Alicia Ault

A new advocacy coalition is putting pressure on the Accreditation Council for Graduate Medical Education to speed up its process of developing new recommendations on work hour restrictions for residents—and to closely follow the Institute of Medicine's recommendations by further reducing hours.

The coalition, led by Public Citizen, sent a letter to Dr. Thomas J. Nasca, ACGME's executive director, urging the accrediting body to adopt rules that aim to reduce sleep deprivation and to better protect patients, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said in a briefing with reporters.

“The available evidence suggests that the public is deeply concerned about the current work hours of medical residents,” the coalition wrote in the letter (www.wakeupdoctor.org

At the briefing, Dr. John Ingell, a fourth-year surgical resident at the University of New Mexico, Albuquerque, said that he had noticed that he became less compassionate when severely fatigued. Concentration also suffered, said Dr. Ingell, who is on the board of the Service Employees International Union's medical resident section.

Dan Henderson, a third-year medical student at the University of Connecticut, Farmington, said that at the time, he was proud to work 12 hours or more a day or a 30-hour continuous shift on his surgical rotation. Now, he feels “ashamed,” because he has realized that such efforts did not improve his education and also had a negative affect on his feelings for patients.

He said he supported the limit on work hours recommended by the IOM in 2008. The IOM urged a reduction from 30-hour shifts to shifts no longer than 16 hours. “I really think medicine needs a wake-up call and needs to move into the 21st century,” Mr. Henderson said.

The ACGME had planned on reviewing the work hours 5 years after they were first reduced, which happened to coincide with the IOM's report, Dr. Nasca said in an interview. The 16-member Duty Hours Task Force has been meeting since last July. New draft standards are likely to be issued by late April, which will then be available for public comment for 45 days, he said.

At the briefing, Dr. Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School, Boston, said that the current ACGME standards are widely flouted. He said that confidential surveys of residents have shown “widespread falsification” by trainees on their actual work hours.

Dr. Nasca responded that his organization was an educational accreditor, “not an employment regulator.” But he added, “Our goal is to ensure substantial compliance with the regulations.”

There is a tension between the educational mission, safety, and other factors, acknowledged Dr. Nasca, adding that this is why the Duty Hours Task Force had gathered evidence and opinions from more than 140 organizations.

“There's a constant balance we have to take between setting realistic expectations for how residents are scheduled for duty and the expectations that programs comply with those, coupled with the desire to inculcate in physicians a sense of personal responsibility for the safety and care of each individual patient,” Dr. Nasca said.

The risk of fatigue also has to be balanced against the risk of increased errors when patients are handed off to an increasing number of caregivers, he said.

The evidence is conflicting on whether reduced work hours improves patient safety, Dr. Nasca said.

However, he said he welcomed the new group's attention to work hours. “This is an important issue for the public to understand,” Dr. Nasca said.

A new advocacy coalition is putting pressure on the Accreditation Council for Graduate Medical Education to speed up its process of developing new recommendations on work hour restrictions for residents—and to closely follow the Institute of Medicine's recommendations by further reducing hours.

The coalition, led by Public Citizen, sent a letter to Dr. Thomas J. Nasca, ACGME's executive director, urging the accrediting body to adopt rules that aim to reduce sleep deprivation and to better protect patients, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said in a briefing with reporters.

“The available evidence suggests that the public is deeply concerned about the current work hours of medical residents,” the coalition wrote in the letter (www.wakeupdoctor.org

At the briefing, Dr. John Ingell, a fourth-year surgical resident at the University of New Mexico, Albuquerque, said that he had noticed that he became less compassionate when severely fatigued. Concentration also suffered, said Dr. Ingell, who is on the board of the Service Employees International Union's medical resident section.

Dan Henderson, a third-year medical student at the University of Connecticut, Farmington, said that at the time, he was proud to work 12 hours or more a day or a 30-hour continuous shift on his surgical rotation. Now, he feels “ashamed,” because he has realized that such efforts did not improve his education and also had a negative affect on his feelings for patients.

He said he supported the limit on work hours recommended by the IOM in 2008. The IOM urged a reduction from 30-hour shifts to shifts no longer than 16 hours. “I really think medicine needs a wake-up call and needs to move into the 21st century,” Mr. Henderson said.

The ACGME had planned on reviewing the work hours 5 years after they were first reduced, which happened to coincide with the IOM's report, Dr. Nasca said in an interview. The 16-member Duty Hours Task Force has been meeting since last July. New draft standards are likely to be issued by late April, which will then be available for public comment for 45 days, he said.

At the briefing, Dr. Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School, Boston, said that the current ACGME standards are widely flouted. He said that confidential surveys of residents have shown “widespread falsification” by trainees on their actual work hours.

Dr. Nasca responded that his organization was an educational accreditor, “not an employment regulator.” But he added, “Our goal is to ensure substantial compliance with the regulations.”

There is a tension between the educational mission, safety, and other factors, acknowledged Dr. Nasca, adding that this is why the Duty Hours Task Force had gathered evidence and opinions from more than 140 organizations.

“There's a constant balance we have to take between setting realistic expectations for how residents are scheduled for duty and the expectations that programs comply with those, coupled with the desire to inculcate in physicians a sense of personal responsibility for the safety and care of each individual patient,” Dr. Nasca said.

The risk of fatigue also has to be balanced against the risk of increased errors when patients are handed off to an increasing number of caregivers, he said.

The evidence is conflicting on whether reduced work hours improves patient safety, Dr. Nasca said.

However, he said he welcomed the new group's attention to work hours. “This is an important issue for the public to understand,” Dr. Nasca said.

A new advocacy coalition is putting pressure on the Accreditation Council for Graduate Medical Education to speed up its process of developing new recommendations on work hour restrictions for residents—and to closely follow the Institute of Medicine's recommendations by further reducing hours.

The coalition, led by Public Citizen, sent a letter to Dr. Thomas J. Nasca, ACGME's executive director, urging the accrediting body to adopt rules that aim to reduce sleep deprivation and to better protect patients, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said in a briefing with reporters.

