Alicia Ault

ICD Maker Pleads Guilty

Boston Scientific has pleaded guilty to failing to report problems with a subsidiary's implantable cardioverter defibrillators (ICDs) to the Food and Drug Administration. Previously, the company paid $296 million in criminal penalties for making false statements to the FDA and failing to notify the agency about material changes to an ICD. Now, however, a federal judge in Minnesota has rejected the plea deal, saying that the government should have insisted on probation in addition to the fine to hold the company more accountable for its actions. It is not clear where the case will go from here. The devices in question were from subsidiary Guidant, which recalled them in 2005. But this March, Boston Scientific recalled eight of its own ICDs. The company said that it had neglected to notify the FDA about manufacturing changes, seemingly a repeat of the Guidant situation. In mid-April, the company said the FDA had approved a resumption of sales for two ICDs: the Cognis and the Telegen. Boston Scientific is still working with the FDA on five other models and hopes to resume sales soon, the company said.

Company Warned on Rings

Showing that it will continue to pursue paperwork and reporting violations, the FDA warned Irvine, Calif.–based Edwards Lifesciences that it failed to properly and promptly notify the agency about problems with several models of its annuloplasty rings. In the letter, the FDA said that six complaints “were not reported within 30 calendar days and are adverse events that resulted in a death or serious injury.” The letter said that the warning related to inspections conducted in September 2009.

Cardiologists Are Reform Skeptics

A small survey showed that a majority of cardiologists are skeptical that health care reform will help them or their patients. The survey of 225 cardiologists was conducted in late March by MedAxiom, an information and networking resource for cardiologists based in Neptune, Fla. Eighty-one percent of those surveyed said they thought the law would hurt their practices, and 83% said their revenue would decrease; 71% said that the law would hurt their ability to serve patients.

Few Complaints to Device Office

The FDA's Center for Devices and Radiological Health (CDRH) has issued its ninth annual ombudsman's report on complaints, disputes, and inquiries from the industry, health care providers, and consumers. Of the 250 contacts to CDRH in 2009, 53% were complaints, 21% were to dispute an agency action, and 26% were inquiries. Source of contacts were 70% from industry, 17% from consumers, and 9% from health providers. Most of the complaints and disputes were about the agency's policies or procedures, followed by the agency's data or testing requirements. Safety or adverse events were the subject of only 4% of the contacts.

CV Admissions High for Women

The Agency for Health Research and Quality (AHRQ) reported that there were 2 million cardiovascular disease–related hospital stays for women in 2007, making it the second biggest reason for admission after pregnancy and childbirth. The reasons for admission included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other arrhythmias, and chest pain with no determined cause. Other top reasons for admission included pneumonia, osteoarthritis, depression and bipolar disorder, urinary tract infections, blood infections, and skin infections. The data is from the AHRQ's Healthcare Cost and Utilization Project report for 2007.

Generics 75% of Dispensed Drugs

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken said in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth-largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other company has detailed trial payments. The data, posted at

www.pfizer.com/responsibility

ICD Maker Pleads Guilty

Boston Scientific has pleaded guilty to failing to report problems with a subsidiary's implantable cardioverter defibrillators (ICDs) to the Food and Drug Administration. Previously, the company paid $296 million in criminal penalties for making false statements to the FDA and failing to notify the agency about material changes to an ICD. Now, however, a federal judge in Minnesota has rejected the plea deal, saying that the government should have insisted on probation in addition to the fine to hold the company more accountable for its actions. It is not clear where the case will go from here. The devices in question were from subsidiary Guidant, which recalled them in 2005. But this March, Boston Scientific recalled eight of its own ICDs. The company said that it had neglected to notify the FDA about manufacturing changes, seemingly a repeat of the Guidant situation. In mid-April, the company said the FDA had approved a resumption of sales for two ICDs: the Cognis and the Telegen. Boston Scientific is still working with the FDA on five other models and hopes to resume sales soon, the company said.

Company Warned on Rings

Showing that it will continue to pursue paperwork and reporting violations, the FDA warned Irvine, Calif.–based Edwards Lifesciences that it failed to properly and promptly notify the agency about problems with several models of its annuloplasty rings. In the letter, the FDA said that six complaints “were not reported within 30 calendar days and are adverse events that resulted in a death or serious injury.” The letter said that the warning related to inspections conducted in September 2009.

Cardiologists Are Reform Skeptics

A small survey showed that a majority of cardiologists are skeptical that health care reform will help them or their patients. The survey of 225 cardiologists was conducted in late March by MedAxiom, an information and networking resource for cardiologists based in Neptune, Fla. Eighty-one percent of those surveyed said they thought the law would hurt their practices, and 83% said their revenue would decrease; 71% said that the law would hurt their ability to serve patients.

Few Complaints to Device Office

The FDA's Center for Devices and Radiological Health (CDRH) has issued its ninth annual ombudsman's report on complaints, disputes, and inquiries from the industry, health care providers, and consumers. Of the 250 contacts to CDRH in 2009, 53% were complaints, 21% were to dispute an agency action, and 26% were inquiries. Source of contacts were 70% from industry, 17% from consumers, and 9% from health providers. Most of the complaints and disputes were about the agency's policies or procedures, followed by the agency's data or testing requirements. Safety or adverse events were the subject of only 4% of the contacts.

CV Admissions High for Women

The Agency for Health Research and Quality (AHRQ) reported that there were 2 million cardiovascular disease–related hospital stays for women in 2007, making it the second biggest reason for admission after pregnancy and childbirth. The reasons for admission included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other arrhythmias, and chest pain with no determined cause. Other top reasons for admission included pneumonia, osteoarthritis, depression and bipolar disorder, urinary tract infections, blood infections, and skin infections. The data is from the AHRQ's Healthcare Cost and Utilization Project report for 2007.

Generics 75% of Dispensed Drugs

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken said in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth-largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other company has detailed trial payments. The data, posted at

www.pfizer.com/responsibility

ICD Maker Pleads Guilty

Boston Scientific has pleaded guilty to failing to report problems with a subsidiary's implantable cardioverter defibrillators (ICDs) to the Food and Drug Administration. Previously, the company paid $296 million in criminal penalties for making false statements to the FDA and failing to notify the agency about material changes to an ICD. Now, however, a federal judge in Minnesota has rejected the plea deal, saying that the government should have insisted on probation in addition to the fine to hold the company more accountable for its actions. It is not clear where the case will go from here. The devices in question were from subsidiary Guidant, which recalled them in 2005. But this March, Boston Scientific recalled eight of its own ICDs. The company said that it had neglected to notify the FDA about manufacturing changes, seemingly a repeat of the Guidant situation. In mid-April, the company said the FDA had approved a resumption of sales for two ICDs: the Cognis and the Telegen. Boston Scientific is still working with the FDA on five other models and hopes to resume sales soon, the company said.

