Alicia Ault

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273–156 to override the president's SCHIP veto, but that 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.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) said that she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview. Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls “myths.” Among those: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

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

The American College of Physicians said it would push for passage of a new bill that would ensure coverage for those additional children. “The current SCHIP formula does not go far enough,” said Dr. David C. Dale, ACP president, in a statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration as being out of touch with the American people. “It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America,” he said in a statement.

The White House said in a statement that it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “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 White House said.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273–156 to override the president's SCHIP veto, but that 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.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) said that she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview. Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls “myths.” Among those: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

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

The American College of Physicians said it would push for passage of a new bill that would ensure coverage for those additional children. “The current SCHIP formula does not go far enough,” said Dr. David C. Dale, ACP president, in a statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration as being out of touch with the American people. “It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America,” he said in a statement.

The White House said in a statement that it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “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 White House said.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273–156 to override the president's SCHIP veto, but that 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.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) said that she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview. Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls “myths.” Among those: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

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

The American College of Physicians said it would push for passage of a new bill that would ensure coverage for those additional children. “The current SCHIP formula does not go far enough,” said Dr. David C. Dale, ACP president, in a statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration as being out of touch with the American people. “It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America,” he said in a statement.

The White House said in a statement that it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “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 White House said.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273-156 to override the President's SCHIP veto, but that was 10 votes short of the needed two-thirds majority.

The House vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of the SCHIPveto override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) has said she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview.

Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls "myths."

Among those that he noted are: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

Dr. Berkelhamer noted that the legislation would have blocked enrollment of many adults and children the White House has considered not eligible for the program, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The White House claimed victory after the House failed to override the veto.

"As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the President in finding common ground to reauthorize this vital program," according to a White House statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration, saying that the White House was out of touch with the American people. "It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America," Rep. Rangel said in a statement.

The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program.

"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," according to a statement from the White House.

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

The American College of Physicians said it would push for passage of a new bill, but one that would ensure coverage for those additional children. "The current SCHIP formula does not go far enough," said Dr. David C. Dale, ACP president, in a statement.

Similarly, the American Medical Association said it was committed to expanding coverage.

"The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend," said Dr. Edward Langston, AMA board chair, in a statement.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273-156 to override the President's SCHIP veto, but that was 10 votes short of the needed two-thirds majority.

The House vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of the SCHIPveto override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) has said she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview.

Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls "myths."

Among those that he noted are: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

Dr. Berkelhamer noted that the legislation would have blocked enrollment of many adults and children the White House has considered not eligible for the program, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The White House claimed victory after the House failed to override the veto.

"As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the President in finding common ground to reauthorize this vital program," according to a White House statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration, saying that the White House was out of touch with the American people. "It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America," Rep. Rangel said in a statement.

The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program.

"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," according to a statement from the White House.

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

The American College of Physicians said it would push for passage of a new bill, but one that would ensure coverage for those additional children. "The current SCHIP formula does not go far enough," said Dr. David C. Dale, ACP president, in a statement.

Similarly, the American Medical Association said it was committed to expanding coverage.

"The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend," said Dr. Edward Langston, AMA board chair, in a statement.

Congress and the Bush administration headed back to the negotiating table in mid-October after the House of Representatives failed to override President Bush's veto of the State Children's Health Insurance Program reauthorization legislation.

The House voted 273-156 to override the President's SCHIP veto, but that was 10 votes short of the needed two-thirds majority.

The House vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of the SCHIPveto override, and 154 Republicans and 2 Democrats voting against.

SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16.

House Speaker Nancy Pelosi (D-Calif.) has said she aims to bring a new version of the SCHIP legislation to the floor for a vote ahead of that deadline, Ron Pollack, executive director of Families USA, said in an interview.

Mr. Pollack predicted that compromises would be crafted around the issues that concern the White House, which he calls "myths."

Among those that he noted are: that the law would cover children in families earning up to $83,000 a year, and that illegal immigrants would be eligible for coverage. These issues led a majority of House Republicans to vote in line with President Bush, he said.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said in a statement that "the rhetoric of those who opposed the legislation to reauthorize SCHIP demonstrated a fundamental misunderstanding of the bill."

Dr. Berkelhamer noted that the legislation would have blocked enrollment of many adults and children the White House has considered not eligible for the program, "while still providing states flexibility and financial support for enrollment of up to 4 million low-income eligible children."

The White House claimed victory after the House failed to override the veto.

"As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the President in finding common ground to reauthorize this vital program," according to a White House statement.

Rep. Charles Rangel (D-N.Y.) blasted the Bush administration, saying that the White House was out of touch with the American people. "It is appalling that the administration would declare victory after denying health care to 10 million of the neediest children in America," Rep. Rangel said in a statement.

The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program.

"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," according to a statement from the White House.

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

The American College of Physicians said it would push for passage of a new bill, but one that would ensure coverage for those additional children. "The current SCHIP formula does not go far enough," said Dr. David C. Dale, ACP president, in a statement.

Similarly, the American Medical Association said it was committed to expanding coverage.

