

The United States ranks highest in utilization of high-tech imaging compared with other countries, according to data presented at the American Roentgen Ray Society meeting in New Orleans last month. The study of high-tech imaging use in 15 countries by Mark Schweitzer, M.D., of the Hospital for Joint Diseases in New York, and his colleagues, found that although Germany, Singapore, and South Korea had the highest per capital x-ray utilization, the United States had the highest per capita use of MRI and CT, almost 10 times greater than Singapore or Germany. India had the lowest MRI usage, the authors noted. “Not surprisingly, the most capital intensive countries more often used CT and MRI,” Dr. Schweitzer said in a statement. Although reasons for the usage differences were not examined, “who is paying for the studies may be a driving force in image utilization,” he added.

The OxyContin Wars: DEA vs. MDs

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, 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 notes.” By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for comment, a DEA spokeswoman referred to a 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.”

Medicine: The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of survey respondents recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, 8% suggested that women choose careers in computers, and 11% suggested that men choose such careers. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan J. Cohen, M.D., president of the Association of American Medical Colleges.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring and reporting. The bureau said it already has taken steps in that direction.

TBI Costs Almost $6 Billion Yearly

Traumatic brain injury was the most frequent cause of death in the hospital among Americans 44 years and younger, according to data from the Agency for Healthcare Research and Quality. More than 5,500 people in this age range died from traumatic brain injury (TBI) in 2002; most of these injuries were related to falls (38%) and motor vehicle accidents (35%). Another 8% of TBI cases involved being struck by or against something. Respiratory intubation and mechanical ventilation were among the most common procedures performed in TBI patients; those who had these procedures done had a 38% mortality, according to the researchers. The aggregate charge billed for all TBI patients nationwide was $5.8 billion.

Patients Allege Gambling Addiction

Patients in the United States and Canada have filed class action suits against Boehringer Ingelheim, maker of pramipexole dihydrochloride (Mirapex), claiming that the Parkinson's disease drug caused them to become gambling addicts. In Canada, lead plaintiff Gerard Schick of Midland, Ontario, alleged that whereas before taking the drug, he had gambled only infrequently and risked small sums of money, once he started taking Mirapex he gambled away more than $100,000, withdrew all available cash from his bank accounts, and mortgaged his house to pay for his addiction. “At no time … did Gerard Schick receive any warning about the risk of compulsive behavior and in particular an addiction to gambling that could result from the use of Mirapex,” notes the lawsuit, which seeks $3 million for each plaintiff and $50 million in punitive damages. Boehringer Ingelheim does not comment on pending litigation, a spokeswoman said.

Medicare AED Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all antiepileptic drugs (AED) on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released in early June, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in the AED group and five other categories—antidepressants, antipsychotics, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

U.S. Is High-Tech Imaging Champ

The United States ranks highest in utilization of high-tech imaging compared with other countries, according to data presented at the American Roentgen Ray Society meeting in New Orleans last month. The study of high-tech imaging use in 15 countries by Mark Schweitzer, M.D., of the Hospital for Joint Diseases in New York, and his colleagues, found that although Germany, Singapore, and South Korea had the highest per capital x-ray utilization, the United States had the highest per capita use of MRI and CT, almost 10 times greater than Singapore or Germany. India had the lowest MRI usage, the authors noted. “Not surprisingly, the most capital intensive countries more often used CT and MRI,” Dr. Schweitzer said in a statement. Although reasons for the usage differences were not examined, “who is paying for the studies may be a driving force in image utilization,” he added.

The OxyContin Wars: DEA vs. MDs

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, 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 notes.” By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for comment, a DEA spokeswoman referred to a 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.”

Medicine: The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of survey respondents recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, 8% suggested that women choose careers in computers, and 11% suggested that men choose such careers. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan J. Cohen, M.D., president of the Association of American Medical Colleges.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring and reporting. The bureau said it already has taken steps in that direction.