Company Warned on Rings

Showing that it will continue to pursue paperwork and reporting violations, the FDA warned Irvine, Calif.–based Edwards Lifesciences that it failed to properly and promptly notify the agency about problems with several models of its annuloplasty rings. In the letter, the FDA said that six complaints “were not reported within 30 calendar days and are adverse events that resulted in a death or serious injury.” The letter said that the warning related to inspections conducted in September 2009.

Cardiologists Are Reform Skeptics

A small survey showed that a majority of cardiologists are skeptical that health care reform will help them or their patients. The survey of 225 cardiologists was conducted in late March by MedAxiom, an information and networking resource for cardiologists based in Neptune, Fla. Eighty-one percent of those surveyed said they thought the law would hurt their practices, and 83% said their revenue would decrease; 71% said that the law would hurt their ability to serve patients.

Few Complaints to Device Office

The FDA's Center for Devices and Radiological Health (CDRH) has issued its ninth annual ombudsman's report on complaints, disputes, and inquiries from the industry, health care providers, and consumers. Of the 250 contacts to CDRH in 2009, 53% were complaints, 21% were to dispute an agency action, and 26% were inquiries. Source of contacts were 70% from industry, 17% from consumers, and 9% from health providers. Most of the complaints and disputes were about the agency's policies or procedures, followed by the agency's data or testing requirements. Safety or adverse events were the subject of only 4% of the contacts.

CV Admissions High for Women

The Agency for Health Research and Quality (AHRQ) reported that there were 2 million cardiovascular disease–related hospital stays for women in 2007, making it the second biggest reason for admission after pregnancy and childbirth. The reasons for admission included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other arrhythmias, and chest pain with no determined cause. Other top reasons for admission included pneumonia, osteoarthritis, depression and bipolar disorder, urinary tract infections, blood infections, and skin infections. The data is from the AHRQ's Healthcare Cost and Utilization Project report for 2007.

Generics 75% of Dispensed Drugs

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken said in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth-largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other company has detailed trial payments. The data, posted at

www.pfizer.com/responsibility

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of their practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. They are also a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists, she said.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego, said that negotiations with the ABP are ongoing.

The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been published because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The common clinical conditions were taken from nonsurgical data collected by the Joint Commission and publications on common pediatric hospitalizations. The specialized services include care that is not based on diagnosis-related group data. The core skills come from the Healthcare Cost and Utilization Project Factbook and randomly selected hospitalist billing data.

The competencies are not meant to be all inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said.

They may even be difficult to achieve during a fellowship, Dr. Stucky added.

In an extensive collaborative process, the competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Dr. Ottolini said that she thought the competencies would be used in a variety of ways, including by educators to help develop curricula, by those new to the specialty to increase their knowledge, by physicians as a marketing tool, and by physician groups as a means of recruiting new partners.

Disclosures: None was reported.

The core competencies are not meant to be all inclusive, rigid, or easily achieved during residency.

Source DR. OTTOLINI

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of their practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. They are also a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists, she said.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego, said that negotiations with the ABP are ongoing.

The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been published because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The common clinical conditions were taken from nonsurgical data collected by the Joint Commission and publications on common pediatric hospitalizations. The specialized services include care that is not based on diagnosis-related group data. The core skills come from the Healthcare Cost and Utilization Project Factbook and randomly selected hospitalist billing data.

The competencies are not meant to be all inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said.

They may even be difficult to achieve during a fellowship, Dr. Stucky added.

In an extensive collaborative process, the competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Dr. Ottolini said that she thought the competencies would be used in a variety of ways, including by educators to help develop curricula, by those new to the specialty to increase their knowledge, by physicians as a marketing tool, and by physician groups as a means of recruiting new partners.

Disclosures: None was reported.

The core competencies are not meant to be all inclusive, rigid, or easily achieved during residency.

Source DR. OTTOLINI

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of their practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. They are also a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists, she said.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego, said that negotiations with the ABP are ongoing.

The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been published because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The common clinical conditions were taken from nonsurgical data collected by the Joint Commission and publications on common pediatric hospitalizations. The specialized services include care that is not based on diagnosis-related group data. The core skills come from the Healthcare Cost and Utilization Project Factbook and randomly selected hospitalist billing data.

The competencies are not meant to be all inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said.

They may even be difficult to achieve during a fellowship, Dr. Stucky added.

In an extensive collaborative process, the competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Dr. Ottolini said that she thought the competencies would be used in a variety of ways, including by educators to help develop curricula, by those new to the specialty to increase their knowledge, by physicians as a marketing tool, and by physician groups as a means of recruiting new partners.

Disclosures: None was reported.

The core competencies are not meant to be all inclusive, rigid, or easily achieved during residency.

Source DR. OTTOLINI

Already struggling from California's diversion of funds meant to pay for uninsured patients, the state's emergency departments may be facing an even grimmer financial scenario when fiscal 2011 begins in July, say California emergency department directors.

Physicians have already been coping with either no pay since last July or with a huge reduction in how much they are paid from county funds for care of uninsured patients. Now, with the state's ongoing budget crisis, some counties have decided to slash reimbursement rates even further. And that scenario could be repeated again in a few months, Dr. Robert Rosenbloom, president of the California chapter of the American College of Emergency Physicians (CAL/ACEP), said in an interview.

Uncompensated care in the state's private emergency departments has been reimbursed primarily through a combination of tobacco taxes and the Maddy Fund, which was created in 1987. The Maddy Fund law allows counties to collect a portion of fines from traffic violations and criminal offenses and dedicate them to emergency medical services. Fifty-eight percent of the fund's revenues must go to reimburse physicians, 25% to hospitals, and 17% to other emergency medical services.

However, physicians can be reimbursed only up to 50% of the losses incurred from uncompensated care.

So far, 50 California counties have established Maddy Funds. Some of those counties have been aggressive about collections, accounting, and distribution. But others have done a poor job of collections or accounting, which means that not all the monies are properly distributed—or distributed at all, said Dr. Rosenbloom.