"The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend," said Dr. Edward Langston, AMA board chair, in a statement.

FDA Warns on Tanning Product

The FDA has urged those using a product called Melanotan II to stop immediately and contact their physicians if they have had an adverse event they suspect is tied to the injectable agent. Melanotan's maker, Hendersonville, Tenn.-based Melanocorp Inc., claims that it protects against skin cancer and rosacea. The product is not FDA approved, and thus is being illegally promoted, the agency said in its warning to the company. At the same time, the FDA warned consumers against "injecting any substance, particularly products that are not FDA approved, into their bodies without the oversight of a licensed health care provider."

U.S. Women Less Wrinkle Tolerant

American women are the least likely to tolerate wrinkles, closely followed by Italian, British, Spanish, French, and German women, but women in France and Italy are more likely to use dermal fillers, according to a recent survey. A total of 10,647 women and men in the United States, United Kingdom, France, Italy, Spain, and Germany responded to the survey, which was sponsored by Allergan Inc. About 50% of Italian women felt they looked younger than their age, compared with about 35% of American women. American and British women were the most likely to report that they believe they look stressed and tired. Overall, among women considering injectables, the top reasons were to look good for their age, to look more refreshed, and to improve self-esteem. When asked about their grooming habits, men also cited those reasons as key motivators, although American men said looking professional was one of the most important reasons. Italian men spent the most on grooming products, while American men spent the least.

Wal-Mart Expands $4 Generics

Wal-Mart has added 24 medications to its growing list of generic prescription drug products that patients can receive for $4 for a 30-day supply. The prescriptions can be filled at 4,005 Wal-Mart, Sam's Club, and Neighborhood Market pharmacies in the United States. Among the 24 new medications are timolol, carvedilol, terbinafine, and benzoyl peroxide 4% creamy wash. The company also expanded its reproductive drugs offerings. For $9, patients in most states can now purchase a 30-day supply of clomiphene (50 mg), and two additional oral contraceptives. Wal-Mart claims that since its $4 generic program began in the fall of 2006, customers have saved $613 million. The generics represent 40% of all prescriptions filled in the last year. Because of state laws, some of the drugs cost more than $4 in California, Colorado, Hawaii, Minnesota, Montana, Pennsylvania, Tennessee, Wisconsin, and Wyoming.

NJ Task Force Examines M.D. Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at www.familiesusa.org.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said that the slowdown probably is temporary and is not providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of their policies. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For more details, visit

www.kff.org/insurance/7672

FDA Warns on Tanning Product

The FDA has urged those using a product called Melanotan II to stop immediately and contact their physicians if they have had an adverse event they suspect is tied to the injectable agent. Melanotan's maker, Hendersonville, Tenn.-based Melanocorp Inc., claims that it protects against skin cancer and rosacea. The product is not FDA approved, and thus is being illegally promoted, the agency said in its warning to the company. At the same time, the FDA warned consumers against "injecting any substance, particularly products that are not FDA approved, into their bodies without the oversight of a licensed health care provider."

U.S. Women Less Wrinkle Tolerant

American women are the least likely to tolerate wrinkles, closely followed by Italian, British, Spanish, French, and German women, but women in France and Italy are more likely to use dermal fillers, according to a recent survey. A total of 10,647 women and men in the United States, United Kingdom, France, Italy, Spain, and Germany responded to the survey, which was sponsored by Allergan Inc. About 50% of Italian women felt they looked younger than their age, compared with about 35% of American women. American and British women were the most likely to report that they believe they look stressed and tired. Overall, among women considering injectables, the top reasons were to look good for their age, to look more refreshed, and to improve self-esteem. When asked about their grooming habits, men also cited those reasons as key motivators, although American men said looking professional was one of the most important reasons. Italian men spent the most on grooming products, while American men spent the least.

Wal-Mart Expands $4 Generics

Wal-Mart has added 24 medications to its growing list of generic prescription drug products that patients can receive for $4 for a 30-day supply. The prescriptions can be filled at 4,005 Wal-Mart, Sam's Club, and Neighborhood Market pharmacies in the United States. Among the 24 new medications are timolol, carvedilol, terbinafine, and benzoyl peroxide 4% creamy wash. The company also expanded its reproductive drugs offerings. For $9, patients in most states can now purchase a 30-day supply of clomiphene (50 mg), and two additional oral contraceptives. Wal-Mart claims that since its $4 generic program began in the fall of 2006, customers have saved $613 million. The generics represent 40% of all prescriptions filled in the last year. Because of state laws, some of the drugs cost more than $4 in California, Colorado, Hawaii, Minnesota, Montana, Pennsylvania, Tennessee, Wisconsin, and Wyoming.

NJ Task Force Examines M.D. Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at www.familiesusa.org.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said that the slowdown probably is temporary and is not providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of their policies. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For more details, visit

www.kff.org/insurance/7672

FDA Warns on Tanning Product

The FDA has urged those using a product called Melanotan II to stop immediately and contact their physicians if they have had an adverse event they suspect is tied to the injectable agent. Melanotan's maker, Hendersonville, Tenn.-based Melanocorp Inc., claims that it protects against skin cancer and rosacea. The product is not FDA approved, and thus is being illegally promoted, the agency said in its warning to the company. At the same time, the FDA warned consumers against "injecting any substance, particularly products that are not FDA approved, into their bodies without the oversight of a licensed health care provider."