TBI Costs Almost $6 Billion Yearly

Traumatic brain injury was the most frequent cause of death in the hospital among Americans 44 years and younger, according to data from the Agency for Healthcare Research and Quality. More than 5,500 people in this age range died from traumatic brain injury (TBI) in 2002; most of these injuries were related to falls (38%) and motor vehicle accidents (35%). Another 8% of TBI cases involved being struck by or against something. Respiratory intubation and mechanical ventilation were among the most common procedures performed in TBI patients; those who had these procedures done had a 38% mortality, according to the researchers. The aggregate charge billed for all TBI patients nationwide was $5.8 billion.

Patients Allege Gambling Addiction

Patients in the United States and Canada have filed class action suits against Boehringer Ingelheim, maker of pramipexole dihydrochloride (Mirapex), claiming that the Parkinson's disease drug caused them to become gambling addicts. In Canada, lead plaintiff Gerard Schick of Midland, Ontario, alleged that whereas before taking the drug, he had gambled only infrequently and risked small sums of money, once he started taking Mirapex he gambled away more than $100,000, withdrew all available cash from his bank accounts, and mortgaged his house to pay for his addiction. “At no time … did Gerard Schick receive any warning about the risk of compulsive behavior and in particular an addiction to gambling that could result from the use of Mirapex,” notes the lawsuit, which seeks $3 million for each plaintiff and $50 million in punitive damages. Boehringer Ingelheim does not comment on pending litigation, a spokeswoman said.

Medicare AED Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all antiepileptic drugs (AED) on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released in early June, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in the AED group and five other categories—antidepressants, antipsychotics, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”

U.S. Is High-Tech Imaging Champ

The United States ranks highest in utilization of high-tech imaging compared with other countries, according to data presented at the American Roentgen Ray Society meeting in New Orleans last month. The study of high-tech imaging use in 15 countries by Mark Schweitzer, M.D., of the Hospital for Joint Diseases in New York, and his colleagues, found that although Germany, Singapore, and South Korea had the highest per capital x-ray utilization, the United States had the highest per capita use of MRI and CT, almost 10 times greater than Singapore or Germany. India had the lowest MRI usage, the authors noted. “Not surprisingly, the most capital intensive countries more often used CT and MRI,” Dr. Schweitzer said in a statement. Although reasons for the usage differences were not examined, “who is paying for the studies may be a driving force in image utilization,” he added.

The OxyContin Wars: DEA vs. MDs

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, 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 notes.” By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for comment, a DEA spokeswoman referred to a 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.”

Medicine: The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of survey respondents recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, 8% suggested that women choose careers in computers, and 11% suggested that men choose such careers. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan J. Cohen, M.D., president of the Association of American Medical Colleges.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring and reporting. The bureau said it already has taken steps in that direction.

DALLAS — Of the existing “concierge” care models, practices that offer fees for non-covered services to patients who have insurance carry the highest legal risk, attorney John Marquis said at a national conference on concierge medicine.

In light of recent actions taken by Congress, state insurance commissioners, and federal agencies, it's clear that authorities are looking out for potential conflicts of interest with this particular care model, said Mr. Marquis, a partner with Warner, Norcross, & Judd, LLP, a Michigan law firm that specializes in concierge-care issues.

There are several models for concierge-care practices. Some opt out of Medicare and private insurance to offer a periodic fee for medical care. Others accept only cash for their services. What seems to attract most of the legal action is the “fee for non-covered services” or FNCS model. These practices accept patients with private insurance or Medicare but also charge a flat fee monthly, quarterly, or annually, he said at the conference, sponsored by the Society for Innovative Medical Practice Design.

In return, patients are promised a smaller patient base, greater access to the physician, and other amenities. For some time, this approach has aroused speculation on whether the physician might be double billing for Medicare patients.

Exactly what the periodic fee pays for is the gray area that incites legal action, Mr. Marquis said. The fact that certain FNCS practices offer preventive care is not a complete answer to the legal issues, given that Medicare covers certain preventive care services, he said. Home visits are another problem; in many cases, they're also a covered service under Medicare.

Although Medicare is usually the 800-pound gorilla in these situations, it's private insurers that currently pose the biggest risks to these practices.

They can tell a practice, “We don't like what you're doing—boom, you're out,” Mr. Marquis said. For an FNCS-style practice counting on insurance reimbursement, “this could be devastating. I have had clients who've essentially decided to not [become an FNCS-style practice] out of fear of being terminated as a result of notifying the insurance companies of what was going on.”