CAL/ACEP is supporting a bill before the state legislature that would require counties with Maddy Funds to be transparent in their accounting so that proper amounts go to emergency services.

Budget Crisis Drains Maddy Funds

The California budget crisis has clouded the already uncertain Maddy Fund picture. In 2009, Gov. Arnold Schwarzenegger (R) used statutory discretion to redirect $25 million of emergency services money into the state's general coffers. That was out of a total $60 million, said Dr. Rosenbloom.

The move had immediate repercussions. Los Angeles County lost $9 million, and as of July 1, 2009, it halted all uncompensated-care payments to the county's private facilities and their physicians. Emergency physicians in the county were already receiving only 27% of their costs of caring for the uninsured.

In February, the Los Angeles County Board of Supervisors voted to give physicians and hospitals back pay, but at a further reduced rate: 18% of the cost of care.

Despite the low reimbursement, CAL/ACEP has fought to keep the system in place, said Dr. Rosenbloom. It ensures that the uninsured get some kind of care and reduces the pressure on public emergency departments, he said.

However, the low to nonexistent pay rates are exacerbating the difficulties in finding physicians who will take emergency department call, Dr. Rosenbloom said. Many specialists find the pay “insulting,” he said.

The latest reductions in funding have had “a huge effect on the willingness of private physicians to back up emergency departments,” said Dr. B. Thomas Hafkenschiel, an emergency physician at Santa Clara Valley Medical Center.

When the county's Maddy Fund is working, it at least ensures a minimal payment, which is better than nothing, said Dr. Hafkenschiel. But now the pay appears even more uncertain. Although he works at a county facility, he is monitoring—and feeling—the effects of the reimbursement cuts for private facilities.

Dr. Hafkenschiel has been working with a group of ED directors in the south San Francisco Bay area to get a better accounting of the criminal penalties being collected by the Maddy Fund and their distribution. As other funding sources have shrunk, including tobacco tax collections, “we have to make sure this is being done properly, or we're going to be in deep trouble,” Dr. Hafkenschiel said.

Uninsured Patient Visits Rising

The lack of funds for uncompensated care is a growing problem because of the increasing numbers of uninsured patients in California. Dr. Hafkenschiel said that the patient volume at his ED has grown from 82,000 visits in 2007 to 128,000 in 2009, largely due to people losing their health insurance. That trend may be accelerating in 2010—ED visits in the first 2 months of 2010 exceeded the volume seen in the same period of 2009.

Other ED directors in the county have noticed the same rise in uninsured patients, he added. In Los Angeles County, the percentage of uninsured patients in the ED has risen from 16% to 19% in the past year, said Dr. Rosenbloom.

At Arrowhead Regional Medical Center, a county facility in San Bernadino County, volume has gone up 6% in the past year, said Dr. Rodney Borger, medical director of the ED at Arrowhead. The number of physician claims to the county's Maddy Fund has gone up 15% over the past 2 years, but the revenues have been flat or decreasing, said Dr. Borger, a member of the fund's oversight board.

When Gov. Schwarzenegger diverted the $25 million, San Bernadino lost $900,000, Dr. Borger said. In October, the county coped by cutting reimbursement by 24% to physicians at private EDs for uninsured care. Another 25% cut may be around the corner in July, said Dr. Borger, who added that he was hopeful that it could be averted.

Already struggling from California's diversion of funds meant to pay for uninsured patients, the state's emergency departments may be facing an even grimmer financial scenario when fiscal 2011 begins in July, say California emergency department directors.

Physicians have already been coping with either no pay since last July or with a huge reduction in how much they are paid from county funds for care of uninsured patients. Now, with the state's ongoing budget crisis, some counties have decided to slash reimbursement rates even further. And that scenario could be repeated again in a few months, Dr. Robert Rosenbloom, president of the California chapter of the American College of Emergency Physicians (CAL/ACEP), said in an interview.

Uncompensated care in the state's private emergency departments has been reimbursed primarily through a combination of tobacco taxes and the Maddy Fund, which was created in 1987. The Maddy Fund law allows counties to collect a portion of fines from traffic violations and criminal offenses and dedicate them to emergency medical services. Fifty-eight percent of the fund's revenues must go to reimburse physicians, 25% to hospitals, and 17% to other emergency medical services.

However, physicians can be reimbursed only up to 50% of the losses incurred from uncompensated care.

So far, 50 California counties have established Maddy Funds. Some of those counties have been aggressive about collections, accounting, and distribution. But others have done a poor job of collections or accounting, which means that not all the monies are properly distributed—or distributed at all, said Dr. Rosenbloom.

CAL/ACEP is supporting a bill before the state legislature that would require counties with Maddy Funds to be transparent in their accounting so that proper amounts go to emergency services.

Budget Crisis Drains Maddy Funds

The California budget crisis has clouded the already uncertain Maddy Fund picture. In 2009, Gov. Arnold Schwarzenegger (R) used statutory discretion to redirect $25 million of emergency services money into the state's general coffers. That was out of a total $60 million, said Dr. Rosenbloom.

The move had immediate repercussions. Los Angeles County lost $9 million, and as of July 1, 2009, it halted all uncompensated-care payments to the county's private facilities and their physicians. Emergency physicians in the county were already receiving only 27% of their costs of caring for the uninsured.

In February, the Los Angeles County Board of Supervisors voted to give physicians and hospitals back pay, but at a further reduced rate: 18% of the cost of care.

Despite the low reimbursement, CAL/ACEP has fought to keep the system in place, said Dr. Rosenbloom. It ensures that the uninsured get some kind of care and reduces the pressure on public emergency departments, he said.

However, the low to nonexistent pay rates are exacerbating the difficulties in finding physicians who will take emergency department call, Dr. Rosenbloom said. Many specialists find the pay “insulting,” he said.

The latest reductions in funding have had “a huge effect on the willingness of private physicians to back up emergency departments,” said Dr. B. Thomas Hafkenschiel, an emergency physician at Santa Clara Valley Medical Center.

When the county's Maddy Fund is working, it at least ensures a minimal payment, which is better than nothing, said Dr. Hafkenschiel. But now the pay appears even more uncertain. Although he works at a county facility, he is monitoring—and feeling—the effects of the reimbursement cuts for private facilities.

Dr. Hafkenschiel has been working with a group of ED directors in the south San Francisco Bay area to get a better accounting of the criminal penalties being collected by the Maddy Fund and their distribution. As other funding sources have shrunk, including tobacco tax collections, “we have to make sure this is being done properly, or we're going to be in deep trouble,” Dr. Hafkenschiel said.

