Alicia Ault

Hospitals that do well on publicly reported measures on discharge planning do not necessarily have fewer readmissions, according to analysis of Medicare data.

Dr. Ashish K. Jha, E. John Orav, and Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, studied the association between hospital performance on discharge planning measures and readmission rates for congestive heart failure and pneumonia, the two most common reasons Medicare patients are readmitted (N. Engl. J. Med. 2009;361:2637–45).

The authors looked at two data sets—Medicare's Hospital Quality Alliance program and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—as well as other Medicare information profiling patients' discharge characteristics.

Conventional wisdom assumed that hospitals documenting discharge planning (only required for congestive heart failure) likely had fewer readmissions, Dr. Jha said in an interview. “The fact that there was no relationship between the chart-based measure and readmission rates was a little bit of a surprise.”

The authors compared data from 2,222 hospitals that had chart documentation and patient surveys, with 1,809 ospitals considered “nonreporting” because they did not provide data for both charts and patients.

The authors found no association between hospital size, location, or any other characteristics, and performance on the chart-based or patient-reported measures. They did find large variations in readmission rates, ranging from 17.5% to 29.6% for congestive heart failure and from 14.1% to 25.6% for pneumonia.

For heart failure readmission, unadjusted results found no difference based on a hospital's performance on chart-based discharge measures. When adjusted for institutional characteristics, hospitals in the highest quartile of performance for 30-day heart failure readmissions had rates that “were nearly identical” to those in the lowest quartile, according to the authors, the authors reported.

The authors found that, even if each facility improved performance to be on par with the hospitals in the 90th percentile on the patient-reported measure, there would be only 4,700 fewer congestive heart failure readmissions and 2,800 fewer pneumonia-related readmissions.

Public reporting has been associated with improvement in performance, but also carries a high administrative cost, said Dr. Jha. The study indicates that the chart-based measure may only be an indication of how well hospitals do in documentation, not performance, he said.

Dr. Jha reported he received consulting fees from UpToDate, which markets clinical decision support tools.

Hospitals that do well on publicly reported measures on discharge planning do not necessarily have fewer readmissions, according to analysis of Medicare data.

Dr. Ashish K. Jha, E. John Orav, and Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, studied the association between hospital performance on discharge planning measures and readmission rates for congestive heart failure and pneumonia, the two most common reasons Medicare patients are readmitted (N. Engl. J. Med. 2009;361:2637–45).

The authors looked at two data sets—Medicare's Hospital Quality Alliance program and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—as well as other Medicare information profiling patients' discharge characteristics.

Conventional wisdom assumed that hospitals documenting discharge planning (only required for congestive heart failure) likely had fewer readmissions, Dr. Jha said in an interview. “The fact that there was no relationship between the chart-based measure and readmission rates was a little bit of a surprise.”

The authors compared data from 2,222 hospitals that had chart documentation and patient surveys, with 1,809 ospitals considered “nonreporting” because they did not provide data for both charts and patients.

The authors found no association between hospital size, location, or any other characteristics, and performance on the chart-based or patient-reported measures. They did find large variations in readmission rates, ranging from 17.5% to 29.6% for congestive heart failure and from 14.1% to 25.6% for pneumonia.

For heart failure readmission, unadjusted results found no difference based on a hospital's performance on chart-based discharge measures. When adjusted for institutional characteristics, hospitals in the highest quartile of performance for 30-day heart failure readmissions had rates that “were nearly identical” to those in the lowest quartile, according to the authors, the authors reported.

The authors found that, even if each facility improved performance to be on par with the hospitals in the 90th percentile on the patient-reported measure, there would be only 4,700 fewer congestive heart failure readmissions and 2,800 fewer pneumonia-related readmissions.

Public reporting has been associated with improvement in performance, but also carries a high administrative cost, said Dr. Jha. The study indicates that the chart-based measure may only be an indication of how well hospitals do in documentation, not performance, he said.

Dr. Jha reported he received consulting fees from UpToDate, which markets clinical decision support tools.

Hospitals that do well on publicly reported measures on discharge planning do not necessarily have fewer readmissions, according to analysis of Medicare data.

Dr. Ashish K. Jha, E. John Orav, and Dr. Arnold M. Epstein of the Harvard School of Public Health, Boston, studied the association between hospital performance on discharge planning measures and readmission rates for congestive heart failure and pneumonia, the two most common reasons Medicare patients are readmitted (N. Engl. J. Med. 2009;361:2637–45).

The authors looked at two data sets—Medicare's Hospital Quality Alliance program and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—as well as other Medicare information profiling patients' discharge characteristics.

Conventional wisdom assumed that hospitals documenting discharge planning (only required for congestive heart failure) likely had fewer readmissions, Dr. Jha said in an interview. “The fact that there was no relationship between the chart-based measure and readmission rates was a little bit of a surprise.”

The authors compared data from 2,222 hospitals that had chart documentation and patient surveys, with 1,809 ospitals considered “nonreporting” because they did not provide data for both charts and patients.

The authors found no association between hospital size, location, or any other characteristics, and performance on the chart-based or patient-reported measures. They did find large variations in readmission rates, ranging from 17.5% to 29.6% for congestive heart failure and from 14.1% to 25.6% for pneumonia.

For heart failure readmission, unadjusted results found no difference based on a hospital's performance on chart-based discharge measures. When adjusted for institutional characteristics, hospitals in the highest quartile of performance for 30-day heart failure readmissions had rates that “were nearly identical” to those in the lowest quartile, according to the authors, the authors reported.

The authors found that, even if each facility improved performance to be on par with the hospitals in the 90th percentile on the patient-reported measure, there would be only 4,700 fewer congestive heart failure readmissions and 2,800 fewer pneumonia-related readmissions.

Public reporting has been associated with improvement in performance, but also carries a high administrative cost, said Dr. Jha. The study indicates that the chart-based measure may only be an indication of how well hospitals do in documentation, not performance, he said.

Dr. Jha reported he received consulting fees from UpToDate, which markets clinical decision support tools.

Mental Health Care Still a Stigma

A survey conducted for the American Psychiatric Association has found that workers are more concerned that seeking mental health treatment will affect their employment status than they are that seeking care for a physical ailment will do so. Harris Interactive conducted the national online survey last August with 2,000 adults, 1,100 of whom were employed full- or part-time. Among the respondents, 76% thought their employment status would be affected if they sought treatment for drug addiction, 73% for alcoholism, and 62% for depression. In comparison, 55% said seeking diabetes treatments and 54% said getting heart disease care might affect job status. The APA pointed out that it works to eliminate barriers to mental health care through its Partnership for Workplace Mental Health.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president Dr. J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use [in the United States] by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the FDA does not have the authority to regulate so-called e-cigarettes–electronic cigarettes–as drug-device combinations. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with FDA's justification for its action. However, he didn't address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June–after the e-cigarette shipments in this case had been halted.

'Extraordinary' Drug Price Hikes

The Government Accountability Office said 416 brand-name pharmaceutical products had “extraordinary” price increases from 2000 to 2008. While this represents only 0.5% of all brand-name products, most of the increases ranged from 100% to 499%, the GAO said in a report released in early January (GAO-10-201). More than half of those products were in three therapeutic classes: central nervous system, anti-infective, and cardiovascular. One possible reason for the price inflation, said the agency: The drugs are bought from wholesalers, repackaged and resold at higher prices to physicians or hospitals. The Pharmaceutical Research and Manufacturers of America (PhRMA) industry group said the report “focuses only on a small number of selected brand medicines rather than the entire prescription drug market.”

FDA OK'd 26 New Meds in 2009

The FDA approved 19 new chemical entities and 7 new biologics in 2009, according to Washington Analysis, a Washington-based investment adviser. Among the new chemical entities were Eli Lilly's oral platelet inhibitor Effient (prasugrel) and Sanofi-Aventis's antiarrhythmic drug Multaq (dronedarone). In his report, Washington Analysis' Ira Loss said he expected more approvals this year because the agency claimed it wouldn't let statutory approval dates be overridden and it received more money for reviews.