The rub is that insurance companies don't need any cause to terminate a plan, he said. “It's a policy business decision that they apparently make, and there's really no clear legal recourse.”

Health departments and insurance commissioners pose another credible risk to FNCS practices. In 2003, New Jersey's health department found that physicians who already had contracts with HMOs were requiring HMO patients to pay an annual fee to get into their practices.

The conflict was that many services these FNCS providers were offering were already required to be included in any health insurance plan offered in the state. “The department's main objection was not duplication of service but that these practices were making patients pay” for covered medical care.

In an edict that had the force of law, New Jersey asserted that this requirement was illegal, even though the fee in these practices was limited to services clearly not covered by the health plan. “They're stating, 'We don't care if the service is covered by the health plan or not. It's illegal if you charge that “poll tax” for a patient to get into the practice,'” Mr. Marquis said.

The New York Department of Health raised similar objections, except the state found FNCS-type practices to be illegal on more than one account.

Typically, insurance contracts in the state of New York require that physicians provide 24-hour case management and coordination of necessary referrals. Furthermore, the state has determined that expedited appointments discriminate against patients who don't have the money to pay the fee, he said.

Legislative efforts at the state and federal level to thwart FNCS practices have caused some commotion but so far haven't amounted to much, Mr. Marquis said.

Several years ago, Rep. Henry Waxman (D-Calif.) targeted an FNCS practice, MDVIP, in a letter to Tommy Thompson, then secretary of the Department of Health and Human Services. “There could be a substantial overlap between services that were covered by Medicare and for which MDVIP was asking patients to pay,” Rep. Waxman wrote. Moreover, MDVIP physicians were providing Medicare services to patients but charging them a “poll tax”—“a conditional payment that says, 'Either pay me $1,500, or I will not render Medicare services to you.'”

Secretary Thompson disposed of the conditional fee argument in a one-page statement. “Under current law, physicians have some discretion regarding the patients they choose to accept. While the limiting charge provisions govern physicians' charges for Medicare-covered services, these provisions do not directly affect charges for non-covered services,” according to the statement.

Insofar as the retainer fee under such an agreement is truly for non-covered services, such fees would not appear to be in violation of Medicare law, Mr. Thompson continued.

An alert issued by HHS' Office of Inspector General in 2002 reminded physicians that they could “have a problem” if they proposed services to patients in exchange for a flat fee that would otherwise be covered by Medicare. The OIG's chief counsel later clarified that the alert did not specifically take a position on concierge medicine but only addressed fees for covered services and was consistent with the position previously taken by Secretary Thompson.

“At least now we know that the Thompson letter is being enforced—that there are such things as non-covered services, and if we charge for those, that should be okay,” Mr. Marquis said.

Several bills have been introduced in Congress that would prohibit physicians from charging a membership fee to a Medicare beneficiary or would forbid physicians from requiring a Medicare beneficiary to purchase a non-covered item or service as a prerequisite for receiving a covered item or service. These bills “never got out of committee,” Mr. Marquis said.

DALLAS — Of the existing “concierge” care models, practices that offer fees for non-covered services to patients who have insurance carry the highest legal risk, attorney John Marquis said at a national conference on concierge medicine.

In light of recent actions taken by Congress, state insurance commissioners, and federal agencies, it's clear that authorities are looking out for potential conflicts of interest with this particular care model, said Mr. Marquis, a partner with Warner, Norcross, & Judd, LLP, a Michigan law firm that specializes in concierge-care issues.

There are several models for concierge-care practices. Some opt out of Medicare and private insurance to offer a periodic fee for medical care. Others accept only cash for their services. What seems to attract most of the legal action is the “fee for non-covered services” or FNCS model. These practices accept patients with private insurance or Medicare but also charge a flat fee monthly, quarterly, or annually, he said at the conference, sponsored by the Society for Innovative Medical Practice Design.

In return, patients are promised a smaller patient base, greater access to the physician, and other amenities. For some time, this approach has aroused speculation on whether the physician might be double billing for Medicare patients.

