Alicia Ault

Patients with preexisting conditions can now get insurance coverage through their states or through the U.S. Health and Human Services department, the federal agency announced July 1.

The Pre-Existing Condition Insurance Plan is a stopgap program that will exist until 2014 when insurance companies will be prohibited from denying coverage to, or discriminating against, anyone who has had a previous serious illness or chronic condition.

The plan, established as part of the Affordable Care Act, was hailed by patient advocacy organizations.

John R. Seffrin, Ph.D., CEO of the American Cancer Society Cancer Action Network, said in a statement that the program will “give at least hundreds of thousands of uninsured people with cancer and other preexisting conditions access to health care.” Dr. Seffrin said that the program was not likely to be able to enroll everyone who needed coverage, but that it “is an important first step toward transforming the health care system to one that provides meaningful coverage to all Americans.”

American Heart Association CEO Nancy Brown said in a statement that the program provides a “valuable new alternative for coverage.” She noted that the “exact terms and coverage will vary depending upon the state in which a person lives.”

That is because states were given the option of letting the HHS administer the plan or running it themselves. Twenty-one states chose the former, while 29 states and the District of Columbia are running their own programs. Enrollment has begun for the HHS plan and will possibly begin by the end of the summer for the state-run programs. Coverage begins Aug. 1 for the HHS plan.

To receive coverage, people must be U.S. citizens or legal residents, and must have been uninsured for at least 6 months, or unable to purchase coverage because of a preexisting condition.

The plan is supported by $5 billion in federal money, but some states have been concerned that the money won’t last and that they would end up having to subsidize the program. Many of those states, like Louisiana, which has an estimated 700,000 uninsured residents, decided to let the federal government run their plans.

The program will cover primary and specialty care, hospitalization, and prescription drugs. Premiums may not exceed the standard individual premium for a policy in that particular state and age may be used to help determine premium rates. The HHS estimated, for instance, that in its plan, the premium for a 50-year-old would range from $320 to $570, depending on where the patient lives. More details on premium pricing will be available in mid-July.

Also on July 1, the federal government launched an online tool that lets anyone seeking insurance see what options are available – from public programs such as Medicaid, to state-run plans, to private insurance. After answering a series of questions, the tool, at www.healthcare.gov, gives the user concrete data on where and how to purchase coverage or to sign up for federal or state-run programs.

This, too, is valuable, said the AHA’s Ms. Brown. “For the first time, consumers faced with an array of choices will have a single site to go to help them understand their coverage options,” she said.

Patients with preexisting conditions can now get insurance coverage through their states or through the U.S. Health and Human Services department, the federal agency announced July 1.

The Pre-Existing Condition Insurance Plan is a stopgap program that will exist until 2014 when insurance companies will be prohibited from denying coverage to, or discriminating against, anyone who has had a previous serious illness or chronic condition.

The plan, established as part of the Affordable Care Act, was hailed by patient advocacy organizations.

John R. Seffrin, Ph.D., CEO of the American Cancer Society Cancer Action Network, said in a statement that the program will “give at least hundreds of thousands of uninsured people with cancer and other preexisting conditions access to health care.” Dr. Seffrin said that the program was not likely to be able to enroll everyone who needed coverage, but that it “is an important first step toward transforming the health care system to one that provides meaningful coverage to all Americans.”

American Heart Association CEO Nancy Brown said in a statement that the program provides a “valuable new alternative for coverage.” She noted that the “exact terms and coverage will vary depending upon the state in which a person lives.”

That is because states were given the option of letting the HHS administer the plan or running it themselves. Twenty-one states chose the former, while 29 states and the District of Columbia are running their own programs. Enrollment has begun for the HHS plan and will possibly begin by the end of the summer for the state-run programs. Coverage begins Aug. 1 for the HHS plan.

To receive coverage, people must be U.S. citizens or legal residents, and must have been uninsured for at least 6 months, or unable to purchase coverage because of a preexisting condition.

The plan is supported by $5 billion in federal money, but some states have been concerned that the money won’t last and that they would end up having to subsidize the program. Many of those states, like Louisiana, which has an estimated 700,000 uninsured residents, decided to let the federal government run their plans.