Many Girls Involved in Violence

About one-quarter of all adolescent females engaged in some sort of violent behavior in the past year, according to a report from the Substance Abuse and Mental Health Services Administration. Looking at data from 2006 to 2008, the researchers found that nearly 19% of adolescent girls reported getting into a serious fight at school, 14% participated in a group-against-group fight, and nearly 6% attacked others with the intent to seriously hurt them. Some teens were in more than one category. The teenagers who engaged in violent behavior were more likely to binge on alcohol or abuse drugs, the study showed. “Acts of teenage violence are most commonly associated with boys,” the report said. However, “it is clear that the problem is pervasive among girls as well.” Pediatricians should consider the issue when seeing adolescent female patients, the report concluded.

Mental Health Care Still a Stigma

A survey conducted for the American Psychiatric Association has found that workers are more concerned that seeking mental health treatment will affect their employment status than they are that seeking care for a physical ailment will do so. Harris Interactive conducted the national online survey last August with 2,000 adults, 1,100 of whom were employed full- or part-time. Among the respondents, 76% thought their employment status would be affected if they sought treatment for drug addiction, 73% for alcoholism, and 62% for depression. In comparison, 55% said seeking diabetes treatments and 54% said getting heart disease care might affect job status. The APA pointed out that it works to eliminate barriers to mental health care through its Partnership for Workplace Mental Health.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president Dr. J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use [in the United States] by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the FDA does not have the authority to regulate so-called e-cigarettes–electronic cigarettes–as drug-device combinations. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with FDA's justification for its action. However, he didn't address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June–after the e-cigarette shipments in this case had been halted.

'Extraordinary' Drug Price Hikes

The Government Accountability Office said 416 brand-name pharmaceutical products had “extraordinary” price increases from 2000 to 2008. While this represents only 0.5% of all brand-name products, most of the increases ranged from 100% to 499%, the GAO said in a report released in early January (GAO-10-201). More than half of those products were in three therapeutic classes: central nervous system, anti-infective, and cardiovascular. One possible reason for the price inflation, said the agency: The drugs are bought from wholesalers, repackaged and resold at higher prices to physicians or hospitals. The Pharmaceutical Research and Manufacturers of America (PhRMA) industry group said the report “focuses only on a small number of selected brand medicines rather than the entire prescription drug market.”

FDA OK'd 26 New Meds in 2009

The FDA approved 19 new chemical entities and 7 new biologics in 2009, according to Washington Analysis, a Washington-based investment adviser. Among the new chemical entities were Eli Lilly's oral platelet inhibitor Effient (prasugrel) and Sanofi-Aventis's antiarrhythmic drug Multaq (dronedarone). In his report, Washington Analysis' Ira Loss said he expected more approvals this year because the agency claimed it wouldn't let statutory approval dates be overridden and it received more money for reviews.

Many Girls Involved in Violence

About one-quarter of all adolescent females engaged in some sort of violent behavior in the past year, according to a report from the Substance Abuse and Mental Health Services Administration. Looking at data from 2006 to 2008, the researchers found that nearly 19% of adolescent girls reported getting into a serious fight at school, 14% participated in a group-against-group fight, and nearly 6% attacked others with the intent to seriously hurt them. Some teens were in more than one category. The teenagers who engaged in violent behavior were more likely to binge on alcohol or abuse drugs, the study showed. “Acts of teenage violence are most commonly associated with boys,” the report said. However, “it is clear that the problem is pervasive among girls as well.” Pediatricians should consider the issue when seeing adolescent female patients, the report concluded.

Mental Health Care Still a Stigma

A survey conducted for the American Psychiatric Association has found that workers are more concerned that seeking mental health treatment will affect their employment status than they are that seeking care for a physical ailment will do so. Harris Interactive conducted the national online survey last August with 2,000 adults, 1,100 of whom were employed full- or part-time. Among the respondents, 76% thought their employment status would be affected if they sought treatment for drug addiction, 73% for alcoholism, and 62% for depression. In comparison, 55% said seeking diabetes treatments and 54% said getting heart disease care might affect job status. The APA pointed out that it works to eliminate barriers to mental health care through its Partnership for Workplace Mental Health.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president Dr. J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use [in the United States] by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

No Smoke, No Device Authority

The U.S. District Court for the District of Columbia ruled that the FDA does not have the authority to regulate so-called e-cigarettes–electronic cigarettes–as drug-device combinations. E-cigarettes are battery-powered devices that deliver vaporized doses of nicotine to be inhaled. The FDA had detained multiple shipments of e-cigarettes imported by one company, Smoking Everywhere, saying that they were unapproved drug-devices. Judge Richard Leon disagreed with FDA's justification for its action. However, he didn't address whether the agency has authority to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June–after the e-cigarette shipments in this case had been halted.

'Extraordinary' Drug Price Hikes

The Government Accountability Office said 416 brand-name pharmaceutical products had “extraordinary” price increases from 2000 to 2008. While this represents only 0.5% of all brand-name products, most of the increases ranged from 100% to 499%, the GAO said in a report released in early January (GAO-10-201). More than half of those products were in three therapeutic classes: central nervous system, anti-infective, and cardiovascular. One possible reason for the price inflation, said the agency: The drugs are bought from wholesalers, repackaged and resold at higher prices to physicians or hospitals. The Pharmaceutical Research and Manufacturers of America (PhRMA) industry group said the report “focuses only on a small number of selected brand medicines rather than the entire prescription drug market.”

FDA OK'd 26 New Meds in 2009

The FDA approved 19 new chemical entities and 7 new biologics in 2009, according to Washington Analysis, a Washington-based investment adviser. Among the new chemical entities were Eli Lilly's oral platelet inhibitor Effient (prasugrel) and Sanofi-Aventis's antiarrhythmic drug Multaq (dronedarone). In his report, Washington Analysis' Ira Loss said he expected more approvals this year because the agency claimed it wouldn't let statutory approval dates be overridden and it received more money for reviews.

Many Girls Involved in Violence

About one-quarter of all adolescent females engaged in some sort of violent behavior in the past year, according to a report from the Substance Abuse and Mental Health Services Administration. Looking at data from 2006 to 2008, the researchers found that nearly 19% of adolescent girls reported getting into a serious fight at school, 14% participated in a group-against-group fight, and nearly 6% attacked others with the intent to seriously hurt them. Some teens were in more than one category. The teenagers who engaged in violent behavior were more likely to binge on alcohol or abuse drugs, the study showed. “Acts of teenage violence are most commonly associated with boys,” the report said. However, “it is clear that the problem is pervasive among girls as well.” Pediatricians should consider the issue when seeing adolescent female patients, the report concluded.

The Centers for Medicare and Medicaid Services made approximately $24 billion in improper payments in fiscal year 2009, an error rate that was almost double the rate of the previous year.

In fiscal year 2009, 7.8% of Medicare fee-for-service claims were paid in error, compared with 3.5% in fiscal year 2008, the agency said in a statement. The CMS said that the increase in the error rate resulted largely from a change in how it identified improper payments.

“This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

The CMS assesses the accuracy of Medicare payments each year and includes an accounting in the HHS Agency Financial Report. The agency calculates Medicaid error rates in a different way, and does not yet have statistics for fiscal year 2009. It uses a 17-state sample to calculate the national error rate; each state is reviewed once every 3 years. According to the most recent assessment, the Medicaid error rate fell from 10.5% in fiscal year 2007 to 8.7% in fiscal year 2008. The reporting of an error rate for the Children's Health Insurance Program (CHIP) has been suspended while the CMS develops a new way to assess the payments, as directed by CHIP's reauthorization in 2009.

The agency is also still developing measures for the Medicare Advantage program and for Medicare Part D. But the baseline for Medicare Advantage was 15.4% in 2007, accounting for $12 billion paid out in error.