Exactly what the periodic fee pays for is the gray area that incites legal action, Mr. Marquis said. The fact that certain FNCS practices offer preventive care is not a complete answer to the legal issues, given that Medicare covers certain preventive care services, he said. Home visits are another problem; in many cases, they're also a covered service under Medicare.

Although Medicare is usually the 800-pound gorilla in these situations, it's private insurers that currently pose the biggest risks to these practices.

They can tell a practice, “We don't like what you're doing—boom, you're out,” Mr. Marquis said. For an FNCS-style practice counting on insurance reimbursement, “this could be devastating. I have had clients who've essentially decided to not [become an FNCS-style practice] out of fear of being terminated as a result of notifying the insurance companies of what was going on.”

The rub is that insurance companies don't need any cause to terminate a plan, he said. “It's a policy business decision that they apparently make, and there's really no clear legal recourse.”

Health departments and insurance commissioners pose another credible risk to FNCS practices. In 2003, New Jersey's health department found that physicians who already had contracts with HMOs were requiring HMO patients to pay an annual fee to get into their practices.

The conflict was that many services these FNCS providers were offering were already required to be included in any health insurance plan offered in the state. “The department's main objection was not duplication of service but that these practices were making patients pay” for covered medical care.

In an edict that had the force of law, New Jersey asserted that this requirement was illegal, even though the fee in these practices was limited to services clearly not covered by the health plan. “They're stating, 'We don't care if the service is covered by the health plan or not. It's illegal if you charge that “poll tax” for a patient to get into the practice,'” Mr. Marquis said.

The New York Department of Health raised similar objections, except the state found FNCS-type practices to be illegal on more than one account.

Typically, insurance contracts in the state of New York require that physicians provide 24-hour case management and coordination of necessary referrals. Furthermore, the state has determined that expedited appointments discriminate against patients who don't have the money to pay the fee, he said.

Legislative efforts at the state and federal level to thwart FNCS practices have caused some commotion but so far haven't amounted to much, Mr. Marquis said.

Several years ago, Rep. Henry Waxman (D-Calif.) targeted an FNCS practice, MDVIP, in a letter to Tommy Thompson, then secretary of the Department of Health and Human Services. “There could be a substantial overlap between services that were covered by Medicare and for which MDVIP was asking patients to pay,” Rep. Waxman wrote. Moreover, MDVIP physicians were providing Medicare services to patients but charging them a “poll tax”—“a conditional payment that says, 'Either pay me $1,500, or I will not render Medicare services to you.'”

Secretary Thompson disposed of the conditional fee argument in a one-page statement. “Under current law, physicians have some discretion regarding the patients they choose to accept. While the limiting charge provisions govern physicians' charges for Medicare-covered services, these provisions do not directly affect charges for non-covered services,” according to the statement.

Insofar as the retainer fee under such an agreement is truly for non-covered services, such fees would not appear to be in violation of Medicare law, Mr. Thompson continued.

An alert issued by HHS' Office of Inspector General in 2002 reminded physicians that they could “have a problem” if they proposed services to patients in exchange for a flat fee that would otherwise be covered by Medicare. The OIG's chief counsel later clarified that the alert did not specifically take a position on concierge medicine but only addressed fees for covered services and was consistent with the position previously taken by Secretary Thompson.

“At least now we know that the Thompson letter is being enforced—that there are such things as non-covered services, and if we charge for those, that should be okay,” Mr. Marquis said.

Several bills have been introduced in Congress that would prohibit physicians from charging a membership fee to a Medicare beneficiary or would forbid physicians from requiring a Medicare beneficiary to purchase a non-covered item or service as a prerequisite for receiving a covered item or service. These bills “never got out of committee,” Mr. Marquis said.

DALLAS — Of the existing “concierge” care models, practices that offer fees for non-covered services to patients who have insurance carry the highest legal risk, attorney John Marquis said at a national conference on concierge medicine.

In light of recent actions taken by Congress, state insurance commissioners, and federal agencies, it's clear that authorities are looking out for potential conflicts of interest with this particular care model, said Mr. Marquis, a partner with Warner, Norcross, & Judd, LLP, a Michigan law firm that specializes in concierge-care issues.