“The available evidence suggests that the public is deeply concerned about the current work hours of medical residents,” the coalition wrote in the letter (www.wakeupdoctor.org

At the briefing, Dr. John Ingell, a fourth-year surgical resident at the University of New Mexico, Albuquerque, said that he had noticed that he became less compassionate when severely fatigued. Concentration also suffered, said Dr. Ingell, who is on the board of the Service Employees International Union's medical resident section.

Dan Henderson, a third-year medical student at the University of Connecticut, Farmington, said that at the time, he was proud to work 12 hours or more a day or a 30-hour continuous shift on his surgical rotation. Now, he feels “ashamed,” because he has realized that such efforts did not improve his education and also had a negative affect on his feelings for patients.

He said he supported the limit on work hours recommended by the IOM in 2008. The IOM urged a reduction from 30-hour shifts to shifts no longer than 16 hours. “I really think medicine needs a wake-up call and needs to move into the 21st century,” Mr. Henderson said.

The ACGME had planned on reviewing the work hours 5 years after they were first reduced, which happened to coincide with the IOM's report, Dr. Nasca said in an interview. The 16-member Duty Hours Task Force has been meeting since last July. New draft standards are likely to be issued by late April, which will then be available for public comment for 45 days, he said.

At the briefing, Dr. Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School, Boston, said that the current ACGME standards are widely flouted. He said that confidential surveys of residents have shown “widespread falsification” by trainees on their actual work hours.

Dr. Nasca responded that his organization was an educational accreditor, “not an employment regulator.” But he added, “Our goal is to ensure substantial compliance with the regulations.”

There is a tension between the educational mission, safety, and other factors, acknowledged Dr. Nasca, adding that this is why the Duty Hours Task Force had gathered evidence and opinions from more than 140 organizations.

“There's a constant balance we have to take between setting realistic expectations for how residents are scheduled for duty and the expectations that programs comply with those, coupled with the desire to inculcate in physicians a sense of personal responsibility for the safety and care of each individual patient,” Dr. Nasca said.

The risk of fatigue also has to be balanced against the risk of increased errors when patients are handed off to an increasing number of caregivers, he said.

The evidence is conflicting on whether reduced work hours improves patient safety, Dr. Nasca said.

However, he said he welcomed the new group's attention to work hours. “This is an important issue for the public to understand,” Dr. Nasca said.

On March 2, one day after a 21% reduction in Medicare physician pay went into effect, Congress passed—and President Obama signed—a measure that would delay implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all of the claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association (AMA), directed his ire at the Senate.

“The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk,” Dr. Rohack said in the statement. “Physicians are outraged by the Senate's failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system.”

The AMA, along with other physician organizations, is urging Congress to find a permanent fix to the SGR.

In a speech at the AMA's annual advocacy conference in Washington on March 3, Rep. Michael Burgess (R-Tex.), who is also a physician, said it appeared Congress did not grasp the “pernicious” effect temporary rate extensions had on physician practices.

He has introduced his own solution to permanently replace the SGR.

On March 2, one day after a 21% reduction in Medicare physician pay went into effect, Congress passed—and President Obama signed—a measure that would delay implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all of the claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association (AMA), directed his ire at the Senate.

“The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk,” Dr. Rohack said in the statement. “Physicians are outraged by the Senate's failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system.”

The AMA, along with other physician organizations, is urging Congress to find a permanent fix to the SGR.

In a speech at the AMA's annual advocacy conference in Washington on March 3, Rep. Michael Burgess (R-Tex.), who is also a physician, said it appeared Congress did not grasp the “pernicious” effect temporary rate extensions had on physician practices.

He has introduced his own solution to permanently replace the SGR.

On March 2, one day after a 21% reduction in Medicare physician pay went into effect, Congress passed—and President Obama signed—a measure that would delay implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all of the claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association (AMA), directed his ire at the Senate.

“The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk,” Dr. Rohack said in the statement. “Physicians are outraged by the Senate's failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system.”

The AMA, along with other physician organizations, is urging Congress to find a permanent fix to the SGR.

In a speech at the AMA's annual advocacy conference in Washington on March 3, Rep. Michael Burgess (R-Tex.), who is also a physician, said it appeared Congress did not grasp the “pernicious” effect temporary rate extensions had on physician practices.

He has introduced his own solution to permanently replace the SGR.

Manufacturers of computed tomography machines have agreed to a standardized set of features that will help ensure that patients receive the appropriate radiation dose when being scanned.

Dave Fisher, executive director of the Medical Imaging & Technology Alliance (MITA), said that the industry had been working for years to make CT machines safer and that the timing of the announcement was not related to either the Food and Drug Administration's recent heightened interest in radiation or the impending House Energy & Commerce Health Subcommittee hearing.

The five CT manufacturers—General Electric, Siemens, Philips, Toshiba, and Hitachi—all agreed to participate in the MITA “dose check” initiative, which focuses on three new main safety features.

First, machine operators will receive an on-screen alert when they exceed recommended dose levels. The second safeguard will also likely come as a pop-up window: a warning if the dose reaches hazardous levels that could result in burns, hair loss, or other injuries. This “red flag” can be configured to prevent the scan, Mr. Fisher said. Clinicians will have the power to determine whether they want to block a scan or have some other series of instructions or steps to prevent harm.

Finally, manufacturers have agreed to a standardized method of image storage so that they can be incorporated into a registry—if such a registry is developed, as the Obama administration has proposed.

The new features will not likely be available until late 2010 or early 2011, Mr. Fisher said.

Manufacturers of computed tomography machines have agreed to a standardized set of features that will help ensure that patients receive the appropriate radiation dose when being scanned.

Dave Fisher, executive director of the Medical Imaging & Technology Alliance (MITA), said that the industry had been working for years to make CT machines safer and that the timing of the announcement was not related to either the Food and Drug Administration's recent heightened interest in radiation or the impending House Energy & Commerce Health Subcommittee hearing.

The five CT manufacturers—General Electric, Siemens, Philips, Toshiba, and Hitachi—all agreed to participate in the MITA “dose check” initiative, which focuses on three new main safety features.

First, machine operators will receive an on-screen alert when they exceed recommended dose levels. The second safeguard will also likely come as a pop-up window: a warning if the dose reaches hazardous levels that could result in burns, hair loss, or other injuries. This “red flag” can be configured to prevent the scan, Mr. Fisher said. Clinicians will have the power to determine whether they want to block a scan or have some other series of instructions or steps to prevent harm.

