Mary Ellen Schneider

Dr. Erin Stucky Fisher has dedicated much of her career to educating pediatric hospitalists. Dr. Fisher, who is the vice chair of clinical affairs and a professor of clinical pediatrics at the University of California, San Diego, at Rady Children’s Hospital, helped establish UCSD’s pediatric hospital medicine fellowship program, one of the first in the nation.

Earlier this year, Dr. Fisher was chosen as a Master in Hospital Medicine by the Society of Hospital Medicine. The award is SHM’s highest honor and is presented to only a few hospitalists each year as a lifetime achievement award. In an interview with Hospitalist News, Dr. Fisher shared her thoughts on educating fellows, recognition for pediatric hospitalists, and her next project.

HN: How many pediatric hospitalist fellowship programs are there?

DR. FISHER: This academic year there will be 18 programs up and running. They vary in duration and in the number of trainees, but there will be about 30-35 trainees this next academic year and that number is growing. The number of programs has jumped in the past year, and it will probably jump by about 50% again a year from now. The number of trainees is likely to double over the next couple of years.

HN: How would you evaluate the state of fellowship training for pediatric hospitalists in the United States? Are trainees being prepared to handle the array of clinical problems and quality questions they will face?

DR. FISHER: The fellowship programs have taken a significant leap forward in the past 12-18 months in assuring specific content is covered during fellowship and also in creating guidelines for what can be expected of a fellow who has finished a 1-, 2-, or 3-year fellowship. We held a meeting of the fellowship directors last year and agreed on the expectations. At the core are systems issues such as quality and safety, as well as clinical excellence and a commitment to the other major domains of our pediatric hospital medicine core competencies. Physicians that are coming out of a 1-year fellowship are certainly much better prepared to address not only complex clinical management and related coordination of care issues, but also the systems practice issues than are those coming directly out of residency. Those fellows that complete 2- and 3-year fellowships have a focus on the research aspects of pediatric hospital medicine and/or greater emphasis on quality projects.

HN: Should pediatric hospitalists have their own type of formal certification?

DR. FISHER: I believe some type of certification is needed for pediatric hospitalists.

One reason to pursue certification is to let the community know we have an expectation of our performance and we hold ourselves accountable for this. The other reason is to create an identity so that we can present ourselves to an institution and its colleagues and they will know who we are.

To meet those goals, it doesn’t necessarily mean that a board has to certify you, although subcertification and a special maintenance of certification pathway are clearly options. There could be another process of recognition, such as through a society. Whether or not a particular certification model is pursued doesn’t matter as much as whether it is done correctly and in a way that meets the needs of the patient, community, and pediatric hospitalists. As we speak, the pediatric hospital medicine community is assessing all options, defining the weaknesses and strengths of each option, and discussing how we as a community should move forward.

HN: What’s next for you in terms of research and quality improvement?

DR. FISHER: One area I’m working on is how to help people deliver evidence-based medicine in the right way within electronic health care systems. Locally, we’ve had clinical pathways in place for a couple of decades. They have been embedded in our day-to-day work and they’ve been incredibly well-received and utilized. I worry that with an electronic system we might lose some of those gains. One of my goals is to make sure that the best practice models, order sets, algorithms, and references that help the physician to do the right thing for the patient in the paper world are moved forward to an electronic system.

Dr. Erin Stucky Fisher has dedicated much of her career to educating pediatric hospitalists. Dr. Fisher, who is the vice chair of clinical affairs and a professor of clinical pediatrics at the University of California, San Diego, at Rady Children’s Hospital, helped establish UCSD’s pediatric hospital medicine fellowship program, one of the first in the nation.

Earlier this year, Dr. Fisher was chosen as a Master in Hospital Medicine by the Society of Hospital Medicine. The award is SHM’s highest honor and is presented to only a few hospitalists each year as a lifetime achievement award. In an interview with Hospitalist News, Dr. Fisher shared her thoughts on educating fellows, recognition for pediatric hospitalists, and her next project.

HN: How many pediatric hospitalist fellowship programs are there?

DR. FISHER: This academic year there will be 18 programs up and running. They vary in duration and in the number of trainees, but there will be about 30-35 trainees this next academic year and that number is growing. The number of programs has jumped in the past year, and it will probably jump by about 50% again a year from now. The number of trainees is likely to double over the next couple of years.

HN: How would you evaluate the state of fellowship training for pediatric hospitalists in the United States? Are trainees being prepared to handle the array of clinical problems and quality questions they will face?

DR. FISHER: The fellowship programs have taken a significant leap forward in the past 12-18 months in assuring specific content is covered during fellowship and also in creating guidelines for what can be expected of a fellow who has finished a 1-, 2-, or 3-year fellowship. We held a meeting of the fellowship directors last year and agreed on the expectations. At the core are systems issues such as quality and safety, as well as clinical excellence and a commitment to the other major domains of our pediatric hospital medicine core competencies. Physicians that are coming out of a 1-year fellowship are certainly much better prepared to address not only complex clinical management and related coordination of care issues, but also the systems practice issues than are those coming directly out of residency. Those fellows that complete 2- and 3-year fellowships have a focus on the research aspects of pediatric hospital medicine and/or greater emphasis on quality projects.

HN: Should pediatric hospitalists have their own type of formal certification?

DR. FISHER: I believe some type of certification is needed for pediatric hospitalists.

One reason to pursue certification is to let the community know we have an expectation of our performance and we hold ourselves accountable for this. The other reason is to create an identity so that we can present ourselves to an institution and its colleagues and they will know who we are.

To meet those goals, it doesn’t necessarily mean that a board has to certify you, although subcertification and a special maintenance of certification pathway are clearly options. There could be another process of recognition, such as through a society. Whether or not a particular certification model is pursued doesn’t matter as much as whether it is done correctly and in a way that meets the needs of the patient, community, and pediatric hospitalists. As we speak, the pediatric hospital medicine community is assessing all options, defining the weaknesses and strengths of each option, and discussing how we as a community should move forward.

HN: What’s next for you in terms of research and quality improvement?

DR. FISHER: One area I’m working on is how to help people deliver evidence-based medicine in the right way within electronic health care systems. Locally, we’ve had clinical pathways in place for a couple of decades. They have been embedded in our day-to-day work and they’ve been incredibly well-received and utilized. I worry that with an electronic system we might lose some of those gains. One of my goals is to make sure that the best practice models, order sets, algorithms, and references that help the physician to do the right thing for the patient in the paper world are moved forward to an electronic system.