There are several models for concierge-care practices. Some opt out of Medicare and private insurance to offer a periodic fee for medical care. Others accept only cash for their services. What seems to attract most of the legal action is the “fee for non-covered services” or FNCS model. These practices accept patients with private insurance or Medicare but also charge a flat fee monthly, quarterly, or annually, he said at the conference, sponsored by the Society for Innovative Medical Practice Design.

In return, patients are promised a smaller patient base, greater access to the physician, and other amenities. For some time, this approach has aroused speculation on whether the physician might be double billing for Medicare patients.

Exactly what the periodic fee pays for is the gray area that incites legal action, Mr. Marquis said. The fact that certain FNCS practices offer preventive care is not a complete answer to the legal issues, given that Medicare covers certain preventive care services, he said. Home visits are another problem; in many cases, they're also a covered service under Medicare.

Although Medicare is usually the 800-pound gorilla in these situations, it's private insurers that currently pose the biggest risks to these practices.

They can tell a practice, “We don't like what you're doing—boom, you're out,” Mr. Marquis said. For an FNCS-style practice counting on insurance reimbursement, “this could be devastating. I have had clients who've essentially decided to not [become an FNCS-style practice] out of fear of being terminated as a result of notifying the insurance companies of what was going on.”

The rub is that insurance companies don't need any cause to terminate a plan, he said. “It's a policy business decision that they apparently make, and there's really no clear legal recourse.”

Health departments and insurance commissioners pose another credible risk to FNCS practices. In 2003, New Jersey's health department found that physicians who already had contracts with HMOs were requiring HMO patients to pay an annual fee to get into their practices.

The conflict was that many services these FNCS providers were offering were already required to be included in any health insurance plan offered in the state. “The department's main objection was not duplication of service but that these practices were making patients pay” for covered medical care.

In an edict that had the force of law, New Jersey asserted that this requirement was illegal, even though the fee in these practices was limited to services clearly not covered by the health plan. “They're stating, 'We don't care if the service is covered by the health plan or not. It's illegal if you charge that “poll tax” for a patient to get into the practice,'” Mr. Marquis said.

The New York Department of Health raised similar objections, except the state found FNCS-type practices to be illegal on more than one account.

Typically, insurance contracts in the state of New York require that physicians provide 24-hour case management and coordination of necessary referrals. Furthermore, the state has determined that expedited appointments discriminate against patients who don't have the money to pay the fee, he said.

Legislative efforts at the state and federal level to thwart FNCS practices have caused some commotion but so far haven't amounted to much, Mr. Marquis said.

Several years ago, Rep. Henry Waxman (D-Calif.) targeted an FNCS practice, MDVIP, in a letter to Tommy Thompson, then secretary of the Department of Health and Human Services. “There could be a substantial overlap between services that were covered by Medicare and for which MDVIP was asking patients to pay,” Rep. Waxman wrote. Moreover, MDVIP physicians were providing Medicare services to patients but charging them a “poll tax”—“a conditional payment that says, 'Either pay me $1,500, or I will not render Medicare services to you.'”

Secretary Thompson disposed of the conditional fee argument in a one-page statement. “Under current law, physicians have some discretion regarding the patients they choose to accept. While the limiting charge provisions govern physicians' charges for Medicare-covered services, these provisions do not directly affect charges for non-covered services,” according to the statement.

Insofar as the retainer fee under such an agreement is truly for non-covered services, such fees would not appear to be in violation of Medicare law, Mr. Thompson continued.

An alert issued by HHS' Office of Inspector General in 2002 reminded physicians that they could “have a problem” if they proposed services to patients in exchange for a flat fee that would otherwise be covered by Medicare. The OIG's chief counsel later clarified that the alert did not specifically take a position on concierge medicine but only addressed fees for covered services and was consistent with the position previously taken by Secretary Thompson.

“At least now we know that the Thompson letter is being enforced—that there are such things as non-covered services, and if we charge for those, that should be okay,” Mr. Marquis said.