Finally, manufacturers have agreed to a standardized method of image storage so that they can be incorporated into a registry—if such a registry is developed, as the Obama administration has proposed.

The new features will not likely be available until late 2010 or early 2011, Mr. Fisher said.

Manufacturers of computed tomography machines have agreed to a standardized set of features that will help ensure that patients receive the appropriate radiation dose when being scanned.

Dave Fisher, executive director of the Medical Imaging & Technology Alliance (MITA), said that the industry had been working for years to make CT machines safer and that the timing of the announcement was not related to either the Food and Drug Administration's recent heightened interest in radiation or the impending House Energy & Commerce Health Subcommittee hearing.

The five CT manufacturers—General Electric, Siemens, Philips, Toshiba, and Hitachi—all agreed to participate in the MITA “dose check” initiative, which focuses on three new main safety features.

First, machine operators will receive an on-screen alert when they exceed recommended dose levels. The second safeguard will also likely come as a pop-up window: a warning if the dose reaches hazardous levels that could result in burns, hair loss, or other injuries. This “red flag” can be configured to prevent the scan, Mr. Fisher said. Clinicians will have the power to determine whether they want to block a scan or have some other series of instructions or steps to prevent harm.

Finally, manufacturers have agreed to a standardized method of image storage so that they can be incorporated into a registry—if such a registry is developed, as the Obama administration has proposed.

The new features will not likely be available until late 2010 or early 2011, Mr. Fisher said.

Walgreens, the nation's largest drugstore chain, is dipping a toe into diabetes care by offering education and counseling in four metropolitan areas.

The company's Optimal Wellness program is based on the North Carolina Center for Pharmaceutical Care's diabetes project and also draws on a Walgreens pilot that was developed by the drugstore chain and Harvard's Joslin Diabetes Center, Boston.

The program initially will be offered in Indianapolis, Phoenix, Albuquerque, and Oklahoma City. These areas were chosen partly because of the large number of diabetic residents, said Dr. Jay Rosan, senior vice president of health innovation at Take Care Health Systems, a Walgreens company.

Dr. Mack Harrell, chair of the socioeconomics and member advocacy committee for the American Association of Clinical Endocrinologists, said the Walgreens program could be helpful but that the AACE believes that any assistance, education, or counseling should be supervised by physicians.

“I'm in favor of people getting all the education they need,” Dr. Harrell said in an interview. But, he added, “what we've learned from a number of recent studies is that the degree of glycemic control has to be individualized. You have to know the patient, know whether they have comorbidities that put them at higher risk, and decide what degree of control is acceptable.” These nuances are beyond the capacity of a nurse practitioner and reinforce the need for a supervisory physician, he said.

Dr. Rosan emphasized that the nurse practitioners in the Optimal Wellness program will not offer treatments, and that physicians will be relied on as primary care coordinators and supervisors.

The program is being rolled out in concert with major insurers. The insurers, who pay a fee to Walgreens, will identify diabetic patients for the chain. When patients go to Walgreens for supplies or a prescription, pharmacists will tell them about the program's availability and ask if they want to enroll.

If the store has a retail clinic, a nurse practitioner will offer counseling; otherwise, the pharmacist will conduct the sessions, Dr. Rosan explained. The pharmacists and nurses receive training through a Joslin program certified by the Accreditation Council for Pharmacy Education.

The aim is to give patients four 30- to 60-minute sessions over a year-long period, with the potential of up to 12 interventions. Patients will pay nothing or a small copay, Dr. Rosan said.

After each session, the counselor will contact the patient's primary care physician with information. “Our intent here is to make certain that this is not a fragmentation of the care,” Dr. Rosan said. If the primary caretaker is an endocrinologist, the counselor will reach out to that physician. For those who do not yet have a designated primary care physician, the pharmacies will make referrals.

Dr. Harrell also expressed reservations about Walgreens' potential conflict of interest. “The pharmacy has a certain secondary gain from having the patient in there,” he noted. For instance, the pharmacy could promote supplies or treatments that favor the pharmacy's bottom line but aren't necessarily the best fit for the patient.

Dr. Rosan acknowledges that there's an opportunity, at a minimum, to fill more prescriptions. It also expands Walgreens' growing role as a multiservice provider and gives it a chance to burnish its brand. “If we can help people get better outcomes, we think they'll have a tendency to use Walgreens more than other stores,” he said.

But the program may also help improve the nation's health if more diabetics take responsibility for managing their own care, he added.

Optimal Wellness won't be available to the uninsured, at least not initially. Walgreens is courting pharmaceutical companies to subsidize that effort, he said.

Walgreens' diabetes education effort is likely to expand nationally sooner rather than later, Dr. Rosan said. Many insurers are interested in the Optimal Wellness program, he said.

Walgreens, the nation's largest drugstore chain, is dipping a toe into diabetes care by offering education and counseling in four metropolitan areas.

The company's Optimal Wellness program is based on the North Carolina Center for Pharmaceutical Care's diabetes project and also draws on a Walgreens pilot that was developed by the drugstore chain and Harvard's Joslin Diabetes Center, Boston.

The program initially will be offered in Indianapolis, Phoenix, Albuquerque, and Oklahoma City. These areas were chosen partly because of the large number of diabetic residents, said Dr. Jay Rosan, senior vice president of health innovation at Take Care Health Systems, a Walgreens company.

Dr. Mack Harrell, chair of the socioeconomics and member advocacy committee for the American Association of Clinical Endocrinologists, said the Walgreens program could be helpful but that the AACE believes that any assistance, education, or counseling should be supervised by physicians.

“I'm in favor of people getting all the education they need,” Dr. Harrell said in an interview. But, he added, “what we've learned from a number of recent studies is that the degree of glycemic control has to be individualized. You have to know the patient, know whether they have comorbidities that put them at higher risk, and decide what degree of control is acceptable.” These nuances are beyond the capacity of a nurse practitioner and reinforce the need for a supervisory physician, he said.

Dr. Rosan emphasized that the nurse practitioners in the Optimal Wellness program will not offer treatments, and that physicians will be relied on as primary care coordinators and supervisors.