The program will cover primary and specialty care, hospitalization, and prescription drugs. Premiums may not exceed the standard individual premium for a policy in that particular state and age may be used to help determine premium rates. The HHS estimated, for instance, that in its plan, the premium for a 50-year-old would range from $320 to $570, depending on where the patient lives. More details on premium pricing will be available in mid-July.

Also on July 1, the federal government launched an online tool that lets anyone seeking insurance see what options are available – from public programs such as Medicaid, to state-run plans, to private insurance. After answering a series of questions, the tool, at www.healthcare.gov, gives the user concrete data on where and how to purchase coverage or to sign up for federal or state-run programs.

This, too, is valuable, said the AHA’s Ms. Brown. “For the first time, consumers faced with an array of choices will have a single site to go to help them understand their coverage options,” she said.

Patients with preexisting conditions can now get insurance coverage through their states or through the U.S. Health and Human Services department, the federal agency announced July 1.

The Pre-Existing Condition Insurance Plan is a stopgap program that will exist until 2014 when insurance companies will be prohibited from denying coverage to, or discriminating against, anyone who has had a previous serious illness or chronic condition.

The plan, established as part of the Affordable Care Act, was hailed by patient advocacy organizations.

John R. Seffrin, Ph.D., CEO of the American Cancer Society Cancer Action Network, said in a statement that the program will “give at least hundreds of thousands of uninsured people with cancer and other preexisting conditions access to health care.” Dr. Seffrin said that the program was not likely to be able to enroll everyone who needed coverage, but that it “is an important first step toward transforming the health care system to one that provides meaningful coverage to all Americans.”

American Heart Association CEO Nancy Brown said in a statement that the program provides a “valuable new alternative for coverage.” She noted that the “exact terms and coverage will vary depending upon the state in which a person lives.”

That is because states were given the option of letting the HHS administer the plan or running it themselves. Twenty-one states chose the former, while 29 states and the District of Columbia are running their own programs. Enrollment has begun for the HHS plan and will possibly begin by the end of the summer for the state-run programs. Coverage begins Aug. 1 for the HHS plan.

To receive coverage, people must be U.S. citizens or legal residents, and must have been uninsured for at least 6 months, or unable to purchase coverage because of a preexisting condition.

The plan is supported by $5 billion in federal money, but some states have been concerned that the money won’t last and that they would end up having to subsidize the program. Many of those states, like Louisiana, which has an estimated 700,000 uninsured residents, decided to let the federal government run their plans.

The program will cover primary and specialty care, hospitalization, and prescription drugs. Premiums may not exceed the standard individual premium for a policy in that particular state and age may be used to help determine premium rates. The HHS estimated, for instance, that in its plan, the premium for a 50-year-old would range from $320 to $570, depending on where the patient lives. More details on premium pricing will be available in mid-July.

Also on July 1, the federal government launched an online tool that lets anyone seeking insurance see what options are available – from public programs such as Medicaid, to state-run plans, to private insurance. After answering a series of questions, the tool, at www.healthcare.gov, gives the user concrete data on where and how to purchase coverage or to sign up for federal or state-run programs.

This, too, is valuable, said the AHA’s Ms. Brown. “For the first time, consumers faced with an array of choices will have a single site to go to help them understand their coverage options,” she said.

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

It has been 15 years since the insurance industry issued any kind of internal standards, according to the AMA, adding in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

America's Health Insurance Plans, the industry trade organization, did not directly address the AMA code. AHIP spokesman Robert Zirkelbach said many of the principles are covered in the health reform law—the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

The code's principles address topics such as cancellations and rescissions; medical loss ratios andcfair premium calculations; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles. The systems are used to select physicians for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For details, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'The health insurance industry has a crisis of credibility' and must reestablish trust with patients.

Source DR. ROHACK

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

It has been 15 years since the insurance industry issued any kind of internal standards, according to the AMA, adding in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

America's Health Insurance Plans, the industry trade organization, did not directly address the AMA code. AHIP spokesman Robert Zirkelbach said many of the principles are covered in the health reform law—the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

The code's principles address topics such as cancellations and rescissions; medical loss ratios andcfair premium calculations; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles. The systems are used to select physicians for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For details, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'The health insurance industry has a crisis of credibility' and must reestablish trust with patients.

