Alicia Ault

NEW ORLEANS — Getting reimbursed is the top concern for physicians who offer the human papillomavirus vaccine, according to a survey by researchers at Brigham and Women's Hospital, Boston.

Using a Web-based tool, Brigham resident Dr. Emily M. Ko and colleagues surveyed 1,488 physicians who practiced with the Partners HealthCare System from May to July 2007. Overall, 424 physicians participated, of whom 87 (21%) were ob.gyns., 196 (46%) were internists, and 104 (25%) were pediatricians, said Dr. Ko in a poster at the annual meeting of the American College of Obstetricians and Gynecologists.

Of those who participated, 80% said they offer the HPV vaccine. That included 92% of pediatricians, 81% of ob.gyns., and 78% of internists. Male physicians were 54% less likely to provide the vaccine than were female physicians. The survey did not ask questions that would determine why some might be less likely to offer the vaccine, Dr. Ko said in an interview.

Physicians in community hospitals were twice as likely to offer the vaccine as were those at tertiary care facilities. Primary care physicians were 14 times more likely than specialists to offer it. Overall, the respondents cited reimbursement as the main hurdle to offering the vaccine. Most (95%) physicians said it would not promote promiscuity or decrease condom use, 3% were neutral, and 1.4% said it might promote promiscuity. There was no difference between genders or in specialties on the promiscuity issue, though 7% of physicians said parents might fear vaccination would promote promiscuity, and 19% of pediatricians said parental fear was a barrier.

Dr. Ko reported no conflicts of interest.

NEW ORLEANS — Getting reimbursed is the top concern for physicians who offer the human papillomavirus vaccine, according to a survey by researchers at Brigham and Women's Hospital, Boston.

Using a Web-based tool, Brigham resident Dr. Emily M. Ko and colleagues surveyed 1,488 physicians who practiced with the Partners HealthCare System from May to July 2007. Overall, 424 physicians participated, of whom 87 (21%) were ob.gyns., 196 (46%) were internists, and 104 (25%) were pediatricians, said Dr. Ko in a poster at the annual meeting of the American College of Obstetricians and Gynecologists.

Of those who participated, 80% said they offer the HPV vaccine. That included 92% of pediatricians, 81% of ob.gyns., and 78% of internists. Male physicians were 54% less likely to provide the vaccine than were female physicians. The survey did not ask questions that would determine why some might be less likely to offer the vaccine, Dr. Ko said in an interview.

Physicians in community hospitals were twice as likely to offer the vaccine as were those at tertiary care facilities. Primary care physicians were 14 times more likely than specialists to offer it. Overall, the respondents cited reimbursement as the main hurdle to offering the vaccine. Most (95%) physicians said it would not promote promiscuity or decrease condom use, 3% were neutral, and 1.4% said it might promote promiscuity. There was no difference between genders or in specialties on the promiscuity issue, though 7% of physicians said parents might fear vaccination would promote promiscuity, and 19% of pediatricians said parental fear was a barrier.

Dr. Ko reported no conflicts of interest.

NEW ORLEANS — Getting reimbursed is the top concern for physicians who offer the human papillomavirus vaccine, according to a survey by researchers at Brigham and Women's Hospital, Boston.

Using a Web-based tool, Brigham resident Dr. Emily M. Ko and colleagues surveyed 1,488 physicians who practiced with the Partners HealthCare System from May to July 2007. Overall, 424 physicians participated, of whom 87 (21%) were ob.gyns., 196 (46%) were internists, and 104 (25%) were pediatricians, said Dr. Ko in a poster at the annual meeting of the American College of Obstetricians and Gynecologists.

Of those who participated, 80% said they offer the HPV vaccine. That included 92% of pediatricians, 81% of ob.gyns., and 78% of internists. Male physicians were 54% less likely to provide the vaccine than were female physicians. The survey did not ask questions that would determine why some might be less likely to offer the vaccine, Dr. Ko said in an interview.

Physicians in community hospitals were twice as likely to offer the vaccine as were those at tertiary care facilities. Primary care physicians were 14 times more likely than specialists to offer it. Overall, the respondents cited reimbursement as the main hurdle to offering the vaccine. Most (95%) physicians said it would not promote promiscuity or decrease condom use, 3% were neutral, and 1.4% said it might promote promiscuity. There was no difference between genders or in specialties on the promiscuity issue, though 7% of physicians said parents might fear vaccination would promote promiscuity, and 19% of pediatricians said parental fear was a barrier.

Dr. Ko reported no conflicts of interest.

Even though the Bush administration has made it nearly impossible to expand the State Children's Health Insurance Program, and the economic downturn has put a squeeze on Medicaid budgets, many states are keeping children covered and some are even expanding eligibility, according to two new studies by Families USA.

Officials at the advocacy organization, based in Washington, D.C., said that at the end of 2007, 17 states were considering expanding coverage for children under SCHIP and Medicaid. But those plans were largely put on hold or scaled back because of President Bush's vetoes of the original SCHIP reauthorization package. A law authorizing the program at 2007 levels expires in March 2009.

Another setback for states came last August, when the Bush administration issued a directive that limited the SCHIP eligibility, going forward, of families with incomes at or below 250% of the federal poverty level.

That directive has remained essentially unchanged, although the Centers for Medicare and Medicaid Services announced in May that it would look at expansion programs on a case-by-case basis.

Expansion plans by New York and Ohio were rejected by CMS, but New York used state funds to expand coverage to children living in families with incomes up to 400% of the poverty level. Ohio is using state money to cover children who can't get private health coverage, but the expansion is not through Medicaid or SCHIP, according to the Families USA report, “Detour on the Road to Kids Coverage: Administration Creates Roadblocks, So States Seek Alternative Routes.”

Ohio also raised eligibility to the federal ceiling (250% of the poverty level).

Indiana, Louisiana, Oklahoma, and Wisconsin had planned to raise eligibility for their programs to 300% of the poverty level, but have now scaled that back to 250%, according to the Detour report. Finally, North Carolina, Washington state, and West Virginia also had expansion plans, but have not yet submitted them to CMS, according to the report. It is not clear yet how those states will proceed.

Despite the CMS directive and the bleak economic outlook, some states–including Colorado, Florida, Iowa, and Kansas–are planning to expand coverage next year. The expansions in Iowa and Kansas, however, depend on a reauthorization of the SCHIP program, according to the Detour report.

There also may be a ballot measure in Montana this fall aimed at increasing eligibility from 175% to 250% of poverty level.

California is currently wrangling over the state's budget, which included an increase in cost sharing for SCHIP (which is called “Healthy Families” in California) as well as reduced Medicaid coverage for parents. Rhode Island is also looking at paring back its SCHIP coverage in fiscal 2009 and increasing cost sharing for families.

“States are committed to covering kids, but they are clearly hampered by the roadblocks the administration has put up,” said Families USA senior policy analyst Jenny Sullivan in a briefing with reporters.

Most states are also feeling the pinch as tax revenues recede while Medicaid costs–increasingly a larger proportion of most state budgets–continue to rise, according to the second Families USA report, “Precarious Position: States Must Balance Declining Revenues With a Growing Need for Medicaid.” The report found that 16 states and Puerto Rico are looking at budget deficits in fiscal year 2008, and 29 states and the District of Columbia are looking at shortfalls in fiscal 2009.

Increasing unemployment means more Americans will turn to Medicaid for health coverage for them and their children, said the organization. The Medicaid report cited a study by the Kaiser Family Foundation showing that a 1% rise in unemployment increases Medicaid and SCHIP enrollment by 1 million, leaving states with an additional $1.4 billion obligation.

In California, Gov. Arnold Schwarzenegger (R) has proposed $1 billion in Medicaid and SCHIP cuts. That means the state would lose an additional $1 billion in federal matching funds–a danger that all states face as they look to balance their budgets through Medicaid cuts, according to the Medicaid report. Mississippi is also considering Medicaid cuts in a special legislative session. Maine instituted some cost-sharing measures; New Jersey is considering shifting more of the burden onto Medicaid recipients. In Rhode Island's 2008 budget, eligibility was reduced for parents and cost sharing was increased; premium payments based on income are required, and the state is looking at further cuts in 2009, according to the report.

Families USA is pushing for federal relief, such as a temporary increase in the matching rate given to states for Medicaid. Congress passed such a fix in 2003, but it is unclear whether a proposed fix could make it out of Congress this year, said a Families USA staffer in the briefing.

Even though the Bush administration has made it nearly impossible to expand the State Children's Health Insurance Program, and the economic downturn has put a squeeze on Medicaid budgets, many states are keeping children covered and some are even expanding eligibility, according to two new studies by Families USA.

Officials at the advocacy organization, based in Washington, D.C., said that at the end of 2007, 17 states were considering expanding coverage for children under SCHIP and Medicaid. But those plans were largely put on hold or scaled back because of President Bush's vetoes of the original SCHIP reauthorization package. A law authorizing the program at 2007 levels expires in March 2009.

Another setback for states came last August, when the Bush administration issued a directive that limited the SCHIP eligibility, going forward, of families with incomes at or below 250% of the federal poverty level.

That directive has remained essentially unchanged, although the Centers for Medicare and Medicaid Services announced in May that it would look at expansion programs on a case-by-case basis.

Expansion plans by New York and Ohio were rejected by CMS, but New York used state funds to expand coverage to children living in families with incomes up to 400% of the poverty level. Ohio is using state money to cover children who can't get private health coverage, but the expansion is not through Medicaid or SCHIP, according to the Families USA report, “Detour on the Road to Kids Coverage: Administration Creates Roadblocks, So States Seek Alternative Routes.”