The program is being rolled out in concert with major insurers. The insurers, who pay a fee to Walgreens, will identify diabetic patients for the chain. When patients go to Walgreens for supplies or a prescription, pharmacists will tell them about the program's availability and ask if they want to enroll.

If the store has a retail clinic, a nurse practitioner will offer counseling; otherwise, the pharmacist will conduct the sessions, Dr. Rosan explained. The pharmacists and nurses receive training through a Joslin program certified by the Accreditation Council for Pharmacy Education.

The aim is to give patients four 30- to 60-minute sessions over a year-long period, with the potential of up to 12 interventions. Patients will pay nothing or a small copay, Dr. Rosan said.

After each session, the counselor will contact the patient's primary care physician with information. “Our intent here is to make certain that this is not a fragmentation of the care,” Dr. Rosan said. If the primary caretaker is an endocrinologist, the counselor will reach out to that physician. For those who do not yet have a designated primary care physician, the pharmacies will make referrals.

Dr. Harrell also expressed reservations about Walgreens' potential conflict of interest. “The pharmacy has a certain secondary gain from having the patient in there,” he noted. For instance, the pharmacy could promote supplies or treatments that favor the pharmacy's bottom line but aren't necessarily the best fit for the patient.

Dr. Rosan acknowledges that there's an opportunity, at a minimum, to fill more prescriptions. It also expands Walgreens' growing role as a multiservice provider and gives it a chance to burnish its brand. “If we can help people get better outcomes, we think they'll have a tendency to use Walgreens more than other stores,” he said.

But the program may also help improve the nation's health if more diabetics take responsibility for managing their own care, he added.

Optimal Wellness won't be available to the uninsured, at least not initially. Walgreens is courting pharmaceutical companies to subsidize that effort, he said.

Walgreens' diabetes education effort is likely to expand nationally sooner rather than later, Dr. Rosan said. Many insurers are interested in the Optimal Wellness program, he said.

Walgreens, the nation's largest drugstore chain, is dipping a toe into diabetes care by offering education and counseling in four metropolitan areas.

The company's Optimal Wellness program is based on the North Carolina Center for Pharmaceutical Care's diabetes project and also draws on a Walgreens pilot that was developed by the drugstore chain and Harvard's Joslin Diabetes Center, Boston.

The program initially will be offered in Indianapolis, Phoenix, Albuquerque, and Oklahoma City. These areas were chosen partly because of the large number of diabetic residents, said Dr. Jay Rosan, senior vice president of health innovation at Take Care Health Systems, a Walgreens company.

Dr. Mack Harrell, chair of the socioeconomics and member advocacy committee for the American Association of Clinical Endocrinologists, said the Walgreens program could be helpful but that the AACE believes that any assistance, education, or counseling should be supervised by physicians.

“I'm in favor of people getting all the education they need,” Dr. Harrell said in an interview. But, he added, “what we've learned from a number of recent studies is that the degree of glycemic control has to be individualized. You have to know the patient, know whether they have comorbidities that put them at higher risk, and decide what degree of control is acceptable.” These nuances are beyond the capacity of a nurse practitioner and reinforce the need for a supervisory physician, he said.

Dr. Rosan emphasized that the nurse practitioners in the Optimal Wellness program will not offer treatments, and that physicians will be relied on as primary care coordinators and supervisors.

The program is being rolled out in concert with major insurers. The insurers, who pay a fee to Walgreens, will identify diabetic patients for the chain. When patients go to Walgreens for supplies or a prescription, pharmacists will tell them about the program's availability and ask if they want to enroll.

If the store has a retail clinic, a nurse practitioner will offer counseling; otherwise, the pharmacist will conduct the sessions, Dr. Rosan explained. The pharmacists and nurses receive training through a Joslin program certified by the Accreditation Council for Pharmacy Education.

The aim is to give patients four 30- to 60-minute sessions over a year-long period, with the potential of up to 12 interventions. Patients will pay nothing or a small copay, Dr. Rosan said.

After each session, the counselor will contact the patient's primary care physician with information. “Our intent here is to make certain that this is not a fragmentation of the care,” Dr. Rosan said. If the primary caretaker is an endocrinologist, the counselor will reach out to that physician. For those who do not yet have a designated primary care physician, the pharmacies will make referrals.

Dr. Harrell also expressed reservations about Walgreens' potential conflict of interest. “The pharmacy has a certain secondary gain from having the patient in there,” he noted. For instance, the pharmacy could promote supplies or treatments that favor the pharmacy's bottom line but aren't necessarily the best fit for the patient.

Dr. Rosan acknowledges that there's an opportunity, at a minimum, to fill more prescriptions. It also expands Walgreens' growing role as a multiservice provider and gives it a chance to burnish its brand. “If we can help people get better outcomes, we think they'll have a tendency to use Walgreens more than other stores,” he said.

But the program may also help improve the nation's health if more diabetics take responsibility for managing their own care, he added.

Optimal Wellness won't be available to the uninsured, at least not initially. Walgreens is courting pharmaceutical companies to subsidize that effort, he said.

Walgreens' diabetes education effort is likely to expand nationally sooner rather than later, Dr. Rosan said. Many insurers are interested in the Optimal Wellness program, he said.

After two decades of debate, the Food and Drug Administration has issued a final rule declaring benzoyl peroxide to be safe and effective as an ingredient in over-the-counter topical acne products.

According to agency policy, benzoyl peroxide is now GRASE (generally recognized as safe and effective). In 1991, the FDA proposed to classify the ingredient as a category III agent, which meant that it needed more study. There was data at that time suggesting that benzoyl peroxide was potentially carcinogenic in animals.

Over the years, though, new data has allayed the agency's concerns. "We now conclude that benzoyl peroxide can be adequately labeled to minimize the risks associated with benzoyl peroxide while delivering effective acne treatment," the FDA noted in its final rule. However, the ingredient is still known to be a skin irritant and skin sensitizer, according to the agency.

The FDA is requiring new labeling on the cartons of products that contain benzoyl peroxide. The boxes will include warnings to avoid unnecessary sun exposure, to not use the product on very sensitive skin, and to keep the product away from the eyes, lips, and mouth. Consumers also will be cautioned that benzoyl peroxide can bleach hair or dye fabric. The label also will recommend that users wear a sunscreen.