Dr. Erin Stucky Fisher has dedicated much of her career to educating pediatric hospitalists. Dr. Fisher, who is the vice chair of clinical affairs and a professor of clinical pediatrics at the University of California, San Diego, at Rady Children’s Hospital, helped establish UCSD’s pediatric hospital medicine fellowship program, one of the first in the nation.

Earlier this year, Dr. Fisher was chosen as a Master in Hospital Medicine by the Society of Hospital Medicine. The award is SHM’s highest honor and is presented to only a few hospitalists each year as a lifetime achievement award. In an interview with Hospitalist News, Dr. Fisher shared her thoughts on educating fellows, recognition for pediatric hospitalists, and her next project.

HN: How many pediatric hospitalist fellowship programs are there?

DR. FISHER: This academic year there will be 18 programs up and running. They vary in duration and in the number of trainees, but there will be about 30-35 trainees this next academic year and that number is growing. The number of programs has jumped in the past year, and it will probably jump by about 50% again a year from now. The number of trainees is likely to double over the next couple of years.

HN: How would you evaluate the state of fellowship training for pediatric hospitalists in the United States? Are trainees being prepared to handle the array of clinical problems and quality questions they will face?

DR. FISHER: The fellowship programs have taken a significant leap forward in the past 12-18 months in assuring specific content is covered during fellowship and also in creating guidelines for what can be expected of a fellow who has finished a 1-, 2-, or 3-year fellowship. We held a meeting of the fellowship directors last year and agreed on the expectations. At the core are systems issues such as quality and safety, as well as clinical excellence and a commitment to the other major domains of our pediatric hospital medicine core competencies. Physicians that are coming out of a 1-year fellowship are certainly much better prepared to address not only complex clinical management and related coordination of care issues, but also the systems practice issues than are those coming directly out of residency. Those fellows that complete 2- and 3-year fellowships have a focus on the research aspects of pediatric hospital medicine and/or greater emphasis on quality projects.

HN: Should pediatric hospitalists have their own type of formal certification?

DR. FISHER: I believe some type of certification is needed for pediatric hospitalists.

One reason to pursue certification is to let the community know we have an expectation of our performance and we hold ourselves accountable for this. The other reason is to create an identity so that we can present ourselves to an institution and its colleagues and they will know who we are.

To meet those goals, it doesn’t necessarily mean that a board has to certify you, although subcertification and a special maintenance of certification pathway are clearly options. There could be another process of recognition, such as through a society. Whether or not a particular certification model is pursued doesn’t matter as much as whether it is done correctly and in a way that meets the needs of the patient, community, and pediatric hospitalists. As we speak, the pediatric hospital medicine community is assessing all options, defining the weaknesses and strengths of each option, and discussing how we as a community should move forward.

HN: What’s next for you in terms of research and quality improvement?

DR. FISHER: One area I’m working on is how to help people deliver evidence-based medicine in the right way within electronic health care systems. Locally, we’ve had clinical pathways in place for a couple of decades. They have been embedded in our day-to-day work and they’ve been incredibly well-received and utilized. I worry that with an electronic system we might lose some of those gains. One of my goals is to make sure that the best practice models, order sets, algorithms, and references that help the physician to do the right thing for the patient in the paper world are moved forward to an electronic system.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women’s preventive services, including contraception, the Health and Human Services department announced Aug. 1.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually-transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New or significantly revised health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012.

The list of women’s preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM’s recommendations, which were released July 19.

"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," HHS Secretary Kathleen Sebelius said in a statement.

The one controversial element of the coverage requirements is the inclusion of contraception on the list of covered services.

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group’s beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women’s preventive services, including contraception, the Health and Human Services department announced Aug. 1.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually-transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New or significantly revised health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012.

The list of women’s preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM’s recommendations, which were released July 19.

"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," HHS Secretary Kathleen Sebelius said in a statement.

The one controversial element of the coverage requirements is the inclusion of contraception on the list of covered services.

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group’s beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

Starting next August, all new health plans will be required to provide copayment-free coverage of a range of women’s preventive services, including contraception, the Health and Human Services department announced Aug. 1.

Covered services include well-woman visits; screening for gestational diabetes; DNA testing for the human papillomavirus in women age 30 and older; counseling for sexually-transmitted infections; HIV screening and counseling; Food and Drug Administration-approved contraceptive methods as well as sterilization procedures; breastfeeding support and supplies; and screening and counseling for domestic violence, according to the HHS.

New or significantly revised health plans must offer these recommended services without copayments, coinsurance, or deductibles under the Affordable Care Act. The requirements take effect for plan years beginning on or after Aug. 1, 2012.

The list of women’s preventive services was developed for HHS by an expert panel of the Institute of Medicine. HHS accepted all of the IOM’s recommendations, which were released July 19.

"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," HHS Secretary Kathleen Sebelius said in a statement.

The one controversial element of the coverage requirements is the inclusion of contraception on the list of covered services.

HHS plans to allow religious institutions that offer insurance to their employees to opt out of covering contraception. HHS issued an interim final rule that allows these groups to buy or sponsor group health insurance that does not cover contraception if it violates the group’s beliefs. The interim final rule is modeled after similar religious exemptions in place in the 28 states that already require insurance companies to cover contraception, according to the HHS.

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act.

The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law.

This summer, government officials are accepting applications from Federally Qualified Health Centers to be part of a 3-year demonstration project. The project, which will run from September 2011 through August 2014, is designed to figure out what resources health centers need to become successful medical homes that improve care and reduce costs.

Under the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, the federal government will pay health centers a monthly care management fee for each eligible Medicare beneficiary that receives primary care services, on top of their regular Medicare payments.

In exchange, health centers must pursue level 3 patient-centered medical home recognition through the National Committee for Quality Assurance.

The project is being run jointly by the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration. The CMS and HRSA will spend $42 million over 3 years to fund up to 500 health centers under the project.

Dr. Roland A. Goertz, the president of the American Academy of Family Physicians, explained how this project could shape future payment policy for primary care physicians.

Dr. Goertz: The five most important ingredients are a true team approach to care; clinical information systems such as e-prescribing, electronic medical records, registries for common chronic illnesses, and electronic patient access via a patient portal; training for all members of the care team in “patient self-management support” and between visit follow-up; care coordination for patients needing care outside of the medical home; and integration with community resources and the medical neighborhood.

CEN: Under the project, health centers will receive a care management payment of $6 per patient per month. Is this enough?

Dr. Goertz: Federally Qualified Health Centers that participate will be paid care management fees only for the Medicare beneficiaries attributed to them. As grantees, the clinic sites will also receive free technical assistance and training resources and funds to cover survey costs.

Health centers will need to make a determination if they are ready for the transformation and whether the care management fees will cover their increased costs.