Ohio also raised eligibility to the federal ceiling (250% of the poverty level).

Indiana, Louisiana, Oklahoma, and Wisconsin had planned to raise eligibility for their programs to 300% of the poverty level, but have now scaled that back to 250%, according to the Detour report. Finally, North Carolina, Washington state, and West Virginia also had expansion plans, but have not yet submitted them to CMS, according to the report. It is not clear yet how those states will proceed.

Despite the CMS directive and the bleak economic outlook, some states–including Colorado, Florida, Iowa, and Kansas–are planning to expand coverage next year. The expansions in Iowa and Kansas, however, depend on a reauthorization of the SCHIP program, according to the Detour report.

There also may be a ballot measure in Montana this fall aimed at increasing eligibility from 175% to 250% of poverty level.

California is currently wrangling over the state's budget, which included an increase in cost sharing for SCHIP (which is called “Healthy Families” in California) as well as reduced Medicaid coverage for parents. Rhode Island is also looking at paring back its SCHIP coverage in fiscal 2009 and increasing cost sharing for families.

“States are committed to covering kids, but they are clearly hampered by the roadblocks the administration has put up,” said Families USA senior policy analyst Jenny Sullivan in a briefing with reporters.

Most states are also feeling the pinch as tax revenues recede while Medicaid costs–increasingly a larger proportion of most state budgets–continue to rise, according to the second Families USA report, “Precarious Position: States Must Balance Declining Revenues With a Growing Need for Medicaid.” The report found that 16 states and Puerto Rico are looking at budget deficits in fiscal year 2008, and 29 states and the District of Columbia are looking at shortfalls in fiscal 2009.

Increasing unemployment means more Americans will turn to Medicaid for health coverage for them and their children, said the organization. The Medicaid report cited a study by the Kaiser Family Foundation showing that a 1% rise in unemployment increases Medicaid and SCHIP enrollment by 1 million, leaving states with an additional $1.4 billion obligation.

In California, Gov. Arnold Schwarzenegger (R) has proposed $1 billion in Medicaid and SCHIP cuts. That means the state would lose an additional $1 billion in federal matching funds–a danger that all states face as they look to balance their budgets through Medicaid cuts, according to the Medicaid report. Mississippi is also considering Medicaid cuts in a special legislative session. Maine instituted some cost-sharing measures; New Jersey is considering shifting more of the burden onto Medicaid recipients. In Rhode Island's 2008 budget, eligibility was reduced for parents and cost sharing was increased; premium payments based on income are required, and the state is looking at further cuts in 2009, according to the report.

Families USA is pushing for federal relief, such as a temporary increase in the matching rate given to states for Medicaid. Congress passed such a fix in 2003, but it is unclear whether a proposed fix could make it out of Congress this year, said a Families USA staffer in the briefing.

Even though the Bush administration has made it nearly impossible to expand the State Children's Health Insurance Program, and the economic downturn has put a squeeze on Medicaid budgets, many states are keeping children covered and some are even expanding eligibility, according to two new studies by Families USA.

Officials at the advocacy organization, based in Washington, D.C., said that at the end of 2007, 17 states were considering expanding coverage for children under SCHIP and Medicaid. But those plans were largely put on hold or scaled back because of President Bush's vetoes of the original SCHIP reauthorization package. A law authorizing the program at 2007 levels expires in March 2009.

Another setback for states came last August, when the Bush administration issued a directive that limited the SCHIP eligibility, going forward, of families with incomes at or below 250% of the federal poverty level.

That directive has remained essentially unchanged, although the Centers for Medicare and Medicaid Services announced in May that it would look at expansion programs on a case-by-case basis.

Expansion plans by New York and Ohio were rejected by CMS, but New York used state funds to expand coverage to children living in families with incomes up to 400% of the poverty level. Ohio is using state money to cover children who can't get private health coverage, but the expansion is not through Medicaid or SCHIP, according to the Families USA report, “Detour on the Road to Kids Coverage: Administration Creates Roadblocks, So States Seek Alternative Routes.”

Ohio also raised eligibility to the federal ceiling (250% of the poverty level).

Indiana, Louisiana, Oklahoma, and Wisconsin had planned to raise eligibility for their programs to 300% of the poverty level, but have now scaled that back to 250%, according to the Detour report. Finally, North Carolina, Washington state, and West Virginia also had expansion plans, but have not yet submitted them to CMS, according to the report. It is not clear yet how those states will proceed.

Despite the CMS directive and the bleak economic outlook, some states–including Colorado, Florida, Iowa, and Kansas–are planning to expand coverage next year. The expansions in Iowa and Kansas, however, depend on a reauthorization of the SCHIP program, according to the Detour report.

There also may be a ballot measure in Montana this fall aimed at increasing eligibility from 175% to 250% of poverty level.

California is currently wrangling over the state's budget, which included an increase in cost sharing for SCHIP (which is called “Healthy Families” in California) as well as reduced Medicaid coverage for parents. Rhode Island is also looking at paring back its SCHIP coverage in fiscal 2009 and increasing cost sharing for families.

“States are committed to covering kids, but they are clearly hampered by the roadblocks the administration has put up,” said Families USA senior policy analyst Jenny Sullivan in a briefing with reporters.

Most states are also feeling the pinch as tax revenues recede while Medicaid costs–increasingly a larger proportion of most state budgets–continue to rise, according to the second Families USA report, “Precarious Position: States Must Balance Declining Revenues With a Growing Need for Medicaid.” The report found that 16 states and Puerto Rico are looking at budget deficits in fiscal year 2008, and 29 states and the District of Columbia are looking at shortfalls in fiscal 2009.

Increasing unemployment means more Americans will turn to Medicaid for health coverage for them and their children, said the organization. The Medicaid report cited a study by the Kaiser Family Foundation showing that a 1% rise in unemployment increases Medicaid and SCHIP enrollment by 1 million, leaving states with an additional $1.4 billion obligation.

In California, Gov. Arnold Schwarzenegger (R) has proposed $1 billion in Medicaid and SCHIP cuts. That means the state would lose an additional $1 billion in federal matching funds–a danger that all states face as they look to balance their budgets through Medicaid cuts, according to the Medicaid report. Mississippi is also considering Medicaid cuts in a special legislative session. Maine instituted some cost-sharing measures; New Jersey is considering shifting more of the burden onto Medicaid recipients. In Rhode Island's 2008 budget, eligibility was reduced for parents and cost sharing was increased; premium payments based on income are required, and the state is looking at further cuts in 2009, according to the report.

Families USA is pushing for federal relief, such as a temporary increase in the matching rate given to states for Medicaid. Congress passed such a fix in 2003, but it is unclear whether a proposed fix could make it out of Congress this year, said a Families USA staffer in the briefing.

The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percent below the update for 2008. As expected, reporting on quality of care is being tied to the amount of increase hospitals and other outpatient providers will receive.

For the first time, hospitals and other recipients of payments under the outpatient system that do not report data on seven quality measures on emergency department and perioperative care will see only a 1% increase.

The proposed rule, issued in July, also outlines changes for ambulatory surgery centers (ASCs) that are part of a 4-year transition to a new payment system that began this year. In 2009, as was the case this year, ASCs would be paid 65% of the rate paid for the same service in an outpatient hospital department.

The agency estimates it will spend $29 billion in 2009 on payments to acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute-care hospitals, community mental health centers, children's hospitals, and cancer hospitals. That's $2 billion more than the estimated $27 billion CMS will spend on such services this year, said the agency.

“The changes proposed for 2009 are intended to give hospitals greater flexibility to manage their resources and give them incentives to improve efficiency so that both beneficiaries and taxpayers get the most value for their health care dollar,” said CMS Acting Administrator Kerry Weems in a statement.

CMS is proposing to more aggressively penalize hospitals and other outpatient providers that do not report quality data. Providers must report on 7 measures in 2008 and on 11 in 2009, including 4 imaging efficiency measures. In addition, the agency is seeking to reduce copayments for beneficiaries who are treated at hospitals that do not report quality data.

By law, Medicare is gradually changing the payment system so that beneficiaries will be liable for only 20% of a covered service. The coinsurance rate has varied widely over the last 8-10 years. In 2009, about 25% of services will be subject to the 20% coinsurance, up from 23% in 2008, said CMS.

For imaging–a huge and growing portion of Medicare expenditures–CMS would make a single payment for multiple imaging procedures performed in a single hospital session, including ultrasound, computed tomography, and magnetic resonance imaging.

CMS also proposes reducing pay for some of the higher-cost device-oriented procedures: a 48% reduction in pay for the placing of left ventricular pacing add-on leads; a 3% decrease for replacing pacemakers, electrodes, or pulse generators; and 4% for stent placement.

A small increase is proposed for most neurology devices, but placement of neurostimulator electrodes would be slashed by 52%.

For ASCs, reimbursement would decrease for 92 procedures, but increase for 2,475 procedures, according to the Ambulatory Surgery Center Association. Gastrointestinal procedures as a whole are slated for a 6% reduction, and nervous system procedures and pain management would be reduced by 3%, according to Washington Analysis, a firm that advises investors on health policy developments.

Finally, the agency said that it is proposing to create four new ambulatory payment classifications for type B emergency departments (those that offer emergency-level services but are not open 24 hours a day, 7 days a week). According to data collected by CMS, most type B emergency visits are more expensive than a clinic visit, but less expensive than a visit to a traditional emergency department. The goal is to make payment for the type B centers more reflective of actual costs.