Manufacturers will not have to include package inserts directed at consumers, however. The FDA believes that the warnings on the carton are sufficient to inform consumers of the potential risks.

It is unclear how many OTC acne products contain benzoyl peroxide, according to the FDA. Based on retail sales data from the Nielsen Company, approximately one-quarter of the estimated 330 products on the market have benzoyl peroxide as an active ingredient. Most of the manufacturers will have a year to relabel their products, but smaller companies will be given up to 2 years.

After two decades of debate, the Food and Drug Administration has issued a final rule declaring benzoyl peroxide to be safe and effective as an ingredient in over-the-counter topical acne products.

According to agency policy, benzoyl peroxide is now GRASE (generally recognized as safe and effective). In 1991, the FDA proposed to classify the ingredient as a category III agent, which meant that it needed more study. There was data at that time suggesting that benzoyl peroxide was potentially carcinogenic in animals.

Over the years, though, new data has allayed the agency's concerns. "We now conclude that benzoyl peroxide can be adequately labeled to minimize the risks associated with benzoyl peroxide while delivering effective acne treatment," the FDA noted in its final rule. However, the ingredient is still known to be a skin irritant and skin sensitizer, according to the agency.

The FDA is requiring new labeling on the cartons of products that contain benzoyl peroxide. The boxes will include warnings to avoid unnecessary sun exposure, to not use the product on very sensitive skin, and to keep the product away from the eyes, lips, and mouth. Consumers also will be cautioned that benzoyl peroxide can bleach hair or dye fabric. The label also will recommend that users wear a sunscreen.

Manufacturers will not have to include package inserts directed at consumers, however. The FDA believes that the warnings on the carton are sufficient to inform consumers of the potential risks.

It is unclear how many OTC acne products contain benzoyl peroxide, according to the FDA. Based on retail sales data from the Nielsen Company, approximately one-quarter of the estimated 330 products on the market have benzoyl peroxide as an active ingredient. Most of the manufacturers will have a year to relabel their products, but smaller companies will be given up to 2 years.

After two decades of debate, the Food and Drug Administration has issued a final rule declaring benzoyl peroxide to be safe and effective as an ingredient in over-the-counter topical acne products.

According to agency policy, benzoyl peroxide is now GRASE (generally recognized as safe and effective). In 1991, the FDA proposed to classify the ingredient as a category III agent, which meant that it needed more study. There was data at that time suggesting that benzoyl peroxide was potentially carcinogenic in animals.

Over the years, though, new data has allayed the agency's concerns. "We now conclude that benzoyl peroxide can be adequately labeled to minimize the risks associated with benzoyl peroxide while delivering effective acne treatment," the FDA noted in its final rule. However, the ingredient is still known to be a skin irritant and skin sensitizer, according to the agency.

The FDA is requiring new labeling on the cartons of products that contain benzoyl peroxide. The boxes will include warnings to avoid unnecessary sun exposure, to not use the product on very sensitive skin, and to keep the product away from the eyes, lips, and mouth. Consumers also will be cautioned that benzoyl peroxide can bleach hair or dye fabric. The label also will recommend that users wear a sunscreen.

Manufacturers will not have to include package inserts directed at consumers, however. The FDA believes that the warnings on the carton are sufficient to inform consumers of the potential risks.

It is unclear how many OTC acne products contain benzoyl peroxide, according to the FDA. Based on retail sales data from the Nielsen Company, approximately one-quarter of the estimated 330 products on the market have benzoyl peroxide as an active ingredient. Most of the manufacturers will have a year to relabel their products, but smaller companies will be given up to 2 years.

Despite a continuing downturn in the economy, surgical and nonsurgical cosmetic procedures remained popular in 2009.

When compared with 2008, there were only 2% fewer procedures performed in 2009, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures dropped by almost 17%, but nonsurgical procedures increased by 0.6%.

Injection of botulinum toxin type A (Botox and Dysport) was the leading procedure overall, at 2.5 million. Nonsurgical procedures far outnumbered surgical procedures: 8.5 million to 1.4 million.

After botulinum toxin injections, which accounted for 26% of all nonsurgical procedures, the second most popular procedure was hyaluronic acid injections, including Hylaform, Juvéderm, and Perlane/Restylane. About 1.3 million procedures were performed.

Laser hair removal followed closely behind in popularity, with 1.28 million procedures. Microdermabrasion and chemical peels rounded out the top five nonsurgical procedures.

With the exception of laser hair removal, which decreased only slightly, there was a larger dip in other types of laser procedures. Intense pulsed light treatments dropped by 14%, laser skin resurfacing by 10%, and laser treatment of leg veins by 10%. The decline does not appear to be entirely related to cost, according to the ASAPS data.

The largest increase among nonsurgical procedure was for Sculptra (poly-L-lactic acid). In 2008, there were 31,928 Sculptra procedures; in 2009, there were 39,516 - an increase of almost 24%.

Nonsurgical procedures were most popular in the 35- to 50-year-old age group (45%), followed by the 51- to 64-year-old group (27%).

Women are still the largest users of cosmetic procedures. About 9% of procedures were performed in men, which is an increase of 8% from 2008. About a quarter of cosmetic procedures were performed in racial and ethnic minorities, with the most being performed in Hispanics (9%).

A new ASAPS survey also found that cosmetic surgery is becoming more acceptable to Americans of all income levels. Of people earning less than $25,000, 48% said that they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

The ASAPS said that 58% of cosmetic procedures were performed in an office-based facility and 23% in freestanding surgical centers. Eighty-eight percent of the 928 plastic surgeons, dermatologists, and otolaryngologists who completed the survey said that they do not work with medical spas.

The top five surgical procedures in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and facelifts.

Americans spent $4.5 billion on nonsurgical treatments in 2009 and $6 billion on surgical procedures.

Despite a continuing downturn in the economy, surgical and nonsurgical cosmetic procedures remained popular in 2009.

When compared with 2008, there were only 2% fewer procedures performed in 2009, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures dropped by almost 17%, but nonsurgical procedures increased by 0.6%.

Injection of botulinum toxin type A (Botox and Dysport) was the leading procedure overall, at 2.5 million. Nonsurgical procedures far outnumbered surgical procedures: 8.5 million to 1.4 million.