The CMS said that the higher improper payment rate is not necessarily an indicator of greater fraud. Rather, it was “a more complete accounting of errors,” according to Ms. Sebelius.

So that physicians and other health care providers are not inappropriately accused of fraud, the CMS is working to ensure that they submit all required clinical and medical documents to support a claim, and that signatures on documents are legible. Durable medical equipment claims will have to include medical information from a health care provider in addition to suppliers' records.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” CMS acting administrator Charlene Frizzera said in a statement.

The Centers for Medicare and Medicaid Services made approximately $24 billion in improper payments in fiscal year 2009, an error rate that was almost double the rate of the previous year.

In fiscal year 2009, 7.8% of Medicare fee-for-service claims were paid in error, compared with 3.5% in fiscal year 2008, the agency said in a statement. The CMS said that the increase in the error rate resulted largely from a change in how it identified improper payments.

“This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

The CMS assesses the accuracy of Medicare payments each year and includes an accounting in the HHS Agency Financial Report. The agency calculates Medicaid error rates in a different way, and does not yet have statistics for fiscal year 2009. It uses a 17-state sample to calculate the national error rate; each state is reviewed once every 3 years. According to the most recent assessment, the Medicaid error rate fell from 10.5% in fiscal year 2007 to 8.7% in fiscal year 2008. The reporting of an error rate for the Children's Health Insurance Program (CHIP) has been suspended while the CMS develops a new way to assess the payments, as directed by CHIP's reauthorization in 2009.

The agency is also still developing measures for the Medicare Advantage program and for Medicare Part D. But the baseline for Medicare Advantage was 15.4% in 2007, accounting for $12 billion paid out in error.

The CMS said that the higher improper payment rate is not necessarily an indicator of greater fraud. Rather, it was “a more complete accounting of errors,” according to Ms. Sebelius.

So that physicians and other health care providers are not inappropriately accused of fraud, the CMS is working to ensure that they submit all required clinical and medical documents to support a claim, and that signatures on documents are legible. Durable medical equipment claims will have to include medical information from a health care provider in addition to suppliers' records.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” CMS acting administrator Charlene Frizzera said in a statement.

The Centers for Medicare and Medicaid Services made approximately $24 billion in improper payments in fiscal year 2009, an error rate that was almost double the rate of the previous year.

In fiscal year 2009, 7.8% of Medicare fee-for-service claims were paid in error, compared with 3.5% in fiscal year 2008, the agency said in a statement. The CMS said that the increase in the error rate resulted largely from a change in how it identified improper payments.

“This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

The CMS assesses the accuracy of Medicare payments each year and includes an accounting in the HHS Agency Financial Report. The agency calculates Medicaid error rates in a different way, and does not yet have statistics for fiscal year 2009. It uses a 17-state sample to calculate the national error rate; each state is reviewed once every 3 years. According to the most recent assessment, the Medicaid error rate fell from 10.5% in fiscal year 2007 to 8.7% in fiscal year 2008. The reporting of an error rate for the Children's Health Insurance Program (CHIP) has been suspended while the CMS develops a new way to assess the payments, as directed by CHIP's reauthorization in 2009.

The agency is also still developing measures for the Medicare Advantage program and for Medicare Part D. But the baseline for Medicare Advantage was 15.4% in 2007, accounting for $12 billion paid out in error.

The CMS said that the higher improper payment rate is not necessarily an indicator of greater fraud. Rather, it was “a more complete accounting of errors,” according to Ms. Sebelius.

So that physicians and other health care providers are not inappropriately accused of fraud, the CMS is working to ensure that they submit all required clinical and medical documents to support a claim, and that signatures on documents are legible. Durable medical equipment claims will have to include medical information from a health care provider in addition to suppliers' records.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” CMS acting administrator Charlene Frizzera said in a statement.

A wide disparity in access to and quality of care across the United States argues for a national health reform plan, according to executives at the Commonwealth Fund, who released a state-by-state survey of 38 health indicators.

The survey revealed a fivefold difference in performance on the indicators between the highest-ranked states and the lowest. The differences “translate to real lives and real dollars,” Karen Davis, Commonwealth Fund president, said at a press conference.

Health reform legislation would go a long way toward improving access and coverage, Ms. Davis said.

Since 2007, the number of uninsured adults has risen, and the “worst is yet to come,” said Cathy Schoen, senior vice president of the Commonwealth Fund.

The top quartile comprises Connecticut, Hawaii, Iowa, Maine, Massachusetts, Minnesota, Nebraska, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, and Wisconsin.

Ten of the 13 states in the lowest quartile—Alabama, Arkansas, Florida, Kentucky, Louisiana, Mississippi, Nevada, Oklahoma, Tennessee, and Texas—also ranked at the bottom on the previous 2007 report. Illinois, New Mexico, and North Carolina dropped into the lowest quartile since the last survey, while California, Georgia, and West Virginia moved up out of the last quartile in this most recent report. The lower-performing states had rates of uninsured adults and children that were double those in the top quartile.

According to Ms. Davis and her colleagues, if the lower-performing states were helped to reach the levels of the higher-performing states, 29 million more people would be insured.

A wide disparity in access to and quality of care across the United States argues for a national health reform plan, according to executives at the Commonwealth Fund, who released a state-by-state survey of 38 health indicators.

The survey revealed a fivefold difference in performance on the indicators between the highest-ranked states and the lowest. The differences “translate to real lives and real dollars,” Karen Davis, Commonwealth Fund president, said at a press conference.

Health reform legislation would go a long way toward improving access and coverage, Ms. Davis said.

Since 2007, the number of uninsured adults has risen, and the “worst is yet to come,” said Cathy Schoen, senior vice president of the Commonwealth Fund.

The top quartile comprises Connecticut, Hawaii, Iowa, Maine, Massachusetts, Minnesota, Nebraska, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, and Wisconsin.

Ten of the 13 states in the lowest quartile—Alabama, Arkansas, Florida, Kentucky, Louisiana, Mississippi, Nevada, Oklahoma, Tennessee, and Texas—also ranked at the bottom on the previous 2007 report. Illinois, New Mexico, and North Carolina dropped into the lowest quartile since the last survey, while California, Georgia, and West Virginia moved up out of the last quartile in this most recent report. The lower-performing states had rates of uninsured adults and children that were double those in the top quartile.

According to Ms. Davis and her colleagues, if the lower-performing states were helped to reach the levels of the higher-performing states, 29 million more people would be insured.

A wide disparity in access to and quality of care across the United States argues for a national health reform plan, according to executives at the Commonwealth Fund, who released a state-by-state survey of 38 health indicators.

The survey revealed a fivefold difference in performance on the indicators between the highest-ranked states and the lowest. The differences “translate to real lives and real dollars,” Karen Davis, Commonwealth Fund president, said at a press conference.

Health reform legislation would go a long way toward improving access and coverage, Ms. Davis said.

Since 2007, the number of uninsured adults has risen, and the “worst is yet to come,” said Cathy Schoen, senior vice president of the Commonwealth Fund.

The top quartile comprises Connecticut, Hawaii, Iowa, Maine, Massachusetts, Minnesota, Nebraska, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, and Wisconsin.

Ten of the 13 states in the lowest quartile—Alabama, Arkansas, Florida, Kentucky, Louisiana, Mississippi, Nevada, Oklahoma, Tennessee, and Texas—also ranked at the bottom on the previous 2007 report. Illinois, New Mexico, and North Carolina dropped into the lowest quartile since the last survey, while California, Georgia, and West Virginia moved up out of the last quartile in this most recent report. The lower-performing states had rates of uninsured adults and children that were double those in the top quartile.

According to Ms. Davis and her colleagues, if the lower-performing states were helped to reach the levels of the higher-performing states, 29 million more people would be insured.