CMS is accepting public comments on the proposals until Sept. 2 and expects to issue the final rule Nov. 1.

The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percent below the update for 2008. As expected, reporting on quality of care is being tied to the amount of increase hospitals and other outpatient providers will receive.

For the first time, hospitals and other recipients of payments under the outpatient system that do not report data on seven quality measures on emergency department and perioperative care will see only a 1% increase.

The proposed rule, issued in July, also outlines changes for ambulatory surgery centers (ASCs) that are part of a 4-year transition to a new payment system that began this year. In 2009, as was the case this year, ASCs would be paid 65% of the rate paid for the same service in an outpatient hospital department.

The agency estimates it will spend $29 billion in 2009 on payments to acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute-care hospitals, community mental health centers, children's hospitals, and cancer hospitals. That's $2 billion more than the estimated $27 billion CMS will spend on such services this year, said the agency.

“The changes proposed for 2009 are intended to give hospitals greater flexibility to manage their resources and give them incentives to improve efficiency so that both beneficiaries and taxpayers get the most value for their health care dollar,” said CMS Acting Administrator Kerry Weems in a statement.

CMS is proposing to more aggressively penalize hospitals and other outpatient providers that do not report quality data. Providers must report on 7 measures in 2008 and on 11 in 2009, including 4 imaging efficiency measures. In addition, the agency is seeking to reduce copayments for beneficiaries who are treated at hospitals that do not report quality data.

By law, Medicare is gradually changing the payment system so that beneficiaries will be liable for only 20% of a covered service. The coinsurance rate has varied widely over the last 8-10 years. In 2009, about 25% of services will be subject to the 20% coinsurance, up from 23% in 2008, said CMS.

For imaging–a huge and growing portion of Medicare expenditures–CMS would make a single payment for multiple imaging procedures performed in a single hospital session, including ultrasound, computed tomography, and magnetic resonance imaging.

CMS also proposes reducing pay for some of the higher-cost device-oriented procedures: a 48% reduction in pay for the placing of left ventricular pacing add-on leads; a 3% decrease for replacing pacemakers, electrodes, or pulse generators; and 4% for stent placement.

A small increase is proposed for most neurology devices, but placement of neurostimulator electrodes would be slashed by 52%.

For ASCs, reimbursement would decrease for 92 procedures, but increase for 2,475 procedures, according to the Ambulatory Surgery Center Association. Gastrointestinal procedures as a whole are slated for a 6% reduction, and nervous system procedures and pain management would be reduced by 3%, according to Washington Analysis, a firm that advises investors on health policy developments.

Finally, the agency said that it is proposing to create four new ambulatory payment classifications for type B emergency departments (those that offer emergency-level services but are not open 24 hours a day, 7 days a week). According to data collected by CMS, most type B emergency visits are more expensive than a clinic visit, but less expensive than a visit to a traditional emergency department. The goal is to make payment for the type B centers more reflective of actual costs.

CMS is accepting public comments on the proposals until Sept. 2 and expects to issue the final rule Nov. 1.

The Centers for Medicare and Medicaid Services has proposed an overall 3% increase in payments for outpatient hospital care in 2009, almost a full percent below the update for 2008. As expected, reporting on quality of care is being tied to the amount of increase hospitals and other outpatient providers will receive.

For the first time, hospitals and other recipients of payments under the outpatient system that do not report data on seven quality measures on emergency department and perioperative care will see only a 1% increase.

The proposed rule, issued in July, also outlines changes for ambulatory surgery centers (ASCs) that are part of a 4-year transition to a new payment system that began this year. In 2009, as was the case this year, ASCs would be paid 65% of the rate paid for the same service in an outpatient hospital department.

The agency estimates it will spend $29 billion in 2009 on payments to acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute-care hospitals, community mental health centers, children's hospitals, and cancer hospitals. That's $2 billion more than the estimated $27 billion CMS will spend on such services this year, said the agency.

“The changes proposed for 2009 are intended to give hospitals greater flexibility to manage their resources and give them incentives to improve efficiency so that both beneficiaries and taxpayers get the most value for their health care dollar,” said CMS Acting Administrator Kerry Weems in a statement.

CMS is proposing to more aggressively penalize hospitals and other outpatient providers that do not report quality data. Providers must report on 7 measures in 2008 and on 11 in 2009, including 4 imaging efficiency measures. In addition, the agency is seeking to reduce copayments for beneficiaries who are treated at hospitals that do not report quality data.

By law, Medicare is gradually changing the payment system so that beneficiaries will be liable for only 20% of a covered service. The coinsurance rate has varied widely over the last 8-10 years. In 2009, about 25% of services will be subject to the 20% coinsurance, up from 23% in 2008, said CMS.

For imaging–a huge and growing portion of Medicare expenditures–CMS would make a single payment for multiple imaging procedures performed in a single hospital session, including ultrasound, computed tomography, and magnetic resonance imaging.

CMS also proposes reducing pay for some of the higher-cost device-oriented procedures: a 48% reduction in pay for the placing of left ventricular pacing add-on leads; a 3% decrease for replacing pacemakers, electrodes, or pulse generators; and 4% for stent placement.

A small increase is proposed for most neurology devices, but placement of neurostimulator electrodes would be slashed by 52%.

For ASCs, reimbursement would decrease for 92 procedures, but increase for 2,475 procedures, according to the Ambulatory Surgery Center Association. Gastrointestinal procedures as a whole are slated for a 6% reduction, and nervous system procedures and pain management would be reduced by 3%, according to Washington Analysis, a firm that advises investors on health policy developments.

Finally, the agency said that it is proposing to create four new ambulatory payment classifications for type B emergency departments (those that offer emergency-level services but are not open 24 hours a day, 7 days a week). According to data collected by CMS, most type B emergency visits are more expensive than a clinic visit, but less expensive than a visit to a traditional emergency department. The goal is to make payment for the type B centers more reflective of actual costs.

CMS is accepting public comments on the proposals until Sept. 2 and expects to issue the final rule Nov. 1.

SAN FRANCISCO – With a new president and a likely Democratic majority in the House and Senate, conditions will be ripe for health care reform in early 2009, a bipartisan group of political insiders predicts.

The Democrats who spoke at Institute 2008, a meeting sponsored by America's Health Insurance Plans, were most certain of impending change. One Republican said he was optimistic, and two of his colleagues hedged their bets.

“I think something's going to happen in the next Congress,” said former Sen. John Breaux (D-La.). Sen. Breaux noted that Congress is likely to be “dramatically different” next year.

Terry McAuliffe, longtime aide to former President Clinton and Sen. Hillary Clinton (D-N.Y.), pointed out that 100 seats are up for grabs in the House and Senate; he predicted that Democrats would take at least 4-7 of the Senate seats and garner a majority in both houses of Congress.

Why is this important? Traditionally, Democrats have called for bigger reforms and more government intervention, and Sen. Barack Obama (D-Ill.) is following that lead, Mr. McAuliffe said.

Despite concerns over the economy, energy prices, and taxes, “health care will be the number one domestic issue” in the presidential campaign and in the Congress early next year because “it affects everybody,” he said.

“I do think health care will be still at the top of the list of things that need to get done,” agreed Sen. Breaux.

Tommy G. Thompson, who served as Health and Human Services secretary under President George W. Bush, agreed with the Democrats that health reform was likely next year. He said he was optimistic because candidates for the House and Senate and both presidential contenders were talking about reform.

He said there were many pressing issues to address, including a looming shortage of physicians and nurses and the predicted bankruptcy of the Medicare Hospital Insurance Trust Fund in the next 5-10 years.

Former Sen. Bill Frist (R-Tenn.) agreed that the Medicare trust fund would get lawmakers' attention early in the next Congress. But he said, “I'm not quite as optimistic that we'll see reform.”

Sen. Frist said he does not think health care reform will be a priority until the American people make it one. In 1993, during the last major attempt at reform, 42% of Americans said the old system needed to be scrapped; “today we're at 34%.”

And, he said, the cost of adding coverage will have to be addressed, which could create some unsettling political realities.

SAN FRANCISCO – With a new president and a likely Democratic majority in the House and Senate, conditions will be ripe for health care reform in early 2009, a bipartisan group of political insiders predicts.

The Democrats who spoke at Institute 2008, a meeting sponsored by America's Health Insurance Plans, were most certain of impending change. One Republican said he was optimistic, and two of his colleagues hedged their bets.

“I think something's going to happen in the next Congress,” said former Sen. John Breaux (D-La.). Sen. Breaux noted that Congress is likely to be “dramatically different” next year.

Terry McAuliffe, longtime aide to former President Clinton and Sen. Hillary Clinton (D-N.Y.), pointed out that 100 seats are up for grabs in the House and Senate; he predicted that Democrats would take at least 4-7 of the Senate seats and garner a majority in both houses of Congress.

Why is this important? Traditionally, Democrats have called for bigger reforms and more government intervention, and Sen. Barack Obama (D-Ill.) is following that lead, Mr. McAuliffe said.

Despite concerns over the economy, energy prices, and taxes, “health care will be the number one domestic issue” in the presidential campaign and in the Congress early next year because “it affects everybody,” he said.

“I do think health care will be still at the top of the list of things that need to get done,” agreed Sen. Breaux.

Tommy G. Thompson, who served as Health and Human Services secretary under President George W. Bush, agreed with the Democrats that health reform was likely next year. He said he was optimistic because candidates for the House and Senate and both presidential contenders were talking about reform.

He said there were many pressing issues to address, including a looming shortage of physicians and nurses and the predicted bankruptcy of the Medicare Hospital Insurance Trust Fund in the next 5-10 years.