Uninsured Patient Visits Rising

The lack of funds for uncompensated care is a growing problem because of the increasing numbers of uninsured patients in California. Dr. Hafkenschiel said that the patient volume at his ED has grown from 82,000 visits in 2007 to 128,000 in 2009, largely due to people losing their health insurance. That trend may be accelerating in 2010—ED visits in the first 2 months of 2010 exceeded the volume seen in the same period of 2009.

Other ED directors in the county have noticed the same rise in uninsured patients, he added. In Los Angeles County, the percentage of uninsured patients in the ED has risen from 16% to 19% in the past year, said Dr. Rosenbloom.

At Arrowhead Regional Medical Center, a county facility in San Bernadino County, volume has gone up 6% in the past year, said Dr. Rodney Borger, medical director of the ED at Arrowhead. The number of physician claims to the county's Maddy Fund has gone up 15% over the past 2 years, but the revenues have been flat or decreasing, said Dr. Borger, a member of the fund's oversight board.

When Gov. Schwarzenegger diverted the $25 million, San Bernadino lost $900,000, Dr. Borger said. In October, the county coped by cutting reimbursement by 24% to physicians at private EDs for uninsured care. Another 25% cut may be around the corner in July, said Dr. Borger, who added that he was hopeful that it could be averted.

Already struggling from California's diversion of funds meant to pay for uninsured patients, the state's emergency departments may be facing an even grimmer financial scenario when fiscal 2011 begins in July, say California emergency department directors.

Physicians have already been coping with either no pay since last July or with a huge reduction in how much they are paid from county funds for care of uninsured patients. Now, with the state's ongoing budget crisis, some counties have decided to slash reimbursement rates even further. And that scenario could be repeated again in a few months, Dr. Robert Rosenbloom, president of the California chapter of the American College of Emergency Physicians (CAL/ACEP), said in an interview.

Uncompensated care in the state's private emergency departments has been reimbursed primarily through a combination of tobacco taxes and the Maddy Fund, which was created in 1987. The Maddy Fund law allows counties to collect a portion of fines from traffic violations and criminal offenses and dedicate them to emergency medical services. Fifty-eight percent of the fund's revenues must go to reimburse physicians, 25% to hospitals, and 17% to other emergency medical services.

However, physicians can be reimbursed only up to 50% of the losses incurred from uncompensated care.

So far, 50 California counties have established Maddy Funds. Some of those counties have been aggressive about collections, accounting, and distribution. But others have done a poor job of collections or accounting, which means that not all the monies are properly distributed—or distributed at all, said Dr. Rosenbloom.

CAL/ACEP is supporting a bill before the state legislature that would require counties with Maddy Funds to be transparent in their accounting so that proper amounts go to emergency services.

Budget Crisis Drains Maddy Funds

The California budget crisis has clouded the already uncertain Maddy Fund picture. In 2009, Gov. Arnold Schwarzenegger (R) used statutory discretion to redirect $25 million of emergency services money into the state's general coffers. That was out of a total $60 million, said Dr. Rosenbloom.

The move had immediate repercussions. Los Angeles County lost $9 million, and as of July 1, 2009, it halted all uncompensated-care payments to the county's private facilities and their physicians. Emergency physicians in the county were already receiving only 27% of their costs of caring for the uninsured.

In February, the Los Angeles County Board of Supervisors voted to give physicians and hospitals back pay, but at a further reduced rate: 18% of the cost of care.

Despite the low reimbursement, CAL/ACEP has fought to keep the system in place, said Dr. Rosenbloom. It ensures that the uninsured get some kind of care and reduces the pressure on public emergency departments, he said.

However, the low to nonexistent pay rates are exacerbating the difficulties in finding physicians who will take emergency department call, Dr. Rosenbloom said. Many specialists find the pay “insulting,” he said.

The latest reductions in funding have had “a huge effect on the willingness of private physicians to back up emergency departments,” said Dr. B. Thomas Hafkenschiel, an emergency physician at Santa Clara Valley Medical Center.

When the county's Maddy Fund is working, it at least ensures a minimal payment, which is better than nothing, said Dr. Hafkenschiel. But now the pay appears even more uncertain. Although he works at a county facility, he is monitoring—and feeling—the effects of the reimbursement cuts for private facilities.

Dr. Hafkenschiel has been working with a group of ED directors in the south San Francisco Bay area to get a better accounting of the criminal penalties being collected by the Maddy Fund and their distribution. As other funding sources have shrunk, including tobacco tax collections, “we have to make sure this is being done properly, or we're going to be in deep trouble,” Dr. Hafkenschiel said.

Uninsured Patient Visits Rising

The lack of funds for uncompensated care is a growing problem because of the increasing numbers of uninsured patients in California. Dr. Hafkenschiel said that the patient volume at his ED has grown from 82,000 visits in 2007 to 128,000 in 2009, largely due to people losing their health insurance. That trend may be accelerating in 2010—ED visits in the first 2 months of 2010 exceeded the volume seen in the same period of 2009.

Other ED directors in the county have noticed the same rise in uninsured patients, he added. In Los Angeles County, the percentage of uninsured patients in the ED has risen from 16% to 19% in the past year, said Dr. Rosenbloom.

At Arrowhead Regional Medical Center, a county facility in San Bernadino County, volume has gone up 6% in the past year, said Dr. Rodney Borger, medical director of the ED at Arrowhead. The number of physician claims to the county's Maddy Fund has gone up 15% over the past 2 years, but the revenues have been flat or decreasing, said Dr. Borger, a member of the fund's oversight board.

When Gov. Schwarzenegger diverted the $25 million, San Bernadino lost $900,000, Dr. Borger said. In October, the county coped by cutting reimbursement by 24% to physicians at private EDs for uninsured care. Another 25% cut may be around the corner in July, said Dr. Borger, who added that he was hopeful that it could be averted.

The White House announced last month that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

Dr. Berwick, a pediatrician, is president and chief executive officer of the Institute for Healthcare Improvement.

In a statement, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced last month that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

Dr. Berwick, a pediatrician, is president and chief executive officer of the Institute for Healthcare Improvement.

In a statement, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

The White House announced last month that it has nominated Dr. Donald Berwick to lead the Centers for Medicare and Medicaid Services.

Dr. Berwick, a pediatrician, is president and chief executive officer of the Institute for Healthcare Improvement.

In a statement, President Obama said, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost. That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves.”