Source DR. ROHACK

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

It has been 15 years since the insurance industry issued any kind of internal standards, according to the AMA, adding in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

America's Health Insurance Plans, the industry trade organization, did not directly address the AMA code. AHIP spokesman Robert Zirkelbach said many of the principles are covered in the health reform law—the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

The code's principles address topics such as cancellations and rescissions; medical loss ratios andcfair premium calculations; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles. The systems are used to select physicians for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For details, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'The health insurance industry has a crisis of credibility' and must reestablish trust with patients.

Source DR. ROHACK

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That's up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC's Morbidity and Mortality Weekly Report.

Overall, 46.3 million people—or 15.4% of the population—were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview—some 58.5 million—but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children's higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children's Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18-64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

For more information, go to www.cdc.gov/nchs

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That's up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC's Morbidity and Mortality Weekly Report.

Overall, 46.3 million people—or 15.4% of the population—were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview—some 58.5 million—but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children's higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children's Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18-64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

For more information, go to www.cdc.gov/nchs

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That's up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC's Morbidity and Mortality Weekly Report.

Overall, 46.3 million people—or 15.4% of the population—were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview—some 58.5 million—but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children's higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children's Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18-64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

For more information, go to www.cdc.gov/nchs

WASHINGTON — A group of 19 health systems is taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier. These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high-quality care. “In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers.”

Members of the Premier ACO to Date

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J. Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore–LIJ Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis, Mo.

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems is taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier. These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high-quality care. “In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers.”

Members of the Premier ACO to Date

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J. Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore–LIJ Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis, Mo.

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems is taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier. These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high-quality care. “In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers.”

Members of the Premier ACO to Date

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J. Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore–LIJ Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis, Mo.

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

President Obama announced the recess appointment of Dr. Donald Berwick to be the administrator of the Centers for Medicare and Medicaid Services, bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, which has been vacant since 2006, the president said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

Dr. Berwick said he was flattered that the president had appointed him to head the CMS, especially at this time. “I have never felt more excited about what is possible for what we all care about—a healthier nation, a healthier system of care, and a healthier world,” he said in a statement. “In moving to CMS as a member of a strong governmental team, I will pursue those aims as hard as I can.” Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

The American College of Physicians President J. Fred Ralston Jr. said that “Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care.” Dr. Ralston added that the ACP believed that “Dr. Berwick will be an able administrator and partner for change.”

Others also leaped to support Dr. Berwick. “Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care,” American Hospital Association President Rich Umbdenstock said in a statement.

In a statment, Sen. John Kerry (D-Mass.) chided Republicans for their “lockstep stalling” of Dr. Berwick's nomination, and praising him for his assistance in overhauling the Massachusetts health care system.

“He's first rate all the way, and throughout Massachusetts's landmark health reform, Don was there, helping lead our state to the highest rate of health care coverage in the nation,” according to Sen. Kerry.

Senate Minority Leader Mitch McConnell (R-Ky.), however, was scathing in his reaction to the appointment, calling Dr. Berwick “one of the most prominent advocates of rationed health care.”

“Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny,” Sen. McConnell said in a statement.

Under the Constitution, the president nominates individuals to serve in high-level government positions; those individuals must then be confirmed by the Senate. However, the Constitution also allows the president to make such appointments without Senate confirmation if Congress is in recess, as it was for the Independence Day holiday.

Dr. Donald Berwick has been a leader in health care quality improvement.

Source Courtesy Institute for Healthcare Improvement

President Obama announced the recess appointment of Dr. Donald Berwick to be the administrator of the Centers for Medicare and Medicaid Services, bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, which has been vacant since 2006, the president said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

Dr. Berwick said he was flattered that the president had appointed him to head the CMS, especially at this time. “I have never felt more excited about what is possible for what we all care about—a healthier nation, a healthier system of care, and a healthier world,” he said in a statement. “In moving to CMS as a member of a strong governmental team, I will pursue those aims as hard as I can.” Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

The American College of Physicians President J. Fred Ralston Jr. said that “Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care.” Dr. Ralston added that the ACP believed that “Dr. Berwick will be an able administrator and partner for change.”