Several bills have been introduced in Congress that would prohibit physicians from charging a membership fee to a Medicare beneficiary or would forbid physicians from requiring a Medicare beneficiary to purchase a non-covered item or service as a prerequisite for receiving a covered item or service. These bills “never got out of committee,” Mr. Marquis said.

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 be used as a tool to cut reimbursement.”

However, not everyone agrees with such a hard-line approach. “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,” said John Nelson, M.D., the AMA's immediate past president.

The two issues were highlighted extensively in a letter sent by ACP, AAFP, AAP, and ACOG to Sen. Bill Frist (R-Tenn.), outlining their own wish list for physician payment reforms. Given the limitations of the actions taken 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.

Mary Frank, M.D., president of the American Academy of Family Physicians, 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 currently 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.

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).

The letter also stated that:

▸ Physicians should receive additional payments for participating in performance measurements and reporting programs.

▸ Pay should increase proportionately, based on the types 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.

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 be used as a tool to cut reimbursement.”

However, not everyone agrees with such a hard-line approach. “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,” said John Nelson, M.D., the AMA's immediate past president.

The two issues were highlighted extensively in a letter sent by ACP, AAFP, AAP, and ACOG to Sen. Bill Frist (R-Tenn.), outlining their own wish list for physician payment reforms. Given the limitations of the actions taken 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.

Mary Frank, M.D., president of the American Academy of Family Physicians, 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 currently 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.

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).

The letter also stated that:

▸ Physicians should receive additional payments for participating in performance measurements and reporting programs.

▸ Pay should increase proportionately, based on the types 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.

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 be used as a tool to cut reimbursement.”

However, not everyone agrees with such a hard-line approach. “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,” said John Nelson, M.D., the AMA's immediate past president.

The two issues were highlighted extensively in a letter sent by ACP, AAFP, AAP, and ACOG to Sen. Bill Frist (R-Tenn.), outlining their own wish list for physician payment reforms. Given the limitations of the actions taken 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.

Mary Frank, M.D., president of the American Academy of Family Physicians, 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 currently 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.

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).

The letter also stated that:

▸ Physicians should receive additional payments for participating in performance measurements and reporting programs.

▸ Pay should increase proportionately, based on the types 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.

Academy Chooses New Leader

Jay E. Berkelhamer, M.D., incoming leader of the American Academy of Pediatrics, said that his primary goal is to improve the quality of health care for children.

“As a community of physicians, we will partner to rise to the challenge and lead the continuous improvement of quality care,” said the Atlanta pediatrician, who was recently elected AAP vice president by 9,680 voting fellows, defeating Charles Linder, M.D.

Dr. Berkelhamer currently serves as the senior vice president for medical affairs at Children's Healthcare of Atlanta. He is clinical professor at Emory University and adjunct professor at Morehouse School of Medicine, both in Atlanta.

He attended medical school at the University of Michigan in Ann Arbor and then received training in pediatrics at the University of Chicago Pritzker School of Medicine.

Assuming office as the president-elect at the October AAP national conference, Dr. Berkelhammer will serve as the 2006–2007 AAP president.

Children and Pollution

Air pollution harms children's lungs for life, according to the California Environmental Protection Agency's Air Resources Board, which has been conducting an ongoing study on children's health in 12 California communities for the past 14 years.

The study, which to date has assessed the health of 5,600 school-aged children, found that children who were exposed to current levels of air pollution had significantly reduced lung growth and development when exposed to higher levels of acid vapor, ozone, nitrogen dioxide, and particulate matter.

Those living in high-ozone communities who participated in sports were more likely to develop asthma, and days with higher ozone levels resulted in significantly higher school absences due to respiratory illness.

Preventing Nontraffic Deaths

Three children are killed each week in preventable, nontraffic, auto-related incidents, according to Kids and Cars, a nonprofit organization whose mission is to ensure that no child dies or is injured in a nontraffic, noncrash motor vehicle-related event.

While some of these deaths result from strangulation by power windows or parents leaving children inside hot cars, most are the result of backovers—where a child is run over by a car because the driver couldn't see the child, the group reported. In 2005, 132 children were involved in non-traffic related incidents on private property; 67 of these children lost their lives.