Former Sen. Bill Frist (R-Tenn.) agreed that the Medicare trust fund would get lawmakers' attention early in the next Congress. But he said, “I'm not quite as optimistic that we'll see reform.”

Sen. Frist said he does not think health care reform will be a priority until the American people make it one. In 1993, during the last major attempt at reform, 42% of Americans said the old system needed to be scrapped; “today we're at 34%.”

And, he said, the cost of adding coverage will have to be addressed, which could create some unsettling political realities.

SAN FRANCISCO – With a new president and a likely Democratic majority in the House and Senate, conditions will be ripe for health care reform in early 2009, a bipartisan group of political insiders predicts.

The Democrats who spoke at Institute 2008, a meeting sponsored by America's Health Insurance Plans, were most certain of impending change. One Republican said he was optimistic, and two of his colleagues hedged their bets.

“I think something's going to happen in the next Congress,” said former Sen. John Breaux (D-La.). Sen. Breaux noted that Congress is likely to be “dramatically different” next year.

Terry McAuliffe, longtime aide to former President Clinton and Sen. Hillary Clinton (D-N.Y.), pointed out that 100 seats are up for grabs in the House and Senate; he predicted that Democrats would take at least 4-7 of the Senate seats and garner a majority in both houses of Congress.

Why is this important? Traditionally, Democrats have called for bigger reforms and more government intervention, and Sen. Barack Obama (D-Ill.) is following that lead, Mr. McAuliffe said.

Despite concerns over the economy, energy prices, and taxes, “health care will be the number one domestic issue” in the presidential campaign and in the Congress early next year because “it affects everybody,” he said.

“I do think health care will be still at the top of the list of things that need to get done,” agreed Sen. Breaux.

Tommy G. Thompson, who served as Health and Human Services secretary under President George W. Bush, agreed with the Democrats that health reform was likely next year. He said he was optimistic because candidates for the House and Senate and both presidential contenders were talking about reform.

He said there were many pressing issues to address, including a looming shortage of physicians and nurses and the predicted bankruptcy of the Medicare Hospital Insurance Trust Fund in the next 5-10 years.

Former Sen. Bill Frist (R-Tenn.) agreed that the Medicare trust fund would get lawmakers' attention early in the next Congress. But he said, “I'm not quite as optimistic that we'll see reform.”

Sen. Frist said he does not think health care reform will be a priority until the American people make it one. In 1993, during the last major attempt at reform, 42% of Americans said the old system needed to be scrapped; “today we're at 34%.”

And, he said, the cost of adding coverage will have to be addressed, which could create some unsettling political realities.

The rankings are posted at www.athenapayerview.com

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

Dr. William F. Jessee, who serves as president and CEO of the Medical Group Management Association, in a statement that his organization commends Aetna for its progress “in improving what should be any insurer's core competnecy: paying insurance claims accurately and promptly.”

In a statement, Aetna CEO Ronald A. Williams acknowledged the achievement but pledged continued improvement.

“While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area,” Mr. Williams said.

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall.

Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days.

Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate–38%–was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York state Medicaid program came in for special criticism. It lagged in most of the key measures.

The program had the highest DAR of any payer–for the second year running–coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category.

According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.”

The best overall Medicaid program, in South Carolina, had a DAR of 40 days, and a first pass resolve rate of 92%.

The number two Medicaid performer, the North Carolina program, had similar rates.

ELSEVIER GLOBAL MEDICAL NEWS

The rankings are posted at www.athenapayerview.com

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

Dr. William F. Jessee, who serves as president and CEO of the Medical Group Management Association, in a statement that his organization commends Aetna for its progress “in improving what should be any insurer's core competnecy: paying insurance claims accurately and promptly.”

In a statement, Aetna CEO Ronald A. Williams acknowledged the achievement but pledged continued improvement.

“While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area,” Mr. Williams said.

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall.

Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days.

Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate–38%–was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York state Medicaid program came in for special criticism. It lagged in most of the key measures.

The program had the highest DAR of any payer–for the second year running–coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category.

According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.”

The best overall Medicaid program, in South Carolina, had a DAR of 40 days, and a first pass resolve rate of 92%.

The number two Medicaid performer, the North Carolina program, had similar rates.

ELSEVIER GLOBAL MEDICAL NEWS

The rankings are posted at www.athenapayerview.com

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

Dr. William F. Jessee, who serves as president and CEO of the Medical Group Management Association, in a statement that his organization commends Aetna for its progress “in improving what should be any insurer's core competnecy: paying insurance claims accurately and promptly.”

In a statement, Aetna CEO Ronald A. Williams acknowledged the achievement but pledged continued improvement.

“While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area,” Mr. Williams said.

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall.

Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days.

Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate–38%–was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York state Medicaid program came in for special criticism. It lagged in most of the key measures.

The program had the highest DAR of any payer–for the second year running–coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category.

According to AthenaHealth, the New York program “ranked at the bottom on the clarity of why the program rejects a medical claim.”

The best overall Medicaid program, in South Carolina, had a DAR of 40 days, and a first pass resolve rate of 92%.

The number two Medicaid performer, the North Carolina program, had similar rates.

ELSEVIER GLOBAL MEDICAL NEWS

Grassley Seeks APA Disclosures

Sen. Charles Grassley (R-Iowa) has asked the American Psychiatric Association (APA) to disclose how much financial support it receives from the pharmaceutical industry. The senator requested that the association provide an accounting of industry funding from January 2003 to the present, including, but not limited to, grants, donations, and sponsorship for meetings. The APA should also explain its conflict of interest policies, including whether the organization allows pharmaceutical companies to place restrictions on how funding is used, according to a letter the senator sent to the association last month. Senator Grassley, who is the ranking minority member of the Senate Finance Committee, has been investigating conflicts of interest, and he cited reporting in the New York Times that led him to believe that nonprofit organizations were being unduly influenced by drug and device makers.

Vt. Psychiatrists Unduly Influenced

The Vermont attorney general is alleging that psychiatrists in the state are being inappropriately influenced by pharmaceutical industry money. In a report issued last month, the AG found that drugmakers spent $3 million in Vermont in fiscal 2007 in sales and marketing efforts directed at physicians–a 33% increase over the previous fiscal year. The money was spent by 84 companies, on fees, travel expenses, and other direct payments, according to the report. More than half the money was provided by five companies: Eli Lilly & Co., Pfizer Inc., UCB Inc., Novartis Pharmaceuticals Corp., and Merck & Co. Psychiatrists were the highest paid, with 11 psychiatrists receiving $626,000, or 20% of the total. Five of the top 10 drugs promoted were for psychiatric conditions, including attention deficit/hyperactivity disorder and depression. The remainder were medications to treat diabetes, hypertension, and high cholesterol. Under Vermont law, manufacturers are required to report on an annual basis to the attorney general payments made to physicians, hospitals, universities, and other prescribers.

N.Y. Tobacco Ban Takes Effect

Starting July 24, all addiction treatment facilities that are certified and funded by the New York Office of Alcoholism and Substance Abuse Services must be entirely tobacco-free. The rules are the strictest in the country, but are aimed at integrating tobacco addiction treatment into programs for other dependencies, according to the state. Facilities will have a 6-month grace period to establish programs before funding and certification is revoked. The facilities themselves can determine how to eliminate tobacco on-site and establish intervention programs. But the Office of Alcoholism and Substance Abuse Services set out some minimum requirements, including that all staff are prohibited from using tobacco products on-site and that visiting families are prohibited from bringing tobacco products or paraphernalia to a facility. The state also has provided an $8 million grant that will go toward nicotine replacement products and education and training to health professionals on strategies and interventions for a tobacco-free environment.

30% Have Received Treatment

About a third of Americans have received treatment or therapy from a psychologist or other mental health professional, according to a Harris Interactive survey of 2,500 adults conducted in April. Men and women equally received treatment, but there was a big difference among age groups. Adults over age 65 years were the least likely to have received treatment, at 17%, compared with 36% of those in their 20s and 30s. The most common reason for seeking treatment was depression and anxiety, reported by 60% of those polled. Trauma and posttraumatic stress, and family and relationship issues were the next most common reasons. The main barriers to getting care were a lack of confidence in outcome of treatment, a lack of knowledge about the process, and concerns about access and the cost of therapy. More than half of those surveyed also said they had concerns about the stigma of receiving treatment or about what others might think if they found out. The survey was conducted for the American Psychological Association and was taken among people who already agree to be part of Harris polling.

Drugs Easy to Get Online

Despite a decline in the number of Web sites advertising or selling prescriptions for controlled substances, 85% of sites selling such drugs in the past year did not require a prescription, according to a new report by the National Center on Addiction and Substance Abuse at Columbia University, New York. Researchers found 365 sites advertising or selling controlled substances during searches that took place in the first 3 months of 2008, compared with 581 sites found during the same period in 2007. The decline in the number of sites offering controlled substance prescriptions might reflect federal and state efforts to crack down on Internet drug trafficking, said Joseph A. Califano Jr., the center's chairman. Only 2 of the 365 sites found online in 2008 were certified by the National Association of Boards of Pharmacy as Verified Internet Pharmacy Practice Sites, the same number found certified in 2007. Of those sites not requiring prescriptions, 42% explicitly stated that no prescription was needed, 45% offered “online consultations,” which enable Internet users to get controlled substances online without a proper prescription, and 13% made no mention of a prescription.