The American Medical Association praised Dr. Berwick's “visionary leadership efforts” in quality and patient safety in a statement given by Dr. Nancy H. Nielsen, the AMA's immediate-past president. “Upon confirmation, we look forward to working with Dr. Berwick at CMS on implementation of the new health reform law and on ensuring that physicians can continue to care for seniors who rely on Medicare.”

With the passage of health reform and the continuing lack of a permanent solution for the fee cuts threatened by Medicare's sustainable growth rate (SGR) formula, Dr. Berwick will have a full plate if he is confirmed by the Senate.

The medical device industry lobby, AdvaMed, issued a statement praising Dr. Berwick's “compelling vision,” but reminded him also of what he will be taking on. “There is perhaps no more important job in health care,” said Stephen J. Ubl, president and CEO of AdvaMed. “The decisions made by Dr. Berwick will affect the lives of America's seniors and every health care provider, and CMS will play a pivotal role in implementing the comprehensive health reform program recently enacted by Congress.”

Dr. Berwick said in a statement that he felt “flattered and humbled” at his nomination. He added, “If confirmed by the U.S. Senate, I would welcome the opportunity to lead CMS because it offers the chance to help extend the effort to improve America's health care system—the very vision that led to the founding of the Institute for Healthcare Improvement.”

Dr. Berwick is a member of the adjunct staff in the department of medicine at Children's Hospital, Boston, and is a consultant in pediatrics at Massachusetts General Hospital. He is an elected member of the Institute of Medicine, and previously chaired the National Advisory Council for the federal Agency for Healthcare Research and Quality. He also served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry in 1997 and 1998.

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare Sustainable Growth Rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said, adding, “If the formula is not repealed, the problem will continue to grow.”

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare Sustainable Growth Rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said, adding, “If the formula is not repealed, the problem will continue to grow.”

President Obama signed legislation late on April 15 giving physicians another temporary reprieve from the 21% Medicare pay cut that, for all intents and purposes, was scheduled to go into effect at midnight.

The reduction in pay has now been deferred until June 1.

The fate of Medicare's physician fees was in doubt as late as the afternoon of the 15th. The Senate spent most of the week debating a bill (H.R. 4851) that would delay the cuts mandated by the Medicare Sustainable Growth Rate (SGR) formula as well as extend unemployment benefits and federal subsidies for COBRA benefits.

The Senate finally approved the bill, with the House doing so in quick succession. The President signed it shortly thereafter.

The Congressional Budget Office estimated the cost of this brief delay in the pay cuts at $2.1 billion, the second most costly aspect of the bill after unemployment benefits extension, at almost $12 billion.

The pay cut technically went into effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) held all claims submitted from that date until April 15, in anticipation that Congress would reverse the cuts retroactively. But on the afternoon of the 15th, CMS officials noted in a statement that claims with dates of service on or after April 1 would be processed at the lower rate “as soon as systems are fully tested to ensure proper claims payment.”

Physician groups were not pleased and began chiding members of Congress for their lack of action.

After the cut was delayed again, Dr. J. James Rohack, president of the American Medical Association, said in a statement, “Congress must now turn toward solving this problem once and for all through repeal of the broken payment formula that will hurt seniors, military families, and the physicians who care for them.”

Dr. Rohack also warned—again—that physicians are starting to limit new Medicare patients.

“It is impossible for physicians to continue to care for all seniors when Medicare payments fall so far below the cost of providing care,” he said, adding, “If the formula is not repealed, the problem will continue to grow.”

DSM-5 Comments Close

The American Psychiatric Association reported that it received 6,400 comments on its draft of the DSM-5. About a quarter of the comments were general, another quarter were on neurodevelopmental disorders, 15% dealt with anxiety disorders, 11% were on psychoses, and 10% concerned sexual and gender-identity disorders. The remainder was split among nine other classes of mental disorders. The comments probably will result in revisions, according to the APA. In fact, the DSM-5 Work Group on Eating Disorders already has proposed revisions to criteria for anorexia nervosa and bulimia nervosa. Now that comments have closed, the APA will test the proposed diagnostic criteria in clinical settings and then refine them. Final publication is planned for May 2013.

New Tobacco-Science Chief

The Food and Drug Administration has named a director for the Office of Science within its new Center for Tobacco Products. Dr. David L. Ashley will assume the position in June. Currently, he is the chief of the Emergency Response and Air Toxicants Branch of the Centers for Disease Control and Prevention's National Center for Environmental Health. Dr. Ashley also is a member of the World Health Organization's study group on tobacco regulation. At the center, he will oversee science, product review, epidemiology and metrics, and social and behavioral sciences, according to the FDA.

$153 Billion Wasted on Medications

Americans are wasting $153 billion a year on medications, primarily because of lack of adherence to prescriptions, estimates the pharmacy-benefit management company Express Scripts. The company came up with this tally as part of its annual report on drug spending. In 2009, $106 billion in waste was caused by nonadherence, $51 billion by failure to use lower-cost alternatives, and $6 billion from people choosing retail over mail order delivery, said the Express Scripts. (It has a mail order subsidiary.) The biggest medical area of waste is in treating high cholesterol, followed by hypertension, ulcer disease, and depression, according to the company. It said that 35% of the annual spending on lipid medications could be saved if people behaved better. Overall, drug spending rose 6.4% in 2009, which reversed a downward trend over the past few years. Spending for specialty drugs–for conditions such as rheumatoid arthritis, cancer, and multiple sclerosis–rose by 11%, driven largely by price increases.

Sales of Generics Still on Rise

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken commented in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer Inc. has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other drug company has detailed trial payments. The data, which are posted at

www.pfizer.com/responsibility

Reform Was Lobbying Cash Cow

Lawyers, professional societies, and other organizations spent $1.2 billion lobbying Congress and the White House on health reform and other issues in 2009, according to a report by the Center for Public Integrity (CPI), a Washington-based watchdog group. How much went to health reform is not known, but if it was even 10%, that would be record lobbying for a single issue in 1 year, according to the CPI. The group estimates that 1,750 entities spread the money around. In addition to making use of its own lobbyists, Pharmaceutical Research and Manufacturers of America, for instance, hired 25 outside firms, CPI said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it isn't overshadowed by other parts of either type of ad. The FDA will accept comments on the proposed rule until June 28.

DSM-5 Comments Close

The American Psychiatric Association reported that it received 6,400 comments on its draft of the DSM-5. About a quarter of the comments were general, another quarter were on neurodevelopmental disorders, 15% dealt with anxiety disorders, 11% were on psychoses, and 10% concerned sexual and gender-identity disorders. The remainder was split among nine other classes of mental disorders. The comments probably will result in revisions, according to the APA. In fact, the DSM-5 Work Group on Eating Disorders already has proposed revisions to criteria for anorexia nervosa and bulimia nervosa. Now that comments have closed, the APA will test the proposed diagnostic criteria in clinical settings and then refine them. Final publication is planned for May 2013.

New Tobacco-Science Chief

The Food and Drug Administration has named a director for the Office of Science within its new Center for Tobacco Products. Dr. David L. Ashley will assume the position in June. Currently, he is the chief of the Emergency Response and Air Toxicants Branch of the Centers for Disease Control and Prevention's National Center for Environmental Health. Dr. Ashley also is a member of the World Health Organization's study group on tobacco regulation. At the center, he will oversee science, product review, epidemiology and metrics, and social and behavioral sciences, according to the FDA.

$153 Billion Wasted on Medications

Americans are wasting $153 billion a year on medications, primarily because of lack of adherence to prescriptions, estimates the pharmacy-benefit management company Express Scripts. The company came up with this tally as part of its annual report on drug spending. In 2009, $106 billion in waste was caused by nonadherence, $51 billion by failure to use lower-cost alternatives, and $6 billion from people choosing retail over mail order delivery, said the Express Scripts. (It has a mail order subsidiary.) The biggest medical area of waste is in treating high cholesterol, followed by hypertension, ulcer disease, and depression, according to the company. It said that 35% of the annual spending on lipid medications could be saved if people behaved better. Overall, drug spending rose 6.4% in 2009, which reversed a downward trend over the past few years. Spending for specialty drugs–for conditions such as rheumatoid arthritis, cancer, and multiple sclerosis–rose by 11%, driven largely by price increases.

Sales of Generics Still on Rise

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken commented in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer Inc. has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other drug company has detailed trial payments. The data, which are posted at

www.pfizer.com/responsibility

Reform Was Lobbying Cash Cow

Lawyers, professional societies, and other organizations spent $1.2 billion lobbying Congress and the White House on health reform and other issues in 2009, according to a report by the Center for Public Integrity (CPI), a Washington-based watchdog group. How much went to health reform is not known, but if it was even 10%, that would be record lobbying for a single issue in 1 year, according to the CPI. The group estimates that 1,750 entities spread the money around. In addition to making use of its own lobbyists, Pharmaceutical Research and Manufacturers of America, for instance, hired 25 outside firms, CPI said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it isn't overshadowed by other parts of either type of ad. The FDA will accept comments on the proposed rule until June 28.

DSM-5 Comments Close

The American Psychiatric Association reported that it received 6,400 comments on its draft of the DSM-5. About a quarter of the comments were general, another quarter were on neurodevelopmental disorders, 15% dealt with anxiety disorders, 11% were on psychoses, and 10% concerned sexual and gender-identity disorders. The remainder was split among nine other classes of mental disorders. The comments probably will result in revisions, according to the APA. In fact, the DSM-5 Work Group on Eating Disorders already has proposed revisions to criteria for anorexia nervosa and bulimia nervosa. Now that comments have closed, the APA will test the proposed diagnostic criteria in clinical settings and then refine them. Final publication is planned for May 2013.

New Tobacco-Science Chief

The Food and Drug Administration has named a director for the Office of Science within its new Center for Tobacco Products. Dr. David L. Ashley will assume the position in June. Currently, he is the chief of the Emergency Response and Air Toxicants Branch of the Centers for Disease Control and Prevention's National Center for Environmental Health. Dr. Ashley also is a member of the World Health Organization's study group on tobacco regulation. At the center, he will oversee science, product review, epidemiology and metrics, and social and behavioral sciences, according to the FDA.

$153 Billion Wasted on Medications

Americans are wasting $153 billion a year on medications, primarily because of lack of adherence to prescriptions, estimates the pharmacy-benefit management company Express Scripts. The company came up with this tally as part of its annual report on drug spending. In 2009, $106 billion in waste was caused by nonadherence, $51 billion by failure to use lower-cost alternatives, and $6 billion from people choosing retail over mail order delivery, said the Express Scripts. (It has a mail order subsidiary.) The biggest medical area of waste is in treating high cholesterol, followed by hypertension, ulcer disease, and depression, according to the company. It said that 35% of the annual spending on lipid medications could be saved if people behaved better. Overall, drug spending rose 6.4% in 2009, which reversed a downward trend over the past few years. Spending for specialty drugs–for conditions such as rheumatoid arthritis, cancer, and multiple sclerosis–rose by 11%, driven largely by price increases.

Sales of Generics Still on Rise

More introductions of lower-cost generics dampened sales of brand name prescription drugs last year, but overall sales were still up 5%, according to IMS Health. U.S. sales grew to $300 billion, with 3.9 billion prescriptions dispensed in 2009. Generics made up 75% of dispensed prescriptions, an increase of almost 6% since 2008. Prescriptions dispensed as branded products decreased by almost 8%. There were 32 novel drugs introduced in 2009, but those “drove a limited increase in drug spending,” IMS Senior Vice President Murray Aitken commented in a statement. The top-selling class was antipsychotics, whose $14 billion in sales equaled the 2008 total. Proton pump inhibitors were second, hitting $13.6 billion in sales last year. Lipid regulators accounted for $13 billion in sales, a figure held down by generics, and antidepressants were fourth largest in sales at $9.9 billion.

Pfizer Details Pay to Physicians

As part of a settlement with the federal government, Pfizer Inc. has posted its first report detailing how much it pays health care professionals for consulting and other duties, including clinical trial participation. No other drug company has detailed trial payments. The data, which are posted at

www.pfizer.com/responsibility

Reform Was Lobbying Cash Cow

Lawyers, professional societies, and other organizations spent $1.2 billion lobbying Congress and the White House on health reform and other issues in 2009, according to a report by the Center for Public Integrity (CPI), a Washington-based watchdog group. How much went to health reform is not known, but if it was even 10%, that would be record lobbying for a single issue in 1 year, according to the CPI. The group estimates that 1,750 entities spread the money around. In addition to making use of its own lobbyists, Pharmaceutical Research and Manufacturers of America, for instance, hired 25 outside firms, CPI said.