After botulinum toxin injections, which accounted for 26% of all nonsurgical procedures, the second most popular procedure was hyaluronic acid injections, including Hylaform, Juvéderm, and Perlane/Restylane. About 1.3 million procedures were performed.

Laser hair removal followed closely behind in popularity, with 1.28 million procedures. Microdermabrasion and chemical peels rounded out the top five nonsurgical procedures.

With the exception of laser hair removal, which decreased only slightly, there was a larger dip in other types of laser procedures. Intense pulsed light treatments dropped by 14%, laser skin resurfacing by 10%, and laser treatment of leg veins by 10%. The decline does not appear to be entirely related to cost, according to the ASAPS data.

The largest increase among nonsurgical procedure was for Sculptra (poly-L-lactic acid). In 2008, there were 31,928 Sculptra procedures; in 2009, there were 39,516 - an increase of almost 24%.

Nonsurgical procedures were most popular in the 35- to 50-year-old age group (45%), followed by the 51- to 64-year-old group (27%).

Women are still the largest users of cosmetic procedures. About 9% of procedures were performed in men, which is an increase of 8% from 2008. About a quarter of cosmetic procedures were performed in racial and ethnic minorities, with the most being performed in Hispanics (9%).

A new ASAPS survey also found that cosmetic surgery is becoming more acceptable to Americans of all income levels. Of people earning less than $25,000, 48% said that they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

The ASAPS said that 58% of cosmetic procedures were performed in an office-based facility and 23% in freestanding surgical centers. Eighty-eight percent of the 928 plastic surgeons, dermatologists, and otolaryngologists who completed the survey said that they do not work with medical spas.

The top five surgical procedures in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and facelifts.

Americans spent $4.5 billion on nonsurgical treatments in 2009 and $6 billion on surgical procedures.

Despite a continuing downturn in the economy, surgical and nonsurgical cosmetic procedures remained popular in 2009.

When compared with 2008, there were only 2% fewer procedures performed in 2009, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures dropped by almost 17%, but nonsurgical procedures increased by 0.6%.

Injection of botulinum toxin type A (Botox and Dysport) was the leading procedure overall, at 2.5 million. Nonsurgical procedures far outnumbered surgical procedures: 8.5 million to 1.4 million.

After botulinum toxin injections, which accounted for 26% of all nonsurgical procedures, the second most popular procedure was hyaluronic acid injections, including Hylaform, Juvéderm, and Perlane/Restylane. About 1.3 million procedures were performed.

Laser hair removal followed closely behind in popularity, with 1.28 million procedures. Microdermabrasion and chemical peels rounded out the top five nonsurgical procedures.

With the exception of laser hair removal, which decreased only slightly, there was a larger dip in other types of laser procedures. Intense pulsed light treatments dropped by 14%, laser skin resurfacing by 10%, and laser treatment of leg veins by 10%. The decline does not appear to be entirely related to cost, according to the ASAPS data.

The largest increase among nonsurgical procedure was for Sculptra (poly-L-lactic acid). In 2008, there were 31,928 Sculptra procedures; in 2009, there were 39,516 - an increase of almost 24%.

Nonsurgical procedures were most popular in the 35- to 50-year-old age group (45%), followed by the 51- to 64-year-old group (27%).

Women are still the largest users of cosmetic procedures. About 9% of procedures were performed in men, which is an increase of 8% from 2008. About a quarter of cosmetic procedures were performed in racial and ethnic minorities, with the most being performed in Hispanics (9%).

A new ASAPS survey also found that cosmetic surgery is becoming more acceptable to Americans of all income levels. Of people earning less than $25,000, 48% said that they approved of cosmetic surgery, compared with 52% of those with incomes of $25,000-$50,000, 55% of those with incomes of $50,000-$75,000, and 62% of those with incomes of more than $75,000.

The ASAPS said that 58% of cosmetic procedures were performed in an office-based facility and 23% in freestanding surgical centers. Eighty-eight percent of the 928 plastic surgeons, dermatologists, and otolaryngologists who completed the survey said that they do not work with medical spas.

The top five surgical procedures in 2009 were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and facelifts.

Americans spent $4.5 billion on nonsurgical treatments in 2009 and $6 billion on surgical procedures.

On March 2, one day after a 21% reduction in Medicare physician pay went into effect, Congress passed--and President Obama signed--a measure that would delay implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association (AMA), directed his ire at the Senate.

"The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk," Dr. Rohack said in the statement. "Physicians are outraged by the Senate's failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system."

The AMA, along with other physician organizations, is urging Congress to find a permanent fix to the SGR.

In a speech at the AMA's annual advocacy conference in Washington on March 3, Rep. Michael Burgess (R-Texas), who is also a physician, said it appeared Congress did not grasp the "pernicious" effect temporary rate extensions had on physician practices.

He has introduced his own solution to permanently replace the SGR.

On March 2, one day after a 21% reduction in Medicare physician pay went into effect, Congress passed--and President Obama signed--a measure that would delay implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association (AMA), directed his ire at the Senate.

"The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk," Dr. Rohack said in the statement. "Physicians are outraged by the Senate's failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system."

The AMA, along with other physician organizations, is urging Congress to find a permanent fix to the SGR.

In a speech at the AMA's annual advocacy conference in Washington on March 3, Rep. Michael Burgess (R-Texas), who is also a physician, said it appeared Congress did not grasp the "pernicious" effect temporary rate extensions had on physician practices.

He has introduced his own solution to permanently replace the SGR.

On March 2, one day after a 21% reduction in Medicare physician pay went into effect, Congress passed--and President Obama signed--a measure that would delay implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association (AMA), directed his ire at the Senate.

"The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk," Dr. Rohack said in the statement. "Physicians are outraged by the Senate's failure to act before the March 1 deadline, as their patients and practices are hurt by the continued instability in the Medicare system."

The AMA, along with other physician organizations, is urging Congress to find a permanent fix to the SGR.

In a speech at the AMA's annual advocacy conference in Washington on March 3, Rep. Michael Burgess (R-Texas), who is also a physician, said it appeared Congress did not grasp the "pernicious" effect temporary rate extensions had on physician practices.