The fees will not be enough to leverage change if the Federally Qualified Health Center serves only a small number of Medicare patients.

CEN: How important is the adoption of electronic health records to the success of the medical home?

Dr. Goertz: The goal is to have computerized support for important clinical functions and integration so that physicians have the information they need to make the best decisions about diagnosis and management.

Electronic medical records with functions to help with prescribing, registries, e-mail, education, and home monitoring will soon be the standard of care.

Whatever other changes a practice is making, they should continue the momentum needed to get to fully integrated electronic medical records at some point in the future.

Two keys to improved care will be appropriate data collection and use of that data. Electronic tools are very effective in these efforts.

CEN: If this demonstration is successful, what will it mean for Medicare payments for medical home services in the future?

Dr. Goertz: This demonstration will show important additional proof of the value of the patient-centered medical home.

A successful demonstration will show improved care while maintaining or reducing costs, which should result in resources flowing to primary care practices to more appropriately pay them for providing patients the best care possible.

ROLAND A. GOERTZ, M.D., is a family physician in Waco, Tex., and the president of the AAFP.

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act.

The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law.

This summer, government officials are accepting applications from Federally Qualified Health Centers to be part of a 3-year demonstration project. The project, which will run from September 2011 through August 2014, is designed to figure out what resources health centers need to become successful medical homes that improve care and reduce costs.

Under the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, the federal government will pay health centers a monthly care management fee for each eligible Medicare beneficiary that receives primary care services, on top of their regular Medicare payments.

In exchange, health centers must pursue level 3 patient-centered medical home recognition through the National Committee for Quality Assurance.

The project is being run jointly by the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration. The CMS and HRSA will spend $42 million over 3 years to fund up to 500 health centers under the project.

Dr. Roland A. Goertz, the president of the American Academy of Family Physicians, explained how this project could shape future payment policy for primary care physicians.

Dr. Goertz: The five most important ingredients are a true team approach to care; clinical information systems such as e-prescribing, electronic medical records, registries for common chronic illnesses, and electronic patient access via a patient portal; training for all members of the care team in “patient self-management support” and between visit follow-up; care coordination for patients needing care outside of the medical home; and integration with community resources and the medical neighborhood.

CEN: Under the project, health centers will receive a care management payment of $6 per patient per month. Is this enough?

Dr. Goertz: Federally Qualified Health Centers that participate will be paid care management fees only for the Medicare beneficiaries attributed to them. As grantees, the clinic sites will also receive free technical assistance and training resources and funds to cover survey costs.

Health centers will need to make a determination if they are ready for the transformation and whether the care management fees will cover their increased costs.

The fees will not be enough to leverage change if the Federally Qualified Health Center serves only a small number of Medicare patients.

CEN: How important is the adoption of electronic health records to the success of the medical home?

Dr. Goertz: The goal is to have computerized support for important clinical functions and integration so that physicians have the information they need to make the best decisions about diagnosis and management.

Electronic medical records with functions to help with prescribing, registries, e-mail, education, and home monitoring will soon be the standard of care.

Whatever other changes a practice is making, they should continue the momentum needed to get to fully integrated electronic medical records at some point in the future.

Two keys to improved care will be appropriate data collection and use of that data. Electronic tools are very effective in these efforts.

CEN: If this demonstration is successful, what will it mean for Medicare payments for medical home services in the future?

Dr. Goertz: This demonstration will show important additional proof of the value of the patient-centered medical home.

A successful demonstration will show improved care while maintaining or reducing costs, which should result in resources flowing to primary care practices to more appropriately pay them for providing patients the best care possible.

ROLAND A. GOERTZ, M.D., is a family physician in Waco, Tex., and the president of the AAFP.

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act.

The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law.

This summer, government officials are accepting applications from Federally Qualified Health Centers to be part of a 3-year demonstration project. The project, which will run from September 2011 through August 2014, is designed to figure out what resources health centers need to become successful medical homes that improve care and reduce costs.

Under the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, the federal government will pay health centers a monthly care management fee for each eligible Medicare beneficiary that receives primary care services, on top of their regular Medicare payments.

In exchange, health centers must pursue level 3 patient-centered medical home recognition through the National Committee for Quality Assurance.

The project is being run jointly by the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration. The CMS and HRSA will spend $42 million over 3 years to fund up to 500 health centers under the project.

Dr. Roland A. Goertz, the president of the American Academy of Family Physicians, explained how this project could shape future payment policy for primary care physicians.

Dr. Goertz: The five most important ingredients are a true team approach to care; clinical information systems such as e-prescribing, electronic medical records, registries for common chronic illnesses, and electronic patient access via a patient portal; training for all members of the care team in “patient self-management support” and between visit follow-up; care coordination for patients needing care outside of the medical home; and integration with community resources and the medical neighborhood.

CEN: Under the project, health centers will receive a care management payment of $6 per patient per month. Is this enough?

Dr. Goertz: Federally Qualified Health Centers that participate will be paid care management fees only for the Medicare beneficiaries attributed to them. As grantees, the clinic sites will also receive free technical assistance and training resources and funds to cover survey costs.

Health centers will need to make a determination if they are ready for the transformation and whether the care management fees will cover their increased costs.

The fees will not be enough to leverage change if the Federally Qualified Health Center serves only a small number of Medicare patients.

CEN: How important is the adoption of electronic health records to the success of the medical home?

Dr. Goertz: The goal is to have computerized support for important clinical functions and integration so that physicians have the information they need to make the best decisions about diagnosis and management.

Electronic medical records with functions to help with prescribing, registries, e-mail, education, and home monitoring will soon be the standard of care.

Whatever other changes a practice is making, they should continue the momentum needed to get to fully integrated electronic medical records at some point in the future.

Two keys to improved care will be appropriate data collection and use of that data. Electronic tools are very effective in these efforts.

CEN: If this demonstration is successful, what will it mean for Medicare payments for medical home services in the future?

Dr. Goertz: This demonstration will show important additional proof of the value of the patient-centered medical home.

A successful demonstration will show improved care while maintaining or reducing costs, which should result in resources flowing to primary care practices to more appropriately pay them for providing patients the best care possible.

ROLAND A. GOERTZ, M.D., is a family physician in Waco, Tex., and the president of the AAFP.

Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

The interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage, and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

CMS plans to issue additional rules, including mandating the adoption of standards for electronic funds transfer and remittance advice.

The deadline to submit comments on the CMS interim rule is Sept. 6.

Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

The interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage, and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

CMS plans to issue additional rules, including mandating the adoption of standards for electronic funds transfer and remittance advice.

The deadline to submit comments on the CMS interim rule is Sept. 6.

Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

The interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage, and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

CMS plans to issue additional rules, including mandating the adoption of standards for electronic funds transfer and remittance advice.

The deadline to submit comments on the CMS interim rule is Sept. 6.

A look at Washington state's Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care (Health Aff. 2011;DOI:10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, wrote Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., of the University of California, San Diego. (Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.)

The authors analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. “Several states are using their Medicaid resources in a way that's helping to reduce the need for more expensive hospital care,” Dr. Gilmer said in a statement. “By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

For example, the programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, such that average overall spending was just below the mean of all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for diabetes.

The authors received funding from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative.

A look at Washington state's Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care (Health Aff. 2011;DOI:10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, wrote Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., of the University of California, San Diego. (Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.)

The authors analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. “Several states are using their Medicaid resources in a way that's helping to reduce the need for more expensive hospital care,” Dr. Gilmer said in a statement. “By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

For example, the programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, such that average overall spending was just below the mean of all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for diabetes.

The authors received funding from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative.

A look at Washington state's Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care (Health Aff. 2011;DOI:10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, wrote Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., of the University of California, San Diego. (Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.)

The authors analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. “Several states are using their Medicaid resources in a way that's helping to reduce the need for more expensive hospital care,” Dr. Gilmer said in a statement. “By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

For example, the programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, such that average overall spending was just below the mean of all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for diabetes.

The authors received funding from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative.

Women Face Chronic Pain

Millions of American women are living with disorders that cause chronic pain but are being neglected by many researchers and practitioners, according to a report from the Campaign to End Chronic Pain in Women, which includes the Endometriosis Association and the National Vulvodynia Association. Failure to adequately diagnose and treat just six conditions affecting women – chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, temporomandibular disorders, and vulvodynia – adds as much as $80 billion in direct and indirect costs to the health care system each year, according to the report. The group recommended that the National Institutes of Health fund at least four women's chronic pain centers of excellence at leading academic health centers. The report also called on the Centers for Disease Control and Prevention to launch a program studying and comparing the six chronic conditions cited.

Heart Disease Also at Issue

Health care providers and policymakers are also neglecting cardiovascular diseases in women, according to a report from the Society for Women's Health Research and WomenHeart. The “call to action” document listed the top 10 unanswered questions in the prevention, diagnosis, and treatment of women with heart disease, including how to explain cardiovascular disease disparities between men and women, what role a woman's reproductive history plays in heart disease, and how psychosocial factors affect cardiovascular disease in women. The report also called on Congress to pass the HEART for Women Act (S. 438), which would step up government efforts to address the topic.

AMA Adopts BPA Policy

At its recent annual meeting, the American Medical Association recognized bisphenol A (BPA) as an endocrine-disrupting agent, supported existing bans on BPA in baby bottles and infant-feeding cups, and called on manufacturers to clearly label products that contain the substance. The AMA policy resolution noted that the chemical can be found in the lining of canned food containers, cigarette filters, certain medical devices, cash register receipts, and dental sealants. “Both the FDA and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers, and cups containing BPA,” Dr. Edward Langston, an AMA board member, said in a statement.

New York Abortion Fight Goes On

A federal judge has temporarily blocked enforcement of a new New York City ordinance regulating pregnancy centers that counsel women against abortion. The ordinance would have required the centers, also known as crisis-pregnancy centers, to post signs and make clear on their websites whether they provide prenatal care by a licensed medical provider, emergency contraception, or abortion. Abortion-rights supporters say the centers advertise in a deceptive way that leads women to believe they offer comprehensive reproductive health services. Judge William H. Pauley III granted a temporary injunction to stop the ordinance from taking effect. He wrote that the law infringes on free speech rights. City officials said they plan to appeal the ruling.

Progress vs. Cancer Is Uneven

Nearly 900,000 cancer deaths have been avoided in the past 17 years thanks to better cancer prevention, detection, and treatment, but those advances have disproportionately eluded the least-educated people in the United States, the American Cancer Society said. Cancer death rates for individuals with the least education are 2.6 times those for the most-educated segment of the population, a society report said. The disparity is highest for lung cancer: The death rate for the least-educated segment was five times that of the most-educated population. The report pointed out that 31% of men with 12 or fewer years of education are smokers, compared with 12% of college graduates and 5% of men with graduate degrees. Closing the cancer gap between demographic groups could have prevented 60,370 deaths in 2007, or more than one-third of the premature cancer deaths that occurred in people aged 25–64 years, the report said.

'

'Bad Ad' Reports Triple

Reports to the FDA of potentially misleading or untruthful drug ads tripled after the FDA launched a “Bad Ad” outreach program to urge health care professionals to report offenders. During its first year, ending in May, the program received 328 reports of problem ads, 188 of which were submitted by health care professionals. Prior to the outreach program's launch, the FDA received only about 104 reports per year. Of the reports submitted by professionals, the agency identified 87 for a comprehensive review, “demonstrating a relatively strong level of knowledge in the medical community about what constitutes misleading promotion,” an FDA announcement said. The agency said it will continue to promote the program to the medical community.

Women Face Chronic Pain

Millions of American women are living with disorders that cause chronic pain but are being neglected by many researchers and practitioners, according to a report from the Campaign to End Chronic Pain in Women, which includes the Endometriosis Association and the National Vulvodynia Association. Failure to adequately diagnose and treat just six conditions affecting women – chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, temporomandibular disorders, and vulvodynia – adds as much as $80 billion in direct and indirect costs to the health care system each year, according to the report. The group recommended that the National Institutes of Health fund at least four women's chronic pain centers of excellence at leading academic health centers. The report also called on the Centers for Disease Control and Prevention to launch a program studying and comparing the six chronic conditions cited.

Heart Disease Also at Issue

Health care providers and policymakers are also neglecting cardiovascular diseases in women, according to a report from the Society for Women's Health Research and WomenHeart. The “call to action” document listed the top 10 unanswered questions in the prevention, diagnosis, and treatment of women with heart disease, including how to explain cardiovascular disease disparities between men and women, what role a woman's reproductive history plays in heart disease, and how psychosocial factors affect cardiovascular disease in women. The report also called on Congress to pass the HEART for Women Act (S. 438), which would step up government efforts to address the topic.

AMA Adopts BPA Policy

At its recent annual meeting, the American Medical Association recognized bisphenol A (BPA) as an endocrine-disrupting agent, supported existing bans on BPA in baby bottles and infant-feeding cups, and called on manufacturers to clearly label products that contain the substance. The AMA policy resolution noted that the chemical can be found in the lining of canned food containers, cigarette filters, certain medical devices, cash register receipts, and dental sealants. “Both the FDA and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers, and cups containing BPA,” Dr. Edward Langston, an AMA board member, said in a statement.