Grassley Seeks APA Disclosures

Sen. Charles Grassley (R-Iowa) has asked the American Psychiatric Association (APA) to disclose how much financial support it receives from the pharmaceutical industry. The senator requested that the association provide an accounting of industry funding from January 2003 to the present, including, but not limited to, grants, donations, and sponsorship for meetings. The APA should also explain its conflict of interest policies, including whether the organization allows pharmaceutical companies to place restrictions on how funding is used, according to a letter the senator sent to the association last month. Senator Grassley, who is the ranking minority member of the Senate Finance Committee, has been investigating conflicts of interest, and he cited reporting in the New York Times that led him to believe that nonprofit organizations were being unduly influenced by drug and device makers.

Vt. Psychiatrists Unduly Influenced

The Vermont attorney general is alleging that psychiatrists in the state are being inappropriately influenced by pharmaceutical industry money. In a report issued last month, the AG found that drugmakers spent $3 million in Vermont in fiscal 2007 in sales and marketing efforts directed at physicians–a 33% increase over the previous fiscal year. The money was spent by 84 companies, on fees, travel expenses, and other direct payments, according to the report. More than half the money was provided by five companies: Eli Lilly & Co., Pfizer Inc., UCB Inc., Novartis Pharmaceuticals Corp., and Merck & Co. Psychiatrists were the highest paid, with 11 psychiatrists receiving $626,000, or 20% of the total. Five of the top 10 drugs promoted were for psychiatric conditions, including attention deficit/hyperactivity disorder and depression. The remainder were medications to treat diabetes, hypertension, and high cholesterol. Under Vermont law, manufacturers are required to report on an annual basis to the attorney general payments made to physicians, hospitals, universities, and other prescribers.

N.Y. Tobacco Ban Takes Effect

Starting July 24, all addiction treatment facilities that are certified and funded by the New York Office of Alcoholism and Substance Abuse Services must be entirely tobacco-free. The rules are the strictest in the country, but are aimed at integrating tobacco addiction treatment into programs for other dependencies, according to the state. Facilities will have a 6-month grace period to establish programs before funding and certification is revoked. The facilities themselves can determine how to eliminate tobacco on-site and establish intervention programs. But the Office of Alcoholism and Substance Abuse Services set out some minimum requirements, including that all staff are prohibited from using tobacco products on-site and that visiting families are prohibited from bringing tobacco products or paraphernalia to a facility. The state also has provided an $8 million grant that will go toward nicotine replacement products and education and training to health professionals on strategies and interventions for a tobacco-free environment.

30% Have Received Treatment

About a third of Americans have received treatment or therapy from a psychologist or other mental health professional, according to a Harris Interactive survey of 2,500 adults conducted in April. Men and women equally received treatment, but there was a big difference among age groups. Adults over age 65 years were the least likely to have received treatment, at 17%, compared with 36% of those in their 20s and 30s. The most common reason for seeking treatment was depression and anxiety, reported by 60% of those polled. Trauma and posttraumatic stress, and family and relationship issues were the next most common reasons. The main barriers to getting care were a lack of confidence in outcome of treatment, a lack of knowledge about the process, and concerns about access and the cost of therapy. More than half of those surveyed also said they had concerns about the stigma of receiving treatment or about what others might think if they found out. The survey was conducted for the American Psychological Association and was taken among people who already agree to be part of Harris polling.

Drugs Easy to Get Online

Despite a decline in the number of Web sites advertising or selling prescriptions for controlled substances, 85% of sites selling such drugs in the past year did not require a prescription, according to a new report by the National Center on Addiction and Substance Abuse at Columbia University, New York. Researchers found 365 sites advertising or selling controlled substances during searches that took place in the first 3 months of 2008, compared with 581 sites found during the same period in 2007. The decline in the number of sites offering controlled substance prescriptions might reflect federal and state efforts to crack down on Internet drug trafficking, said Joseph A. Califano Jr., the center's chairman. Only 2 of the 365 sites found online in 2008 were certified by the National Association of Boards of Pharmacy as Verified Internet Pharmacy Practice Sites, the same number found certified in 2007. Of those sites not requiring prescriptions, 42% explicitly stated that no prescription was needed, 45% offered “online consultations,” which enable Internet users to get controlled substances online without a proper prescription, and 13% made no mention of a prescription.

Grassley Seeks APA Disclosures

Sen. Charles Grassley (R-Iowa) has asked the American Psychiatric Association (APA) to disclose how much financial support it receives from the pharmaceutical industry. The senator requested that the association provide an accounting of industry funding from January 2003 to the present, including, but not limited to, grants, donations, and sponsorship for meetings. The APA should also explain its conflict of interest policies, including whether the organization allows pharmaceutical companies to place restrictions on how funding is used, according to a letter the senator sent to the association last month. Senator Grassley, who is the ranking minority member of the Senate Finance Committee, has been investigating conflicts of interest, and he cited reporting in the New York Times that led him to believe that nonprofit organizations were being unduly influenced by drug and device makers.

Vt. Psychiatrists Unduly Influenced

The Vermont attorney general is alleging that psychiatrists in the state are being inappropriately influenced by pharmaceutical industry money. In a report issued last month, the AG found that drugmakers spent $3 million in Vermont in fiscal 2007 in sales and marketing efforts directed at physicians–a 33% increase over the previous fiscal year. The money was spent by 84 companies, on fees, travel expenses, and other direct payments, according to the report. More than half the money was provided by five companies: Eli Lilly & Co., Pfizer Inc., UCB Inc., Novartis Pharmaceuticals Corp., and Merck & Co. Psychiatrists were the highest paid, with 11 psychiatrists receiving $626,000, or 20% of the total. Five of the top 10 drugs promoted were for psychiatric conditions, including attention deficit/hyperactivity disorder and depression. The remainder were medications to treat diabetes, hypertension, and high cholesterol. Under Vermont law, manufacturers are required to report on an annual basis to the attorney general payments made to physicians, hospitals, universities, and other prescribers.

N.Y. Tobacco Ban Takes Effect

Starting July 24, all addiction treatment facilities that are certified and funded by the New York Office of Alcoholism and Substance Abuse Services must be entirely tobacco-free. The rules are the strictest in the country, but are aimed at integrating tobacco addiction treatment into programs for other dependencies, according to the state. Facilities will have a 6-month grace period to establish programs before funding and certification is revoked. The facilities themselves can determine how to eliminate tobacco on-site and establish intervention programs. But the Office of Alcoholism and Substance Abuse Services set out some minimum requirements, including that all staff are prohibited from using tobacco products on-site and that visiting families are prohibited from bringing tobacco products or paraphernalia to a facility. The state also has provided an $8 million grant that will go toward nicotine replacement products and education and training to health professionals on strategies and interventions for a tobacco-free environment.

30% Have Received Treatment

About a third of Americans have received treatment or therapy from a psychologist or other mental health professional, according to a Harris Interactive survey of 2,500 adults conducted in April. Men and women equally received treatment, but there was a big difference among age groups. Adults over age 65 years were the least likely to have received treatment, at 17%, compared with 36% of those in their 20s and 30s. The most common reason for seeking treatment was depression and anxiety, reported by 60% of those polled. Trauma and posttraumatic stress, and family and relationship issues were the next most common reasons. The main barriers to getting care were a lack of confidence in outcome of treatment, a lack of knowledge about the process, and concerns about access and the cost of therapy. More than half of those surveyed also said they had concerns about the stigma of receiving treatment or about what others might think if they found out. The survey was conducted for the American Psychological Association and was taken among people who already agree to be part of Harris polling.

Drugs Easy to Get Online

Despite a decline in the number of Web sites advertising or selling prescriptions for controlled substances, 85% of sites selling such drugs in the past year did not require a prescription, according to a new report by the National Center on Addiction and Substance Abuse at Columbia University, New York. Researchers found 365 sites advertising or selling controlled substances during searches that took place in the first 3 months of 2008, compared with 581 sites found during the same period in 2007. The decline in the number of sites offering controlled substance prescriptions might reflect federal and state efforts to crack down on Internet drug trafficking, said Joseph A. Califano Jr., the center's chairman. Only 2 of the 365 sites found online in 2008 were certified by the National Association of Boards of Pharmacy as Verified Internet Pharmacy Practice Sites, the same number found certified in 2007. Of those sites not requiring prescriptions, 42% explicitly stated that no prescription was needed, 45% offered “online consultations,” which enable Internet users to get controlled substances online without a proper prescription, and 13% made no mention of a prescription.

Hospitals are rapidly adding palliative care services, but their availability is widely disparate, according to a report that gave a grade of “C” to the state of palliative care services in the nation's hospitals.

Overall, 53% of U.S. hospitals with 50 or more beds reported offering palliative care, according to the report card that was compiled by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which is based at Mt. Sinai School of Medicine in New York.

But geographic access varies widely, the report found. In three states—Alabama, Mississippi, and Oklahoma—10%–20% of hospitals offer palliative care. In Vermont, every hospital offers the service. The results were published online in the Journal of Palliative Medicine (2008 Oct. 2 [doi:10.1089/jpm.2008.0053]).

Hospitals were graded on patient access to palliative care services, patient access to board-certified palliative medicine specialists, medical student access to clinical training in palliative medicine, and physician access to specialty-level training in the field. The report is based on the American Hospital Association's 2006 Annual Survey Database and a more recent survey that was mailed to hospitals by the CAPC.

The report excluded rehabilitation, psychiatric, and pediatric hospitals. Children's hospitals were excluded because many pediatric palliative care programs are within general acute care facilities and there was no way to distinguish them, Dr. R. Sean Morrison, director of the NPCRC, said in an interview. Veterans Affairs hospitals also were excluded because the government requires every VA facility to offer palliative care, said Dr. Morrison, a coauthor of the report.