FDA Proposes New Ad Rules

The Food and Drug Administration wants manufacturers to detail more of the contraindications and potential side effects of drugs in radio and television direct-to-consumer advertisements. The proposed rule would require that an ad's major statement on side effects and contraindications “be presented in a clear, conspicuous, and neutral manner.” The new rule would require manufacturers to present the information in both the audio and visual components of a video ad and make sure that it isn't overshadowed by other parts of either type of ad. The FDA will accept comments on the proposed rule until June 28.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The agreement comes after decades of effort to develop an appropriate way for emergency physicians to receive certification in critical care medicine. Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was no pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows took an examination through the European Society of Intensive Care Medicine. Some hospitals accept such overseas credentialing, because of the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The potential impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate communication between the ABEM and the two other medical specialty boards that currently certify physicians in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

The availability of a 2-year fellowship and subsequent U.S. certification also will help produce more U.S.-trained intensivists, Dr. Emlet said. Currently, about 20 emergency medicine residents enter a critical care fellowship program each year, he said, pointing out the natural affinity between emergency medicine and critical care medicine.

In a recent survey of emergency physicians who participated in a critical care medicine fellowship program, 49% of the physicians who had completed their fellowship (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9). The number of emergency physicians who have completed critical care fellowships rose from 12 over the 1974–1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem that was discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current medical specialty boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said that they expect the first certification exam to be offered in 2012.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The agreement comes after decades of effort to develop an appropriate way for emergency physicians to receive certification in critical care medicine. Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was no pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows took an examination through the European Society of Intensive Care Medicine. Some hospitals accept such overseas credentialing, because of the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The potential impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate communication between the ABEM and the two other medical specialty boards that currently certify physicians in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

The availability of a 2-year fellowship and subsequent U.S. certification also will help produce more U.S.-trained intensivists, Dr. Emlet said. Currently, about 20 emergency medicine residents enter a critical care fellowship program each year, he said, pointing out the natural affinity between emergency medicine and critical care medicine.

In a recent survey of emergency physicians who participated in a critical care medicine fellowship program, 49% of the physicians who had completed their fellowship (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9). The number of emergency physicians who have completed critical care fellowships rose from 12 over the 1974–1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem that was discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current medical specialty boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said that they expect the first certification exam to be offered in 2012.

In a long-awaited move, the American Board of Emergency Medicine and the American Board of Internal Medicine have agreed to cosponsor a pathway to certification in Internal Medicine Critical Care Medicine.

The agreement comes after decades of effort to develop an appropriate way for emergency physicians to receive certification in critical care medicine. Emergency physicians have been receiving advanced training through critical care fellowships since the late 1980s, but there was no pathway to board certification, Dr. Eric Holmboe, the ABIM's chief medical officer, Quality Research and Academic Affairs, said in an interview.

Many of those critical care fellows took an examination through the European Society of Intensive Care Medicine. Some hospitals accept such overseas credentialing, because of the lack of an equivalent U.S. examination, said Dr. Lillian L. Emlet, chair of the Critical Care Medicine section of the American College of Emergency Physicians.

The potential impact of the new certification is unclear, but “it's a very exciting thing for all of us,” Dr. Emlet said in an interview. At a minimum, it should facilitate communication between the ABEM and the two other medical specialty boards that currently certify physicians in adult critical care medicine, the American Board of Surgery and the American Board of Anesthesiology, said Dr. Emlet, of the University of Pittsburgh.

The availability of a 2-year fellowship and subsequent U.S. certification also will help produce more U.S.-trained intensivists, Dr. Emlet said. Currently, about 20 emergency medicine residents enter a critical care fellowship program each year, he said, pointing out the natural affinity between emergency medicine and critical care medicine.

In a recent survey of emergency physicians who participated in a critical care medicine fellowship program, 49% of the physicians who had completed their fellowship (36 of 73) were practicing both specialties (Acad. Emerg. Med. 2010;17:325–9). The number of emergency physicians who have completed critical care fellowships rose from 12 over the 1974–1989 time period to 43 in 2000-2007, according to the survey.

Even so, Dr. Debra G. Perina, ABEM president, said that there is a continuing shortage of critical care physicians in the United States—a problem that was discussed in a 2006 report by the Institute of Medicine called “The Future of Emergency Care in the United States Health System.”

The current medical specialty boards are not supplying enough specialists to meet the demand in critical care medicine, Dr. Perina, an associate professor at the University of Virginia, Charlottesville, said in an interview.

A 2005 white paper—published by the ACEP, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Society of Academic Emergency Medicine, and the Society of Critical Care Medicine—urged an expansion of training to allow emergency physicians to become certified in critical care medicine.

The new certification program still requires approval from the American Board of Medical Specialties. At this point, “we're not aware of any issues that would keep this from coming to fruition,” Dr. Perina said.

She and Dr. Holmboe said that they expect the first certification exam to be offered in 2012.

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. The competencies also are a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Negotiations with the ABP are ongoing, said coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego. The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been defined, because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

“This groundbreaking event now gives a context by which all pediatric hospitalists can judge their expertise and training. As this new subspecialty emerges, it will give training programs and examiners a body of knowledge and skill to aspire to,” commented Dr. Michelle Marks, director of pediatric hospitalist medicine and director of medical operations at the the Cleveland Clinic Children's Hospital.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said. They may even be difficult to achieve during a fellowship, Dr. Stucky added.

The competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Next steps include developing assessment strategies, including examinations, simulations, and practice reviews. The competencies themselves also will be continually assessed and revised, Dr. Ottolini said.

Disclosures: Dr. Ottolini, Dr. Stucky, and Dr. Marks reported no financial conflicts.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location. However, the competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Mary C. Ottolini said.

Source Courtesy Children's National Medical Center

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. The competencies also are a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Negotiations with the ABP are ongoing, said coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego. The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been defined, because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

“This groundbreaking event now gives a context by which all pediatric hospitalists can judge their expertise and training. As this new subspecialty emerges, it will give training programs and examiners a body of knowledge and skill to aspire to,” commented Dr. Michelle Marks, director of pediatric hospitalist medicine and director of medical operations at the the Cleveland Clinic Children's Hospital.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said. They may even be difficult to achieve during a fellowship, Dr. Stucky added.

The competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Next steps include developing assessment strategies, including examinations, simulations, and practice reviews. The competencies themselves also will be continually assessed and revised, Dr. Ottolini said.

Disclosures: Dr. Ottolini, Dr. Stucky, and Dr. Marks reported no financial conflicts.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location. However, the competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Mary C. Ottolini said.