Kids and Cars supports bipartisan legislation introduced by Reps. Peter King (R-N.Y.) and Jan Schakowsky (D-Ill.) requiring automobile manufacturers to make technology standards that would allow drivers to see what's behind them when backing up their vehicles.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program.

The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals.

The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those who need it. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

The Chosen Profession?

Physicians don't necessarily want their children to follow in their footsteps.

In a poll conducted by the Doctors Company, a physician-owned, medical malpractice insurance provider, two-thirds of the 973 physicians surveyed said they would not encourage their children to become high-risk physicians such as ob.gyns. due to fear of litigation, and 70% would push their children toward lower-risk specialties.

Outside of the medical profession, “be a doctor” remains popular career advice. A separate Gallup poll of 1,003 adults aged 18 years and older by Gallup found that Americans were encouraging young adults to become physicians.

Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, 8% suggested that women choose careers in computers, and 11% suggested that men choose such careers.

Academy Chooses New Leader

Jay E. Berkelhamer, M.D., incoming leader of the American Academy of Pediatrics, said that his primary goal is to improve the quality of health care for children.

“As a community of physicians, we will partner to rise to the challenge and lead the continuous improvement of quality care,” said the Atlanta pediatrician, who was recently elected AAP vice president by 9,680 voting fellows, defeating Charles Linder, M.D.

Dr. Berkelhamer currently serves as the senior vice president for medical affairs at Children's Healthcare of Atlanta. He is clinical professor at Emory University and adjunct professor at Morehouse School of Medicine, both in Atlanta.

He attended medical school at the University of Michigan in Ann Arbor and then received training in pediatrics at the University of Chicago Pritzker School of Medicine.

Assuming office as the president-elect at the October AAP national conference, Dr. Berkelhammer will serve as the 2006–2007 AAP president.

Children and Pollution

Air pollution harms children's lungs for life, according to the California Environmental Protection Agency's Air Resources Board, which has been conducting an ongoing study on children's health in 12 California communities for the past 14 years.

The study, which to date has assessed the health of 5,600 school-aged children, found that children who were exposed to current levels of air pollution had significantly reduced lung growth and development when exposed to higher levels of acid vapor, ozone, nitrogen dioxide, and particulate matter.

Those living in high-ozone communities who participated in sports were more likely to develop asthma, and days with higher ozone levels resulted in significantly higher school absences due to respiratory illness.

Preventing Nontraffic Deaths

Three children are killed each week in preventable, nontraffic, auto-related incidents, according to Kids and Cars, a nonprofit organization whose mission is to ensure that no child dies or is injured in a nontraffic, noncrash motor vehicle-related event.

While some of these deaths result from strangulation by power windows or parents leaving children inside hot cars, most are the result of backovers—where a child is run over by a car because the driver couldn't see the child, the group reported. In 2005, 132 children were involved in non-traffic related incidents on private property; 67 of these children lost their lives.

Kids and Cars supports bipartisan legislation introduced by Reps. Peter King (R-N.Y.) and Jan Schakowsky (D-Ill.) requiring automobile manufacturers to make technology standards that would allow drivers to see what's behind them when backing up their vehicles.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program.

The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals.

The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those who need it. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

The Chosen Profession?

Physicians don't necessarily want their children to follow in their footsteps.

In a poll conducted by the Doctors Company, a physician-owned, medical malpractice insurance provider, two-thirds of the 973 physicians surveyed said they would not encourage their children to become high-risk physicians such as ob.gyns. due to fear of litigation, and 70% would push their children toward lower-risk specialties.

Outside of the medical profession, “be a doctor” remains popular career advice. A separate Gallup poll of 1,003 adults aged 18 years and older by Gallup found that Americans were encouraging young adults to become physicians.

Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, 8% suggested that women choose careers in computers, and 11% suggested that men choose such careers.

Academy Chooses New Leader

Jay E. Berkelhamer, M.D., incoming leader of the American Academy of Pediatrics, said that his primary goal is to improve the quality of health care for children.

“As a community of physicians, we will partner to rise to the challenge and lead the continuous improvement of quality care,” said the Atlanta pediatrician, who was recently elected AAP vice president by 9,680 voting fellows, defeating Charles Linder, M.D.