Hospitals with more than 300 beds were most likely to have palliative care, with 75% reporting a program. Nonprofit hospitals and hospitals affiliated with a medical school also were more likely to offer a palliative program.

Only 20% of for-profit hospitals report offering palliative care. Dr. Morrison said he was not sure why programs were few and far between at these facilities.

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, creating a disparity of access for many urban, rural, and isolated areas, Dr. Morrison said.

The Midwest had the highest prevalence of hospitals with palliative care programs (65%), followed by the Northeast and the West. In the South, only 41% of hospitals offer palliative care.

There were some exceptions to the general trends. Montana, a largely rural state, had the second-highest prevalence, with 88% of hospitals offering palliative care. Dr. Morrison said that one of the pioneering palliative care programs was started in the state, which might explain why so many Montana hospitals have palliative care.

The report also pointed out a need for palliative care training to meet the needs of an estimated 90 million Americans living with a serious or life-threatening illness. At least one hospital palliative care program is affiliated with 88% of private U.S. medical schools and 82% of state-funded schools. There are no postgraduate fellowship training programs, however, in 23 states and Washington, D.C.

The 2,651 physicians who have board certification in palliative medicine translate to 1 certified physician per 31,000 people living with a serious or life-threatening illness. In comparison, there are 16,800 cardiologists (or 1 per 71 patients with myocardial infarctions) and 10,000 oncologists (or 1 per 145 newly diagnosed cancer patients).

A new certification program in hospice and palliative medicine being offered by the American Board of Medical Specialties should help the field grow, Dr. Morrison said. But the “dramatic growth in the number of young physicians entering palliative care [is] … not quite enough to staff all these programs that are developing, so we also need to see midcareer people make a shift.”

Palliative care helps hospitals to improve patients' quality of life and satisfaction, and to match patients' goals to treatments, according to Dr. Morrison. Patients and families are demanding palliative care because it helps them to navigate care for life-threatening illness, one of the toughest times there is to get through the health care system, Dr. Morrison said.

Palliative care offers a coordinated approach to pain and symptom management, and addresses the patient's emotional, financial, and spiritual needs. Palliative care is usually delivered through a multidisciplinary team that might include physicians, nurses, social workers, pharmacists, psychiatrists, and a chaplain, priest, rabbi, or other religious representative.

The study was funded by seven nonprofit foundations and the United Hospital Fund, all of which support the CAPC and the NPCRC. The report is online at www.capc.org

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, Dr. R. Sean Morrison said. ©Norman Y. Lono

Hospitals are rapidly adding palliative care services, but their availability is widely disparate, according to a report that gave a grade of “C” to the state of palliative care services in the nation's hospitals.

Overall, 53% of U.S. hospitals with 50 or more beds reported offering palliative care, according to the report card that was compiled by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which is based at Mt. Sinai School of Medicine in New York.

But geographic access varies widely, the report found. In three states—Alabama, Mississippi, and Oklahoma—10%–20% of hospitals offer palliative care. In Vermont, every hospital offers the service. The results were published online in the Journal of Palliative Medicine (2008 Oct. 2 [doi:10.1089/jpm.2008.0053]).

Hospitals were graded on patient access to palliative care services, patient access to board-certified palliative medicine specialists, medical student access to clinical training in palliative medicine, and physician access to specialty-level training in the field. The report is based on the American Hospital Association's 2006 Annual Survey Database and a more recent survey that was mailed to hospitals by the CAPC.

The report excluded rehabilitation, psychiatric, and pediatric hospitals. Children's hospitals were excluded because many pediatric palliative care programs are within general acute care facilities and there was no way to distinguish them, Dr. R. Sean Morrison, director of the NPCRC, said in an interview. Veterans Affairs hospitals also were excluded because the government requires every VA facility to offer palliative care, said Dr. Morrison, a coauthor of the report.

Hospitals with more than 300 beds were most likely to have palliative care, with 75% reporting a program. Nonprofit hospitals and hospitals affiliated with a medical school also were more likely to offer a palliative program.

Only 20% of for-profit hospitals report offering palliative care. Dr. Morrison said he was not sure why programs were few and far between at these facilities.

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, creating a disparity of access for many urban, rural, and isolated areas, Dr. Morrison said.

The Midwest had the highest prevalence of hospitals with palliative care programs (65%), followed by the Northeast and the West. In the South, only 41% of hospitals offer palliative care.

There were some exceptions to the general trends. Montana, a largely rural state, had the second-highest prevalence, with 88% of hospitals offering palliative care. Dr. Morrison said that one of the pioneering palliative care programs was started in the state, which might explain why so many Montana hospitals have palliative care.

The report also pointed out a need for palliative care training to meet the needs of an estimated 90 million Americans living with a serious or life-threatening illness. At least one hospital palliative care program is affiliated with 88% of private U.S. medical schools and 82% of state-funded schools. There are no postgraduate fellowship training programs, however, in 23 states and Washington, D.C.

The 2,651 physicians who have board certification in palliative medicine translate to 1 certified physician per 31,000 people living with a serious or life-threatening illness. In comparison, there are 16,800 cardiologists (or 1 per 71 patients with myocardial infarctions) and 10,000 oncologists (or 1 per 145 newly diagnosed cancer patients).

A new certification program in hospice and palliative medicine being offered by the American Board of Medical Specialties should help the field grow, Dr. Morrison said. But the “dramatic growth in the number of young physicians entering palliative care [is] … not quite enough to staff all these programs that are developing, so we also need to see midcareer people make a shift.”

Palliative care helps hospitals to improve patients' quality of life and satisfaction, and to match patients' goals to treatments, according to Dr. Morrison. Patients and families are demanding palliative care because it helps them to navigate care for life-threatening illness, one of the toughest times there is to get through the health care system, Dr. Morrison said.

Palliative care offers a coordinated approach to pain and symptom management, and addresses the patient's emotional, financial, and spiritual needs. Palliative care is usually delivered through a multidisciplinary team that might include physicians, nurses, social workers, pharmacists, psychiatrists, and a chaplain, priest, rabbi, or other religious representative.

The study was funded by seven nonprofit foundations and the United Hospital Fund, all of which support the CAPC and the NPCRC. The report is online at www.capc.org

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, Dr. R. Sean Morrison said. ©Norman Y. Lono

Hospitals are rapidly adding palliative care services, but their availability is widely disparate, according to a report that gave a grade of “C” to the state of palliative care services in the nation's hospitals.

Overall, 53% of U.S. hospitals with 50 or more beds reported offering palliative care, according to the report card that was compiled by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which is based at Mt. Sinai School of Medicine in New York.

But geographic access varies widely, the report found. In three states—Alabama, Mississippi, and Oklahoma—10%–20% of hospitals offer palliative care. In Vermont, every hospital offers the service. The results were published online in the Journal of Palliative Medicine (2008 Oct. 2 [doi:10.1089/jpm.2008.0053]).

Hospitals were graded on patient access to palliative care services, patient access to board-certified palliative medicine specialists, medical student access to clinical training in palliative medicine, and physician access to specialty-level training in the field. The report is based on the American Hospital Association's 2006 Annual Survey Database and a more recent survey that was mailed to hospitals by the CAPC.

The report excluded rehabilitation, psychiatric, and pediatric hospitals. Children's hospitals were excluded because many pediatric palliative care programs are within general acute care facilities and there was no way to distinguish them, Dr. R. Sean Morrison, director of the NPCRC, said in an interview. Veterans Affairs hospitals also were excluded because the government requires every VA facility to offer palliative care, said Dr. Morrison, a coauthor of the report.

Hospitals with more than 300 beds were most likely to have palliative care, with 75% reporting a program. Nonprofit hospitals and hospitals affiliated with a medical school also were more likely to offer a palliative program.

Only 20% of for-profit hospitals report offering palliative care. Dr. Morrison said he was not sure why programs were few and far between at these facilities.

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, creating a disparity of access for many urban, rural, and isolated areas, Dr. Morrison said.

The Midwest had the highest prevalence of hospitals with palliative care programs (65%), followed by the Northeast and the West. In the South, only 41% of hospitals offer palliative care.

There were some exceptions to the general trends. Montana, a largely rural state, had the second-highest prevalence, with 88% of hospitals offering palliative care. Dr. Morrison said that one of the pioneering palliative care programs was started in the state, which might explain why so many Montana hospitals have palliative care.

The report also pointed out a need for palliative care training to meet the needs of an estimated 90 million Americans living with a serious or life-threatening illness. At least one hospital palliative care program is affiliated with 88% of private U.S. medical schools and 82% of state-funded schools. There are no postgraduate fellowship training programs, however, in 23 states and Washington, D.C.

The 2,651 physicians who have board certification in palliative medicine translate to 1 certified physician per 31,000 people living with a serious or life-threatening illness. In comparison, there are 16,800 cardiologists (or 1 per 71 patients with myocardial infarctions) and 10,000 oncologists (or 1 per 145 newly diagnosed cancer patients).

A new certification program in hospice and palliative medicine being offered by the American Board of Medical Specialties should help the field grow, Dr. Morrison said. But the “dramatic growth in the number of young physicians entering palliative care [is] … not quite enough to staff all these programs that are developing, so we also need to see midcareer people make a shift.”

Palliative care helps hospitals to improve patients' quality of life and satisfaction, and to match patients' goals to treatments, according to Dr. Morrison. Patients and families are demanding palliative care because it helps them to navigate care for life-threatening illness, one of the toughest times there is to get through the health care system, Dr. Morrison said.