Source Courtesy Children's National Medical Center

NATIONAL HARBOR, MD. — After an 8-year development effort, the Society of Hospital Medicine has published core competencies for pediatric hospitalists.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location, said Dr. Mary C. Ottolini of the SHM's pediatric committee. The competencies also are a means of differentiating hospitalists from primary care pediatricians or other pediatric specialists.

Although the competencies are viewed as the first step in gaining recognition as a new specialty through the American Board of Pediatrics, it is not guaranteed that a certification process will be forthcoming soon, Dr. Ottolini said at the annual meeting of the Society of Hospital Medicine.

Negotiations with the ABP are ongoing, said coauthor Dr. Erin R. Stucky of Rady Children's Hospital and the University of California, San Diego. The American Board of Pediatrics, however, has not been petitioned to consider a new pediatric hospitalist subspecialty, according to Dr. James A. Stockman III, president and CEO of the board. In the absence of a petition, the board will not formally weigh the pros and cons of introducing such certification, he noted in an interview.

The American Board of Internal Medicine and the American Board of Family Practice have chosen to offer Recognition of Focused Practice in Hospital Medicine, a credential available for the first time in 2010. The new certification requirements will be met through an exam, along with self-evaluation and practice improvement modules to be completed as part of the maintenance of certification process. But the ABP is not certain that such a mechanism would be appropriate for pediatrics, Dr. Stockman said.

Many hospitalists thought that the competencies had already been defined, because a development framework was published in 2006, noted Dr. Ottolini of Children's National Medical Center and George Washington University, both in Washington. In the years since the SHM's pediatric core competencies task force was created, there have been many iterations, corrections, and reviews, she said.

“This groundbreaking event now gives a context by which all pediatric hospitalists can judge their expertise and training. As this new subspecialty emerges, it will give training programs and examiners a body of knowledge and skill to aspire to,” commented Dr. Michelle Marks, director of pediatric hospitalist medicine and director of medical operations at the the Cleveland Clinic Children's Hospital.

The final publication contains 54 chapters covering 22 common clinical diagnoses, 6 specialized clinical services, 13 core skills, and 13 health care systems for supporting and advancing child health (J. Hosp. Med. 2010 April 9 [doi:10.1002/jhm.776

The competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Ottolini said. They may even be difficult to achieve during a fellowship, Dr. Stucky added.

The competencies were reviewed by 9 section editors, 50-plus authors and contributors, 3 senior editors, 33 internal reviewers, and dozens of external reviewers, including all the major academic and certifying societies, “stakeholder” agencies such as the American Hospital Association and the American College of Emergency Physicians, and pediatric hospital medicine fellowship directors at major children's hospitals around the country.

Next steps include developing assessment strategies, including examinations, simulations, and practice reviews. The competencies themselves also will be continually assessed and revised, Dr. Ottolini said.

Disclosures: Dr. Ottolini, Dr. Stucky, and Dr. Marks reported no financial conflicts.

The competencies define the expected standards for all pediatric hospitalists, regardless of practice setting or location. However, the competencies are not meant to be all-inclusive, rigid, or easily achieved during residency training, Dr. Mary C. Ottolini said.

Source Courtesy Children's National Medical Center

The federal government has granted states and territories $119 million to reduce tobacco use, increase physical activity, and fight obesity, the Health and Human Services department said.

The grants are funded by the American Recovery and Reinvestment Act, also known as the stimulus package.

The money will go to programs aimed at prevention and wellness, HHS Secretary Kathleen Sebelius said at a press briefing.

“Prevention is a 'best buy' for health,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said during the press conference. His agency will help states implement the grants.

The awards were made in three major categories: policy and environmental changes, innovative programs, and tobacco cessation/telephone “quit-lines.”

All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quit-lines. Dr. Frieden called the lines “highly cost effective.” He noted that tobacco-related disease is the No. 1 cause of preventable death.

Innovative programs in 13 states will be receiving money for 15 projects. Among those: Mississippi will receive $3 million to fund a smoke-free air policy, and Rhode Island will get $3 million to fund a program to help elderly residents age at home. These programs will likely serve as models for other states, Ms. Sebelius said.

Other awards will go to help support healthy food choices and physical activity, Dr. Frieden said.

Details on the awards are available at www.cdc.gov/chronicdisease/recovery

The federal government has granted states and territories $119 million to reduce tobacco use, increase physical activity, and fight obesity, the Health and Human Services department said.

The grants are funded by the American Recovery and Reinvestment Act, also known as the stimulus package.

The money will go to programs aimed at prevention and wellness, HHS Secretary Kathleen Sebelius said at a press briefing.

“Prevention is a 'best buy' for health,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said during the press conference. His agency will help states implement the grants.

The awards were made in three major categories: policy and environmental changes, innovative programs, and tobacco cessation/telephone “quit-lines.”

All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quit-lines. Dr. Frieden called the lines “highly cost effective.” He noted that tobacco-related disease is the No. 1 cause of preventable death.

Innovative programs in 13 states will be receiving money for 15 projects. Among those: Mississippi will receive $3 million to fund a smoke-free air policy, and Rhode Island will get $3 million to fund a program to help elderly residents age at home. These programs will likely serve as models for other states, Ms. Sebelius said.

Other awards will go to help support healthy food choices and physical activity, Dr. Frieden said.

Details on the awards are available at www.cdc.gov/chronicdisease/recovery

The federal government has granted states and territories $119 million to reduce tobacco use, increase physical activity, and fight obesity, the Health and Human Services department said.

The grants are funded by the American Recovery and Reinvestment Act, also known as the stimulus package.

The money will go to programs aimed at prevention and wellness, HHS Secretary Kathleen Sebelius said at a press briefing.

“Prevention is a 'best buy' for health,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said during the press conference. His agency will help states implement the grants.

The awards were made in three major categories: policy and environmental changes, innovative programs, and tobacco cessation/telephone “quit-lines.”

All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quit-lines. Dr. Frieden called the lines “highly cost effective.” He noted that tobacco-related disease is the No. 1 cause of preventable death.

Innovative programs in 13 states will be receiving money for 15 projects. Among those: Mississippi will receive $3 million to fund a smoke-free air policy, and Rhode Island will get $3 million to fund a program to help elderly residents age at home. These programs will likely serve as models for other states, Ms. Sebelius said.

Other awards will go to help support healthy food choices and physical activity, Dr. Frieden said.

Details on the awards are available at www.cdc.gov/chronicdisease/recovery