Others also leaped to support Dr. Berwick. “Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care,” American Hospital Association President Rich Umbdenstock said in a statement.

In a statment, Sen. John Kerry (D-Mass.) chided Republicans for their “lockstep stalling” of Dr. Berwick's nomination, and praising him for his assistance in overhauling the Massachusetts health care system.

“He's first rate all the way, and throughout Massachusetts's landmark health reform, Don was there, helping lead our state to the highest rate of health care coverage in the nation,” according to Sen. Kerry.

Senate Minority Leader Mitch McConnell (R-Ky.), however, was scathing in his reaction to the appointment, calling Dr. Berwick “one of the most prominent advocates of rationed health care.”

“Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny,” Sen. McConnell said in a statement.

Under the Constitution, the president nominates individuals to serve in high-level government positions; those individuals must then be confirmed by the Senate. However, the Constitution also allows the president to make such appointments without Senate confirmation if Congress is in recess, as it was for the Independence Day holiday.

Dr. Donald Berwick has been a leader in health care quality improvement.

Source Courtesy Institute for Healthcare Improvement

President Obama announced the recess appointment of Dr. Donald Berwick to be the administrator of the Centers for Medicare and Medicaid Services, bypassing what looked like a lengthy fight to have the nominee confirmed by the Senate.

In making the appointment, which has been vacant since 2006, the president said in a statement, “It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes.”

Dr. Berwick said he was flattered that the president had appointed him to head the CMS, especially at this time. “I have never felt more excited about what is possible for what we all care about—a healthier nation, a healthier system of care, and a healthier world,” he said in a statement. “In moving to CMS as a member of a strong governmental team, I will pursue those aims as hard as I can.” Dr. Berwick is president and CEO of the Cambridge, Mass.–based Institute for Healthcare Improvement.

The American College of Physicians President J. Fred Ralston Jr. said that “Dr. Berwick's career and work at the Institute for Healthcare Improvement illustrates the drive to provide patient-centered care, patient safety, quality improvement, and care coordination in health care.” Dr. Ralston added that the ACP believed that “Dr. Berwick will be an able administrator and partner for change.”

Others also leaped to support Dr. Berwick. “Don has dedicated his career to engaging hospitals, doctors, nurses and other health care providers to improve patient care,” American Hospital Association President Rich Umbdenstock said in a statement.

In a statment, Sen. John Kerry (D-Mass.) chided Republicans for their “lockstep stalling” of Dr. Berwick's nomination, and praising him for his assistance in overhauling the Massachusetts health care system.

“He's first rate all the way, and throughout Massachusetts's landmark health reform, Don was there, helping lead our state to the highest rate of health care coverage in the nation,” according to Sen. Kerry.

Senate Minority Leader Mitch McConnell (R-Ky.), however, was scathing in his reaction to the appointment, calling Dr. Berwick “one of the most prominent advocates of rationed health care.”

“Democrats haven't scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny,” Sen. McConnell said in a statement.

Under the Constitution, the president nominates individuals to serve in high-level government positions; those individuals must then be confirmed by the Senate. However, the Constitution also allows the president to make such appointments without Senate confirmation if Congress is in recess, as it was for the Independence Day holiday.

Dr. Donald Berwick has been a leader in health care quality improvement.

Source Courtesy Institute for Healthcare Improvement

The Food and Drug Administration issued a warning to physicians and consumers that proton pump inhibitors may increase the risk of hip, wrist, and spine fractures.

The agency said that it is changing the labeling for prescription and over-the-counter versions of proton pump inhibitors (PPIs) to reflect new safety information that is the result of a review of seven epidemiologic studies. Most of the observed risk was in people older than age 50 years and those who took high doses or used the drugs for more than a year. Prescription PPIs include esomeprazole (Nexium), dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex). There are OTC versions of Prilosec, Zegerid, and Prevacid.

“Because these products are used by a great number of people, it's important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient's condition,” said Dr. Joyce Korvick, deputy director for safety in FDA's Division of Gastroenterology Products, in a statement.

The FDA did not have access to the raw data in the studies; it merely reviewed what was published. But, said the FDA, it accepted the results because the studies appear to be well designed. Even so, those studies had limitations, and there is still no understanding of why PPIs might lead to fractures.