Dr. Berkelhamer currently serves as the senior vice president for medical affairs at Children's Healthcare of Atlanta. He is clinical professor at Emory University and adjunct professor at Morehouse School of Medicine, both in Atlanta.

He attended medical school at the University of Michigan in Ann Arbor and then received training in pediatrics at the University of Chicago Pritzker School of Medicine.

Assuming office as the president-elect at the October AAP national conference, Dr. Berkelhammer will serve as the 2006–2007 AAP president.

Children and Pollution

Air pollution harms children's lungs for life, according to the California Environmental Protection Agency's Air Resources Board, which has been conducting an ongoing study on children's health in 12 California communities for the past 14 years.

The study, which to date has assessed the health of 5,600 school-aged children, found that children who were exposed to current levels of air pollution had significantly reduced lung growth and development when exposed to higher levels of acid vapor, ozone, nitrogen dioxide, and particulate matter.

Those living in high-ozone communities who participated in sports were more likely to develop asthma, and days with higher ozone levels resulted in significantly higher school absences due to respiratory illness.

Preventing Nontraffic Deaths

Three children are killed each week in preventable, nontraffic, auto-related incidents, according to Kids and Cars, a nonprofit organization whose mission is to ensure that no child dies or is injured in a nontraffic, noncrash motor vehicle-related event.

While some of these deaths result from strangulation by power windows or parents leaving children inside hot cars, most are the result of backovers—where a child is run over by a car because the driver couldn't see the child, the group reported. In 2005, 132 children were involved in non-traffic related incidents on private property; 67 of these children lost their lives.

Kids and Cars supports bipartisan legislation introduced by Reps. Peter King (R-N.Y.) and Jan Schakowsky (D-Ill.) requiring automobile manufacturers to make technology standards that would allow drivers to see what's behind them when backing up their vehicles.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program.

The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals.

The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those who need it. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

The Chosen Profession?

Physicians don't necessarily want their children to follow in their footsteps.

In a poll conducted by the Doctors Company, a physician-owned, medical malpractice insurance provider, two-thirds of the 973 physicians surveyed said they would not encourage their children to become high-risk physicians such as ob.gyns. due to fear of litigation, and 70% would push their children toward lower-risk specialties.

Outside of the medical profession, “be a doctor” remains popular career advice. A separate Gallup poll of 1,003 adults aged 18 years and older by Gallup found that Americans were encouraging young adults to become physicians.

Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, 8% suggested that women choose careers in computers, and 11% suggested that men choose such careers.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Pay-for-Performance Shortfalls

The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed to prevent the effects of pay for performance from being dulled by a lack of consisitency in implementation, she said. She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those who need it. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Studies on Gender Differences Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related studies, but they are encouraged that some NIH institutes have established mechanisms to foster such research.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Pay-for-Performance Shortfalls

The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed to prevent the effects of pay for performance from being dulled by a lack of consisitency in implementation, she said. She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those who need it. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Studies on Gender Differences Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related studies, but they are encouraged that some NIH institutes have established mechanisms to foster such research.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Pay-for-Performance Shortfalls

The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed to prevent the effects of pay for performance from being dulled by a lack of consisitency in implementation, she said. She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those who need it. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Studies on Gender Differences Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related studies, but they are encouraged that some NIH institutes have established mechanisms to foster such research.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Pay-for-Performance Shortfalls

The “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. Also, there is little guidance in the literature for purchasers and health plans to reference when they set out to design pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Medicaid Commission Formed

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those in need. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Gender-Difference Research Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related research, but they are encouraged that some NIH institutes have established mechanisms to foster such research.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Pay-for-Performance Shortfalls

The “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. Also, there is little guidance in the literature for purchasers and health plans to reference when they set out to design pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Medicaid Commission Formed

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those in need. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Gender-Difference Research Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related research, but they are encouraged that some NIH institutes have established mechanisms to foster such research.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Pay-for-Performance Shortfalls

The “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. Also, there is little guidance in the literature for purchasers and health plans to reference when they set out to design pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Monitoring Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Medicaid Commission Formed

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those in need. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Gender-Difference Research Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related research, but they are encouraged that some NIH institutes have established mechanisms to foster such research.