Palliative care offers a coordinated approach to pain and symptom management, and addresses the patient's emotional, financial, and spiritual needs. Palliative care is usually delivered through a multidisciplinary team that might include physicians, nurses, social workers, pharmacists, psychiatrists, and a chaplain, priest, rabbi, or other religious representative.

The study was funded by seven nonprofit foundations and the United Hospital Fund, all of which support the CAPC and the NPCRC. The report is online at www.capc.org

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, Dr. R. Sean Morrison said. ©Norman Y. Lono

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive defended the company's performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke at the AHIP Institute, at a conference sponsored by America's Health Insurance Plans.

Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut. Physicians have claimed that the networks use inappropriate methodology to rate their performance.

In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, Dr. Bishop said.

He noted, for instance, that Aetna reviews and updates its provider list every 2 years and notifies each physician in writing if there has been any change in his or her status. Physicians have the opportunity to appeal if there is an error—before any data are made public, he said.

The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating.

Aetna first began developing its Aexcel network in 2002, Dr. Bishop said. The goal was to mitigate rising costs, ensure patient access to specialists, and find a way to recognize the variations in costs and practices in each individual market, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery.

When considering which physicians are eligible for the network, Aetna looks at the number of Aetna cases managed over a 3-year period (there was a 20-case minimum). The company also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded.

The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. A physician is considered efficient if his or her score is greater than the mean for that specialty and that market, Dr. Bishop said.

The Aexcel network now exists in 35 markets, covering 670,000 members. Aetna members in most, though not all, those areas can log onto a secure patient Web site and see costs for various procedures and information on why his or her physician has been designated a preferred provider in the network.

Dr. Bishop said that Aetna has determined that physicians in the Aexcel network typically perform 1%–8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network, he said.

Although some physicians have been unhappy with the designations, “amazingly few physicians balk at this,” Dr. Bishop said.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive defended the company's performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke at the AHIP Institute, at a conference sponsored by America's Health Insurance Plans.

Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut. Physicians have claimed that the networks use inappropriate methodology to rate their performance.

In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, Dr. Bishop said.

He noted, for instance, that Aetna reviews and updates its provider list every 2 years and notifies each physician in writing if there has been any change in his or her status. Physicians have the opportunity to appeal if there is an error—before any data are made public, he said.

The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating.

Aetna first began developing its Aexcel network in 2002, Dr. Bishop said. The goal was to mitigate rising costs, ensure patient access to specialists, and find a way to recognize the variations in costs and practices in each individual market, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery.

When considering which physicians are eligible for the network, Aetna looks at the number of Aetna cases managed over a 3-year period (there was a 20-case minimum). The company also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded.

The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. A physician is considered efficient if his or her score is greater than the mean for that specialty and that market, Dr. Bishop said.

The Aexcel network now exists in 35 markets, covering 670,000 members. Aetna members in most, though not all, those areas can log onto a secure patient Web site and see costs for various procedures and information on why his or her physician has been designated a preferred provider in the network.

Dr. Bishop said that Aetna has determined that physicians in the Aexcel network typically perform 1%–8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network, he said.

Although some physicians have been unhappy with the designations, “amazingly few physicians balk at this,” Dr. Bishop said.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive defended the company's performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke at the AHIP Institute, at a conference sponsored by America's Health Insurance Plans.

Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut. Physicians have claimed that the networks use inappropriate methodology to rate their performance.

In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, Dr. Bishop said.

He noted, for instance, that Aetna reviews and updates its provider list every 2 years and notifies each physician in writing if there has been any change in his or her status. Physicians have the opportunity to appeal if there is an error—before any data are made public, he said.

The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating.

Aetna first began developing its Aexcel network in 2002, Dr. Bishop said. The goal was to mitigate rising costs, ensure patient access to specialists, and find a way to recognize the variations in costs and practices in each individual market, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery.

When considering which physicians are eligible for the network, Aetna looks at the number of Aetna cases managed over a 3-year period (there was a 20-case minimum). The company also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded.

The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. A physician is considered efficient if his or her score is greater than the mean for that specialty and that market, Dr. Bishop said.

The Aexcel network now exists in 35 markets, covering 670,000 members. Aetna members in most, though not all, those areas can log onto a secure patient Web site and see costs for various procedures and information on why his or her physician has been designated a preferred provider in the network.

Dr. Bishop said that Aetna has determined that physicians in the Aexcel network typically perform 1%–8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network, he said.

Although some physicians have been unhappy with the designations, “amazingly few physicians balk at this,” Dr. Bishop said.

SAN DIEGO — Physicians may be conducting surveillance colonoscopy too often on low-risk patients and not enough on high-risk patients, according to results of a substudy of the Polyp Prevention Trial presented at the annual Digestive Disease Week.

Dr. Adeyinka Laiyemo, a cancer prevention fellow at the National Cancer Institute, said that colonoscopy resources need to be managed more effectively, based on the substudy's findings. He presented data on behalf of his colleagues at NCI and the University of Pittsburgh Cancer Institute.

The Polyp Prevention Trial was a 4-year, multicenter, randomized, controlled trial of a low-fat, high-fiber, fruit and vegetable diet on adenoma recurrence. The diet was not found to be effective. However, when that study ended in 2000, 1,297 subjects agreed to be followed prospectively. The aim was to determine utilization and yield of surveillance colonoscopy in the community, said Dr. Laiyemo, who briefed reporters.

Most studies of surveillance have been based on physician surveys, generally asking them about hypothetical cases, he said. This study followed the actual use of colonoscopy, as reported by patients and through medical record reviews.

Patients were followed for a mean of 6.2 years. Of the 1,297 patients, 774 (60%) had a repeat colonoscopy during the follow-up period. There were 431 patients who were considered low risk because they had one or two nonadvanced adenomas at baseline and no adenoma recurrence at the end of the Polyp Prevention Trial. Thirty percent had a repeat colonoscopy within 4 years. This is sooner than recommended, Dr. Laiyemo said.

There were 55 patients who were considered high risk because they had an advanced adenoma and/or three or more nonadvanced adenomas at baseline and at the end of the original study. Only 41% had a surveillance colonoscopy within the recommended 3 years, and 64% had a repeat exam within 5 years.

After examining the yield of these colonoscopies, the researchers determined that only 4% of the lowest risk group had significant lesions at the 6-year mark, compared with 40% of the highest risk group, Dr. Laiyemo said. “This leads us to realize that we need to improve our use of colonoscopy resources,” he said.

Dr. Laiyemo made no conflict-of-interest disclosures.

SAN DIEGO — Physicians may be conducting surveillance colonoscopy too often on low-risk patients and not enough on high-risk patients, according to results of a substudy of the Polyp Prevention Trial presented at the annual Digestive Disease Week.

Dr. Adeyinka Laiyemo, a cancer prevention fellow at the National Cancer Institute, said that colonoscopy resources need to be managed more effectively, based on the substudy's findings. He presented data on behalf of his colleagues at NCI and the University of Pittsburgh Cancer Institute.

The Polyp Prevention Trial was a 4-year, multicenter, randomized, controlled trial of a low-fat, high-fiber, fruit and vegetable diet on adenoma recurrence. The diet was not found to be effective. However, when that study ended in 2000, 1,297 subjects agreed to be followed prospectively. The aim was to determine utilization and yield of surveillance colonoscopy in the community, said Dr. Laiyemo, who briefed reporters.

Most studies of surveillance have been based on physician surveys, generally asking them about hypothetical cases, he said. This study followed the actual use of colonoscopy, as reported by patients and through medical record reviews.

Patients were followed for a mean of 6.2 years. Of the 1,297 patients, 774 (60%) had a repeat colonoscopy during the follow-up period. There were 431 patients who were considered low risk because they had one or two nonadvanced adenomas at baseline and no adenoma recurrence at the end of the Polyp Prevention Trial. Thirty percent had a repeat colonoscopy within 4 years. This is sooner than recommended, Dr. Laiyemo said.

There were 55 patients who were considered high risk because they had an advanced adenoma and/or three or more nonadvanced adenomas at baseline and at the end of the original study. Only 41% had a surveillance colonoscopy within the recommended 3 years, and 64% had a repeat exam within 5 years.

After examining the yield of these colonoscopies, the researchers determined that only 4% of the lowest risk group had significant lesions at the 6-year mark, compared with 40% of the highest risk group, Dr. Laiyemo said. “This leads us to realize that we need to improve our use of colonoscopy resources,” he said.

Dr. Laiyemo made no conflict-of-interest disclosures.

SAN DIEGO — Physicians may be conducting surveillance colonoscopy too often on low-risk patients and not enough on high-risk patients, according to results of a substudy of the Polyp Prevention Trial presented at the annual Digestive Disease Week.

Dr. Adeyinka Laiyemo, a cancer prevention fellow at the National Cancer Institute, said that colonoscopy resources need to be managed more effectively, based on the substudy's findings. He presented data on behalf of his colleagues at NCI and the University of Pittsburgh Cancer Institute.

The Polyp Prevention Trial was a 4-year, multicenter, randomized, controlled trial of a low-fat, high-fiber, fruit and vegetable diet on adenoma recurrence. The diet was not found to be effective. However, when that study ended in 2000, 1,297 subjects agreed to be followed prospectively. The aim was to determine utilization and yield of surveillance colonoscopy in the community, said Dr. Laiyemo, who briefed reporters.

