Alicia Ault

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 of Representatives and the Senate. He predicted that Democrats would take at least 4-7 of the Senate seats and garner a majority in both chambers of Congress.

Why is this important? Traditionally, Democrats have called for bigger reforms and more government intervention, and Democratic presidential candidate 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. "That tells me that 2009 is going to be the biggest year we've ever had," said Mr. Thompson, who is also a former governor of Wisconsin. 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 with Mr. Thompson 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 that he does not think health care reform will be a priority until the American people make it a priority. In 1993, during the last major attempt at health care 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.

Dan Bartlett, who served as President George W. Bush's communications director and counselor, agreed, noting that Sen. Obama had not been discussing details of his health proposals on the campaign trail.

Like Sen. Frist, Mr. Bartlett said he did not see reform as an imperative. "I don't see the mandate coming out of this election," he said, adding, "I think you'll see incremental change, but I don't think you'll see radical change."

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 of Representatives and the Senate. He predicted that Democrats would take at least 4-7 of the Senate seats and garner a majority in both chambers of Congress.

Why is this important? Traditionally, Democrats have called for bigger reforms and more government intervention, and Democratic presidential candidate 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. "That tells me that 2009 is going to be the biggest year we've ever had," said Mr. Thompson, who is also a former governor of Wisconsin. 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 with Mr. Thompson 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 that he does not think health care reform will be a priority until the American people make it a priority. In 1993, during the last major attempt at health care 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.

Dan Bartlett, who served as President George W. Bush's communications director and counselor, agreed, noting that Sen. Obama had not been discussing details of his health proposals on the campaign trail.

Like Sen. Frist, Mr. Bartlett said he did not see reform as an imperative. "I don't see the mandate coming out of this election," he said, adding, "I think you'll see incremental change, but I don't think you'll see radical change."

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 of Representatives and the Senate. He predicted that Democrats would take at least 4-7 of the Senate seats and garner a majority in both chambers of Congress.

Why is this important? Traditionally, Democrats have called for bigger reforms and more government intervention, and Democratic presidential candidate 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. "That tells me that 2009 is going to be the biggest year we've ever had," said Mr. Thompson, who is also a former governor of Wisconsin. 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 with Mr. Thompson 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 that he does not think health care reform will be a priority until the American people make it a priority. In 1993, during the last major attempt at health care 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.

Dan Bartlett, who served as President George W. Bush's communications director and counselor, agreed, noting that Sen. Obama had not been discussing details of his health proposals on the campaign trail.

Like Sen. Frist, Mr. Bartlett said he did not see reform as an imperative. "I don't see the mandate coming out of this election," he said, adding, "I think you'll see incremental change, but I don't think you'll see radical change."

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.

"We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly," said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

Aetna CEO Ronald A. Williams said in a statement, "While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area."

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 rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

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.

"We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly," said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

Aetna CEO Ronald A. Williams said in a statement, "While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area."

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 rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

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.

"We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly," said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

Aetna CEO Ronald A. Williams said in a statement, "While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area."

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 rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive detailed and defended the company's performance-based physician networks, maintaining that such "preferred provider" systems are a good way to keep costs down and to let patients know which physicians offer the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke during the concurrent session "Driving Quality in the Health Care System: Performance-based Networks 2008" at the America's Health Insurance Plans (AHIP): Institute 2008, 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. Some 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, said Dr. Bishop. 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, said Dr. Bishop.

The goal was to mitigate rising medical costs, ensure that patients had sufficient 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 a total of 70% of spending on specialists and 50% of the overall spending: These specialties were 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 Aexcel network, the company looks at the number of Aetna cases that were managed over a 3-year period (there was a 20-case minimum).

Aetna also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded from the Aexcel network.

Moreover, the company 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, said Dr. Bishop.

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

Dr. Bishop said that Aetna has determined that physicians who are members of 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," commented Dr. Bishop.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive detailed and defended the company's performance-based physician networks, maintaining that such "preferred provider" systems are a good way to keep costs down and to let patients know which physicians offer the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke during the concurrent session "Driving Quality in the Health Care System: Performance-based Networks 2008" at the America's Health Insurance Plans (AHIP): Institute 2008, 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. Some 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, said Dr. Bishop. 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, said Dr. Bishop.

The goal was to mitigate rising medical costs, ensure that patients had sufficient 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 a total of 70% of spending on specialists and 50% of the overall spending: These specialties were 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 Aexcel network, the company looks at the number of Aetna cases that were managed over a 3-year period (there was a 20-case minimum).

Aetna also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded from the Aexcel network.

Moreover, the company 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, said Dr. Bishop.

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

Dr. Bishop said that Aetna has determined that physicians who are members of 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," commented Dr. Bishop.

SAN FRANCISCO — Speaking at the insurance industry's annual meeting, an Aetna executive detailed and defended the company's performance-based physician networks, maintaining that such "preferred provider" systems are a good way to keep costs down and to let patients know which physicians offer the best and most cost-effective care.

Dr. Gerald Bishop, senior medical director for Aetna's West division, spoke during the concurrent session "Driving Quality in the Health Care System: Performance-based Networks 2008" at the America's Health Insurance Plans (AHIP): Institute 2008, 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. Some 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, said Dr. Bishop. 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, said Dr. Bishop.

The goal was to mitigate rising medical costs, ensure that patients had sufficient 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 a total of 70% of spending on specialists and 50% of the overall spending: These specialties were 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 Aexcel network, the company looks at the number of Aetna cases that were managed over a 3-year period (there was a 20-case minimum).

Aetna also uses nationally recognized performance measures to gauge clinical performance. Physicians who score statistically significantly below their peers are excluded from the Aexcel network.

Moreover, the company 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, said Dr. Bishop.

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

Dr. Bishop said that Aetna has determined that physicians who are members of 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," commented Dr. Bishop.

FDA Delays Hydroquinone Action

The Food and Drug Administration says over-the-counter products containing hydroquinone will be allowed to stay on the market until July 30, 2009. The move was buried in the agency's Unified Agenda for 2008, a twice-yearly update on regulatory actions and is available at

www.regulations.gov

www.fda.gov

Sunscreens Ineffective, Group Claims

The Environmental Working Group (EWG)says that 85% of sunscreens either offer inadequate protection from ultraviolet rays or contain ingredients that are hazardous or have not been tested for safety. This is the second year that the Washington-based nonprofit organization has rated sunscreen safety and effectiveness. The EWG based its ratings on 400 peer-reviewed studies of the 17 ingredients approved for use in products sold in the United States. Among top-selling sunscreens, none of the 41 Coppertone products and only 1 of 103 Neutrogena and Banana Boat products met the EWG's criteria, said the group, which has been lobbying the FDA to finalize sunscreen safety standards. A spokeswoman for Coppertone maker Schering-Plough Corp. said that its products are "photostable, provide UVA/UVB protection, and are routinely evaluated for safety and efficacy by independent dermatologists and scientists." The American Academy of Dermatology (AAD)issued a statement that it also was awaiting the FDA's final rule, but that dermatologists still recommend the use of broad-spectrum sunscreen products. "Sunscreen is an important tool in the fight against skin cancer," said Dr. C. William Hanke, AAD president. The AAD did not directly address the EWG's findings.

Slump Hasn't Hit Cosmetic Derm

The American Society for Dermatologic Surgery says that a new survey of 562 members has found that "63% are maintaining a consistent volume of bookings for existing patients seeking cosmetic-related procedures compared to 6 months ago." Almost a quarter of the membership reported an increase in appointments with established patients, and about a third said there had been a 30% increase in bookings by new patients. About half the respondents said the use of fillers and lasers had stayed steady and that they expected it to hold over the next 6 months. Slightly more members—about 40%—said the use of injectable toxins was up from 6 months ago. Finally, about half said that patients were more concerned about the cost of the procedures; 44% said that patients were stretching the time between visits.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, according to the CMS. "These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services," Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/pqri

FDA Delays Hydroquinone Action

The Food and Drug Administration says over-the-counter products containing hydroquinone will be allowed to stay on the market until July 30, 2009. The move was buried in the agency's Unified Agenda for 2008, a twice-yearly update on regulatory actions and is available at

www.regulations.gov

www.fda.gov

Sunscreens Ineffective, Group Claims

The Environmental Working Group (EWG)says that 85% of sunscreens either offer inadequate protection from ultraviolet rays or contain ingredients that are hazardous or have not been tested for safety. This is the second year that the Washington-based nonprofit organization has rated sunscreen safety and effectiveness. The EWG based its ratings on 400 peer-reviewed studies of the 17 ingredients approved for use in products sold in the United States. Among top-selling sunscreens, none of the 41 Coppertone products and only 1 of 103 Neutrogena and Banana Boat products met the EWG's criteria, said the group, which has been lobbying the FDA to finalize sunscreen safety standards. A spokeswoman for Coppertone maker Schering-Plough Corp. said that its products are "photostable, provide UVA/UVB protection, and are routinely evaluated for safety and efficacy by independent dermatologists and scientists." The American Academy of Dermatology (AAD)issued a statement that it also was awaiting the FDA's final rule, but that dermatologists still recommend the use of broad-spectrum sunscreen products. "Sunscreen is an important tool in the fight against skin cancer," said Dr. C. William Hanke, AAD president. The AAD did not directly address the EWG's findings.

Slump Hasn't Hit Cosmetic Derm

The American Society for Dermatologic Surgery says that a new survey of 562 members has found that "63% are maintaining a consistent volume of bookings for existing patients seeking cosmetic-related procedures compared to 6 months ago." Almost a quarter of the membership reported an increase in appointments with established patients, and about a third said there had been a 30% increase in bookings by new patients. About half the respondents said the use of fillers and lasers had stayed steady and that they expected it to hold over the next 6 months. Slightly more members—about 40%—said the use of injectable toxins was up from 6 months ago. Finally, about half said that patients were more concerned about the cost of the procedures; 44% said that patients were stretching the time between visits.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, according to the CMS. "These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services," Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/pqri

FDA Delays Hydroquinone Action

The Food and Drug Administration says over-the-counter products containing hydroquinone will be allowed to stay on the market until July 30, 2009. The move was buried in the agency's Unified Agenda for 2008, a twice-yearly update on regulatory actions and is available at

www.regulations.gov

www.fda.gov

Sunscreens Ineffective, Group Claims

The Environmental Working Group (EWG)says that 85% of sunscreens either offer inadequate protection from ultraviolet rays or contain ingredients that are hazardous or have not been tested for safety. This is the second year that the Washington-based nonprofit organization has rated sunscreen safety and effectiveness. The EWG based its ratings on 400 peer-reviewed studies of the 17 ingredients approved for use in products sold in the United States. Among top-selling sunscreens, none of the 41 Coppertone products and only 1 of 103 Neutrogena and Banana Boat products met the EWG's criteria, said the group, which has been lobbying the FDA to finalize sunscreen safety standards. A spokeswoman for Coppertone maker Schering-Plough Corp. said that its products are "photostable, provide UVA/UVB protection, and are routinely evaluated for safety and efficacy by independent dermatologists and scientists." The American Academy of Dermatology (AAD)issued a statement that it also was awaiting the FDA's final rule, but that dermatologists still recommend the use of broad-spectrum sunscreen products. "Sunscreen is an important tool in the fight against skin cancer," said Dr. C. William Hanke, AAD president. The AAD did not directly address the EWG's findings.

Slump Hasn't Hit Cosmetic Derm

The American Society for Dermatologic Surgery says that a new survey of 562 members has found that "63% are maintaining a consistent volume of bookings for existing patients seeking cosmetic-related procedures compared to 6 months ago." Almost a quarter of the membership reported an increase in appointments with established patients, and about a third said there had been a 30% increase in bookings by new patients. About half the respondents said the use of fillers and lasers had stayed steady and that they expected it to hold over the next 6 months. Slightly more members—about 40%—said the use of injectable toxins was up from 6 months ago. Finally, about half said that patients were more concerned about the cost of the procedures; 44% said that patients were stretching the time between visits.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, according to the CMS. "These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services," Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/pqri

SAN FRANCISCO — Athletic teenage girls who are amenorrheic have higher ghrelin and lower leptin levels than do athletic girls who are eumenorrheic or girls who are nonathletic, according to a small study.

The findings could help tease out which girls are more likely to stop menstruating, said study investigator Dr. Madhusmita Misra of Harvard Medical School.

Dr. Misra, a pediatric endocrinologist at Massachusetts General Hospital for Children, Boston, presented the study results at the annual meeting of the Endocrine Society. She and her colleagues aimed to determine whether ghrelin, which stimulates appetite, and leptin, which suppresses appetite, might be related to amenorrhea in young women, especially those with intense energy expenditures and a heightened need for caloric intake. Ghrelin levels have been shown to be increased in people with anorexia nervosa, and higher levels also have been linked to impaired secretion of hormones that regulate menstrual and ovarian function.

“The hormonal factors that link energy deficit and the stopping of periods in athletes are not well characterized,” said Dr. Misra, who spoke with reporters during the meeting.

The study was funded by the National Institutes of Health.

It is especially important to tease out the relationships, given that evidence suggests that amenorrhea causes infertility and early onset of low bone density, she said. Some 25% of female high school athletes experience an absence of menstruation.

Dr. Misra and colleagues enrolled 21 girls who were amenorrheic athletes, 19 eumenorrheic athletes, and 18 nonathletic controls. All were aged 12–18 years. Fasting blood was drawn to measure ghrelin, leptin, estradiol, testosterone, and follicle-stimulating hormone levels.

The two athletic groups had similar activity levels, which were higher than that for the control group of nonathletes. The athletes were 85% of ideal body weight for their age.

But the amenorrheic girls weighed less and had lower body mass index scores than did eumenorrheic girls. They also had slightly disordered eating behaviors—which included dieting—but no use of laxatives or medications to lose weight, said Dr. Misra.

As predicted, the amenorrheic girls had lower leptin levels—half those of the other two groups—and their ghrelin levels were twice those of the other two arms. The girls with the highest ghrelin levels and lowest leptin levels also had the lowest levels of estrogen and of follicle-stimulating hormone, she said.

In an interview, Dr. Misra said that it was not clear whether these hormone disturbances existed before the onset of amenorrhea, but that she was leaning toward a hypothesis that the hormone disturbances are an adaptive response in some girls.

Moreover, these girls might have an intrinsic abnormality that causes that response in the face of energy demands.

Dr. Misra has applied to the NIH for funding of a prospective study more closely examining energy availability and its affect on hormones.

She stated that she had no conflicts of interest related to this study.

SAN FRANCISCO — Athletic teenage girls who are amenorrheic have higher ghrelin and lower leptin levels than do athletic girls who are eumenorrheic or girls who are nonathletic, according to a small study.

The findings could help tease out which girls are more likely to stop menstruating, said study investigator Dr. Madhusmita Misra of Harvard Medical School.

Dr. Misra, a pediatric endocrinologist at Massachusetts General Hospital for Children, Boston, presented the study results at the annual meeting of the Endocrine Society. She and her colleagues aimed to determine whether ghrelin, which stimulates appetite, and leptin, which suppresses appetite, might be related to amenorrhea in young women, especially those with intense energy expenditures and a heightened need for caloric intake. Ghrelin levels have been shown to be increased in people with anorexia nervosa, and higher levels also have been linked to impaired secretion of hormones that regulate menstrual and ovarian function.

“The hormonal factors that link energy deficit and the stopping of periods in athletes are not well characterized,” said Dr. Misra, who spoke with reporters during the meeting.

The study was funded by the National Institutes of Health.

It is especially important to tease out the relationships, given that evidence suggests that amenorrhea causes infertility and early onset of low bone density, she said. Some 25% of female high school athletes experience an absence of menstruation.

Dr. Misra and colleagues enrolled 21 girls who were amenorrheic athletes, 19 eumenorrheic athletes, and 18 nonathletic controls. All were aged 12–18 years. Fasting blood was drawn to measure ghrelin, leptin, estradiol, testosterone, and follicle-stimulating hormone levels.

The two athletic groups had similar activity levels, which were higher than that for the control group of nonathletes. The athletes were 85% of ideal body weight for their age.

But the amenorrheic girls weighed less and had lower body mass index scores than did eumenorrheic girls. They also had slightly disordered eating behaviors—which included dieting—but no use of laxatives or medications to lose weight, said Dr. Misra.

As predicted, the amenorrheic girls had lower leptin levels—half those of the other two groups—and their ghrelin levels were twice those of the other two arms. The girls with the highest ghrelin levels and lowest leptin levels also had the lowest levels of estrogen and of follicle-stimulating hormone, she said.

In an interview, Dr. Misra said that it was not clear whether these hormone disturbances existed before the onset of amenorrhea, but that she was leaning toward a hypothesis that the hormone disturbances are an adaptive response in some girls.

Moreover, these girls might have an intrinsic abnormality that causes that response in the face of energy demands.

Dr. Misra has applied to the NIH for funding of a prospective study more closely examining energy availability and its affect on hormones.

She stated that she had no conflicts of interest related to this study.

SAN FRANCISCO — Athletic teenage girls who are amenorrheic have higher ghrelin and lower leptin levels than do athletic girls who are eumenorrheic or girls who are nonathletic, according to a small study.

The findings could help tease out which girls are more likely to stop menstruating, said study investigator Dr. Madhusmita Misra of Harvard Medical School.

Dr. Misra, a pediatric endocrinologist at Massachusetts General Hospital for Children, Boston, presented the study results at the annual meeting of the Endocrine Society. She and her colleagues aimed to determine whether ghrelin, which stimulates appetite, and leptin, which suppresses appetite, might be related to amenorrhea in young women, especially those with intense energy expenditures and a heightened need for caloric intake. Ghrelin levels have been shown to be increased in people with anorexia nervosa, and higher levels also have been linked to impaired secretion of hormones that regulate menstrual and ovarian function.

“The hormonal factors that link energy deficit and the stopping of periods in athletes are not well characterized,” said Dr. Misra, who spoke with reporters during the meeting.

The study was funded by the National Institutes of Health.

It is especially important to tease out the relationships, given that evidence suggests that amenorrhea causes infertility and early onset of low bone density, she said. Some 25% of female high school athletes experience an absence of menstruation.

Dr. Misra and colleagues enrolled 21 girls who were amenorrheic athletes, 19 eumenorrheic athletes, and 18 nonathletic controls. All were aged 12–18 years. Fasting blood was drawn to measure ghrelin, leptin, estradiol, testosterone, and follicle-stimulating hormone levels.

The two athletic groups had similar activity levels, which were higher than that for the control group of nonathletes. The athletes were 85% of ideal body weight for their age.

But the amenorrheic girls weighed less and had lower body mass index scores than did eumenorrheic girls. They also had slightly disordered eating behaviors—which included dieting—but no use of laxatives or medications to lose weight, said Dr. Misra.

As predicted, the amenorrheic girls had lower leptin levels—half those of the other two groups—and their ghrelin levels were twice those of the other two arms. The girls with the highest ghrelin levels and lowest leptin levels also had the lowest levels of estrogen and of follicle-stimulating hormone, she said.

In an interview, Dr. Misra said that it was not clear whether these hormone disturbances existed before the onset of amenorrhea, but that she was leaning toward a hypothesis that the hormone disturbances are an adaptive response in some girls.

Moreover, these girls might have an intrinsic abnormality that causes that response in the face of energy demands.

Dr. Misra has applied to the NIH for funding of a prospective study more closely examining energy availability and its affect on hormones.

She stated that she had no conflicts of interest related to this study.

NEW ORLEANS — Among women who have discontinued hormone therapy for vasomotor symptoms, black cohosh and multivitamins with calcium were two of the most common substitutes, according to survey data from more than 500 women.

Elizabeth M. Kupferer, Ph.D., sent questionnaires primarily to a convenience sample of women selected from a general mailing list obtained from a marketing company. She also recruited women through advertisements and flyers placed at health providers' offices, a weight-loss program, and a grocery store in the Austin, Tex., area.

Eligible women were over age 40 years, were menopausal, and had been prescribed and had taken hormone therapy for at least 3 months before discontinuing. The surveys were mailed back to Dr. Kupferer, a nurse practitioner and faculty member at the University of Texas at Austin. She presented her results at the annual meeting of the American College of Obstetricians and Gynecologists.

Questionnaires were sent to 2,550 women; 563 were included in the final analysis. Surveys were completed in December 2006. The participants were from every state except Hawaii and were primarily white. The mean age was 58 years, with a range of 40–82 years. Sixty-eight percent (382) had a high school diploma and 41% had a household income of $30,000 or less.

Most women who reported menopause type had a natural menopause; about a third (193) had surgical menopause.

Three-quarters of the respondents said they had vasomotor symptoms before they started HT. Eighty percent had a return of symptoms after discontinuing.

Of the 563 participants, 252 (45%) said they had used an alternative to treat those symptoms. Those most likely to use alternative therapies were aged 40–50 years, were less than 5 years after menopause onset, and had medically induced menopause.

The most common choice of therapy was multivitamins with calcium; use was reported by 59% of the respondents. No. 2 was black cohosh (46%), followed by soy supplements and food (42%), antidepressants (32%), meditation and relaxation (26%), evening primrose oil (17%), and blood pressure medications (14%). Some respondents said they used more than one choice of therapy.

Women also reported using homeopathy (12%), red clover (8%), antiepileptic medications (8%), traditional Chinese medicine (3%), acupuncture (2%), Ayurvedic medicine (0.2%), and a variety of other supplements.

Only 6% of women said they were using bioidentical hormones.

Women were asked to comment on effectiveness of their therapy of choice. Given the small numbers in some categories, it was not possible to say definitively which worked best, said Dr. Kupferer in an interview. But overall, survey respondents perceived antidepressants to be one of the most effective methods, followed by homeopathy, meditation and relaxation, evening primrose, blood pressure medications, black cohosh, soy products, and multivitamins and calcium.

Dr. Kupferer said she hopes to explore more about women's use of alternative therapies, especially among lower-income and minority populations.

She disclosed that she is currently a medical science liaison at Duramed Research Inc.'s contraceptive division, but that her work on the survey was completed before she accepted the position.

NEW ORLEANS — Among women who have discontinued hormone therapy for vasomotor symptoms, black cohosh and multivitamins with calcium were two of the most common substitutes, according to survey data from more than 500 women.

Elizabeth M. Kupferer, Ph.D., sent questionnaires primarily to a convenience sample of women selected from a general mailing list obtained from a marketing company. She also recruited women through advertisements and flyers placed at health providers' offices, a weight-loss program, and a grocery store in the Austin, Tex., area.

Eligible women were over age 40 years, were menopausal, and had been prescribed and had taken hormone therapy for at least 3 months before discontinuing. The surveys were mailed back to Dr. Kupferer, a nurse practitioner and faculty member at the University of Texas at Austin. She presented her results at the annual meeting of the American College of Obstetricians and Gynecologists.

Questionnaires were sent to 2,550 women; 563 were included in the final analysis. Surveys were completed in December 2006. The participants were from every state except Hawaii and were primarily white. The mean age was 58 years, with a range of 40–82 years. Sixty-eight percent (382) had a high school diploma and 41% had a household income of $30,000 or less.

Most women who reported menopause type had a natural menopause; about a third (193) had surgical menopause.

Three-quarters of the respondents said they had vasomotor symptoms before they started HT. Eighty percent had a return of symptoms after discontinuing.

Of the 563 participants, 252 (45%) said they had used an alternative to treat those symptoms. Those most likely to use alternative therapies were aged 40–50 years, were less than 5 years after menopause onset, and had medically induced menopause.

The most common choice of therapy was multivitamins with calcium; use was reported by 59% of the respondents. No. 2 was black cohosh (46%), followed by soy supplements and food (42%), antidepressants (32%), meditation and relaxation (26%), evening primrose oil (17%), and blood pressure medications (14%). Some respondents said they used more than one choice of therapy.

Women also reported using homeopathy (12%), red clover (8%), antiepileptic medications (8%), traditional Chinese medicine (3%), acupuncture (2%), Ayurvedic medicine (0.2%), and a variety of other supplements.

Only 6% of women said they were using bioidentical hormones.

Women were asked to comment on effectiveness of their therapy of choice. Given the small numbers in some categories, it was not possible to say definitively which worked best, said Dr. Kupferer in an interview. But overall, survey respondents perceived antidepressants to be one of the most effective methods, followed by homeopathy, meditation and relaxation, evening primrose, blood pressure medications, black cohosh, soy products, and multivitamins and calcium.

Dr. Kupferer said she hopes to explore more about women's use of alternative therapies, especially among lower-income and minority populations.

She disclosed that she is currently a medical science liaison at Duramed Research Inc.'s contraceptive division, but that her work on the survey was completed before she accepted the position.

NEW ORLEANS — Among women who have discontinued hormone therapy for vasomotor symptoms, black cohosh and multivitamins with calcium were two of the most common substitutes, according to survey data from more than 500 women.

Elizabeth M. Kupferer, Ph.D., sent questionnaires primarily to a convenience sample of women selected from a general mailing list obtained from a marketing company. She also recruited women through advertisements and flyers placed at health providers' offices, a weight-loss program, and a grocery store in the Austin, Tex., area.

Eligible women were over age 40 years, were menopausal, and had been prescribed and had taken hormone therapy for at least 3 months before discontinuing. The surveys were mailed back to Dr. Kupferer, a nurse practitioner and faculty member at the University of Texas at Austin. She presented her results at the annual meeting of the American College of Obstetricians and Gynecologists.

Questionnaires were sent to 2,550 women; 563 were included in the final analysis. Surveys were completed in December 2006. The participants were from every state except Hawaii and were primarily white. The mean age was 58 years, with a range of 40–82 years. Sixty-eight percent (382) had a high school diploma and 41% had a household income of $30,000 or less.

Most women who reported menopause type had a natural menopause; about a third (193) had surgical menopause.

Three-quarters of the respondents said they had vasomotor symptoms before they started HT. Eighty percent had a return of symptoms after discontinuing.

Of the 563 participants, 252 (45%) said they had used an alternative to treat those symptoms. Those most likely to use alternative therapies were aged 40–50 years, were less than 5 years after menopause onset, and had medically induced menopause.

The most common choice of therapy was multivitamins with calcium; use was reported by 59% of the respondents. No. 2 was black cohosh (46%), followed by soy supplements and food (42%), antidepressants (32%), meditation and relaxation (26%), evening primrose oil (17%), and blood pressure medications (14%). Some respondents said they used more than one choice of therapy.

Women also reported using homeopathy (12%), red clover (8%), antiepileptic medications (8%), traditional Chinese medicine (3%), acupuncture (2%), Ayurvedic medicine (0.2%), and a variety of other supplements.

Only 6% of women said they were using bioidentical hormones.

Women were asked to comment on effectiveness of their therapy of choice. Given the small numbers in some categories, it was not possible to say definitively which worked best, said Dr. Kupferer in an interview. But overall, survey respondents perceived antidepressants to be one of the most effective methods, followed by homeopathy, meditation and relaxation, evening primrose, blood pressure medications, black cohosh, soy products, and multivitamins and calcium.

Dr. Kupferer said she hopes to explore more about women's use of alternative therapies, especially among lower-income and minority populations.

She disclosed that she is currently a medical science liaison at Duramed Research Inc.'s contraceptive division, but that her work on the survey was completed before she accepted the position.

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 held steady.

“We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

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.

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 held steady.

“We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

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.

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 held steady.

“We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly,” said Dr. William F. Jessee, president and CEO of the Medical Group Management Association, in a statement.

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.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Although health care has been a key issue in this year's presidential campaign, plans from both Barack Obama and John McCain are light on details when it comes to the most important aspects of the health system, including controlling costs, and improving efficiency and productivity.

The candidates have presented a wish list with very little detail on how they would accomplish the “fundamental change needed for our delivery system,” said Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, at a briefing sponsored by the Alliance for Health Reform. “They could have a debate over how best to do that,” he said, adding, “We aren't hearing that.”

Economists have estimated that over the next decade, U.S. health spending will double from $2.2 trillion to $4.3 trillion. Dr. Ginsburg, along with Princeton University economist Uwe Reinhardt and former Centers for Medicare and Medicaid Services Administrator Dr. Mark McClellan, said that rising costs are largely being driven by variations in practice, growth in volume, and intensity of services.

Senator Obama has said that he favors health information technology, transparency of price, promotion of quality care, chronic care coordination, payment reforms for value, malpractice reform, and promotion of generics.

Most of these are old, but not worthless, ideas, said Dr. Reinhardt, James Madison Professor of Political Economy at Princeton. “These are not to be laughed off, but they won't get us out of the box.”

Dr. Reinhardt called Senator McCain a “true radical” for his proposal to eliminate the tax exemption for employer-provided health insurance. Under Senator McCain's plan, individuals who purchase insurance on their own would instead receive a $2,500 tax credit; families would receive $5,000.

“This is almost un-American—to take away a tax preference,” said Dr. Reinhardt, adding that it is “a shocking idea and not easy to get through Congress.”

Dr. Ginsburg called the proposal “a potentially powerful idea,” saying that it could make consumers more sensitive to the cost side of insurance, and thus make them a more potent demand force.

Cost control is important because there will be no new federal money available to increase access to insurance or initiatives aimed at improving quality or productivity, said Dr. McClellan. “Next year is going to be a very tight year fiscally.”

He added that new spending will be next to impossible, especially for a Republican who, politically, would be faced with maintaining the tax cuts instituted in 2001, and continuing to fund the war in Iraq and the war on terrorism.

In fact, tax reform, the Iraq war, and the economy are likely to be higher up on the campaign agenda than health during the general election run-up this fall, said Dr. McClellan and his fellow panelists.

“I'm not personally persuaded that health care, in fact, will drive the campaign in the fall,” said Dr. Reinhardt.

But Dr. McClellan said, “My hope is it doesn't get pushed to the back burner,” noting that, “it will be a major missed opportunity if we don't have health reform next year.”

WASHINGTON — Although health care has been a key issue in this year's presidential campaign, plans from both Barack Obama and John McCain are light on details when it comes to the most important aspects of the health system, including controlling costs, and improving efficiency and productivity.

The candidates have presented a wish list with very little detail on how they would accomplish the “fundamental change needed for our delivery system,” said Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, at a briefing sponsored by the Alliance for Health Reform. “They could have a debate over how best to do that,” he said, adding, “We aren't hearing that.”

Economists have estimated that over the next decade, U.S. health spending will double from $2.2 trillion to $4.3 trillion. Dr. Ginsburg, along with Princeton University economist Uwe Reinhardt and former Centers for Medicare and Medicaid Services Administrator Dr. Mark McClellan, said that rising costs are largely being driven by variations in practice, growth in volume, and intensity of services.

Senator Obama has said that he favors health information technology, transparency of price, promotion of quality care, chronic care coordination, payment reforms for value, malpractice reform, and promotion of generics.

Most of these are old, but not worthless, ideas, said Dr. Reinhardt, James Madison Professor of Political Economy at Princeton. “These are not to be laughed off, but they won't get us out of the box.”

Dr. Reinhardt called Senator McCain a “true radical” for his proposal to eliminate the tax exemption for employer-provided health insurance. Under Senator McCain's plan, individuals who purchase insurance on their own would instead receive a $2,500 tax credit; families would receive $5,000.

“This is almost un-American—to take away a tax preference,” said Dr. Reinhardt, adding that it is “a shocking idea and not easy to get through Congress.”

Dr. Ginsburg called the proposal “a potentially powerful idea,” saying that it could make consumers more sensitive to the cost side of insurance, and thus make them a more potent demand force.

Cost control is important because there will be no new federal money available to increase access to insurance or initiatives aimed at improving quality or productivity, said Dr. McClellan. “Next year is going to be a very tight year fiscally.”

He added that new spending will be next to impossible, especially for a Republican who, politically, would be faced with maintaining the tax cuts instituted in 2001, and continuing to fund the war in Iraq and the war on terrorism.

In fact, tax reform, the Iraq war, and the economy are likely to be higher up on the campaign agenda than health during the general election run-up this fall, said Dr. McClellan and his fellow panelists.

“I'm not personally persuaded that health care, in fact, will drive the campaign in the fall,” said Dr. Reinhardt.

But Dr. McClellan said, “My hope is it doesn't get pushed to the back burner,” noting that, “it will be a major missed opportunity if we don't have health reform next year.”

WASHINGTON — Although health care has been a key issue in this year's presidential campaign, plans from both Barack Obama and John McCain are light on details when it comes to the most important aspects of the health system, including controlling costs, and improving efficiency and productivity.

The candidates have presented a wish list with very little detail on how they would accomplish the “fundamental change needed for our delivery system,” said Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, at a briefing sponsored by the Alliance for Health Reform. “They could have a debate over how best to do that,” he said, adding, “We aren't hearing that.”

Economists have estimated that over the next decade, U.S. health spending will double from $2.2 trillion to $4.3 trillion. Dr. Ginsburg, along with Princeton University economist Uwe Reinhardt and former Centers for Medicare and Medicaid Services Administrator Dr. Mark McClellan, said that rising costs are largely being driven by variations in practice, growth in volume, and intensity of services.

Senator Obama has said that he favors health information technology, transparency of price, promotion of quality care, chronic care coordination, payment reforms for value, malpractice reform, and promotion of generics.

Most of these are old, but not worthless, ideas, said Dr. Reinhardt, James Madison Professor of Political Economy at Princeton. “These are not to be laughed off, but they won't get us out of the box.”

Dr. Reinhardt called Senator McCain a “true radical” for his proposal to eliminate the tax exemption for employer-provided health insurance. Under Senator McCain's plan, individuals who purchase insurance on their own would instead receive a $2,500 tax credit; families would receive $5,000.

“This is almost un-American—to take away a tax preference,” said Dr. Reinhardt, adding that it is “a shocking idea and not easy to get through Congress.”

Dr. Ginsburg called the proposal “a potentially powerful idea,” saying that it could make consumers more sensitive to the cost side of insurance, and thus make them a more potent demand force.

Cost control is important because there will be no new federal money available to increase access to insurance or initiatives aimed at improving quality or productivity, said Dr. McClellan. “Next year is going to be a very tight year fiscally.”

He added that new spending will be next to impossible, especially for a Republican who, politically, would be faced with maintaining the tax cuts instituted in 2001, and continuing to fund the war in Iraq and the war on terrorism.

In fact, tax reform, the Iraq war, and the economy are likely to be higher up on the campaign agenda than health during the general election run-up this fall, said Dr. McClellan and his fellow panelists.

“I'm not personally persuaded that health care, in fact, will drive the campaign in the fall,” said Dr. Reinhardt.

But Dr. McClellan said, “My hope is it doesn't get pushed to the back burner,” noting that, “it will be a major missed opportunity if we don't have health reform next year.”

SAN DIEGO — Sepsis has become a leading cause of death for hospitalized patients with cirrhosis, according to a retrospective cohort study.

Overall mortality from cirrhosis is high, but mortality due to variceal bleeding is declining, Dr. Suraj Naik reported at Digestive Disease Week.

He and his colleagues hypothesized that as treatment of variceal bleeding has improved, the leading cause of in-hospital mortality for cirrhotic patients has shifted.

They studied two specific time periods at Parkland Memorial Hospital in Dallas: 1983–1985 and 2003–2005. Patients were identified by ICD9 codes for any and all causes of cirrhosis. The condition was defined by clinical history, physical findings, and laboratory measures. The cause of death was defined by diagnoses in clinical data and death summaries.

In 1983–1985, there were 610 patients admitted to Parkland with confirmed cirrhosis; 163 (27%) died in-hospital. In 2003–2005, there were 1,187 patients admitted and 241 (20%) died in-hospital. The two cohorts were matched in gender, race, and age (the average age was 50 years in the first group and 53 years in the later group). In 1983–1985, the most common cause of death was variceal bleed (49 patients, or 8%), followed by sepsis (43 patients, or 7%), and liver failure/hepatorenal syndrome (14 patients, or 2%). In 2003–2005, the most common cause of death was sepsis (97 patients, or 8%), followed by variceal bleed (31 patients, or 3%) and liver failure (23 patients, or 2%).

Overall mortality decreased from the first to the second cohort by 22%, and death due to variceal bleeding decreased by 57%.

Mortality due to sepsis increased by 50% in the second cohort, and led to death three times as often as in the earlier cohort, said Dr. Naik of the University of Texas at Dallas.

The etiology of cirrhosis changed from the earlier cohort to the later, with alcohol as a factor in 88% of patients in the first group and only 46% of the second, more recent group.

Dr. Naik said that it was not clear how many patients in each group also had hepatitis C, although he believed that it was a majority.

The most frequent causes of infection in these patients were pneumonia, bacteremia, and spontaneous bacterial peritonitis.

The study results suggest that clinicians should be more aware of the danger of infection in patients with cirrhosis, Dr. Naik said.

He reported no disclosures.

SAN DIEGO — Sepsis has become a leading cause of death for hospitalized patients with cirrhosis, according to a retrospective cohort study.

Overall mortality from cirrhosis is high, but mortality due to variceal bleeding is declining, Dr. Suraj Naik reported at Digestive Disease Week.

He and his colleagues hypothesized that as treatment of variceal bleeding has improved, the leading cause of in-hospital mortality for cirrhotic patients has shifted.

They studied two specific time periods at Parkland Memorial Hospital in Dallas: 1983–1985 and 2003–2005. Patients were identified by ICD9 codes for any and all causes of cirrhosis. The condition was defined by clinical history, physical findings, and laboratory measures. The cause of death was defined by diagnoses in clinical data and death summaries.

In 1983–1985, there were 610 patients admitted to Parkland with confirmed cirrhosis; 163 (27%) died in-hospital. In 2003–2005, there were 1,187 patients admitted and 241 (20%) died in-hospital. The two cohorts were matched in gender, race, and age (the average age was 50 years in the first group and 53 years in the later group). In 1983–1985, the most common cause of death was variceal bleed (49 patients, or 8%), followed by sepsis (43 patients, or 7%), and liver failure/hepatorenal syndrome (14 patients, or 2%). In 2003–2005, the most common cause of death was sepsis (97 patients, or 8%), followed by variceal bleed (31 patients, or 3%) and liver failure (23 patients, or 2%).

Overall mortality decreased from the first to the second cohort by 22%, and death due to variceal bleeding decreased by 57%.

Mortality due to sepsis increased by 50% in the second cohort, and led to death three times as often as in the earlier cohort, said Dr. Naik of the University of Texas at Dallas.

The etiology of cirrhosis changed from the earlier cohort to the later, with alcohol as a factor in 88% of patients in the first group and only 46% of the second, more recent group.

Dr. Naik said that it was not clear how many patients in each group also had hepatitis C, although he believed that it was a majority.

The most frequent causes of infection in these patients were pneumonia, bacteremia, and spontaneous bacterial peritonitis.

The study results suggest that clinicians should be more aware of the danger of infection in patients with cirrhosis, Dr. Naik said.

He reported no disclosures.

SAN DIEGO — Sepsis has become a leading cause of death for hospitalized patients with cirrhosis, according to a retrospective cohort study.

Overall mortality from cirrhosis is high, but mortality due to variceal bleeding is declining, Dr. Suraj Naik reported at Digestive Disease Week.

He and his colleagues hypothesized that as treatment of variceal bleeding has improved, the leading cause of in-hospital mortality for cirrhotic patients has shifted.

They studied two specific time periods at Parkland Memorial Hospital in Dallas: 1983–1985 and 2003–2005. Patients were identified by ICD9 codes for any and all causes of cirrhosis. The condition was defined by clinical history, physical findings, and laboratory measures. The cause of death was defined by diagnoses in clinical data and death summaries.

In 1983–1985, there were 610 patients admitted to Parkland with confirmed cirrhosis; 163 (27%) died in-hospital. In 2003–2005, there were 1,187 patients admitted and 241 (20%) died in-hospital. The two cohorts were matched in gender, race, and age (the average age was 50 years in the first group and 53 years in the later group). In 1983–1985, the most common cause of death was variceal bleed (49 patients, or 8%), followed by sepsis (43 patients, or 7%), and liver failure/hepatorenal syndrome (14 patients, or 2%). In 2003–2005, the most common cause of death was sepsis (97 patients, or 8%), followed by variceal bleed (31 patients, or 3%) and liver failure (23 patients, or 2%).

Overall mortality decreased from the first to the second cohort by 22%, and death due to variceal bleeding decreased by 57%.

Mortality due to sepsis increased by 50% in the second cohort, and led to death three times as often as in the earlier cohort, said Dr. Naik of the University of Texas at Dallas.

The etiology of cirrhosis changed from the earlier cohort to the later, with alcohol as a factor in 88% of patients in the first group and only 46% of the second, more recent group.

Dr. Naik said that it was not clear how many patients in each group also had hepatitis C, although he believed that it was a majority.

The most frequent causes of infection in these patients were pneumonia, bacteremia, and spontaneous bacterial peritonitis.

The study results suggest that clinicians should be more aware of the danger of infection in patients with cirrhosis, Dr. Naik said.

He reported no 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 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.

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, which is sooner than recommended.

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 to 40% of the highest risk group, said Dr. Laiyemo. “This leads us to realize that we need to improve our use of colonoscopy.”

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 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.

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, which is sooner than recommended.

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 to 40% of the highest risk group, said Dr. Laiyemo. “This leads us to realize that we need to improve our use of colonoscopy.”

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 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.

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, which is sooner than recommended.

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 to 40% of the highest risk group, said Dr. Laiyemo. “This leads us to realize that we need to improve our use of colonoscopy.”