New York Abortion Fight Goes On

A federal judge has temporarily blocked enforcement of a new New York City ordinance regulating pregnancy centers that counsel women against abortion. The ordinance would have required the centers, also known as crisis-pregnancy centers, to post signs and make clear on their websites whether they provide prenatal care by a licensed medical provider, emergency contraception, or abortion. Abortion-rights supporters say the centers advertise in a deceptive way that leads women to believe they offer comprehensive reproductive health services. Judge William H. Pauley III granted a temporary injunction to stop the ordinance from taking effect. He wrote that the law infringes on free speech rights. City officials said they plan to appeal the ruling.

Progress vs. Cancer Is Uneven

Nearly 900,000 cancer deaths have been avoided in the past 17 years thanks to better cancer prevention, detection, and treatment, but those advances have disproportionately eluded the least-educated people in the United States, the American Cancer Society said. Cancer death rates for individuals with the least education are 2.6 times those for the most-educated segment of the population, a society report said. The disparity is highest for lung cancer: The death rate for the least-educated segment was five times that of the most-educated population. The report pointed out that 31% of men with 12 or fewer years of education are smokers, compared with 12% of college graduates and 5% of men with graduate degrees. Closing the cancer gap between demographic groups could have prevented 60,370 deaths in 2007, or more than one-third of the premature cancer deaths that occurred in people aged 25–64 years, the report said.

'

'Bad Ad' Reports Triple

Reports to the FDA of potentially misleading or untruthful drug ads tripled after the FDA launched a “Bad Ad” outreach program to urge health care professionals to report offenders. During its first year, ending in May, the program received 328 reports of problem ads, 188 of which were submitted by health care professionals. Prior to the outreach program's launch, the FDA received only about 104 reports per year. Of the reports submitted by professionals, the agency identified 87 for a comprehensive review, “demonstrating a relatively strong level of knowledge in the medical community about what constitutes misleading promotion,” an FDA announcement said. The agency said it will continue to promote the program to the medical community.

Women Face Chronic Pain

Millions of American women are living with disorders that cause chronic pain but are being neglected by many researchers and practitioners, according to a report from the Campaign to End Chronic Pain in Women, which includes the Endometriosis Association and the National Vulvodynia Association. Failure to adequately diagnose and treat just six conditions affecting women – chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, temporomandibular disorders, and vulvodynia – adds as much as $80 billion in direct and indirect costs to the health care system each year, according to the report. The group recommended that the National Institutes of Health fund at least four women's chronic pain centers of excellence at leading academic health centers. The report also called on the Centers for Disease Control and Prevention to launch a program studying and comparing the six chronic conditions cited.

Heart Disease Also at Issue

Health care providers and policymakers are also neglecting cardiovascular diseases in women, according to a report from the Society for Women's Health Research and WomenHeart. The “call to action” document listed the top 10 unanswered questions in the prevention, diagnosis, and treatment of women with heart disease, including how to explain cardiovascular disease disparities between men and women, what role a woman's reproductive history plays in heart disease, and how psychosocial factors affect cardiovascular disease in women. The report also called on Congress to pass the HEART for Women Act (S. 438), which would step up government efforts to address the topic.

AMA Adopts BPA Policy

At its recent annual meeting, the American Medical Association recognized bisphenol A (BPA) as an endocrine-disrupting agent, supported existing bans on BPA in baby bottles and infant-feeding cups, and called on manufacturers to clearly label products that contain the substance. The AMA policy resolution noted that the chemical can be found in the lining of canned food containers, cigarette filters, certain medical devices, cash register receipts, and dental sealants. “Both the FDA and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers, and cups containing BPA,” Dr. Edward Langston, an AMA board member, said in a statement.

New York Abortion Fight Goes On

A federal judge has temporarily blocked enforcement of a new New York City ordinance regulating pregnancy centers that counsel women against abortion. The ordinance would have required the centers, also known as crisis-pregnancy centers, to post signs and make clear on their websites whether they provide prenatal care by a licensed medical provider, emergency contraception, or abortion. Abortion-rights supporters say the centers advertise in a deceptive way that leads women to believe they offer comprehensive reproductive health services. Judge William H. Pauley III granted a temporary injunction to stop the ordinance from taking effect. He wrote that the law infringes on free speech rights. City officials said they plan to appeal the ruling.

Progress vs. Cancer Is Uneven

Nearly 900,000 cancer deaths have been avoided in the past 17 years thanks to better cancer prevention, detection, and treatment, but those advances have disproportionately eluded the least-educated people in the United States, the American Cancer Society said. Cancer death rates for individuals with the least education are 2.6 times those for the most-educated segment of the population, a society report said. The disparity is highest for lung cancer: The death rate for the least-educated segment was five times that of the most-educated population. The report pointed out that 31% of men with 12 or fewer years of education are smokers, compared with 12% of college graduates and 5% of men with graduate degrees. Closing the cancer gap between demographic groups could have prevented 60,370 deaths in 2007, or more than one-third of the premature cancer deaths that occurred in people aged 25–64 years, the report said.

'

'Bad Ad' Reports Triple

Reports to the FDA of potentially misleading or untruthful drug ads tripled after the FDA launched a “Bad Ad” outreach program to urge health care professionals to report offenders. During its first year, ending in May, the program received 328 reports of problem ads, 188 of which were submitted by health care professionals. Prior to the outreach program's launch, the FDA received only about 104 reports per year. Of the reports submitted by professionals, the agency identified 87 for a comprehensive review, “demonstrating a relatively strong level of knowledge in the medical community about what constitutes misleading promotion,” an FDA announcement said. The agency said it will continue to promote the program to the medical community.

A look at Washington state's Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published in the journal Health Affairs (doi: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

“Several states are using their Medicaid resources in a way that's helping to reduce the need for more expensive hospital care,” Dr. Gilmer said in a statement. “This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative.

A look at Washington state's Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published in the journal Health Affairs (doi: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

“Several states are using their Medicaid resources in a way that's helping to reduce the need for more expensive hospital care,” Dr. Gilmer said in a statement. “This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative.

A look at Washington state's Medicaid program could provide some clues for how to control costs as states prepare for the massive 2014 expansion of Medicaid under the Affordable Care Act.

Washington has been able to provide widespread access to outpatient services and prescription drugs, while keeping down spending on inpatient care, according to an analysis published in the journal Health Affairs (doi: 10.1377/hlthaff.2011.0106).