He has introduced his own solution to permanently replace the SGR.

Walgreens, the nation's largest drug store chain, is dipping a toe into diabetes care by offering education and counseling in four metropolitan areas.

The company's Optimal Wellness program is based on the North Carolina Center for Pharmaceutical Care's diabetes project and also draws on a Walgreens pilot that was developed by the drug store chain and Harvard's Joslin Diabetes Center.

The program initially will be offered in Indianapolis, Phoenix, Albuquerque, and Oklahoma City, areas chosen in part because of the large number of diabetic residents, said Dr. Jay Rosan, senior VP of health innovation at Take Care Health Systems, a Walgreens company.

Dr. Mack Harrell, chair of the socioeconomics and member advocacy committee for the American Association of Clinical Endocrinologists, said the Walgreens program could be helpful but that AACE believes that any assistance, education, or counseling should be supervised by physicians.

“I'm in favor of people getting all the education they need,” Dr. Harrell said in an interview. But, he added, “what we've learned from a number of recent studies is that the degree of glycemic control has to be individualized. You have to know the patient, know whether they have comorbidities that put them at higher risk, and decide what degree of control is acceptable.” These nuances are beyond the capacity of a nurse practitioner and reinforce the need for a supervisory physician, he said.

Dr. Rosan emphasized that the nurse practitioners in the Optimal Wellness program will not offer treatments, and that physicians will be relied upon as primary care coordinators and supervisors.

The program is being rolled out in concert with major insurers. The insurers, who pay a fee to Walgreens, will identify diabetic patients for the chain. When patients go to Walgreens for supplies or a prescription, pharmacists will tell them about the program's availability and then attempt to enroll them. If the store has a retail clinic, a nurse practitioner will offer counseling; otherwise, the pharmacist will conduct the sessions, Dr. Rosan explained. The pharmacists and nurses have been trained through a Joslin program certified by the Accreditation Council for Pharmacy Education.

The aim is to give patients four 30- to 60-minute sessions over a year-long period, with the potential of up to 12 interventions. Patients will pay nothing or a small copay for the sessions, Dr. Rosan said.

After each session, the counselor will fax, e-mail, or call the patient's primary care physician with information. If the primary caretaker is an endocrinologist, the counselor will reach out to that physician. For those who do not yet have a designated primary care physician, the pharmacies will make referrals, he said.

Dr. Harrell also expressed reservations about Walgreens' potential conflict of interest. “The pharmacy has a certain secondary gain from having the patient in there,” he noted. For instance, the pharmacy could promote supplies or treatments that favor the pharmacy's bottom line but are not necessarily the best fit for the patient.

Dr. Rosan acknowledges that there is an opportunity to fill more prescriptions. It also expands Walgreens' growing role as a multiservice provider and gives it a chance to burnish its brand. But the program may also help improve the nation's health if more diabetics learn to manage their own care, he added.

Optimal Wellness won't be available to the uninsured, for now. Walgreens is courting pharmaceutical companies to subsidize that effort, he said.

Walgreens, the nation's largest drug store chain, is dipping a toe into diabetes care by offering education and counseling in four metropolitan areas.

The company's Optimal Wellness program is based on the North Carolina Center for Pharmaceutical Care's diabetes project and also draws on a Walgreens pilot that was developed by the drug store chain and Harvard's Joslin Diabetes Center.

The program initially will be offered in Indianapolis, Phoenix, Albuquerque, and Oklahoma City, areas chosen in part because of the large number of diabetic residents, said Dr. Jay Rosan, senior VP of health innovation at Take Care Health Systems, a Walgreens company.

Dr. Mack Harrell, chair of the socioeconomics and member advocacy committee for the American Association of Clinical Endocrinologists, said the Walgreens program could be helpful but that AACE believes that any assistance, education, or counseling should be supervised by physicians.

“I'm in favor of people getting all the education they need,” Dr. Harrell said in an interview. But, he added, “what we've learned from a number of recent studies is that the degree of glycemic control has to be individualized. You have to know the patient, know whether they have comorbidities that put them at higher risk, and decide what degree of control is acceptable.” These nuances are beyond the capacity of a nurse practitioner and reinforce the need for a supervisory physician, he said.

Dr. Rosan emphasized that the nurse practitioners in the Optimal Wellness program will not offer treatments, and that physicians will be relied upon as primary care coordinators and supervisors.

The program is being rolled out in concert with major insurers. The insurers, who pay a fee to Walgreens, will identify diabetic patients for the chain. When patients go to Walgreens for supplies or a prescription, pharmacists will tell them about the program's availability and then attempt to enroll them. If the store has a retail clinic, a nurse practitioner will offer counseling; otherwise, the pharmacist will conduct the sessions, Dr. Rosan explained. The pharmacists and nurses have been trained through a Joslin program certified by the Accreditation Council for Pharmacy Education.

The aim is to give patients four 30- to 60-minute sessions over a year-long period, with the potential of up to 12 interventions. Patients will pay nothing or a small copay for the sessions, Dr. Rosan said.

After each session, the counselor will fax, e-mail, or call the patient's primary care physician with information. If the primary caretaker is an endocrinologist, the counselor will reach out to that physician. For those who do not yet have a designated primary care physician, the pharmacies will make referrals, he said.

Dr. Harrell also expressed reservations about Walgreens' potential conflict of interest. “The pharmacy has a certain secondary gain from having the patient in there,” he noted. For instance, the pharmacy could promote supplies or treatments that favor the pharmacy's bottom line but are not necessarily the best fit for the patient.

Dr. Rosan acknowledges that there is an opportunity to fill more prescriptions. It also expands Walgreens' growing role as a multiservice provider and gives it a chance to burnish its brand. But the program may also help improve the nation's health if more diabetics learn to manage their own care, he added.

Optimal Wellness won't be available to the uninsured, for now. Walgreens is courting pharmaceutical companies to subsidize that effort, he said.

Walgreens, the nation's largest drug store chain, is dipping a toe into diabetes care by offering education and counseling in four metropolitan areas.

The company's Optimal Wellness program is based on the North Carolina Center for Pharmaceutical Care's diabetes project and also draws on a Walgreens pilot that was developed by the drug store chain and Harvard's Joslin Diabetes Center.

The program initially will be offered in Indianapolis, Phoenix, Albuquerque, and Oklahoma City, areas chosen in part because of the large number of diabetic residents, said Dr. Jay Rosan, senior VP of health innovation at Take Care Health Systems, a Walgreens company.

Dr. Mack Harrell, chair of the socioeconomics and member advocacy committee for the American Association of Clinical Endocrinologists, said the Walgreens program could be helpful but that AACE believes that any assistance, education, or counseling should be supervised by physicians.

“I'm in favor of people getting all the education they need,” Dr. Harrell said in an interview. But, he added, “what we've learned from a number of recent studies is that the degree of glycemic control has to be individualized. You have to know the patient, know whether they have comorbidities that put them at higher risk, and decide what degree of control is acceptable.” These nuances are beyond the capacity of a nurse practitioner and reinforce the need for a supervisory physician, he said.

Dr. Rosan emphasized that the nurse practitioners in the Optimal Wellness program will not offer treatments, and that physicians will be relied upon as primary care coordinators and supervisors.

The program is being rolled out in concert with major insurers. The insurers, who pay a fee to Walgreens, will identify diabetic patients for the chain. When patients go to Walgreens for supplies or a prescription, pharmacists will tell them about the program's availability and then attempt to enroll them. If the store has a retail clinic, a nurse practitioner will offer counseling; otherwise, the pharmacist will conduct the sessions, Dr. Rosan explained. The pharmacists and nurses have been trained through a Joslin program certified by the Accreditation Council for Pharmacy Education.

The aim is to give patients four 30- to 60-minute sessions over a year-long period, with the potential of up to 12 interventions. Patients will pay nothing or a small copay for the sessions, Dr. Rosan said.

After each session, the counselor will fax, e-mail, or call the patient's primary care physician with information. If the primary caretaker is an endocrinologist, the counselor will reach out to that physician. For those who do not yet have a designated primary care physician, the pharmacies will make referrals, he said.

Dr. Harrell also expressed reservations about Walgreens' potential conflict of interest. “The pharmacy has a certain secondary gain from having the patient in there,” he noted. For instance, the pharmacy could promote supplies or treatments that favor the pharmacy's bottom line but are not necessarily the best fit for the patient.

Dr. Rosan acknowledges that there is an opportunity to fill more prescriptions. It also expands Walgreens' growing role as a multiservice provider and gives it a chance to burnish its brand. But the program may also help improve the nation's health if more diabetics learn to manage their own care, he added.

Optimal Wellness won't be available to the uninsured, for now. Walgreens is courting pharmaceutical companies to subsidize that effort, he said.

On March 2, a day after a 21% reduction in Medicare physician pay went into effect, Congress passed—and President Obama signed—a measure that would delay the implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association, directed his ire at the Senate.

“The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk,” Dr. Rohack said in the statement.

On March 2, a day after a 21% reduction in Medicare physician pay went into effect, Congress passed—and President Obama signed—a measure that would delay the implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association, directed his ire at the Senate.

“The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk,” Dr. Rohack said in the statement.

On March 2, a day after a 21% reduction in Medicare physician pay went into effect, Congress passed—and President Obama signed—a measure that would delay the implementation of the cut until April 1.

The Temporary Extension Act of 2010 (H.R. 4691) extends the zero percent update in the Medicare sustainable growth rate (SGR) formula through March 31. That zero percent increase went into effect Jan. 1, but expired March 1.

Just before the expiration date, the Centers for Medicare and Medicaid Services (CMS) instructed its contractors to hold all claims submitted from March 1 through at least March 12. This was because the agency anticipated a temporary extension to be approved by Congress.

After the extension, the CMS said that all claims were being immediately released for payment.

With the debate on health care reform ongoing, the fate of the SGR has been largely an afterthought on Capitol Hill.

The House passed a permanent repeal of the formula as part of its health reform package. The Senate, however, included only a temporary fix in the proposal it passed in late December. As part of February legislation to raise the national debt limit, the Senate made a fiscal promise to delay the SGR-mandated cuts for 7 months.

But the solution that passed political muster was the 1-month extension that was included in a package that also extended unemployment benefits.

In a statement issued shortly after the temporary fix was approved, Dr. J. James Rohack, president of the American Medical Association, directed his ire at the Senate.

“The Senate should use this time to permanently repeal the flawed Medicare physician payment formula that puts access to care for seniors and military families at risk,” Dr. Rohack said in the statement.

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 announced.

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 conference.

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

The awards were made in three major categories: policy and environmental changes; innovative programs; and tobacco cessation/telephone-based “quitlines.” All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quitlines.

Dr. Frieden called the lines “highly cost effective,” noting that tobacco-related disease is the No. 1 cause of preventable death, and that two-thirds of smokers want to quit, but haven't found the right motivation or program.

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

For details, visit www.cdc.gov/chronicdisease/recovery

The 'quitlines' are 'highly cost effective.' Most smokers want to quit, but haven't found the right program.

Source DR. FRIEDEN

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 announced.

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 conference.

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

The awards were made in three major categories: policy and environmental changes; innovative programs; and tobacco cessation/telephone-based “quitlines.” All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quitlines.

Dr. Frieden called the lines “highly cost effective,” noting that tobacco-related disease is the No. 1 cause of preventable death, and that two-thirds of smokers want to quit, but haven't found the right motivation or program.

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

For details, visit www.cdc.gov/chronicdisease/recovery

The 'quitlines' are 'highly cost effective.' Most smokers want to quit, but haven't found the right program.

Source DR. FRIEDEN

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 announced.

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 conference.

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

The awards were made in three major categories: policy and environmental changes; innovative programs; and tobacco cessation/telephone-based “quitlines.” All 50 states, the District of Columbia, and Puerto Rico will receive funding to expand quitlines.

Dr. Frieden called the lines “highly cost effective,” noting that tobacco-related disease is the No. 1 cause of preventable death, and that two-thirds of smokers want to quit, but haven't found the right motivation or program.

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

For details, visit www.cdc.gov/chronicdisease/recovery

The 'quitlines' are 'highly cost effective.' Most smokers want to quit, but haven't found the right program.

Source DR. FRIEDEN