WASHINGTON — A report commissioned by the Blue Cross Blue Shield Association says that if the Senate health reform bill is enacted, individuals buying insurance on the open market will pay 54% more in premiums than they do today.

The analysis comes on the heels of a Congressional Budget Office report that estimated premium costs for individuals and the group market if all the Senate reform proposals were adopted and put into place by the scheduled 2016 implementation date. The CBO estimated that individuals would pay $5,800 a year for premiums, a slight increase from the $5,500 they could expect to pay under current law.

The individual premium, without federal subsidies, would also be about 10%-13% higher than premiums paid by group members under the reform proposal, said the CBO. But the agency estimated that slightly more than half of those individuals would be eligible for federal subsidies. Those individuals would actually pay 56%-59% less than someone in a group would pay, the CBO estimated.

The BlueCross analysis, which was conducted by the actuarial company Oliver Wyman Inc., estimated that individuals would pay $4,561 in annual premiums, or 54% more than they would pay without reform. Small group premiums (for employers with 2 to 50 workers) will be about 20% higher, according to the analysis. Both figures exclude medical inflation, so the increases could be even greater, said Jason Grau, an associate partner at Oliver Wyman and a co-author of the analysis.

The Wyman analysis calculated premiums for the year 2019, a few years after the market had settled into the new law, he said.

The CBO underestimated the effects of adverse selection, which he said was more likely, given that the Senate bill had minimal penalties for those who choose not to purchase insurance. The lack of stiff fines and the elimination of age rating—in which younger, healthier people pay less—means that insurers will have to raise premiums to cover costs for the older, sicker population likely to sign up for policies, said Mr. Grau.

“As the bill stands right now the protections that are in place and the incentives that are in place to encourage healthy people to participate, and to get really broad participation, [are] not at the level that you're going to need to achieve optimal affordability and ensure you that you have high coverage as well,” said Mr. Grau.

BCBS Association Senior Vice President Alissa Fox agreed that the Senate needed to figure out another way to encourage the young and healthy to purchase insurance. “The penalties to purchase and obtain coverage are very weak, and because of that, young, healthy people we estimate, are likely—many of them—to forego coverage,” said Ms. Fox in an interview.

The insurance organization risked inciting a political backlash by releasing the study in the midst of the Senate's debate, but Ms. Fox and other association officials said they had been in regular contact with the White House about their concerns and that the report was rigorous in its methods and conclusions.

WASHINGTON — A report commissioned by the Blue Cross Blue Shield Association says that if the Senate health reform bill is enacted, individuals buying insurance on the open market will pay 54% more in premiums than they do today.

The analysis comes on the heels of a Congressional Budget Office report that estimated premium costs for individuals and the group market if all the Senate reform proposals were adopted and put into place by the scheduled 2016 implementation date. The CBO estimated that individuals would pay $5,800 a year for premiums, a slight increase from the $5,500 they could expect to pay under current law.

The individual premium, without federal subsidies, would also be about 10%-13% higher than premiums paid by group members under the reform proposal, said the CBO. But the agency estimated that slightly more than half of those individuals would be eligible for federal subsidies. Those individuals would actually pay 56%-59% less than someone in a group would pay, the CBO estimated.

The BlueCross analysis, which was conducted by the actuarial company Oliver Wyman Inc., estimated that individuals would pay $4,561 in annual premiums, or 54% more than they would pay without reform. Small group premiums (for employers with 2 to 50 workers) will be about 20% higher, according to the analysis. Both figures exclude medical inflation, so the increases could be even greater, said Jason Grau, an associate partner at Oliver Wyman and a co-author of the analysis.

The Wyman analysis calculated premiums for the year 2019, a few years after the market had settled into the new law, he said.

The CBO underestimated the effects of adverse selection, which he said was more likely, given that the Senate bill had minimal penalties for those who choose not to purchase insurance. The lack of stiff fines and the elimination of age rating—in which younger, healthier people pay less—means that insurers will have to raise premiums to cover costs for the older, sicker population likely to sign up for policies, said Mr. Grau.

“As the bill stands right now the protections that are in place and the incentives that are in place to encourage healthy people to participate, and to get really broad participation, [are] not at the level that you're going to need to achieve optimal affordability and ensure you that you have high coverage as well,” said Mr. Grau.

BCBS Association Senior Vice President Alissa Fox agreed that the Senate needed to figure out another way to encourage the young and healthy to purchase insurance. “The penalties to purchase and obtain coverage are very weak, and because of that, young, healthy people we estimate, are likely—many of them—to forego coverage,” said Ms. Fox in an interview.

The insurance organization risked inciting a political backlash by releasing the study in the midst of the Senate's debate, but Ms. Fox and other association officials said they had been in regular contact with the White House about their concerns and that the report was rigorous in its methods and conclusions.

WASHINGTON — A report commissioned by the Blue Cross Blue Shield Association says that if the Senate health reform bill is enacted, individuals buying insurance on the open market will pay 54% more in premiums than they do today.

The analysis comes on the heels of a Congressional Budget Office report that estimated premium costs for individuals and the group market if all the Senate reform proposals were adopted and put into place by the scheduled 2016 implementation date. The CBO estimated that individuals would pay $5,800 a year for premiums, a slight increase from the $5,500 they could expect to pay under current law.

The individual premium, without federal subsidies, would also be about 10%-13% higher than premiums paid by group members under the reform proposal, said the CBO. But the agency estimated that slightly more than half of those individuals would be eligible for federal subsidies. Those individuals would actually pay 56%-59% less than someone in a group would pay, the CBO estimated.

The BlueCross analysis, which was conducted by the actuarial company Oliver Wyman Inc., estimated that individuals would pay $4,561 in annual premiums, or 54% more than they would pay without reform. Small group premiums (for employers with 2 to 50 workers) will be about 20% higher, according to the analysis. Both figures exclude medical inflation, so the increases could be even greater, said Jason Grau, an associate partner at Oliver Wyman and a co-author of the analysis.

The Wyman analysis calculated premiums for the year 2019, a few years after the market had settled into the new law, he said.

The CBO underestimated the effects of adverse selection, which he said was more likely, given that the Senate bill had minimal penalties for those who choose not to purchase insurance. The lack of stiff fines and the elimination of age rating—in which younger, healthier people pay less—means that insurers will have to raise premiums to cover costs for the older, sicker population likely to sign up for policies, said Mr. Grau.

“As the bill stands right now the protections that are in place and the incentives that are in place to encourage healthy people to participate, and to get really broad participation, [are] not at the level that you're going to need to achieve optimal affordability and ensure you that you have high coverage as well,” said Mr. Grau.

BCBS Association Senior Vice President Alissa Fox agreed that the Senate needed to figure out another way to encourage the young and healthy to purchase insurance. “The penalties to purchase and obtain coverage are very weak, and because of that, young, healthy people we estimate, are likely—many of them—to forego coverage,” said Ms. Fox in an interview.

The insurance organization risked inciting a political backlash by releasing the study in the midst of the Senate's debate, but Ms. Fox and other association officials said they had been in regular contact with the White House about their concerns and that the report was rigorous in its methods and conclusions.

The Senate on Dec. 19 passed a Defense Department spending bill that included a 2-month delay in the scheduled 21% cut in the rate Medicare pays physicians. President Obama signed the bill into law the same day.

Physician groups hope to secure a permanent overhaul to the Sustainable Growth Rate (SGR) formula, which governs the Medicare payment rate.

In a statement, Dr. J. James Rohack, president of the American Medical Association, said that the group agreed with Senate Majority Leader Harry Reid (D-Nev.) who removed a 1-year fix from his health reform package with an aim of separately winning a permanent overhaul.

“As we call for a permanent solution, the AMA acknowledges the House and Senate votes to stop the cuts for 2 months so that access to care for Medicare and TRICARE patients is not disrupted while the Senate works on solving the problem once and for all,” he said.

The House of Representatives voted for a permanent fix in a stand alone bill, but the Senate later rejected it. Neither the House nor the Senate has included a permanent fix in their respective health reform bills.

The fee reduction was due to go into effect Jan. 1. Lawmakers had ways left to avert that cut, and thus attached the delay to the Defense spending bill, knowing that, with American military in Iraq and Afghanistan, it was a must-pass proposal.

The $636 billion Defense appropriations bill had passed the House. The package includes almost $14 billion in non-Defense spending, including an extension of unemployment benefits and subsidies to help pay for COBRA benefits. The Senate passed the bill on an 88-10 vote.

The Senate on Dec. 19 passed a Defense Department spending bill that included a 2-month delay in the scheduled 21% cut in the rate Medicare pays physicians. President Obama signed the bill into law the same day.

Physician groups hope to secure a permanent overhaul to the Sustainable Growth Rate (SGR) formula, which governs the Medicare payment rate.

In a statement, Dr. J. James Rohack, president of the American Medical Association, said that the group agreed with Senate Majority Leader Harry Reid (D-Nev.) who removed a 1-year fix from his health reform package with an aim of separately winning a permanent overhaul.

“As we call for a permanent solution, the AMA acknowledges the House and Senate votes to stop the cuts for 2 months so that access to care for Medicare and TRICARE patients is not disrupted while the Senate works on solving the problem once and for all,” he said.

The House of Representatives voted for a permanent fix in a stand alone bill, but the Senate later rejected it. Neither the House nor the Senate has included a permanent fix in their respective health reform bills.

The fee reduction was due to go into effect Jan. 1. Lawmakers had ways left to avert that cut, and thus attached the delay to the Defense spending bill, knowing that, with American military in Iraq and Afghanistan, it was a must-pass proposal.

The $636 billion Defense appropriations bill had passed the House. The package includes almost $14 billion in non-Defense spending, including an extension of unemployment benefits and subsidies to help pay for COBRA benefits. The Senate passed the bill on an 88-10 vote.

The Senate on Dec. 19 passed a Defense Department spending bill that included a 2-month delay in the scheduled 21% cut in the rate Medicare pays physicians. President Obama signed the bill into law the same day.

Physician groups hope to secure a permanent overhaul to the Sustainable Growth Rate (SGR) formula, which governs the Medicare payment rate.

In a statement, Dr. J. James Rohack, president of the American Medical Association, said that the group agreed with Senate Majority Leader Harry Reid (D-Nev.) who removed a 1-year fix from his health reform package with an aim of separately winning a permanent overhaul.

“As we call for a permanent solution, the AMA acknowledges the House and Senate votes to stop the cuts for 2 months so that access to care for Medicare and TRICARE patients is not disrupted while the Senate works on solving the problem once and for all,” he said.

The House of Representatives voted for a permanent fix in a stand alone bill, but the Senate later rejected it. Neither the House nor the Senate has included a permanent fix in their respective health reform bills.

The fee reduction was due to go into effect Jan. 1. Lawmakers had ways left to avert that cut, and thus attached the delay to the Defense spending bill, knowing that, with American military in Iraq and Afghanistan, it was a must-pass proposal.

The $636 billion Defense appropriations bill had passed the House. The package includes almost $14 billion in non-Defense spending, including an extension of unemployment benefits and subsidies to help pay for COBRA benefits. The Senate passed the bill on an 88-10 vote.

The Centers for Medicare and Medicaid Services made approximately $24 billion in improper payments to physicians and other vendors in fiscal year 2009, an error rate that was almost double the rate of the previous year.

In fiscal year 2009, 7.8% of Medicare fee-for-service claims were paid in error, compared with 3.5% in fiscal year 2008, said the agency in a statement. The CMS said that the increase in the error rate resulted largely from a change in how it identified improper payments.

“This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

The CMS assesses the accuracy of its Medicare payments each year and includes an accounting in the HHS Agency Financial Report.

The agency calculates Medicaid error rates in a different way, and does not yet have statistics for fiscal year 2009. It uses a 17-state sample to calculate the national error rate; each state is reviewed once every 3 years. According to the most recent assessment, the Medicaid error rate decreased from 10.5% in fiscal year 2007 to 8.7% in fiscal year 2008. The reporting of an error rate for the Children's Health Insurance Program (CHIP) has been suspended while the CMS develops a new way to assess the payments, as directed by the reauthorization of CHIP earlier this year.

The agency is also still developing measures for the Medicare Advantage program and for Medicare Part D. But the baseline for Medicare Advantage was 15.4% in 2007, accounting for $12 billion paid out in error.

The CMS said that the higher improper payment rate is not necessarily an indicator of greater fraud. Rather, it was “a more complete accounting of errors,” according to Ms. Sebelius.

To ensure that physicians and other health care providers are not inappropriately accused of fraud, the CMS is working to ensure that they submit all required clinical and medical documents to support a claim, and that signatures on documents are legible. Durable medical equipment claims will have to include medical information from a health care provider in addition to suppliers' records.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said acting CMS Administrator Charlene Frizzera in a statement.

The Centers for Medicare and Medicaid Services made approximately $24 billion in improper payments to physicians and other vendors in fiscal year 2009, an error rate that was almost double the rate of the previous year.

In fiscal year 2009, 7.8% of Medicare fee-for-service claims were paid in error, compared with 3.5% in fiscal year 2008, said the agency in a statement. The CMS said that the increase in the error rate resulted largely from a change in how it identified improper payments.

“This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

The CMS assesses the accuracy of its Medicare payments each year and includes an accounting in the HHS Agency Financial Report.

The agency calculates Medicaid error rates in a different way, and does not yet have statistics for fiscal year 2009. It uses a 17-state sample to calculate the national error rate; each state is reviewed once every 3 years. According to the most recent assessment, the Medicaid error rate decreased from 10.5% in fiscal year 2007 to 8.7% in fiscal year 2008. The reporting of an error rate for the Children's Health Insurance Program (CHIP) has been suspended while the CMS develops a new way to assess the payments, as directed by the reauthorization of CHIP earlier this year.

The agency is also still developing measures for the Medicare Advantage program and for Medicare Part D. But the baseline for Medicare Advantage was 15.4% in 2007, accounting for $12 billion paid out in error.

The CMS said that the higher improper payment rate is not necessarily an indicator of greater fraud. Rather, it was “a more complete accounting of errors,” according to Ms. Sebelius.

To ensure that physicians and other health care providers are not inappropriately accused of fraud, the CMS is working to ensure that they submit all required clinical and medical documents to support a claim, and that signatures on documents are legible. Durable medical equipment claims will have to include medical information from a health care provider in addition to suppliers' records.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said acting CMS Administrator Charlene Frizzera in a statement.

The Centers for Medicare and Medicaid Services made approximately $24 billion in improper payments to physicians and other vendors in fiscal year 2009, an error rate that was almost double the rate of the previous year.

In fiscal year 2009, 7.8% of Medicare fee-for-service claims were paid in error, compared with 3.5% in fiscal year 2008, said the agency in a statement. The CMS said that the increase in the error rate resulted largely from a change in how it identified improper payments.

“This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

The CMS assesses the accuracy of its Medicare payments each year and includes an accounting in the HHS Agency Financial Report.

The agency calculates Medicaid error rates in a different way, and does not yet have statistics for fiscal year 2009. It uses a 17-state sample to calculate the national error rate; each state is reviewed once every 3 years. According to the most recent assessment, the Medicaid error rate decreased from 10.5% in fiscal year 2007 to 8.7% in fiscal year 2008. The reporting of an error rate for the Children's Health Insurance Program (CHIP) has been suspended while the CMS develops a new way to assess the payments, as directed by the reauthorization of CHIP earlier this year.

The agency is also still developing measures for the Medicare Advantage program and for Medicare Part D. But the baseline for Medicare Advantage was 15.4% in 2007, accounting for $12 billion paid out in error.

The CMS said that the higher improper payment rate is not necessarily an indicator of greater fraud. Rather, it was “a more complete accounting of errors,” according to Ms. Sebelius.

To ensure that physicians and other health care providers are not inappropriately accused of fraud, the CMS is working to ensure that they submit all required clinical and medical documents to support a claim, and that signatures on documents are legible. Durable medical equipment claims will have to include medical information from a health care provider in addition to suppliers' records.

“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said acting CMS Administrator Charlene Frizzera in a statement.

At a meeting convened by the Food and Drug Administration, pharmaceutical and medical device manufacturers, advertisers, medical Web site owners, search engine companies, and consumer advocates argued for greater regulation of health-specific content on the Internet, including social media sites.

The agency sought opinions on how it could guide health-related communications and promotions for YouTube, Twitter, blogging, and social networking sites. No speakers from medical society or health care provider organizations attended.

The Food and Drug Administration will accept comments until Feb. 28, 2010, said Thomas W. Abrams, director of the FDA Center for Drug Evaluation and Research's division of drug marketing, advertising, and communications.

All speakers agreed that consumers and health care providers increasingly rely on the Internet for information about drugs, devices, and specific conditions, and to forge communities to share everything from caregiving recommendations to tips on how to perform a knee replacement.

They also agreed that there is much inaccurate and misleading information, which aas a great potential for harm to patients and their families, health care providers, and industries seeking credibility. Even as they seek to be the go-to place for accurate, scientific information, drug and device makers said they are wary—of social media in particular—because of the lack of FDA guidance.

Consumer groups raised the specter of pharmaceutical or device companies putting out purely promotional information that glosses over FDA rules requiring a fair balance of a product's risks and benefits.

Michele Sharp, senior director of United States Regulatory Affairs at Eli Lilly, said the company “had avoided significant interactions with providers and patients online” because of the FDA's lack of clarity. “We're looking to the FDA to provide leadership,” Ms. Sharp said.

Jeffrey K. Francer, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said “the FDA should facilitate manufacturers' communication of important medical information about their products in a responsible way.”

PhRMA has proposed that posts on social media sites be accompanied by an official logo that would signify that the information was officially sanctioned by the FDA. Tweets, limited to 140 characters, could provide hyperlinks to full risk and benefit information, Mr. Francer said.

He and other industry representatives said they wanted FDA to review information and promotional materials before they were posted on the Web. This would be a departure from current policy where only a small fraction of print or broadcast materials are reviewed in advance.

Some groups are trying to establish rules before FDA does. The Interactive Advertising Bureau is developing standards to provide “safe harbors” for the drug and device industry,.said IAB representative David Wright. The Social Media Working Group is discussing what drug companies can do to self-police, said Mark Gaydos, chairman, and a regulatory affairs director at Sanofi-Aventis U.S.

Google proposed its own standards for “sponsored” searches. The search result would include a link to the official drug site and a link at the end, “more info,” which would take users directly to the risk information, said Amy Cowan, head of industry for Google's health division. Results would include a short warning statement.

Consumer advocate Diana Zuckerman, Ph.D., president of the Washington-based National Research Center for Women and Families, said the FDA must monitor the Internet and social media. The center, along with Consumers Union, will push for higher users fees to fund policing of the Web, she added.

At a meeting convened by the Food and Drug Administration, pharmaceutical and medical device manufacturers, advertisers, medical Web site owners, search engine companies, and consumer advocates argued for greater regulation of health-specific content on the Internet, including social media sites.

The agency sought opinions on how it could guide health-related communications and promotions for YouTube, Twitter, blogging, and social networking sites. No speakers from medical society or health care provider organizations attended.

The Food and Drug Administration will accept comments until Feb. 28, 2010, said Thomas W. Abrams, director of the FDA Center for Drug Evaluation and Research's division of drug marketing, advertising, and communications.

All speakers agreed that consumers and health care providers increasingly rely on the Internet for information about drugs, devices, and specific conditions, and to forge communities to share everything from caregiving recommendations to tips on how to perform a knee replacement.

They also agreed that there is much inaccurate and misleading information, which aas a great potential for harm to patients and their families, health care providers, and industries seeking credibility. Even as they seek to be the go-to place for accurate, scientific information, drug and device makers said they are wary—of social media in particular—because of the lack of FDA guidance.

Consumer groups raised the specter of pharmaceutical or device companies putting out purely promotional information that glosses over FDA rules requiring a fair balance of a product's risks and benefits.

Michele Sharp, senior director of United States Regulatory Affairs at Eli Lilly, said the company “had avoided significant interactions with providers and patients online” because of the FDA's lack of clarity. “We're looking to the FDA to provide leadership,” Ms. Sharp said.

Jeffrey K. Francer, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said “the FDA should facilitate manufacturers' communication of important medical information about their products in a responsible way.”

PhRMA has proposed that posts on social media sites be accompanied by an official logo that would signify that the information was officially sanctioned by the FDA. Tweets, limited to 140 characters, could provide hyperlinks to full risk and benefit information, Mr. Francer said.

He and other industry representatives said they wanted FDA to review information and promotional materials before they were posted on the Web. This would be a departure from current policy where only a small fraction of print or broadcast materials are reviewed in advance.

Some groups are trying to establish rules before FDA does. The Interactive Advertising Bureau is developing standards to provide “safe harbors” for the drug and device industry,.said IAB representative David Wright. The Social Media Working Group is discussing what drug companies can do to self-police, said Mark Gaydos, chairman, and a regulatory affairs director at Sanofi-Aventis U.S.

Google proposed its own standards for “sponsored” searches. The search result would include a link to the official drug site and a link at the end, “more info,” which would take users directly to the risk information, said Amy Cowan, head of industry for Google's health division. Results would include a short warning statement.

Consumer advocate Diana Zuckerman, Ph.D., president of the Washington-based National Research Center for Women and Families, said the FDA must monitor the Internet and social media. The center, along with Consumers Union, will push for higher users fees to fund policing of the Web, she added.

At a meeting convened by the Food and Drug Administration, pharmaceutical and medical device manufacturers, advertisers, medical Web site owners, search engine companies, and consumer advocates argued for greater regulation of health-specific content on the Internet, including social media sites.

The agency sought opinions on how it could guide health-related communications and promotions for YouTube, Twitter, blogging, and social networking sites. No speakers from medical society or health care provider organizations attended.

The Food and Drug Administration will accept comments until Feb. 28, 2010, said Thomas W. Abrams, director of the FDA Center for Drug Evaluation and Research's division of drug marketing, advertising, and communications.

All speakers agreed that consumers and health care providers increasingly rely on the Internet for information about drugs, devices, and specific conditions, and to forge communities to share everything from caregiving recommendations to tips on how to perform a knee replacement.

They also agreed that there is much inaccurate and misleading information, which aas a great potential for harm to patients and their families, health care providers, and industries seeking credibility. Even as they seek to be the go-to place for accurate, scientific information, drug and device makers said they are wary—of social media in particular—because of the lack of FDA guidance.

Consumer groups raised the specter of pharmaceutical or device companies putting out purely promotional information that glosses over FDA rules requiring a fair balance of a product's risks and benefits.

Michele Sharp, senior director of United States Regulatory Affairs at Eli Lilly, said the company “had avoided significant interactions with providers and patients online” because of the FDA's lack of clarity. “We're looking to the FDA to provide leadership,” Ms. Sharp said.

Jeffrey K. Francer, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said “the FDA should facilitate manufacturers' communication of important medical information about their products in a responsible way.”

PhRMA has proposed that posts on social media sites be accompanied by an official logo that would signify that the information was officially sanctioned by the FDA. Tweets, limited to 140 characters, could provide hyperlinks to full risk and benefit information, Mr. Francer said.

He and other industry representatives said they wanted FDA to review information and promotional materials before they were posted on the Web. This would be a departure from current policy where only a small fraction of print or broadcast materials are reviewed in advance.

Some groups are trying to establish rules before FDA does. The Interactive Advertising Bureau is developing standards to provide “safe harbors” for the drug and device industry,.said IAB representative David Wright. The Social Media Working Group is discussing what drug companies can do to self-police, said Mark Gaydos, chairman, and a regulatory affairs director at Sanofi-Aventis U.S.

Google proposed its own standards for “sponsored” searches. The search result would include a link to the official drug site and a link at the end, “more info,” which would take users directly to the risk information, said Amy Cowan, head of industry for Google's health division. Results would include a short warning statement.

Consumer advocate Diana Zuckerman, Ph.D., president of the Washington-based National Research Center for Women and Families, said the FDA must monitor the Internet and social media. The center, along with Consumers Union, will push for higher users fees to fund policing of the Web, she added.

CMS Reviewing Ornish, Pritikin

The Centers for Medicare and Medicaid Services is reviewing evidence on two well-known cardiac-rehabilitation programs to determine whether they should be covered for Medicare beneficiaries. Late last year, the agency said it was accepting public comments during November and December on the Dean Ornish Program for Reversing Heart Disease and the Pritikin Program. The agency said that it expects to propose a decision on coverage of the two diet-and-lifestyle plans in May, and it will make a final determination in August.

…And Tobacco Counseling for All

The CMS is analyzing the effectiveness of counseling more Medicare beneficiaries to prevent tobacco use and tobacco-caused disease. Medicare pays for such services for beneficiaries who already have been diagnosed with “a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco disease.” The agency is now reviewing whether the evidence supports coverage of counseling for people who are asymptomatic. The CMS also is looking at the benefits for pregnant women who use tobacco products, with an eye toward expanding preventive services for that group as well. The agency expects to post its proposed decision in May.

Cardiac Cath Surveys Endorsed

The Society for Cardiovascular Angiography and Interventions is urging members, if called, to participate in a survey by the RBRVS (Resource-Based Relative Value Scale) Update Committee (RUC) on new CPT codes assigned to cardiac catheterization. A joint work group from the RUC and the CPT Editorial Panel agreed that certain codes should be bundled because they are reported together more than 95% of the time. For instance, diagnostic cardiac catheterization codes 93510-93529 were regularly reported with supervision and imaging codes 3555-93556 and at least one injection code 93539, 93540, or 93545. In October, the CPT panel approved 20 new codes: 11 catheter-placement codes, 2 new codes for reporting additional work associated with administering drugs and conducting exercise studies, and 7 new injection-imaging combination codes. Members should participate in the RUC survey process because it will have “a direct impact on the valuation assigned to these new codes,” according to the SCAI.

Drug Promotion Levels Off

After double-digit growth earlier in the decade, promotional spending for pharmaceuticals leveled off in 2008, according to a new study by the Congressional Budget Office. That year, drug makers spent $20 billion (or about 11% of total sales in the United States) on promotional activities. The companies spent $12 billion on detailing physicians and other health care providers, $3.4 billion on sponsoring professional meetings, and $400 million on journal advertising. The rest of the spending was on direct-to-consumer advertising. Much of the consumer spending was for television advertising (at $1.6 billion);, print ads cost the industry $900 million. Manufacturers spent only $93 million in 2008 to advertise online, to sponsor links in search engines, and to host product- or disease-specific Web sites. Just 10 drugs accounted for 30% of all direct-to-consumer spending.

CMS Reviewing Ornish, Pritikin

The Centers for Medicare and Medicaid Services is reviewing evidence on two well-known cardiac-rehabilitation programs to determine whether they should be covered for Medicare beneficiaries. Late last year, the agency said it was accepting public comments during November and December on the Dean Ornish Program for Reversing Heart Disease and the Pritikin Program. The agency said that it expects to propose a decision on coverage of the two diet-and-lifestyle plans in May, and it will make a final determination in August.

…And Tobacco Counseling for All

The CMS is analyzing the effectiveness of counseling more Medicare beneficiaries to prevent tobacco use and tobacco-caused disease. Medicare pays for such services for beneficiaries who already have been diagnosed with “a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco disease.” The agency is now reviewing whether the evidence supports coverage of counseling for people who are asymptomatic. The CMS also is looking at the benefits for pregnant women who use tobacco products, with an eye toward expanding preventive services for that group as well. The agency expects to post its proposed decision in May.

Cardiac Cath Surveys Endorsed

The Society for Cardiovascular Angiography and Interventions is urging members, if called, to participate in a survey by the RBRVS (Resource-Based Relative Value Scale) Update Committee (RUC) on new CPT codes assigned to cardiac catheterization. A joint work group from the RUC and the CPT Editorial Panel agreed that certain codes should be bundled because they are reported together more than 95% of the time. For instance, diagnostic cardiac catheterization codes 93510-93529 were regularly reported with supervision and imaging codes 3555-93556 and at least one injection code 93539, 93540, or 93545. In October, the CPT panel approved 20 new codes: 11 catheter-placement codes, 2 new codes for reporting additional work associated with administering drugs and conducting exercise studies, and 7 new injection-imaging combination codes. Members should participate in the RUC survey process because it will have “a direct impact on the valuation assigned to these new codes,” according to the SCAI.

Drug Promotion Levels Off

After double-digit growth earlier in the decade, promotional spending for pharmaceuticals leveled off in 2008, according to a new study by the Congressional Budget Office. That year, drug makers spent $20 billion (or about 11% of total sales in the United States) on promotional activities. The companies spent $12 billion on detailing physicians and other health care providers, $3.4 billion on sponsoring professional meetings, and $400 million on journal advertising. The rest of the spending was on direct-to-consumer advertising. Much of the consumer spending was for television advertising (at $1.6 billion);, print ads cost the industry $900 million. Manufacturers spent only $93 million in 2008 to advertise online, to sponsor links in search engines, and to host product- or disease-specific Web sites. Just 10 drugs accounted for 30% of all direct-to-consumer spending.

CMS Reviewing Ornish, Pritikin

The Centers for Medicare and Medicaid Services is reviewing evidence on two well-known cardiac-rehabilitation programs to determine whether they should be covered for Medicare beneficiaries. Late last year, the agency said it was accepting public comments during November and December on the Dean Ornish Program for Reversing Heart Disease and the Pritikin Program. The agency said that it expects to propose a decision on coverage of the two diet-and-lifestyle plans in May, and it will make a final determination in August.

…And Tobacco Counseling for All

The CMS is analyzing the effectiveness of counseling more Medicare beneficiaries to prevent tobacco use and tobacco-caused disease. Medicare pays for such services for beneficiaries who already have been diagnosed with “a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco disease.” The agency is now reviewing whether the evidence supports coverage of counseling for people who are asymptomatic. The CMS also is looking at the benefits for pregnant women who use tobacco products, with an eye toward expanding preventive services for that group as well. The agency expects to post its proposed decision in May.

Cardiac Cath Surveys Endorsed

The Society for Cardiovascular Angiography and Interventions is urging members, if called, to participate in a survey by the RBRVS (Resource-Based Relative Value Scale) Update Committee (RUC) on new CPT codes assigned to cardiac catheterization. A joint work group from the RUC and the CPT Editorial Panel agreed that certain codes should be bundled because they are reported together more than 95% of the time. For instance, diagnostic cardiac catheterization codes 93510-93529 were regularly reported with supervision and imaging codes 3555-93556 and at least one injection code 93539, 93540, or 93545. In October, the CPT panel approved 20 new codes: 11 catheter-placement codes, 2 new codes for reporting additional work associated with administering drugs and conducting exercise studies, and 7 new injection-imaging combination codes. Members should participate in the RUC survey process because it will have “a direct impact on the valuation assigned to these new codes,” according to the SCAI.

Drug Promotion Levels Off

After double-digit growth earlier in the decade, promotional spending for pharmaceuticals leveled off in 2008, according to a new study by the Congressional Budget Office. That year, drug makers spent $20 billion (or about 11% of total sales in the United States) on promotional activities. The companies spent $12 billion on detailing physicians and other health care providers, $3.4 billion on sponsoring professional meetings, and $400 million on journal advertising. The rest of the spending was on direct-to-consumer advertising. Much of the consumer spending was for television advertising (at $1.6 billion);, print ads cost the industry $900 million. Manufacturers spent only $93 million in 2008 to advertise online, to sponsor links in search engines, and to host product- or disease-specific Web sites. Just 10 drugs accounted for 30% of all direct-to-consumer spending.

WASHINGTON — The number of teenagers reporting marijuana use is up slightly over the last 2 years, along with the proportion of those reporting any illicit drug use, according to the biannual Monitoring the Future survey, which is conducted for the National Institute on Drug Abuse.

The survey is being conducted by the University of Michigan for NIDA and queries 8th, 10th, and 12th graders about drug, alcohol, and tobacco use and also about attitudes and behaviors. This year, 46,097 students from 389 public and private schools participated.

The increase in illicit drug use was largely accounted for by the rise in marijuana use because it is the most widely used drug, reportedly used by 33% of 12th graders, said Lloyd Johnston, Ph.D., the lead author of the survey and a research professor at the University of Michigan's Institute for Social Research, Ann Arbor. Alcohol is the most widely used substance; 66% of 12th graders said they'd used alcohol in the previous year.

Dr. Johnston, joined by NIDA director Nora Volkow and White House Office of National Drug Control Policy director, R. Gil Kerlikowske all said the report contained both good and bad news.

“We are containing the drug use problem among America's young people,” said Mr. Kerlikowske, who joined the ONDCP after a 37-year career in law enforcement, most recently, as chief of police for Seattle. But, said Mr. Kerlikowske, “is containment really what we're after? I would argue that certainly, it is not.”

He said that President Obama would issue his National Drug Control Strategy in February.

The number of high school seniors reporting methamphetamine use in the past year was 1.2%, the lowest since teens were first asked about the drug in 1999. Cigarette smoking also is at an all-time low among the 8th, 10th, and 12th graders surveyed. A total of 11% percent of high school seniors said they smoked daily, which is half the peak rate of 25% in 1997.

Seniors also reported declining use of hallucinogens—particularly LSD—and cocaine, and younger students said that it was harder to access cocaine, sedatives, heroin, and crystal methamphetamine. And they also had an increased perception that LSD, amphetamines, sedatives, heroin, and cocaine were dangerous.

Attitudes about harmfulness generally portend future use trends, said Mr. Kerlikowske. Marijuana rates stayed steady for most of the last 5 years but had a slight uptick each of the last 2 years. Meanwhile, over the same period, the number of eighth graders who reported that marijuana use was harmful fell from 76% to 70%. Fewer teenagers report personal disapproval of marijuana, also.

Rates of prescription drug use reported by survey participants had not risen but are still at peak levels, Dr. Johnston said. A total of 10% of seniors reported Vicodin use in the last 12 months, and 6% reported using amphetamines and tranquilizers.

WASHINGTON — The number of teenagers reporting marijuana use is up slightly over the last 2 years, along with the proportion of those reporting any illicit drug use, according to the biannual Monitoring the Future survey, which is conducted for the National Institute on Drug Abuse.

The survey is being conducted by the University of Michigan for NIDA and queries 8th, 10th, and 12th graders about drug, alcohol, and tobacco use and also about attitudes and behaviors. This year, 46,097 students from 389 public and private schools participated.

The increase in illicit drug use was largely accounted for by the rise in marijuana use because it is the most widely used drug, reportedly used by 33% of 12th graders, said Lloyd Johnston, Ph.D., the lead author of the survey and a research professor at the University of Michigan's Institute for Social Research, Ann Arbor. Alcohol is the most widely used substance; 66% of 12th graders said they'd used alcohol in the previous year.

Dr. Johnston, joined by NIDA director Nora Volkow and White House Office of National Drug Control Policy director, R. Gil Kerlikowske all said the report contained both good and bad news.

“We are containing the drug use problem among America's young people,” said Mr. Kerlikowske, who joined the ONDCP after a 37-year career in law enforcement, most recently, as chief of police for Seattle. But, said Mr. Kerlikowske, “is containment really what we're after? I would argue that certainly, it is not.”

He said that President Obama would issue his National Drug Control Strategy in February.

The number of high school seniors reporting methamphetamine use in the past year was 1.2%, the lowest since teens were first asked about the drug in 1999. Cigarette smoking also is at an all-time low among the 8th, 10th, and 12th graders surveyed. A total of 11% percent of high school seniors said they smoked daily, which is half the peak rate of 25% in 1997.

Seniors also reported declining use of hallucinogens—particularly LSD—and cocaine, and younger students said that it was harder to access cocaine, sedatives, heroin, and crystal methamphetamine. And they also had an increased perception that LSD, amphetamines, sedatives, heroin, and cocaine were dangerous.

Attitudes about harmfulness generally portend future use trends, said Mr. Kerlikowske. Marijuana rates stayed steady for most of the last 5 years but had a slight uptick each of the last 2 years. Meanwhile, over the same period, the number of eighth graders who reported that marijuana use was harmful fell from 76% to 70%. Fewer teenagers report personal disapproval of marijuana, also.

Rates of prescription drug use reported by survey participants had not risen but are still at peak levels, Dr. Johnston said. A total of 10% of seniors reported Vicodin use in the last 12 months, and 6% reported using amphetamines and tranquilizers.

WASHINGTON — The number of teenagers reporting marijuana use is up slightly over the last 2 years, along with the proportion of those reporting any illicit drug use, according to the biannual Monitoring the Future survey, which is conducted for the National Institute on Drug Abuse.

The survey is being conducted by the University of Michigan for NIDA and queries 8th, 10th, and 12th graders about drug, alcohol, and tobacco use and also about attitudes and behaviors. This year, 46,097 students from 389 public and private schools participated.

The increase in illicit drug use was largely accounted for by the rise in marijuana use because it is the most widely used drug, reportedly used by 33% of 12th graders, said Lloyd Johnston, Ph.D., the lead author of the survey and a research professor at the University of Michigan's Institute for Social Research, Ann Arbor. Alcohol is the most widely used substance; 66% of 12th graders said they'd used alcohol in the previous year.

Dr. Johnston, joined by NIDA director Nora Volkow and White House Office of National Drug Control Policy director, R. Gil Kerlikowske all said the report contained both good and bad news.

“We are containing the drug use problem among America's young people,” said Mr. Kerlikowske, who joined the ONDCP after a 37-year career in law enforcement, most recently, as chief of police for Seattle. But, said Mr. Kerlikowske, “is containment really what we're after? I would argue that certainly, it is not.”

He said that President Obama would issue his National Drug Control Strategy in February.

The number of high school seniors reporting methamphetamine use in the past year was 1.2%, the lowest since teens were first asked about the drug in 1999. Cigarette smoking also is at an all-time low among the 8th, 10th, and 12th graders surveyed. A total of 11% percent of high school seniors said they smoked daily, which is half the peak rate of 25% in 1997.

Seniors also reported declining use of hallucinogens—particularly LSD—and cocaine, and younger students said that it was harder to access cocaine, sedatives, heroin, and crystal methamphetamine. And they also had an increased perception that LSD, amphetamines, sedatives, heroin, and cocaine were dangerous.

Attitudes about harmfulness generally portend future use trends, said Mr. Kerlikowske. Marijuana rates stayed steady for most of the last 5 years but had a slight uptick each of the last 2 years. Meanwhile, over the same period, the number of eighth graders who reported that marijuana use was harmful fell from 76% to 70%. Fewer teenagers report personal disapproval of marijuana, also.

Rates of prescription drug use reported by survey participants had not risen but are still at peak levels, Dr. Johnston said. A total of 10% of seniors reported Vicodin use in the last 12 months, and 6% reported using amphetamines and tranquilizers.