The per beneficiary cost for inpatient stays was about 35% below the national average in Washington state, while outpatient visits and prescriptions were each 15% above the national average, according to authors Todd P. Gilmer, Ph.D., and Richard G. Kronick, Ph.D., who were both at the University of California, San Diego, when the article was written. Dr. Kronick is now a deputy assistant secretary for health policy at the Department of Health and Human Services.

Dr. Gilmer and Dr. Kronick analyzed Medicaid claims data from 2001-2005 to see how the volume and the price of services affected the variation in spending across the states. They limited their analysis to claims for Medicaid-only, disabled beneficiaries receiving cash assistance.

“Several states are using their Medicaid resources in a way that's helping to reduce the need for more expensive hospital care,” Dr. Gilmer said in a statement. “This suggests that there is a great deal of room for innovation in Medicaid. By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

For example, the Medicaid programs in Connecticut, Massachusetts, New Hampshire, and Vermont spent more than most on prescription costs and outpatient visits, but had a lower-than-average number of hospital days. The inpatient and outpatient spending offset each other, the researchers wrote, resulting in average overall spending that was just below the mean among all states.

The researchers also found that having a large primary care workforce was associated with reduced hospital stays for some chronic conditions such as diabetes, chronic obstructive pulmonary disease, and adult asthma. Paying more for outpatient visits was also linked to reduced hospital admissions. Similarly, paying more for hospital stays was associated with more admissions.

The authors received funding from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization initiative.

Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.

Scheduled to be published in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.

Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.

The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.

The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.

In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.

The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.

Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.

The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula, the formula used to set Medicare payments to physicians.

Physicians' groups, led by the American Medical Association, lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.

The new law of the land, the Budget Control Act of 2011, puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.

The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel will be comprised of legislators from both parties and both houses of Congress.

Party leaders have named the first nine members of the joint committee. Senate Majority Leader Harry Reid (D.-Nev.) appointed the first members of the committee. He chose Sen. Patty Murray (D.-Wash. who serves on both the Senate budget and appropriations committees, to co-chair the Joint Select Committee on Deficit Reduction. Sen. Reid also tapped Sen. Max Baucus (D.-Mont.), chairman of the Senate Finance Committee and an architect of the Affordable Care Act, and Sen. John Kerry (D.-Mass.), who was the 2004 Democratic presidential nominee, to serve on the joint committee.

Senate Minority Leader Mitch McConnell (R.-Ky.) appointed Sen. Jon Kyl (R.-Ariz.), a member of the Senate Budget Committee, Sen. Pat Toomey (R.-Pa.), a member of the Senate Budget Committee, and Sen. Rob Portman (R.-Ohio), a former director of the Office of Management and Budget, to serve on the joint committee. House Speaker John Boehner (R.-Ohio) also named three members of the joint committee. He appointed Rep. Jeb Hensarling (R.-Tex.), the House Republican Conference chairman, to serve as co-chair of the joint committee. He will be joined by Rep. Dave Camp (R.-Mich.), the chairman of the House Ways and Means Committee, and Rep. Fred Upton (R.-Mich.), chairman of the House Energy and Commerce Committee.

Rep. Nancy Pelosi (D.-Calif.), the House Minority Leader, has until Aug. 16 to choose the last three members of the joint committee.

Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.

“There's a lot of concern that the committee will be deadlocked,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.

The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee's bill by Dec. 23.

To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee's bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.

Should the joint committee's bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.

Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year. “I don't know anyone who can continue very well with a 30% reduction in payment for a significant segment of their business,” said Dr. Roland Goertz, president of the American Academy of Family Physicians. “It just makes it very, very tough.”

Physicians won't stop practicing medicine, Dr. Goertz said, but they may move into another community with fewer Medicare patients or join a group that sees fewer Medicare patients.

Dr. Timothy J. Laing, a rheumatologist at the University of Michigan and chairman of the government affairs committee for the American College of Rheumatology, agreed that physicians would be forced to make tough choices if the cuts went into effect.

“I think it would make a lot of rheumatologists think very hard about access for Medicare patients,” Dr. Laing said. “What had always been taken for granted since the inception of the program – that Medicare was welcome in every office – would now begin to be questioned.” The hope for physicians, Dr. Laing said, is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect.

Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.

The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula, the formula used to set Medicare payments to physicians.

Physicians' groups, led by the American Medical Association, lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.

The new law of the land, the Budget Control Act of 2011, puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.

The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel will be comprised of legislators from both parties and both houses of Congress.

Party leaders have named the first nine members of the joint committee. Senate Majority Leader Harry Reid (D.-Nev.) appointed the first members of the committee. He chose Sen. Patty Murray (D.-Wash. who serves on both the Senate budget and appropriations committees, to co-chair the Joint Select Committee on Deficit Reduction. Sen. Reid also tapped Sen. Max Baucus (D.-Mont.), chairman of the Senate Finance Committee and an architect of the Affordable Care Act, and Sen. John Kerry (D.-Mass.), who was the 2004 Democratic presidential nominee, to serve on the joint committee.

Senate Minority Leader Mitch McConnell (R.-Ky.) appointed Sen. Jon Kyl (R.-Ariz.), a member of the Senate Budget Committee, Sen. Pat Toomey (R.-Pa.), a member of the Senate Budget Committee, and Sen. Rob Portman (R.-Ohio), a former director of the Office of Management and Budget, to serve on the joint committee. House Speaker John Boehner (R.-Ohio) also named three members of the joint committee. He appointed Rep. Jeb Hensarling (R.-Tex.), the House Republican Conference chairman, to serve as co-chair of the joint committee. He will be joined by Rep. Dave Camp (R.-Mich.), the chairman of the House Ways and Means Committee, and Rep. Fred Upton (R.-Mich.), chairman of the House Energy and Commerce Committee.

Rep. Nancy Pelosi (D.-Calif.), the House Minority Leader, has until Aug. 16 to choose the last three members of the joint committee.

Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.

“There's a lot of concern that the committee will be deadlocked,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.

The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee's bill by Dec. 23.

To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee's bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.

Should the joint committee's bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.

Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year. “I don't know anyone who can continue very well with a 30% reduction in payment for a significant segment of their business,” said Dr. Roland Goertz, president of the American Academy of Family Physicians. “It just makes it very, very tough.”

Physicians won't stop practicing medicine, Dr. Goertz said, but they may move into another community with fewer Medicare patients or join a group that sees fewer Medicare patients.

Dr. Timothy J. Laing, a rheumatologist at the University of Michigan and chairman of the government affairs committee for the American College of Rheumatology, agreed that physicians would be forced to make tough choices if the cuts went into effect.

“I think it would make a lot of rheumatologists think very hard about access for Medicare patients,” Dr. Laing said. “What had always been taken for granted since the inception of the program – that Medicare was welcome in every office – would now begin to be questioned.” The hope for physicians, Dr. Laing said, is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect.