The full agency communication is located at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm

The Food and Drug Administration issued a warning to physicians and consumers that proton pump inhibitors may increase the risk of hip, wrist, and spine fractures.

The agency said that it is changing the labeling for prescription and over-the-counter versions of proton pump inhibitors (PPIs) to reflect new safety information that is the result of a review of seven epidemiologic studies. Most of the observed risk was in people older than age 50 years and those who took high doses or used the drugs for more than a year. Prescription PPIs include esomeprazole (Nexium), dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex). There are OTC versions of Prilosec, Zegerid, and Prevacid.

“Because these products are used by a great number of people, it's important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient's condition,” said Dr. Joyce Korvick, deputy director for safety in FDA's Division of Gastroenterology Products, in a statement.

The FDA did not have access to the raw data in the studies; it merely reviewed what was published. But, said the FDA, it accepted the results because the studies appear to be well designed. Even so, those studies had limitations, and there is still no understanding of why PPIs might lead to fractures.

The full agency communication is located at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm

The Food and Drug Administration issued a warning to physicians and consumers that proton pump inhibitors may increase the risk of hip, wrist, and spine fractures.

The agency said that it is changing the labeling for prescription and over-the-counter versions of proton pump inhibitors (PPIs) to reflect new safety information that is the result of a review of seven epidemiologic studies. Most of the observed risk was in people older than age 50 years and those who took high doses or used the drugs for more than a year. Prescription PPIs include esomeprazole (Nexium), dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex). There are OTC versions of Prilosec, Zegerid, and Prevacid.

“Because these products are used by a great number of people, it's important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient's condition,” said Dr. Joyce Korvick, deputy director for safety in FDA's Division of Gastroenterology Products, in a statement.

The FDA did not have access to the raw data in the studies; it merely reviewed what was published. But, said the FDA, it accepted the results because the studies appear to be well designed. Even so, those studies had limitations, and there is still no understanding of why PPIs might lead to fractures.

The full agency communication is located at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm

The federal government published regulations in June that allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the “meaningful use” standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the Recovery Act.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification

The federal government published regulations in June that allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the “meaningful use” standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the Recovery Act.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification

The federal government published regulations in June that allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the “meaningful use” standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the Recovery Act.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification

The number of uninsured Americans rose last year, with 21% of all adults aged 18–64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported.

That's up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC's Morbidity and Mortality Weekly Report.

Overall, 46.3 million people—or 15.4% of the population—were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview—some 58.5 million—but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children's higher rate of coverage, according to the survey. In 2009, 37.7% of children younger than 18 years were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children's Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18–64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year. Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents younger than 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%.

More information on the NIH survey is available at www.cdc.gov/nchs

The number of uninsured Americans rose last year, with 21% of all adults aged 18–64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported.

That's up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC's Morbidity and Mortality Weekly Report.

Overall, 46.3 million people—or 15.4% of the population—were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview—some 58.5 million—but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children's higher rate of coverage, according to the survey. In 2009, 37.7% of children younger than 18 years were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children's Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18–64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year. Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents younger than 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%.

More information on the NIH survey is available at www.cdc.gov/nchs

The number of uninsured Americans rose last year, with 21% of all adults aged 18–64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported.

That's up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC's Morbidity and Mortality Weekly Report.

Overall, 46.3 million people—or 15.4% of the population—were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview—some 58.5 million—but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children's higher rate of coverage, according to the survey. In 2009, 37.7% of children younger than 18 years were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children's Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18–64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year. Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents younger than 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%.

More information on the NIH survey is available at www.cdc.gov/nchs

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing.

The Affordable Care Act—one of the health reform laws—gives government agencies new enforcement powers and new funding to go after fraud and abuse, and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. The law will make it more difficult to become enrolled as a Medicare or Medicaid provider, as potential providers will be categorized as presenting a high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, she said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model that's used now.

HHS and the Justice Department will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, she added. “For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians, other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

In all, 583 individuals were convicted of health care fraud in 2009 by U.S. attorneys' offices and federal prosecutors. On the civil side, the Justice Department opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes. A California physician paid $2.2 million to settle allegations that in 2002–2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said. The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing.