Most studies of surveillance have been based on physician surveys, generally asking them about hypothetical cases, he said. This study followed the actual use of colonoscopy, as reported by patients and through medical record reviews.

Patients were followed for a mean of 6.2 years. Of the 1,297 patients, 774 (60%) had a repeat colonoscopy during the follow-up period. There were 431 patients who were considered low risk because they had one or two nonadvanced adenomas at baseline and no adenoma recurrence at the end of the Polyp Prevention Trial. Thirty percent had a repeat colonoscopy within 4 years. This is sooner than recommended, Dr. Laiyemo said.

There were 55 patients who were considered high risk because they had an advanced adenoma and/or three or more nonadvanced adenomas at baseline and at the end of the original study. Only 41% had a surveillance colonoscopy within the recommended 3 years, and 64% had a repeat exam within 5 years.

After examining the yield of these colonoscopies, the researchers determined that only 4% of the lowest risk group had significant lesions at the 6-year mark, compared with 40% of the highest risk group, Dr. Laiyemo said. “This leads us to realize that we need to improve our use of colonoscopy resources,” he said.

Dr. Laiyemo made no conflict-of-interest disclosures.

SAN DIEGO — Use of the guidelines recommended by the American College of Radiology for computed tomographic colonography could mean that up to one-third of high-risk adenoma findings would be interpreted as normal, Dr. Douglas K. Rex reported.

The study included 10,034 colonoscopies performed over a 5-year period at Indiana University. Dr. Rex and his colleagues applied the 2005 ACR guidelines to the colonoscopy results, which included 10,780 polyps that were removed. The researchers had access to the size and histology of each polyp that was removed, Dr. Rex said at Digestive Disease Week.

According to the ACR guidelines, polyps 5 mm or smaller in size should not be reported on CT colonography (CTC), resulting in a normal finding if no larger polyps are seen. Patients with one or two polyps that are 6–9 mm in size can be offered CTC surveillance in 3 years, instead of a colonoscopy with polypectomy.

High-risk findings include three or more adenomas of any size, adenomas with villous or tubulovillous histology, those with high-grade dysplasia, and adenomas greater than or equal to 1 cm in size, according to surveillance recommendations from the U.S. Multisociety Task Force and the American Cancer Society. Patients with high-risk findings should have a repeat colonoscopy with polypectomy 3 years after the initial exam, according to the guidelines.

Among all the patients in the database, 51% (5,079) had at least one polyp, and 29% (2,907) had at least one adenoma. Ten percent (1,001) had high-risk findings.

Overall, out of those with high-risk findings, there were 293 patients (29%) with either three adenomas less than 5 mm, or an advanced adenoma less than 5 mm and no larger polyp of any histology in the colon. These 293 patients would have been regarded as normal on CTC, said Dr. Rex, who is Chancellor's Professor and professor of medicine at Indiana University, Indianapolis, and director of endoscopy at Indiana University Hospital.

There were 2,174 patients over age 50 years; 326 (15%) had high-risk adenoma findings. Of that high-risk group, 33% (108) had either three or more adenomas less than 5 mm in size, or an advanced adenoma less than 5 mm in size and no polyps greater than 6 mm in size. Again, those 108 patients would have been told that they had normal findings.

The Indiana researchers also found that 18% of all patients with high-risk findings, and a similar number of patients over age 50 with high-risk findings, could have been inappropriately told to delay a colonoscopy for at least 3 years. These patients had either three adenomas less than or equal to 9 mm, or an advanced adenoma less than or equal to 9 mm in size, or both, and no polyp of any histology that was 10 mm or larger.

Following the ACR guidelines, “the bottom line is about 33% of everyone with high-risk adenoma findings would be told they were normal and another 20% would be told they could wait at least 3 years” before another CTC, Dr. Rex said.

Dr. Rex disclosed that he is a speaker for Olympus America Inc. and that he receives grant support from Given Imaging Ltd.

Following the guidelines, 'about 33% of everyone with high-risk adenoma findings would be told they were normal.' DR. REX

SAN DIEGO — Use of the guidelines recommended by the American College of Radiology for computed tomographic colonography could mean that up to one-third of high-risk adenoma findings would be interpreted as normal, Dr. Douglas K. Rex reported.

The study included 10,034 colonoscopies performed over a 5-year period at Indiana University. Dr. Rex and his colleagues applied the 2005 ACR guidelines to the colonoscopy results, which included 10,780 polyps that were removed. The researchers had access to the size and histology of each polyp that was removed, Dr. Rex said at Digestive Disease Week.

According to the ACR guidelines, polyps 5 mm or smaller in size should not be reported on CT colonography (CTC), resulting in a normal finding if no larger polyps are seen. Patients with one or two polyps that are 6–9 mm in size can be offered CTC surveillance in 3 years, instead of a colonoscopy with polypectomy.

High-risk findings include three or more adenomas of any size, adenomas with villous or tubulovillous histology, those with high-grade dysplasia, and adenomas greater than or equal to 1 cm in size, according to surveillance recommendations from the U.S. Multisociety Task Force and the American Cancer Society. Patients with high-risk findings should have a repeat colonoscopy with polypectomy 3 years after the initial exam, according to the guidelines.

Among all the patients in the database, 51% (5,079) had at least one polyp, and 29% (2,907) had at least one adenoma. Ten percent (1,001) had high-risk findings.

Overall, out of those with high-risk findings, there were 293 patients (29%) with either three adenomas less than 5 mm, or an advanced adenoma less than 5 mm and no larger polyp of any histology in the colon. These 293 patients would have been regarded as normal on CTC, said Dr. Rex, who is Chancellor's Professor and professor of medicine at Indiana University, Indianapolis, and director of endoscopy at Indiana University Hospital.

There were 2,174 patients over age 50 years; 326 (15%) had high-risk adenoma findings. Of that high-risk group, 33% (108) had either three or more adenomas less than 5 mm in size, or an advanced adenoma less than 5 mm in size and no polyps greater than 6 mm in size. Again, those 108 patients would have been told that they had normal findings.

The Indiana researchers also found that 18% of all patients with high-risk findings, and a similar number of patients over age 50 with high-risk findings, could have been inappropriately told to delay a colonoscopy for at least 3 years. These patients had either three adenomas less than or equal to 9 mm, or an advanced adenoma less than or equal to 9 mm in size, or both, and no polyp of any histology that was 10 mm or larger.

Following the ACR guidelines, “the bottom line is about 33% of everyone with high-risk adenoma findings would be told they were normal and another 20% would be told they could wait at least 3 years” before another CTC, Dr. Rex said.

Dr. Rex disclosed that he is a speaker for Olympus America Inc. and that he receives grant support from Given Imaging Ltd.

Following the guidelines, 'about 33% of everyone with high-risk adenoma findings would be told they were normal.' DR. REX

SAN DIEGO — Use of the guidelines recommended by the American College of Radiology for computed tomographic colonography could mean that up to one-third of high-risk adenoma findings would be interpreted as normal, Dr. Douglas K. Rex reported.

The study included 10,034 colonoscopies performed over a 5-year period at Indiana University. Dr. Rex and his colleagues applied the 2005 ACR guidelines to the colonoscopy results, which included 10,780 polyps that were removed. The researchers had access to the size and histology of each polyp that was removed, Dr. Rex said at Digestive Disease Week.

According to the ACR guidelines, polyps 5 mm or smaller in size should not be reported on CT colonography (CTC), resulting in a normal finding if no larger polyps are seen. Patients with one or two polyps that are 6–9 mm in size can be offered CTC surveillance in 3 years, instead of a colonoscopy with polypectomy.

High-risk findings include three or more adenomas of any size, adenomas with villous or tubulovillous histology, those with high-grade dysplasia, and adenomas greater than or equal to 1 cm in size, according to surveillance recommendations from the U.S. Multisociety Task Force and the American Cancer Society. Patients with high-risk findings should have a repeat colonoscopy with polypectomy 3 years after the initial exam, according to the guidelines.

Among all the patients in the database, 51% (5,079) had at least one polyp, and 29% (2,907) had at least one adenoma. Ten percent (1,001) had high-risk findings.

Overall, out of those with high-risk findings, there were 293 patients (29%) with either three adenomas less than 5 mm, or an advanced adenoma less than 5 mm and no larger polyp of any histology in the colon. These 293 patients would have been regarded as normal on CTC, said Dr. Rex, who is Chancellor's Professor and professor of medicine at Indiana University, Indianapolis, and director of endoscopy at Indiana University Hospital.

There were 2,174 patients over age 50 years; 326 (15%) had high-risk adenoma findings. Of that high-risk group, 33% (108) had either three or more adenomas less than 5 mm in size, or an advanced adenoma less than 5 mm in size and no polyps greater than 6 mm in size. Again, those 108 patients would have been told that they had normal findings.

The Indiana researchers also found that 18% of all patients with high-risk findings, and a similar number of patients over age 50 with high-risk findings, could have been inappropriately told to delay a colonoscopy for at least 3 years. These patients had either three adenomas less than or equal to 9 mm, or an advanced adenoma less than or equal to 9 mm in size, or both, and no polyp of any histology that was 10 mm or larger.

Following the ACR guidelines, “the bottom line is about 33% of everyone with high-risk adenoma findings would be told they were normal and another 20% would be told they could wait at least 3 years” before another CTC, Dr. Rex said.

Dr. Rex disclosed that he is a speaker for Olympus America Inc. and that he receives grant support from Given Imaging Ltd.

Following the guidelines, 'about 33% of everyone with high-risk adenoma findings would be told they were normal.' DR. REX