Legislation to raise the debt ceiling and cut the deficit, signed by the president Aug. 2, leaves physicians in limbo regarding their Medicare payments next year and in the future.

The biggest question is whether the 29.5% cut to Medicare physician fees scheduled for Jan. 1, 2012, will go into effect. This massive payment cut is called for under the Sustainable Growth Rate (SGR) formula, the formula used to set Medicare payments to physicians.

Physicians' groups, led by the American Medical Association, lobbied Congress to include a permanent fix to the SGR in the deficit reduction package. They argued that while fixing the SGR carries a $300 billion price tag, getting the job done now would save the government money down the road. Instead, lawmakers left the SGR out of the package completely.

The new law of the land, the Budget Control Act of 2011, puts into place about $1 trillion in spending cuts over the next decade from the discretionary side of the federal budget. While these immediate cuts do not directly affect physicians, they do impact graduate medical education: Medical students who take out subsidized graduate student loans on or after July 1, 2012, will have to start paying the interest on those loans earlier.

The next round of budget cuts will be determined by the Joint Select Committee on Deficit Reduction, also known as the super committee. The 12-member panel will be comprised of legislators from both parties and both houses of Congress.

Party leaders have named the first nine members of the joint committee. Senate Majority Leader Harry Reid (D.-Nev.) appointed the first members of the committee. He chose Sen. Patty Murray (D.-Wash. who serves on both the Senate budget and appropriations committees, to co-chair the Joint Select Committee on Deficit Reduction. Sen. Reid also tapped Sen. Max Baucus (D.-Mont.), chairman of the Senate Finance Committee and an architect of the Affordable Care Act, and Sen. John Kerry (D.-Mass.), who was the 2004 Democratic presidential nominee, to serve on the joint committee.

Senate Minority Leader Mitch McConnell (R.-Ky.) appointed Sen. Jon Kyl (R.-Ariz.), a member of the Senate Budget Committee, Sen. Pat Toomey (R.-Pa.), a member of the Senate Budget Committee, and Sen. Rob Portman (R.-Ohio), a former director of the Office of Management and Budget, to serve on the joint committee. House Speaker John Boehner (R.-Ohio) also named three members of the joint committee. He appointed Rep. Jeb Hensarling (R.-Tex.), the House Republican Conference chairman, to serve as co-chair of the joint committee. He will be joined by Rep. Dave Camp (R.-Mich.), the chairman of the House Ways and Means Committee, and Rep. Fred Upton (R.-Mich.), chairman of the House Energy and Commerce Committee.

Rep. Nancy Pelosi (D.-Calif.), the House Minority Leader, has until Aug. 16 to choose the last three members of the joint committee.

Before the joint committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote.

“There's a lot of concern that the committee will be deadlocked,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. The law requires the joint committee to draft legislation cutting another $1.2 trillion to $1.5 trillion in federal spending over 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs. Funding for Affordable Care Act programs is also on the table.

The joint committee must vote on recommendations by Nov. 23, and lawmakers must vote on the joint committee's bill by Dec. 23.

To keep the legislation from getting bogged down in the Senate, the Budget Control Act requires that the joint committee's bill be given a fast-track, up-or-down vote requiring a simple majority to pass each chamber.

Should the joint committee's bill fail, or if the committee deadlocks, the Budget Control Act calls for automatic cuts across the federal government totaling $1.2 trillion over 10 years.

Those cuts would include up to a 2% reduction in Medicare physician payments beginning in 2013. Under a worst-case scenario, physicians could face not only the 29.5% SGR cut in January 2012, but another 2% annual fee cut starting the following year. “I don't know anyone who can continue very well with a 30% reduction in payment for a significant segment of their business,” said Dr. Roland Goertz, president of the American Academy of Family Physicians. “It just makes it very, very tough.”

Physicians won't stop practicing medicine, Dr. Goertz said, but they may move into another community with fewer Medicare patients or join a group that sees fewer Medicare patients.

Dr. Timothy J. Laing, a rheumatologist at the University of Michigan and chairman of the government affairs committee for the American College of Rheumatology, agreed that physicians would be forced to make tough choices if the cuts went into effect.

“I think it would make a lot of rheumatologists think very hard about access for Medicare patients,” Dr. Laing said. “What had always been taken for granted since the inception of the program – that Medicare was welcome in every office – would now begin to be questioned.” The hope for physicians, Dr. Laing said, is that the 29.5% cut mandated by the SGR is simply so large that it would be unthinkable for members of Congress to let it go into effect.

Knee Scope: Nope

Officials at the Centers for Medicare and Medicaid Services are instructing Medicare contractors not to pay for most knee arthroscopy for osteoarthritis. In its July decision memo, the CMS wrote that arthroscopic lavage is not reasonable or necessary for patients with the condition, and debridement shouldn't be covered in patients presenting only with knee pain or even severe osteoarthritis (Outerbridge classification III or IV). Other indications of debridement for beneficiaries with knee osteoarthritis will at the discretion of contractors. The report cited the American College of Rheumatology's position that routine arthroscopic lavage with or without debridement should not be routine for patients with knee osteoarthritis. The college told the CMS, however, that arthroscopic debris removal can be useful for pain relief and improving joint function.

FDA to Review Bisphosphonates

Two expert panels will meet Sept. 9 to advise the Food and Drug Administration on the benefits and risks of long-term treatment of osteoporosis using bisphosphonates, the FDA announced. The agency's Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee will discuss concerns that cases of osteonecrosis of the jaw and atypical femur fractures may be associated with the long-term use of the osteoporosis drugs.

Many Power Chairs Unneeded

Medicare spent about $95 million in the first 6 months of 2007 for power wheelchairs that were either not medical necessary or had no proof of being so. The figures come from an audit by the Health and Human Services' Office of Inspector General. The investigation of 375 claims for power wheelchairs found that 9% of those provided were medically unnecessary. In some cases, beneficiaries needed only less-expensive equipment, such as a scooter or manual wheelchair, while other beneficiaries should have received a different type of power wheelchair. Another 52% of the claims for power wheelchairs did not have adequate documentation to show they were medically necessary.

Medicare Moves Against Fraud

Medicare is turning to the technology of credit card companies to fight fraud. The CMS has started using “predictive modeling” technology to look for beneficiary, provider, and other patterns suggesting fraudulent billing. Alerts should prompt CMS officials to deny payment and investigate, the agency said. Meanwhile, the HHS Office of Inspector General said that it expects to recover up to $3.4 billion from fraud investigations concluded October 2010 to March 2011. The bulk of those funds, $3.2 billion, resulted from criminal investigation. About $222 million was recovered after audits of health care providers.

FDA May Change Consumer Ads

The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. The research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. In contrast, prescription drug ads use densely packed, small-type paragraphs to describe a drug's risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.

Maine Repeals Disclosure Laws

Maine's legislature has voided provisions of three laws that required prescription drugmakers to disclose marketing costs, prices, and details of clinical trials. The repealed provisions, similar to those still in effect in several other states, required drugmakers to report gifts to health care professionals and travel support valued at more than $25. The laws required manufacturers to disclose all costs of marketing drugs to Maine residents, unless those costs were part of a regional or national ad campaign, and to disclose data that could affect prices paid by the state's Medicaid program. The clinical trials disclosures covered any drug marketed in Maine.

Managers Face Challenges

Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO Dr. William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.

Knee Scope: Nope

Officials at the Centers for Medicare and Medicaid Services are instructing Medicare contractors not to pay for most knee arthroscopy for osteoarthritis. In its July decision memo, the CMS wrote that arthroscopic lavage is not reasonable or necessary for patients with the condition, and debridement shouldn't be covered in patients presenting only with knee pain or even severe osteoarthritis (Outerbridge classification III or IV). Other indications of debridement for beneficiaries with knee osteoarthritis will at the discretion of contractors. The report cited the American College of Rheumatology's position that routine arthroscopic lavage with or without debridement should not be routine for patients with knee osteoarthritis. The college told the CMS, however, that arthroscopic debris removal can be useful for pain relief and improving joint function.

FDA to Review Bisphosphonates

Two expert panels will meet Sept. 9 to advise the Food and Drug Administration on the benefits and risks of long-term treatment of osteoporosis using bisphosphonates, the FDA announced. The agency's Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee will discuss concerns that cases of osteonecrosis of the jaw and atypical femur fractures may be associated with the long-term use of the osteoporosis drugs.

Many Power Chairs Unneeded

Medicare spent about $95 million in the first 6 months of 2007 for power wheelchairs that were either not medical necessary or had no proof of being so. The figures come from an audit by the Health and Human Services' Office of Inspector General. The investigation of 375 claims for power wheelchairs found that 9% of those provided were medically unnecessary. In some cases, beneficiaries needed only less-expensive equipment, such as a scooter or manual wheelchair, while other beneficiaries should have received a different type of power wheelchair. Another 52% of the claims for power wheelchairs did not have adequate documentation to show they were medically necessary.

Medicare Moves Against Fraud

Medicare is turning to the technology of credit card companies to fight fraud. The CMS has started using “predictive modeling” technology to look for beneficiary, provider, and other patterns suggesting fraudulent billing. Alerts should prompt CMS officials to deny payment and investigate, the agency said. Meanwhile, the HHS Office of Inspector General said that it expects to recover up to $3.4 billion from fraud investigations concluded October 2010 to March 2011. The bulk of those funds, $3.2 billion, resulted from criminal investigation. About $222 million was recovered after audits of health care providers.

FDA May Change Consumer Ads

The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. The research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. In contrast, prescription drug ads use densely packed, small-type paragraphs to describe a drug's risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.

Maine Repeals Disclosure Laws

Maine's legislature has voided provisions of three laws that required prescription drugmakers to disclose marketing costs, prices, and details of clinical trials. The repealed provisions, similar to those still in effect in several other states, required drugmakers to report gifts to health care professionals and travel support valued at more than $25. The laws required manufacturers to disclose all costs of marketing drugs to Maine residents, unless those costs were part of a regional or national ad campaign, and to disclose data that could affect prices paid by the state's Medicaid program. The clinical trials disclosures covered any drug marketed in Maine.

Managers Face Challenges

Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO Dr. William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.

Knee Scope: Nope

Officials at the Centers for Medicare and Medicaid Services are instructing Medicare contractors not to pay for most knee arthroscopy for osteoarthritis. In its July decision memo, the CMS wrote that arthroscopic lavage is not reasonable or necessary for patients with the condition, and debridement shouldn't be covered in patients presenting only with knee pain or even severe osteoarthritis (Outerbridge classification III or IV). Other indications of debridement for beneficiaries with knee osteoarthritis will at the discretion of contractors. The report cited the American College of Rheumatology's position that routine arthroscopic lavage with or without debridement should not be routine for patients with knee osteoarthritis. The college told the CMS, however, that arthroscopic debris removal can be useful for pain relief and improving joint function.

FDA to Review Bisphosphonates

Two expert panels will meet Sept. 9 to advise the Food and Drug Administration on the benefits and risks of long-term treatment of osteoporosis using bisphosphonates, the FDA announced. The agency's Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee will discuss concerns that cases of osteonecrosis of the jaw and atypical femur fractures may be associated with the long-term use of the osteoporosis drugs.

Many Power Chairs Unneeded

Medicare spent about $95 million in the first 6 months of 2007 for power wheelchairs that were either not medical necessary or had no proof of being so. The figures come from an audit by the Health and Human Services' Office of Inspector General. The investigation of 375 claims for power wheelchairs found that 9% of those provided were medically unnecessary. In some cases, beneficiaries needed only less-expensive equipment, such as a scooter or manual wheelchair, while other beneficiaries should have received a different type of power wheelchair. Another 52% of the claims for power wheelchairs did not have adequate documentation to show they were medically necessary.

Medicare Moves Against Fraud

Medicare is turning to the technology of credit card companies to fight fraud. The CMS has started using “predictive modeling” technology to look for beneficiary, provider, and other patterns suggesting fraudulent billing. Alerts should prompt CMS officials to deny payment and investigate, the agency said. Meanwhile, the HHS Office of Inspector General said that it expects to recover up to $3.4 billion from fraud investigations concluded October 2010 to March 2011. The bulk of those funds, $3.2 billion, resulted from criminal investigation. About $222 million was recovered after audits of health care providers.

FDA May Change Consumer Ads

The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. The research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. In contrast, prescription drug ads use densely packed, small-type paragraphs to describe a drug's risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.

Maine Repeals Disclosure Laws

Maine's legislature has voided provisions of three laws that required prescription drugmakers to disclose marketing costs, prices, and details of clinical trials. The repealed provisions, similar to those still in effect in several other states, required drugmakers to report gifts to health care professionals and travel support valued at more than $25. The laws required manufacturers to disclose all costs of marketing drugs to Maine residents, unless those costs were part of a regional or national ad campaign, and to disclose data that could affect prices paid by the state's Medicaid program. The clinical trials disclosures covered any drug marketed in Maine.

Managers Face Challenges

Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO Dr. William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.