The Affordable Care Act—one of the health reform laws—gives government agencies new enforcement powers and new funding to go after fraud and abuse, and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. The law will make it more difficult to become enrolled as a Medicare or Medicaid provider, as potential providers will be categorized as presenting a high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, she said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model that's used now.

HHS and the Justice Department will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, she added. “For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians, other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

In all, 583 individuals were convicted of health care fraud in 2009 by U.S. attorneys' offices and federal prosecutors. On the civil side, the Justice Department opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes. A California physician paid $2.2 million to settle allegations that in 2002–2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said. The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government recovered $2.5 billion in fraudulent Medicare payments in 2009, government officials said at a briefing.

The Affordable Care Act—one of the health reform laws—gives government agencies new enforcement powers and new funding to go after fraud and abuse, and physicians may find themselves under increased scrutiny as a result.

Daniel Levinson, the Health and Human Services Department Inspector General, said that the Affordable Care Act will require providers and suppliers to adopt compliance programs that meet core criteria. He added that his office will provide training to health care providers once those criteria are issued.

According to HHS Secretary Kathleen Sebelius, the Affordable Care Act provides $600 million over the next 10 years to combat fraud and abuse. The law will make it more difficult to become enrolled as a Medicare or Medicaid provider, as potential providers will be categorized as presenting a high, medium, or low risk of fraud at the time of enrollment. More face-to-face checks will be used to verify a provider's legitimacy, she said. The law increases penalties for fraud, and puts more emphasis on real-time detection of fraud and abuse as opposed to the “pay and chase” model that's used now.

HHS and the Justice Department will look closely at adopting strategies used by credit card companies to immediately flag aberrant charges, said Ms. Sebelius. Preventing waste, fraud, and abuse is especially important as the cost of health care continues to rise, she added. “For years, we've tolerated health care fraud,” she said. “We've accepted that with any big enterprise there was going to be some waste and abuse, but those days are coming to an end.”

In 2009, the federal government received about $1.6 billion in settlements and judgments from hospitals, physicians, other health care providers, drug and device makers, and non-health providers that were found to have illegally billed federal health care programs. With penalties and settlements, $2.5 billion was returned to the Medicare Trust Fund and $441 million to Medicaid, according to the Health Care Fraud and Abuse Control Program Report.

In all, 583 individuals were convicted of health care fraud in 2009 by U.S. attorneys' offices and federal prosecutors. On the civil side, the Justice Department opened 886 new investigations and had 1,155 civil fraud matters pending.

Physicians were among those convicted or fined for fraud and abuse schemes. A California physician paid $2.2 million to settle allegations that in 2002–2006, he allowed his universal provider identification number to be used to bill Medicare for respiratory therapy. A Kansas cardiologist paid $1.3 million to settle allegations that his group submitted claims for services not provided.

Ms. Sebelius and Attorney General Eric Holder highlighted efforts by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Medicare Fraud Strike Force, which was begun in 2007 to address durable medical equipment fraud and abuse in south Florida. The strike force has since been expanded to focus on potential hot spots of potential fraud, identified by claims patterns. In 2009, Los Angeles, Detroit, and Houston were added; now the strike force also operates in Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.

Ms. Sebelius said that new types of scams are emerging, as criminals attempt to take advantage of seniors who may not understand the health reform laws. Scam artists have gone door-to-door in some states selling bogus “ObamaCare” policies, or asking Medicare beneficiaries for identifying information to issue “new Medicare cards,” she said.

Other scams are tied to the issuance of rebate checks to Medicare beneficiaries whose Medicare Part D drug expenditures push them into the doughnut hole, Ms. Sebelius said. The HHS is working with advocacy organizations to educate laypersons who can train their peers how to recognize illegal and inappropriate come-ons, she added.

The federal government has published regulations that will allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the “meaningful use” standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid. The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the Recovery Act.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

This rule, published June 18th, was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification

The federal government has published regulations that will allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the “meaningful use” standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid. The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the Recovery Act.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

This rule, published June 18th, was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification

The federal government has published regulations that will allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the “meaningful use” standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid. The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the Recovery Act.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

This rule, published June 18th, was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification