Alicia Ault

The number of students entering medical school this fall—17,759—is the highest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007.

It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows "that the interest in medicine runs very strong in our country."

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants.

There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the AAMC. Ultimately, black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels.

There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

Eleven of the 126 medical schools increased their class size by more than 10%: Michigan State University (47% increase), Texas A&M University System (24%), University of Arizona (22%), Florida State University (19%), Emory University (14%), Mount Sinai School of Medicine (14%), University of California, Davis (13%), Joan C. Edwards School of Medicine at Marshall University (12%), and Drexel University, Howard University, and University of Minnesota (10% each). Some of the increase in enrollment came through added capacity—both Michigan State and Arizona opened additional campuses.

Six universities are currently seeking accreditation for a medical school, said Dr. Kirch.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and other organizations have warned of looming physician shortages.

Depending on the estimates used, there will be a shortfall of 55,000-90,000 physicians across all specialties by 2020.

The AAMC has pushed for a 30% increase in enrollment by 2015, said Dr. Kirch. He acknowledged that it can be difficult to accurately predict shortages, noting that medical school enrollment has waxed and waned over the years.

Even so, despite the many current challenges of being a physician—including a patchwork health care system and unpredictable reimbursement picture—it's still seen as an attractive career choice, Dr. Kirch said.

"What I think is most striking here is to see the draw that medicine still has despite those environmental forces," he said. "I personally view this as a reflection that there are few careers that can be as meaningful, as fulfilling as pursuing medicine," he added.

ELSEVIER GLOBAL MEDICAL NEWS

The number of students entering medical school this fall—17,759—is the highest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007.

It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows "that the interest in medicine runs very strong in our country."

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants.

There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the AAMC. Ultimately, black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels.

There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

Eleven of the 126 medical schools increased their class size by more than 10%: Michigan State University (47% increase), Texas A&M University System (24%), University of Arizona (22%), Florida State University (19%), Emory University (14%), Mount Sinai School of Medicine (14%), University of California, Davis (13%), Joan C. Edwards School of Medicine at Marshall University (12%), and Drexel University, Howard University, and University of Minnesota (10% each). Some of the increase in enrollment came through added capacity—both Michigan State and Arizona opened additional campuses.

Six universities are currently seeking accreditation for a medical school, said Dr. Kirch.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and other organizations have warned of looming physician shortages.

Depending on the estimates used, there will be a shortfall of 55,000-90,000 physicians across all specialties by 2020.

The AAMC has pushed for a 30% increase in enrollment by 2015, said Dr. Kirch. He acknowledged that it can be difficult to accurately predict shortages, noting that medical school enrollment has waxed and waned over the years.

Even so, despite the many current challenges of being a physician—including a patchwork health care system and unpredictable reimbursement picture—it's still seen as an attractive career choice, Dr. Kirch said.

"What I think is most striking here is to see the draw that medicine still has despite those environmental forces," he said. "I personally view this as a reflection that there are few careers that can be as meaningful, as fulfilling as pursuing medicine," he added.

ELSEVIER GLOBAL MEDICAL NEWS

The number of students entering medical school this fall—17,759—is the highest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007.

It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows "that the interest in medicine runs very strong in our country."

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants.

There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the AAMC. Ultimately, black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels.

There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

Eleven of the 126 medical schools increased their class size by more than 10%: Michigan State University (47% increase), Texas A&M University System (24%), University of Arizona (22%), Florida State University (19%), Emory University (14%), Mount Sinai School of Medicine (14%), University of California, Davis (13%), Joan C. Edwards School of Medicine at Marshall University (12%), and Drexel University, Howard University, and University of Minnesota (10% each). Some of the increase in enrollment came through added capacity—both Michigan State and Arizona opened additional campuses.

Six universities are currently seeking accreditation for a medical school, said Dr. Kirch.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and other organizations have warned of looming physician shortages.

Depending on the estimates used, there will be a shortfall of 55,000-90,000 physicians across all specialties by 2020.

The AAMC has pushed for a 30% increase in enrollment by 2015, said Dr. Kirch. He acknowledged that it can be difficult to accurately predict shortages, noting that medical school enrollment has waxed and waned over the years.

Even so, despite the many current challenges of being a physician—including a patchwork health care system and unpredictable reimbursement picture—it's still seen as an attractive career choice, Dr. Kirch said.

"What I think is most striking here is to see the draw that medicine still has despite those environmental forces," he said. "I personally view this as a reflection that there are few careers that can be as meaningful, as fulfilling as pursuing medicine," he added.

ELSEVIER GLOBAL MEDICAL NEWS

Largest-Ever Psoriasis Grant

The National Institute of Arthritis and Musculoskeletal and Skin Diseases has awarded Case Western Reserve University $6.37 million to establish a Center of Research Translation for psoriasis. The NIAMS funds will be added to a $5 million donation made in 2006 by the Murdough Foundation, and seek to bring together multidisciplinary teams of scientists, physicians, nurses, and researchers. The NIAMS grant will initially be used for development of Pc 4, a novel photodynamic therapy; for a project to understand the role of S100A8/9, a proinflammatory protein; and, for mouse models for analysis of biochemical processes and cardiovascular risks associated with psoriasis.

NIH Lupus Research Plan

Government scientists recently outlined their plans for future research in lupus. The goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, expanding biopsychosocial research, discovering and validating biomarkers, and advancing therapy options. These goals are part of a long-range planning document recently released by NIAMS. The document predicts that lupus prevention could become an attainable goal in the next decade, and outlines a need to advance research efforts to identify disease risk through family studies and genetics. "The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus," Dr. Stephen Katz, NIAMS director, wrote in the introduction to the research plan.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus (MRSA) infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5 days) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. "Our findings suggest that low health literacy exacts enormous costs on both the health system and society," lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, "Low Health Literacy: Implications for National Health Policy," was supported by a grant from Pfizer Inc.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by 2010. "Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year," said a letter from the coalition, which includes Aetna, Consumers Union, the Corporate Health Care Coalition, the Pacific Business Group on Health, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, House Committee on Ways and Means, and House Energy and Commerce Committee. The letter noted that the IOM called on all physicians to adopt e-prescribing by 2010 to address medication errors. "Unfortunately, fewer than 1 in 10 physicians are meeting this challenge," the coalition wrote. The American Medical Association, however, said e-prescribing should be voluntary, not mandatory, and that it should be tied to the Medicare Part D drug benefit. In a letter to several House and Senate members, the organization also said that it is still waiting for the Department of Health and Human Services to issue national e-prescribing standards, called for in the 2003 Medicare Prescription Drug Improvement and Modernization Act. Physicians also need financial incentives and other support to adopt e-prescribing, said the AMA, noting that half of practices are made up of five or fewer physicians. "The costs for such small practices of e-prescribing technology, training, and upgrades are significant," said the AMA.

California Enacts AIDS Bill

Gov. Arnold Schwarzenegger (R) last month signed into law a measure that its advocates say removes a major barrier to HIV testing by requiring a patient to give simple consent, rather than informed consent, prior to the test. The legislation, which garnered almost unanimous support in the state legislature, also streamlines some of the procedures a physician must follow in testing pregnant women. The law "normalizes the process of testing by making HIV screening a routine part of medical care," said Joseph Terrill, public policy coordinator for Sacramento-based AIDS Healthcare Foundation, adding that the legislation also has provisions to maintain and safeguard patient confidentiality and an individual's right to choose whether to be tested.

Largest-Ever Psoriasis Grant

The National Institute of Arthritis and Musculoskeletal and Skin Diseases has awarded Case Western Reserve University $6.37 million to establish a Center of Research Translation for psoriasis. The NIAMS funds will be added to a $5 million donation made in 2006 by the Murdough Foundation, and seek to bring together multidisciplinary teams of scientists, physicians, nurses, and researchers. The NIAMS grant will initially be used for development of Pc 4, a novel photodynamic therapy; for a project to understand the role of S100A8/9, a proinflammatory protein; and, for mouse models for analysis of biochemical processes and cardiovascular risks associated with psoriasis.

NIH Lupus Research Plan

Government scientists recently outlined their plans for future research in lupus. The goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, expanding biopsychosocial research, discovering and validating biomarkers, and advancing therapy options. These goals are part of a long-range planning document recently released by NIAMS. The document predicts that lupus prevention could become an attainable goal in the next decade, and outlines a need to advance research efforts to identify disease risk through family studies and genetics. "The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus," Dr. Stephen Katz, NIAMS director, wrote in the introduction to the research plan.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus (MRSA) infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5 days) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. "Our findings suggest that low health literacy exacts enormous costs on both the health system and society," lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, "Low Health Literacy: Implications for National Health Policy," was supported by a grant from Pfizer Inc.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by 2010. "Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year," said a letter from the coalition, which includes Aetna, Consumers Union, the Corporate Health Care Coalition, the Pacific Business Group on Health, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, House Committee on Ways and Means, and House Energy and Commerce Committee. The letter noted that the IOM called on all physicians to adopt e-prescribing by 2010 to address medication errors. "Unfortunately, fewer than 1 in 10 physicians are meeting this challenge," the coalition wrote. The American Medical Association, however, said e-prescribing should be voluntary, not mandatory, and that it should be tied to the Medicare Part D drug benefit. In a letter to several House and Senate members, the organization also said that it is still waiting for the Department of Health and Human Services to issue national e-prescribing standards, called for in the 2003 Medicare Prescription Drug Improvement and Modernization Act. Physicians also need financial incentives and other support to adopt e-prescribing, said the AMA, noting that half of practices are made up of five or fewer physicians. "The costs for such small practices of e-prescribing technology, training, and upgrades are significant," said the AMA.

California Enacts AIDS Bill

Gov. Arnold Schwarzenegger (R) last month signed into law a measure that its advocates say removes a major barrier to HIV testing by requiring a patient to give simple consent, rather than informed consent, prior to the test. The legislation, which garnered almost unanimous support in the state legislature, also streamlines some of the procedures a physician must follow in testing pregnant women. The law "normalizes the process of testing by making HIV screening a routine part of medical care," said Joseph Terrill, public policy coordinator for Sacramento-based AIDS Healthcare Foundation, adding that the legislation also has provisions to maintain and safeguard patient confidentiality and an individual's right to choose whether to be tested.

Largest-Ever Psoriasis Grant

The National Institute of Arthritis and Musculoskeletal and Skin Diseases has awarded Case Western Reserve University $6.37 million to establish a Center of Research Translation for psoriasis. The NIAMS funds will be added to a $5 million donation made in 2006 by the Murdough Foundation, and seek to bring together multidisciplinary teams of scientists, physicians, nurses, and researchers. The NIAMS grant will initially be used for development of Pc 4, a novel photodynamic therapy; for a project to understand the role of S100A8/9, a proinflammatory protein; and, for mouse models for analysis of biochemical processes and cardiovascular risks associated with psoriasis.

NIH Lupus Research Plan

Government scientists recently outlined their plans for future research in lupus. The goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, expanding biopsychosocial research, discovering and validating biomarkers, and advancing therapy options. These goals are part of a long-range planning document recently released by NIAMS. The document predicts that lupus prevention could become an attainable goal in the next decade, and outlines a need to advance research efforts to identify disease risk through family studies and genetics. "The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus," Dr. Stephen Katz, NIAMS director, wrote in the introduction to the research plan.

MRSA Mortality Reaches 5%

Almost 5% of all patients hospitalized in 2004 with a methicillin-resistant Staphylococcus aureus (MRSA) infection died, according to a statistical brief by the Agency for Healthcare Research and Quality. Hospital stays for patients with a MRSA infection were both longer (10 days vs. 5 days) and more expensive ($14,000 vs. $7,600) than stays for patients with other conditions. The number of hospital stays for MRSA increased from 1,900 in 1993 to 368,600 in 2005, and more commonly occurred in Medicare patients and those aged 65 years and older. Males and people in the South were also more likely to be hospitalized for MRSA treatment.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. "Our findings suggest that low health literacy exacts enormous costs on both the health system and society," lead author John A. Vernon, Ph.D., said in a statement. The researchers also found that while 7% of those with employer-provided insurance had low health literacy, 30% of those on Medicaid, 27% of those on Medicare, and 28% of those with no insurance had low health literacy. The report, "Low Health Literacy: Implications for National Health Policy," was supported by a grant from Pfizer Inc.

Push for Medicare E-Prescribing

A coalition of 22 health, business, and consumer organizations has asked Congress to pass legislation requiring physicians who see Medicare patients to adopt electronic prescribing by 2010. "Last year, the Institute of Medicine estimated that preventable medication errors harm an estimated 1.5 million Americans each year," said a letter from the coalition, which includes Aetna, Consumers Union, the Corporate Health Care Coalition, the Pacific Business Group on Health, and the Pharmaceutical Care Management Association, to leaders of the Senate Finance Committee, House Committee on Ways and Means, and House Energy and Commerce Committee. The letter noted that the IOM called on all physicians to adopt e-prescribing by 2010 to address medication errors. "Unfortunately, fewer than 1 in 10 physicians are meeting this challenge," the coalition wrote. The American Medical Association, however, said e-prescribing should be voluntary, not mandatory, and that it should be tied to the Medicare Part D drug benefit. In a letter to several House and Senate members, the organization also said that it is still waiting for the Department of Health and Human Services to issue national e-prescribing standards, called for in the 2003 Medicare Prescription Drug Improvement and Modernization Act. Physicians also need financial incentives and other support to adopt e-prescribing, said the AMA, noting that half of practices are made up of five or fewer physicians. "The costs for such small practices of e-prescribing technology, training, and upgrades are significant," said the AMA.

California Enacts AIDS Bill

Gov. Arnold Schwarzenegger (R) last month signed into law a measure that its advocates say removes a major barrier to HIV testing by requiring a patient to give simple consent, rather than informed consent, prior to the test. The legislation, which garnered almost unanimous support in the state legislature, also streamlines some of the procedures a physician must follow in testing pregnant women. The law "normalizes the process of testing by making HIV screening a routine part of medical care," said Joseph Terrill, public policy coordinator for Sacramento-based AIDS Healthcare Foundation, adding that the legislation also has provisions to maintain and safeguard patient confidentiality and an individual's right to choose whether to be tested.

Working together, hospitals, nursing homes, and home health agencies in New Jersey and in some other states have curbed pressure ulcer incidence and prevalence. Their efforts are likely to serve as models for providers preparing to cope with the development that beginning on October 2008, Medicare will no longer pay hospitals for ulcers that develop under their watch.

The Centers for Medicare and Medicaid Services (CMS) reported recently that 52 nursing homes in 39 states reduced the onset of pressure ulcers 69% by working together on process improvement. The project was coordinated by Qualis Health, the quality improvement organization for Washington state.

In a run-up to its new nonpayment rule, the CMS is requiring hospitals to start collecting data now on secondary diagnoses present at time of admission.

Making hospitals more accountable may cut down on the "blame game" that often occurs among providers when a patient develops an ulcer, said Theresa Edelstein, vice president of continuing care at the New Jersey Hospital Association, which has a program that is widely viewed as the pioneering effort in provider collaborations.

In the fall of 2005, the NJHA decided to bring hospitals and nursing homes together to share best practices—building on two successful collaboratives among NJHA member hospitals to reduce ventilator-associated pneumonia and central line bloodstream infections.

Forty of 80 hospitals, 60 of 350 nursing homes, and 12 of 40 home health agencies in the state eventually signed on to participate in the voluntary, 2-year NJHA Pressure Ulcer Collaborative, which involved monthly conference calls in which best practices, education programs, brochures to distribute to providers, access to a Listserv, and technical support for data collection were shared. Some joined only in the second year.

Participants were asked to hit 95% or better in three strategies: conducting head-to-toe skin assessments on every patient or resident; conducting a Braden Risk Assessment within 8 hours of initial contact; and implementing preventive actions in the first 24 hours on those identified as at risk on the Braden Scale.

In the first year, some participants collected point prevalence data, which counted how many patients had an ulcer on a particular day in the month. The second year, they assessed how many new ulcers had developed in a month.

"The data collection was a big challenge pretty much across the board," Ms. Edelstein said.

For providers who submitted data in both years, overall incidence dropped 70% from September 2005 to May 2007—from 18% to 5%. Forty-eight providers reported no new ulcers for 3 or more months. Ulcer prevalence was cut 30%.

Working together, hospitals, nursing homes, and home health agencies in New Jersey and in some other states have curbed pressure ulcer incidence and prevalence. Their efforts are likely to serve as models for providers preparing to cope with the development that beginning on October 2008, Medicare will no longer pay hospitals for ulcers that develop under their watch.

The Centers for Medicare and Medicaid Services (CMS) reported recently that 52 nursing homes in 39 states reduced the onset of pressure ulcers 69% by working together on process improvement. The project was coordinated by Qualis Health, the quality improvement organization for Washington state.

In a run-up to its new nonpayment rule, the CMS is requiring hospitals to start collecting data now on secondary diagnoses present at time of admission.

Making hospitals more accountable may cut down on the "blame game" that often occurs among providers when a patient develops an ulcer, said Theresa Edelstein, vice president of continuing care at the New Jersey Hospital Association, which has a program that is widely viewed as the pioneering effort in provider collaborations.

In the fall of 2005, the NJHA decided to bring hospitals and nursing homes together to share best practices—building on two successful collaboratives among NJHA member hospitals to reduce ventilator-associated pneumonia and central line bloodstream infections.

Forty of 80 hospitals, 60 of 350 nursing homes, and 12 of 40 home health agencies in the state eventually signed on to participate in the voluntary, 2-year NJHA Pressure Ulcer Collaborative, which involved monthly conference calls in which best practices, education programs, brochures to distribute to providers, access to a Listserv, and technical support for data collection were shared. Some joined only in the second year.

Participants were asked to hit 95% or better in three strategies: conducting head-to-toe skin assessments on every patient or resident; conducting a Braden Risk Assessment within 8 hours of initial contact; and implementing preventive actions in the first 24 hours on those identified as at risk on the Braden Scale.

In the first year, some participants collected point prevalence data, which counted how many patients had an ulcer on a particular day in the month. The second year, they assessed how many new ulcers had developed in a month.

"The data collection was a big challenge pretty much across the board," Ms. Edelstein said.

For providers who submitted data in both years, overall incidence dropped 70% from September 2005 to May 2007—from 18% to 5%. Forty-eight providers reported no new ulcers for 3 or more months. Ulcer prevalence was cut 30%.

Working together, hospitals, nursing homes, and home health agencies in New Jersey and in some other states have curbed pressure ulcer incidence and prevalence. Their efforts are likely to serve as models for providers preparing to cope with the development that beginning on October 2008, Medicare will no longer pay hospitals for ulcers that develop under their watch.

The Centers for Medicare and Medicaid Services (CMS) reported recently that 52 nursing homes in 39 states reduced the onset of pressure ulcers 69% by working together on process improvement. The project was coordinated by Qualis Health, the quality improvement organization for Washington state.

In a run-up to its new nonpayment rule, the CMS is requiring hospitals to start collecting data now on secondary diagnoses present at time of admission.

Making hospitals more accountable may cut down on the "blame game" that often occurs among providers when a patient develops an ulcer, said Theresa Edelstein, vice president of continuing care at the New Jersey Hospital Association, which has a program that is widely viewed as the pioneering effort in provider collaborations.

In the fall of 2005, the NJHA decided to bring hospitals and nursing homes together to share best practices—building on two successful collaboratives among NJHA member hospitals to reduce ventilator-associated pneumonia and central line bloodstream infections.

Forty of 80 hospitals, 60 of 350 nursing homes, and 12 of 40 home health agencies in the state eventually signed on to participate in the voluntary, 2-year NJHA Pressure Ulcer Collaborative, which involved monthly conference calls in which best practices, education programs, brochures to distribute to providers, access to a Listserv, and technical support for data collection were shared. Some joined only in the second year.

Participants were asked to hit 95% or better in three strategies: conducting head-to-toe skin assessments on every patient or resident; conducting a Braden Risk Assessment within 8 hours of initial contact; and implementing preventive actions in the first 24 hours on those identified as at risk on the Braden Scale.

In the first year, some participants collected point prevalence data, which counted how many patients had an ulcer on a particular day in the month. The second year, they assessed how many new ulcers had developed in a month.

"The data collection was a big challenge pretty much across the board," Ms. Edelstein said.

For providers who submitted data in both years, overall incidence dropped 70% from September 2005 to May 2007—from 18% to 5%. Forty-eight providers reported no new ulcers for 3 or more months. Ulcer prevalence was cut 30%.

With the end of the year drawing near—and Congress past due to adjourn—the fate of the reauthorization of the State Children's Health Insurance Plan was unclear.

SCHIP received one reprieve in October when Congress approved a continuing resolution to keep the government operating through at least mid-November. The resolution kept funding at current levels for all government programs. As that November deadline approached at press time, the House had come up with another continuing resolution, which it attached to next year's defense spending bill, but the Senate had not taken up the legislation.

The continuing resolutions at least kept SCHIP operating. But without funding increases—as were promised under a reauthorization—many states were slated to start cutting enrollment as early as January.

About 6 million children are currently enrolled in SCHIP. The congressional proposal under consideration would increase funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

What had seemed like a foregone conclusion early this year—that no one would question SCHIP's success and it would be easily refunded for 5 more years—was a distant memory by the time House and Senate negotiators sat down last month to discuss how to avert a second White House veto.

President Bush's first veto came in October. Soon thereafter, the House voted 273-156 to override the veto; that tally was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

With that failure, the House took up a new SCHIP package on Oct. 25, voting 265-142 in favor. However, there were no new Republican converts, making it doubtful that the bill would survive another presidential veto. The Senate approved the same package by a vote of 64-30.

House and Senate leaders delayed sending the bill to the president, hoping to work out a compromise in conference that would withstand White House scrutiny.

Negotiators from the Bush administration were intent on making sure that at least 500,000 children who are currently eligible for SCHIP but not receiving benefits would be enrolled, according to a White House statement. "If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," the statement noted.

House Republicans said they also would work to ensure that only low-income children would receive SCHIP benefits, and that the program would not extend benefits to illegal immigrants.

At press time, negotiators were deep in discussions over how to ensure that those requirements might be met, said Ron Pollack, executive director of the advocacy group Families USA, in an interview.

The goal of covering 10 million children and financing the program through an increase in the tobacco tax was not at issue among congressional negotiators, said Mr. Pollack. The Bush administration, however, has said it is adamantly opposed to a tobacco tax increase.

Children's advocates and physician organizations continue to be perplexed by the White House stance. After the initial veto, Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a written statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

He noted that the first package passed by Congress would have blocked the enrollment of many adults and children that the White House considered not eligible, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

With the end of the year drawing near—and Congress past due to adjourn—the fate of the reauthorization of the State Children's Health Insurance Plan was unclear.

SCHIP received one reprieve in October when Congress approved a continuing resolution to keep the government operating through at least mid-November. The resolution kept funding at current levels for all government programs. As that November deadline approached at press time, the House had come up with another continuing resolution, which it attached to next year's defense spending bill, but the Senate had not taken up the legislation.

The continuing resolutions at least kept SCHIP operating. But without funding increases—as were promised under a reauthorization—many states were slated to start cutting enrollment as early as January.

About 6 million children are currently enrolled in SCHIP. The congressional proposal under consideration would increase funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

What had seemed like a foregone conclusion early this year—that no one would question SCHIP's success and it would be easily refunded for 5 more years—was a distant memory by the time House and Senate negotiators sat down last month to discuss how to avert a second White House veto.

President Bush's first veto came in October. Soon thereafter, the House voted 273-156 to override the veto; that tally was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

With that failure, the House took up a new SCHIP package on Oct. 25, voting 265-142 in favor. However, there were no new Republican converts, making it doubtful that the bill would survive another presidential veto. The Senate approved the same package by a vote of 64-30.

House and Senate leaders delayed sending the bill to the president, hoping to work out a compromise in conference that would withstand White House scrutiny.

Negotiators from the Bush administration were intent on making sure that at least 500,000 children who are currently eligible for SCHIP but not receiving benefits would be enrolled, according to a White House statement. "If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," the statement noted.

House Republicans said they also would work to ensure that only low-income children would receive SCHIP benefits, and that the program would not extend benefits to illegal immigrants.

At press time, negotiators were deep in discussions over how to ensure that those requirements might be met, said Ron Pollack, executive director of the advocacy group Families USA, in an interview.

The goal of covering 10 million children and financing the program through an increase in the tobacco tax was not at issue among congressional negotiators, said Mr. Pollack. The Bush administration, however, has said it is adamantly opposed to a tobacco tax increase.

Children's advocates and physician organizations continue to be perplexed by the White House stance. After the initial veto, Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a written statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

He noted that the first package passed by Congress would have blocked the enrollment of many adults and children that the White House considered not eligible, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

With the end of the year drawing near—and Congress past due to adjourn—the fate of the reauthorization of the State Children's Health Insurance Plan was unclear.

SCHIP received one reprieve in October when Congress approved a continuing resolution to keep the government operating through at least mid-November. The resolution kept funding at current levels for all government programs. As that November deadline approached at press time, the House had come up with another continuing resolution, which it attached to next year's defense spending bill, but the Senate had not taken up the legislation.

The continuing resolutions at least kept SCHIP operating. But without funding increases—as were promised under a reauthorization—many states were slated to start cutting enrollment as early as January.

About 6 million children are currently enrolled in SCHIP. The congressional proposal under consideration would increase funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls.

What had seemed like a foregone conclusion early this year—that no one would question SCHIP's success and it would be easily refunded for 5 more years—was a distant memory by the time House and Senate negotiators sat down last month to discuss how to avert a second White House veto.

President Bush's first veto came in October. Soon thereafter, the House voted 273-156 to override the veto; that tally was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against.

With that failure, the House took up a new SCHIP package on Oct. 25, voting 265-142 in favor. However, there were no new Republican converts, making it doubtful that the bill would survive another presidential veto. The Senate approved the same package by a vote of 64-30.

House and Senate leaders delayed sending the bill to the president, hoping to work out a compromise in conference that would withstand White House scrutiny.

Negotiators from the Bush administration were intent on making sure that at least 500,000 children who are currently eligible for SCHIP but not receiving benefits would be enrolled, according to a White House statement. "If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money," the statement noted.

House Republicans said they also would work to ensure that only low-income children would receive SCHIP benefits, and that the program would not extend benefits to illegal immigrants.

At press time, negotiators were deep in discussions over how to ensure that those requirements might be met, said Ron Pollack, executive director of the advocacy group Families USA, in an interview.

The goal of covering 10 million children and financing the program through an increase in the tobacco tax was not at issue among congressional negotiators, said Mr. Pollack. The Bush administration, however, has said it is adamantly opposed to a tobacco tax increase.

Children's advocates and physician organizations continue to be perplexed by the White House stance. After the initial veto, Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a written statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

He noted that the first package passed by Congress would have blocked the enrollment of many adults and children that the White House considered not eligible, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The number of students entering medical school this fall–17,759–is the largest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows “that the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity–26,916–still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool. Black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels.

There was a near-even split among men and women applicants and enrollees.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and others have warned of looming physician shortages. Estimates range from 55,000 to 90,000 physicians across all specialties by 2020.

The number of students entering medical school this fall–17,759–is the largest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows “that the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity–26,916–still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool. Black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels.

There was a near-even split among men and women applicants and enrollees.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and others have warned of looming physician shortages. Estimates range from 55,000 to 90,000 physicians across all specialties by 2020.

The number of students entering medical school this fall–17,759–is the largest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows “that the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity–26,916–still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool. Black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels.

There was a near-even split among men and women applicants and enrollees.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and others have warned of looming physician shortages. Estimates range from 55,000 to 90,000 physicians across all specialties by 2020.

The number of students entering medical school this fall—17,759—is the largest ever, according to the Association of American Medical Colleges.

Although that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a press briefing, Darrell G. Kirch, AAMC president, said the increase in applicants and enrollees shows “the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. Although the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the association. Black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels. There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

The AAMC and other groups have warned of looming physician shortages. Depending on the estimates used, there will be a shortfall of 55,000–90,000 physicians across all specialties by 2020. The AAMC has pushed for a 30% increase in enrollment by 2015, said Dr. Kirch.

The number of students entering medical school this fall—17,759—is the largest ever, according to the Association of American Medical Colleges.

Although that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a press briefing, Darrell G. Kirch, AAMC president, said the increase in applicants and enrollees shows “the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. Although the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the association. Black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels. There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

The AAMC and other groups have warned of looming physician shortages. Depending on the estimates used, there will be a shortfall of 55,000–90,000 physicians across all specialties by 2020. The AAMC has pushed for a 30% increase in enrollment by 2015, said Dr. Kirch.

The number of students entering medical school this fall—17,759—is the largest ever, according to the Association of American Medical Colleges.

Although that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a press briefing, Darrell G. Kirch, AAMC president, said the increase in applicants and enrollees shows “the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. Although the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the association. Black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels. There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

The AAMC and other groups have warned of looming physician shortages. Depending on the estimates used, there will be a shortfall of 55,000–90,000 physicians across all specialties by 2020. The AAMC has pushed for a 30% increase in enrollment by 2015, said Dr. Kirch.

WASHINGTON — Thousands of lives are being saved each year as health plans and physicians more closely follow quality measures such as giving β-blockers after a heart attack, managing hypertension and hypercholesterolemia, and controlling hemoglobin A_1c levels, according to the latest report card from the National Committee for Quality Assurance.

And, plans that report publicly on these measures deliver higher quality care, said NCQA president Margaret O'Kane in a briefing.

The NCQA's recently released report card shows that commercial and Medicaid plans that publicly disclose NCQA-tracked quality measures perform anywhere from half a percent to 16% better than plans that do not disclose their data.

However, even with some notable successes, some of the gains—such as in controlling blood sugar—are starting to plateau, said Ms. O'Kane. And, there are still gaps in quality between top-performing and average health plans. Thousands more lives could be saved if the laggards did as well as the top-performers in the NCQA database, she said.

The report is based on data that are voluntarily submitted to the NCQA, which also accredits health plans. In 2006, 767 organizations—626 managed care plans covering private patients and Medicare and Medicaid enrollees, and 83 commercial and 58 Medicare PPO plans—submitted data using the NCQA's Healthcare Effectiveness Data and Information Set (HEDIS).

Much of the data come from claims, but some also come from chart reviews. None of it is adjusted for severity of illness, socioeconomic, or other factors.

Approximately 84 million Americans were enrolled in plans that used HEDIS measures to report to the NCQA in 2006. Although that is a big number, at least 100 million Americans are in health plans that do not report quality data, and some 47 million have no insurance, said Ms. O'Kane. The quality picture is completely dark for the uninsured, she said.

But for those plans that did report, the news was good. Overall, commercial plans improved performance in 30 of 44 HEDIS measures where a trend could be discerned, Medicaid plans notched increases in 34 of 43 “trendable” measures, and Medicare plans achieved increase only on 7 of 21 trendable measures.

Among the biggest successes was that 98% of commercial plans, 94% of Medicare, and 88% of Medicaid plans reported prescribing a β-blocker upon discharge after acute myocardial infarction. Over the last 6 years, β-blocker treatment has saved an estimated 4,400–5,600 lives, said Ms. O'Kane.

Given the high prescribing rates, the NCQA will no longer track this measure. Instead, the organization will collect data on how many patients still receive β-blockers 6 months after discharge—currently, only about 74% in commercial plans and 70% for Medicare and Medicaid.

Childhood immunization rates are also at all-time highs, at about 80% for commercial plans and 73% for Medicaid plans for the recommended series of vaccinations.

There has been “stalling” in some of the older HEDIS measures, however, said Ms. O'Kane. Baseline screening for HbA_1c has plateaued at 88% in commercial plans and is down slightly for Medicare and Medicaid, at 87% and 78%, respectively.

Cholesterol screening and control of total cholesterol are also trending flat or down. The NCQA has no explanation for the leveling off, said Ms. O'Kane.

Adherence to mental health measures—which are already abysmally low—has also been flat for almost a decade. For instance, only 20% of commercial, 21% of Medicaid, and 11% of Medicare plans are meeting the benchmark of treating newly diagnosed depression patients with an antidepressant and following up with at least three visits within the 12-week acute treatment phase. These rates have stayed virtually the same since 1998.

Similarly, patients who have been hospitalized for a mental illness are not getting quality care, said Ms. O'Kane. Only 57% of patients in commercial, 37% of those in a Medicare, and 39% of those in a Medicaid plan had a follow-up within a week of hospitalization. Rates improved somewhat a month out, to 75%, 55%, and 58%. Studies have shown that follow-up care decreases the risk of repeat hospitalizations and improves adherence, according to the NCQA.

The low follow-up rates are “a national disgrace,” said Ms. O'Kane, adding that for anyone to be “out 30 days with no one checking on you is unacceptable.”

Several new HEDIS measures are in place for 2007, including tracking of potentially harmful drug-disease interactions in the elderly.

And, for the first time, health plans are being asked to report on their use of resources in treating various conditions. In 2007, they are diabetes, asthma, and low back pain.

In 2008, chronic obstructive pulmonary disease, hypertension, and cardiovascular disease will be added. These conditions account for 60% of health care spending, said Ms. O'Kane. The data will be used to determine the variations in resource use among health plans.

Coupled with the HEDIS quality measures, the NCQA will eventually be able to rate which plans give the best quality care for the least amount of money, said Ms. O'Kane.

WASHINGTON — Thousands of lives are being saved each year as health plans and physicians more closely follow quality measures such as giving β-blockers after a heart attack, managing hypertension and hypercholesterolemia, and controlling hemoglobin A_1c levels, according to the latest report card from the National Committee for Quality Assurance.

And, plans that report publicly on these measures deliver higher quality care, said NCQA president Margaret O'Kane in a briefing.

The NCQA's recently released report card shows that commercial and Medicaid plans that publicly disclose NCQA-tracked quality measures perform anywhere from half a percent to 16% better than plans that do not disclose their data.

However, even with some notable successes, some of the gains—such as in controlling blood sugar—are starting to plateau, said Ms. O'Kane. And, there are still gaps in quality between top-performing and average health plans. Thousands more lives could be saved if the laggards did as well as the top-performers in the NCQA database, she said.

The report is based on data that are voluntarily submitted to the NCQA, which also accredits health plans. In 2006, 767 organizations—626 managed care plans covering private patients and Medicare and Medicaid enrollees, and 83 commercial and 58 Medicare PPO plans—submitted data using the NCQA's Healthcare Effectiveness Data and Information Set (HEDIS).

Much of the data come from claims, but some also come from chart reviews. None of it is adjusted for severity of illness, socioeconomic, or other factors.

Approximately 84 million Americans were enrolled in plans that used HEDIS measures to report to the NCQA in 2006. Although that is a big number, at least 100 million Americans are in health plans that do not report quality data, and some 47 million have no insurance, said Ms. O'Kane. The quality picture is completely dark for the uninsured, she said.

But for those plans that did report, the news was good. Overall, commercial plans improved performance in 30 of 44 HEDIS measures where a trend could be discerned, Medicaid plans notched increases in 34 of 43 “trendable” measures, and Medicare plans achieved increase only on 7 of 21 trendable measures.

Among the biggest successes was that 98% of commercial plans, 94% of Medicare, and 88% of Medicaid plans reported prescribing a β-blocker upon discharge after acute myocardial infarction. Over the last 6 years, β-blocker treatment has saved an estimated 4,400–5,600 lives, said Ms. O'Kane.

Given the high prescribing rates, the NCQA will no longer track this measure. Instead, the organization will collect data on how many patients still receive β-blockers 6 months after discharge—currently, only about 74% in commercial plans and 70% for Medicare and Medicaid.

Childhood immunization rates are also at all-time highs, at about 80% for commercial plans and 73% for Medicaid plans for the recommended series of vaccinations.

There has been “stalling” in some of the older HEDIS measures, however, said Ms. O'Kane. Baseline screening for HbA_1c has plateaued at 88% in commercial plans and is down slightly for Medicare and Medicaid, at 87% and 78%, respectively.

Cholesterol screening and control of total cholesterol are also trending flat or down. The NCQA has no explanation for the leveling off, said Ms. O'Kane.

Adherence to mental health measures—which are already abysmally low—has also been flat for almost a decade. For instance, only 20% of commercial, 21% of Medicaid, and 11% of Medicare plans are meeting the benchmark of treating newly diagnosed depression patients with an antidepressant and following up with at least three visits within the 12-week acute treatment phase. These rates have stayed virtually the same since 1998.

Similarly, patients who have been hospitalized for a mental illness are not getting quality care, said Ms. O'Kane. Only 57% of patients in commercial, 37% of those in a Medicare, and 39% of those in a Medicaid plan had a follow-up within a week of hospitalization. Rates improved somewhat a month out, to 75%, 55%, and 58%. Studies have shown that follow-up care decreases the risk of repeat hospitalizations and improves adherence, according to the NCQA.

The low follow-up rates are “a national disgrace,” said Ms. O'Kane, adding that for anyone to be “out 30 days with no one checking on you is unacceptable.”

Several new HEDIS measures are in place for 2007, including tracking of potentially harmful drug-disease interactions in the elderly.

And, for the first time, health plans are being asked to report on their use of resources in treating various conditions. In 2007, they are diabetes, asthma, and low back pain.

In 2008, chronic obstructive pulmonary disease, hypertension, and cardiovascular disease will be added. These conditions account for 60% of health care spending, said Ms. O'Kane. The data will be used to determine the variations in resource use among health plans.

Coupled with the HEDIS quality measures, the NCQA will eventually be able to rate which plans give the best quality care for the least amount of money, said Ms. O'Kane.

WASHINGTON — Thousands of lives are being saved each year as health plans and physicians more closely follow quality measures such as giving β-blockers after a heart attack, managing hypertension and hypercholesterolemia, and controlling hemoglobin A_1c levels, according to the latest report card from the National Committee for Quality Assurance.

And, plans that report publicly on these measures deliver higher quality care, said NCQA president Margaret O'Kane in a briefing.

The NCQA's recently released report card shows that commercial and Medicaid plans that publicly disclose NCQA-tracked quality measures perform anywhere from half a percent to 16% better than plans that do not disclose their data.

However, even with some notable successes, some of the gains—such as in controlling blood sugar—are starting to plateau, said Ms. O'Kane. And, there are still gaps in quality between top-performing and average health plans. Thousands more lives could be saved if the laggards did as well as the top-performers in the NCQA database, she said.

The report is based on data that are voluntarily submitted to the NCQA, which also accredits health plans. In 2006, 767 organizations—626 managed care plans covering private patients and Medicare and Medicaid enrollees, and 83 commercial and 58 Medicare PPO plans—submitted data using the NCQA's Healthcare Effectiveness Data and Information Set (HEDIS).

Much of the data come from claims, but some also come from chart reviews. None of it is adjusted for severity of illness, socioeconomic, or other factors.

Approximately 84 million Americans were enrolled in plans that used HEDIS measures to report to the NCQA in 2006. Although that is a big number, at least 100 million Americans are in health plans that do not report quality data, and some 47 million have no insurance, said Ms. O'Kane. The quality picture is completely dark for the uninsured, she said.

But for those plans that did report, the news was good. Overall, commercial plans improved performance in 30 of 44 HEDIS measures where a trend could be discerned, Medicaid plans notched increases in 34 of 43 “trendable” measures, and Medicare plans achieved increase only on 7 of 21 trendable measures.

Among the biggest successes was that 98% of commercial plans, 94% of Medicare, and 88% of Medicaid plans reported prescribing a β-blocker upon discharge after acute myocardial infarction. Over the last 6 years, β-blocker treatment has saved an estimated 4,400–5,600 lives, said Ms. O'Kane.

Given the high prescribing rates, the NCQA will no longer track this measure. Instead, the organization will collect data on how many patients still receive β-blockers 6 months after discharge—currently, only about 74% in commercial plans and 70% for Medicare and Medicaid.

Childhood immunization rates are also at all-time highs, at about 80% for commercial plans and 73% for Medicaid plans for the recommended series of vaccinations.

There has been “stalling” in some of the older HEDIS measures, however, said Ms. O'Kane. Baseline screening for HbA_1c has plateaued at 88% in commercial plans and is down slightly for Medicare and Medicaid, at 87% and 78%, respectively.

Cholesterol screening and control of total cholesterol are also trending flat or down. The NCQA has no explanation for the leveling off, said Ms. O'Kane.

Adherence to mental health measures—which are already abysmally low—has also been flat for almost a decade. For instance, only 20% of commercial, 21% of Medicaid, and 11% of Medicare plans are meeting the benchmark of treating newly diagnosed depression patients with an antidepressant and following up with at least three visits within the 12-week acute treatment phase. These rates have stayed virtually the same since 1998.

Similarly, patients who have been hospitalized for a mental illness are not getting quality care, said Ms. O'Kane. Only 57% of patients in commercial, 37% of those in a Medicare, and 39% of those in a Medicaid plan had a follow-up within a week of hospitalization. Rates improved somewhat a month out, to 75%, 55%, and 58%. Studies have shown that follow-up care decreases the risk of repeat hospitalizations and improves adherence, according to the NCQA.

The low follow-up rates are “a national disgrace,” said Ms. O'Kane, adding that for anyone to be “out 30 days with no one checking on you is unacceptable.”

Several new HEDIS measures are in place for 2007, including tracking of potentially harmful drug-disease interactions in the elderly.

And, for the first time, health plans are being asked to report on their use of resources in treating various conditions. In 2007, they are diabetes, asthma, and low back pain.

In 2008, chronic obstructive pulmonary disease, hypertension, and cardiovascular disease will be added. These conditions account for 60% of health care spending, said Ms. O'Kane. The data will be used to determine the variations in resource use among health plans.

Coupled with the HEDIS quality measures, the NCQA will eventually be able to rate which plans give the best quality care for the least amount of money, said Ms. O'Kane.

As expected, the Food and Drug Administration has relaxed some of the rules for prescribing the acne drug isotretinoin, including eliminating the 23-day lockout period for women of childbearing potential.

Women still must have their initial prescription filled within 7 days of their first office visit or they will be prevented from getting the drug for 23 days. But the restriction no longer will apply to succeeding prescriptions.

Dermatologists, drugmakers, and professional organizations such as the American Academy of Dermatology had encouraged the FDA to make that change to the iPLEDGE program that governs isotretinoin prescribing.

At a meeting in August, the FDA's Dermatologic and Ophthalmic Drugs and Drug Safety and Risk Management advisory committees voted unanimously in support of eliminating the 23-day lockout and several other changes, which the agency also approved. Those included:

▸ Starting the 7-day window for the initial prescription for those of childbearing potential from the date of pregnancy testing, instead of the date of the office visit.

▸ Extending the prescription window from 7 days to 30 days for men and for women not of childbearing potential.

▸ Modifying the list of acceptable secondary forms of contraception to include male condoms with or without spermicide.

The changes will be effective Dec. 2. Updated materials will be sent to pharmacies and prescribers before then, said Roche Laboratories Inc., one of the isotretinoin manufacturers. The others are Mylan Laboratories Inc., Ranbaxy Laboratories Ltd., and Barr Pharmaceuticals Inc.

The committee members said iPLEDGE seemed to be interfering with the doctor-patient relationship and had not, despite all its restrictions, eliminated pregnancies. From March 2006 to March 31, 2007, there were 122 pregnancies in 91,894 women of childbearing potential who received a prescription.

There were 37 pregnancies in April, May, and June 2007, and 19 pregnancies outside the iPLEDGE program, Roche officials noted at the meeting.

As expected, the Food and Drug Administration has relaxed some of the rules for prescribing the acne drug isotretinoin, including eliminating the 23-day lockout period for women of childbearing potential.

Women still must have their initial prescription filled within 7 days of their first office visit or they will be prevented from getting the drug for 23 days. But the restriction no longer will apply to succeeding prescriptions.

Dermatologists, drugmakers, and professional organizations such as the American Academy of Dermatology had encouraged the FDA to make that change to the iPLEDGE program that governs isotretinoin prescribing.

At a meeting in August, the FDA's Dermatologic and Ophthalmic Drugs and Drug Safety and Risk Management advisory committees voted unanimously in support of eliminating the 23-day lockout and several other changes, which the agency also approved. Those included:

▸ Starting the 7-day window for the initial prescription for those of childbearing potential from the date of pregnancy testing, instead of the date of the office visit.

▸ Extending the prescription window from 7 days to 30 days for men and for women not of childbearing potential.

▸ Modifying the list of acceptable secondary forms of contraception to include male condoms with or without spermicide.

The changes will be effective Dec. 2. Updated materials will be sent to pharmacies and prescribers before then, said Roche Laboratories Inc., one of the isotretinoin manufacturers. The others are Mylan Laboratories Inc., Ranbaxy Laboratories Ltd., and Barr Pharmaceuticals Inc.

The committee members said iPLEDGE seemed to be interfering with the doctor-patient relationship and had not, despite all its restrictions, eliminated pregnancies. From March 2006 to March 31, 2007, there were 122 pregnancies in 91,894 women of childbearing potential who received a prescription.

There were 37 pregnancies in April, May, and June 2007, and 19 pregnancies outside the iPLEDGE program, Roche officials noted at the meeting.

As expected, the Food and Drug Administration has relaxed some of the rules for prescribing the acne drug isotretinoin, including eliminating the 23-day lockout period for women of childbearing potential.

Women still must have their initial prescription filled within 7 days of their first office visit or they will be prevented from getting the drug for 23 days. But the restriction no longer will apply to succeeding prescriptions.

Dermatologists, drugmakers, and professional organizations such as the American Academy of Dermatology had encouraged the FDA to make that change to the iPLEDGE program that governs isotretinoin prescribing.

At a meeting in August, the FDA's Dermatologic and Ophthalmic Drugs and Drug Safety and Risk Management advisory committees voted unanimously in support of eliminating the 23-day lockout and several other changes, which the agency also approved. Those included:

▸ Starting the 7-day window for the initial prescription for those of childbearing potential from the date of pregnancy testing, instead of the date of the office visit.

▸ Extending the prescription window from 7 days to 30 days for men and for women not of childbearing potential.

▸ Modifying the list of acceptable secondary forms of contraception to include male condoms with or without spermicide.

The changes will be effective Dec. 2. Updated materials will be sent to pharmacies and prescribers before then, said Roche Laboratories Inc., one of the isotretinoin manufacturers. The others are Mylan Laboratories Inc., Ranbaxy Laboratories Ltd., and Barr Pharmaceuticals Inc.

The committee members said iPLEDGE seemed to be interfering with the doctor-patient relationship and had not, despite all its restrictions, eliminated pregnancies. From March 2006 to March 31, 2007, there were 122 pregnancies in 91,894 women of childbearing potential who received a prescription.

There were 37 pregnancies in April, May, and June 2007, and 19 pregnancies outside the iPLEDGE program, Roche officials noted at the meeting.

The number of students entering medical school this fall—17,759—is the largest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows “that the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the AAMC. Ultimately, black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels. There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

Eleven of the 126 medical schools increased class size by more than 10%: Michigan State University (47% increase), Texas A&M University System (24%), University of Arizona (22%), Florida State University (19%), Emory University (14%), Mount Sinai School of Medicine (14%), University of California, Davis (13%), Joan C. Edwards School of Medicine at Marshall University (12%), Drexel University (10%), and Howard University and University of Minnesota (10%). Some of the increase in enrollment came through added capacity—both Michigan State and Arizona opened additional campuses. Six universities are currently seeking accreditation for a medical school, Dr. Kirch said.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and other organizations have warned of looming physician shortages. Depending on the estimates used, there will be a shortfall of 55,000–90,000 physicians across all specialties by 2020.

The AAMC has pushed for a 30% increase in enrollment by 2015, Dr. Kirch said. He acknowledged that it can be difficult to accurately predict shortages, noting that medical school enrollment has waxed and waned over the years.

Even so, despite the many current challenges of being a physician—including a patchwork health care system and unpredictable reimbursement picture—it's still seen as an attractive career choice, Dr. Kirch said. “What I think is most striking here is to see the draw that medicine still has despite those environmental forces,” he said. “I personally view this as a reflection that there are few careers that can be as meaningful, as fulfilling as pursuing medicine,” he added.

ELSEVIER GLOBAL MEDICAL NEWS

The number of students entering medical school this fall—17,759—is the largest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows “that the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the AAMC. Ultimately, black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels. There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

Eleven of the 126 medical schools increased class size by more than 10%: Michigan State University (47% increase), Texas A&M University System (24%), University of Arizona (22%), Florida State University (19%), Emory University (14%), Mount Sinai School of Medicine (14%), University of California, Davis (13%), Joan C. Edwards School of Medicine at Marshall University (12%), Drexel University (10%), and Howard University and University of Minnesota (10%). Some of the increase in enrollment came through added capacity—both Michigan State and Arizona opened additional campuses. Six universities are currently seeking accreditation for a medical school, Dr. Kirch said.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and other organizations have warned of looming physician shortages. Depending on the estimates used, there will be a shortfall of 55,000–90,000 physicians across all specialties by 2020.

The AAMC has pushed for a 30% increase in enrollment by 2015, Dr. Kirch said. He acknowledged that it can be difficult to accurately predict shortages, noting that medical school enrollment has waxed and waned over the years.

Even so, despite the many current challenges of being a physician—including a patchwork health care system and unpredictable reimbursement picture—it's still seen as an attractive career choice, Dr. Kirch said. “What I think is most striking here is to see the draw that medicine still has despite those environmental forces,” he said. “I personally view this as a reflection that there are few careers that can be as meaningful, as fulfilling as pursuing medicine,” he added.

ELSEVIER GLOBAL MEDICAL NEWS

The number of students entering medical school this fall—17,759—is the largest ever, according to the Association of American Medical Colleges.

While that number represents only a 2.3% increase from the previous year, there was an 8% increase in applicants, with 42,300 seeking to enter medical school in 2007. It was the fourth consecutive year in which the number of applicants was on the rise, after a 6-year decline.

In a briefing with reporters, AAMC President Darrell G. Kirch said that the continuing increase in applicants and enrollees shows “that the interest in medicine runs very strong in our country.”

Applicants and enrollees are more diverse than ever, according to the AAMC. While the number of applicants who identified themselves as white or white combined with another ethnicity—26,916—still dwarfs other races, there was an increase in the number of minority applicants. There were 2,999 applicants who identified themselves as Latino or Hispanic alone or in combination with another race, 3,471 African American/combination applicants, and 9,225 Asian/combination applicants.

The number of black and Hispanic male applicants rose by 9.2%, which was larger than the growth of the overall applicant pool, according to the AAMC. Ultimately, black male acceptance and enrollment increased by 5.3%, and Hispanic male acceptance remained even with 2006 levels. There was an almost-even split among men and women applicants and enrollees. Men slightly edged out women, accounting for 51% of applicants and 51.7% of enrollees.

Eleven of the 126 medical schools increased class size by more than 10%: Michigan State University (47% increase), Texas A&M University System (24%), University of Arizona (22%), Florida State University (19%), Emory University (14%), Mount Sinai School of Medicine (14%), University of California, Davis (13%), Joan C. Edwards School of Medicine at Marshall University (12%), Drexel University (10%), and Howard University and University of Minnesota (10%). Some of the increase in enrollment came through added capacity—both Michigan State and Arizona opened additional campuses. Six universities are currently seeking accreditation for a medical school, Dr. Kirch said.

The rise in applicants and enrollment represents some light at the end of the tunnel, he said. The AAMC and other organizations have warned of looming physician shortages. Depending on the estimates used, there will be a shortfall of 55,000–90,000 physicians across all specialties by 2020.

The AAMC has pushed for a 30% increase in enrollment by 2015, Dr. Kirch said. He acknowledged that it can be difficult to accurately predict shortages, noting that medical school enrollment has waxed and waned over the years.

Even so, despite the many current challenges of being a physician—including a patchwork health care system and unpredictable reimbursement picture—it's still seen as an attractive career choice, Dr. Kirch said. “What I think is most striking here is to see the draw that medicine still has despite those environmental forces,” he said. “I personally view this as a reflection that there are few careers that can be as meaningful, as fulfilling as pursuing medicine,” he added.

ELSEVIER GLOBAL MEDICAL NEWS

The Food and Drug Administration soon will begin to scrutinize the warning labels on tanning beds, under a new federal law signed by the president in late September.

The Tanning Accountability and Notification Act was included in the Food and Drug Administration Amendments Act of 2007. Four members of Congress—Sen. Jack Reed (D-R.I.), Sen. Johnny Isakson (R-Ga.), Rep. Carolyn Maloney (D-N.Y.), and Rep. Ginny Brown-Waite (R-Fla.)—originally sponsored the TAN Act.

Under the new law, the FDA is being directed to determine if the label is positioned correctly, whether it gives sufficient risk data, whether alternative warnings would better communicate risks, or if there is no warning that could communicate the risk of using tanning beds adequately.

To reach those determinations, the law requires the FDA to conduct tests with consumers; the agency is to issue a report by September 2008.

The American Academy of Dermatology Association applauded the passage of the TAN Act.

“The current labeling on tanning equipment inadequately explains the serious risks associated with indoor tanning,” said AAD president Dr. Diane R. Baker in a statement. “The TAN Act is the first step to correct this and ultimately will help educate the millions of Americans who tan each day about the potential cancer risks associated with ultraviolet radiation.”

AAD estimates that 30 million Americans use tanning beds each year, and that 2.3 million are teenagers. The Indoor Tanning Association does not have exact figures, but said the industry estimates that at least 25 million Americans are indoor tanners.

John Overstreet, executive director of the association, said that requiring the FDA to study new warnings is not necessary.

The current warning—which was devised by the FDA—is very detailed and blunt, Mr. Overstreet said in an interview. “With all the challenges facing FDA and all they have to do, this seems a little unnecessary,” he said, adding that the industry believes that the AAD and other organizations exaggerate the dangers of UV radiation.

The American Medical Association has continued to support the strengthening of state and local laws to regulate indoor tanning more stringently, including toughening the warnings posted in salons and spas.

Dr. Jessica Krant, an AMA alternate delegate representing the American Society for Dermatologic Surgery, said that passage of the bill means that Congress recognizes that teenagers still are being exposed to unnecessary risks from tanning. “I think it's the first step and a very good and important change,” she said in an interview.

But the AMA and the ASDS both feel that the current warnings—created in the 1970s—need to be updated and placed more prominently in tanning beds, said Dr. Krant, also of State University of New York, Brooklyn.

It is estimated that 25–30 million Americans are indoor tanners, and 2.3 million of these are teenagers. ©Dragan Trifunovic/Fotolia.com

The Food and Drug Administration soon will begin to scrutinize the warning labels on tanning beds, under a new federal law signed by the president in late September.

The Tanning Accountability and Notification Act was included in the Food and Drug Administration Amendments Act of 2007. Four members of Congress—Sen. Jack Reed (D-R.I.), Sen. Johnny Isakson (R-Ga.), Rep. Carolyn Maloney (D-N.Y.), and Rep. Ginny Brown-Waite (R-Fla.)—originally sponsored the TAN Act.

Under the new law, the FDA is being directed to determine if the label is positioned correctly, whether it gives sufficient risk data, whether alternative warnings would better communicate risks, or if there is no warning that could communicate the risk of using tanning beds adequately.

To reach those determinations, the law requires the FDA to conduct tests with consumers; the agency is to issue a report by September 2008.

The American Academy of Dermatology Association applauded the passage of the TAN Act.

“The current labeling on tanning equipment inadequately explains the serious risks associated with indoor tanning,” said AAD president Dr. Diane R. Baker in a statement. “The TAN Act is the first step to correct this and ultimately will help educate the millions of Americans who tan each day about the potential cancer risks associated with ultraviolet radiation.”

AAD estimates that 30 million Americans use tanning beds each year, and that 2.3 million are teenagers. The Indoor Tanning Association does not have exact figures, but said the industry estimates that at least 25 million Americans are indoor tanners.

John Overstreet, executive director of the association, said that requiring the FDA to study new warnings is not necessary.

The current warning—which was devised by the FDA—is very detailed and blunt, Mr. Overstreet said in an interview. “With all the challenges facing FDA and all they have to do, this seems a little unnecessary,” he said, adding that the industry believes that the AAD and other organizations exaggerate the dangers of UV radiation.

The American Medical Association has continued to support the strengthening of state and local laws to regulate indoor tanning more stringently, including toughening the warnings posted in salons and spas.

Dr. Jessica Krant, an AMA alternate delegate representing the American Society for Dermatologic Surgery, said that passage of the bill means that Congress recognizes that teenagers still are being exposed to unnecessary risks from tanning. “I think it's the first step and a very good and important change,” she said in an interview.

But the AMA and the ASDS both feel that the current warnings—created in the 1970s—need to be updated and placed more prominently in tanning beds, said Dr. Krant, also of State University of New York, Brooklyn.

It is estimated that 25–30 million Americans are indoor tanners, and 2.3 million of these are teenagers. ©Dragan Trifunovic/Fotolia.com

The Food and Drug Administration soon will begin to scrutinize the warning labels on tanning beds, under a new federal law signed by the president in late September.

The Tanning Accountability and Notification Act was included in the Food and Drug Administration Amendments Act of 2007. Four members of Congress—Sen. Jack Reed (D-R.I.), Sen. Johnny Isakson (R-Ga.), Rep. Carolyn Maloney (D-N.Y.), and Rep. Ginny Brown-Waite (R-Fla.)—originally sponsored the TAN Act.

Under the new law, the FDA is being directed to determine if the label is positioned correctly, whether it gives sufficient risk data, whether alternative warnings would better communicate risks, or if there is no warning that could communicate the risk of using tanning beds adequately.

To reach those determinations, the law requires the FDA to conduct tests with consumers; the agency is to issue a report by September 2008.

The American Academy of Dermatology Association applauded the passage of the TAN Act.

“The current labeling on tanning equipment inadequately explains the serious risks associated with indoor tanning,” said AAD president Dr. Diane R. Baker in a statement. “The TAN Act is the first step to correct this and ultimately will help educate the millions of Americans who tan each day about the potential cancer risks associated with ultraviolet radiation.”

AAD estimates that 30 million Americans use tanning beds each year, and that 2.3 million are teenagers. The Indoor Tanning Association does not have exact figures, but said the industry estimates that at least 25 million Americans are indoor tanners.

John Overstreet, executive director of the association, said that requiring the FDA to study new warnings is not necessary.

The current warning—which was devised by the FDA—is very detailed and blunt, Mr. Overstreet said in an interview. “With all the challenges facing FDA and all they have to do, this seems a little unnecessary,” he said, adding that the industry believes that the AAD and other organizations exaggerate the dangers of UV radiation.

The American Medical Association has continued to support the strengthening of state and local laws to regulate indoor tanning more stringently, including toughening the warnings posted in salons and spas.

Dr. Jessica Krant, an AMA alternate delegate representing the American Society for Dermatologic Surgery, said that passage of the bill means that Congress recognizes that teenagers still are being exposed to unnecessary risks from tanning. “I think it's the first step and a very good and important change,” she said in an interview.

But the AMA and the ASDS both feel that the current warnings—created in the 1970s—need to be updated and placed more prominently in tanning beds, said Dr. Krant, also of State University of New York, Brooklyn.

It is estimated that 25–30 million Americans are indoor tanners, and 2.3 million of these are teenagers. ©Dragan Trifunovic/Fotolia.com