U.S. Women Less Wrinkle Tolerant

American women are the least likely to tolerate wrinkles, closely followed by Italian, British, Spanish, French, and German women, but women in France and Italy are more likely to use dermal fillers, according to a recent survey. A total of 10,647 women and men in the United States, United Kingdom, France, Italy, Spain, and Germany responded to the survey, which was sponsored by Allergan Inc. About 50% of Italian women felt they looked younger than their age, compared with about 35% of American women. American and British women were the most likely to report that they believe they look stressed and tired. Overall, among women considering injectables, the top reasons were to look good for their age, to look more refreshed, and to improve self-esteem. When asked about their grooming habits, men also cited those reasons as key motivators, although American men said looking professional was one of the most important reasons. Italian men spent the most on grooming products, while American men spent the least.

Wal-Mart Expands $4 Generics

Wal-Mart has added 24 medications to its growing list of generic prescription drug products that patients can receive for $4 for a 30-day supply. The prescriptions can be filled at 4,005 Wal-Mart, Sam's Club, and Neighborhood Market pharmacies in the United States. Among the 24 new medications are timolol, carvedilol, terbinafine, and benzoyl peroxide 4% creamy wash. The company also expanded its reproductive drugs offerings. For $9, patients in most states can now purchase a 30-day supply of clomiphene (50 mg), and two additional oral contraceptives. Wal-Mart claims that since its $4 generic program began in the fall of 2006, customers have saved $613 million. The generics represent 40% of all prescriptions filled in the last year. Because of state laws, some of the drugs cost more than $4 in California, Colorado, Hawaii, Minnesota, Montana, Pennsylvania, Tennessee, Wisconsin, and Wyoming.

NJ Task Force Examines M.D. Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at www.familiesusa.org.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said that the slowdown probably is temporary and is not providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of their policies. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For more details, visit

www.kff.org/insurance/7672

WASHINGTON — For the second year in a row, federal officials and professional societies are urging health care providers to administer influenza vaccination beyond the traditional months of October and November.

A record number of doses will be available, they said at a press briefing highlighting persistent gaps in vaccination coverage for the most vulnerable populations—children and the elderly. The officials also encouraged providers to be more aggressive in offering pneumococcal vaccine to patients over age 65.

Influenza leads to 36,000 deaths and 200,000 hospitalizations each year. It disproportionately affects the very young, and those with chronic disease. For instance, influenza may trigger up to 92,000 cardiac deaths per year, according to the National Foundation for Infectious Diseases, which sponsored the briefing.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said that manufacturers are on track to deliver about 132 million doses of influenza vaccine this season, which would be the largest amount of vaccine ever produced. Although manufacturers could run into problems delivering those doses, as has happened in the past, "every indication is that the supply is not going to be the rate-limiting step for us," she said.

The biggest hurdle in raising vaccination rates is misperceptions among providers and patients, she and others noted during the briefing.

Many patients mistakenly believe that influenza vaccination causes illness. "It does not cause flu in any way, shape, or form," Dr. Gerberding said, calling on physicians to help dispel this myth.

Influenza vaccination rates are below goal for high-risk patients aged 18-49 (30%), healthy adults aged 50-64 (37%), and all adults over age 65 (69%), according to data from the 2005-2006 flu season, which was presented by Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division at the CDC's National Center for Immunization. During the 2005-2006 flu season, only 21% of children aged 6 months to 2 years received the two doses required for full vaccination coverage. The rates were published in the Morbidity and Mortality Weekly Report (2007 Sept. 21;56[37]:953–9).

CMS Acting Administrator Kerry Weems pointed out that Medicare recipients can receive flu shots free of charge. Medicare reimbursement for the shots will increase 5% in the upcoming season, to %13.22 for the most-used version and %17.37 for the preservative-free shot. The administration fee, which will be %19.33 in 2007, has not yet been calculated for 2008, Mr. Weems said.

Dr. Ardis Hoven, an infectious disease specialist and member of the American Medical Association's Board of Trustees, urged providers to extend their time frame for vaccination. Health care providers typically focus their vaccination efforts during October and November, but influenza usually peaks in February. Doses often remain available after November but go unused.

In 2006, 120 million doses were produced and 102 million were distributed, Dr. Santoli said.

"Health care professionals and their patients must work together to make sure every opportunity to discuss influenza immunization… is used," Dr. Hoven said.

Health care workers, including physicians, have almost the lowest rates of vaccination. The CDC does not have data for the 2005-2006 flu season, but over the 10 previous seasons, only about 40% of health workers were vaccinated annually, Dr. Santoli said.

WASHINGTON — For the second year in a row, federal officials and professional societies are urging health care providers to administer influenza vaccination beyond the traditional months of October and November.

A record number of doses will be available, they said at a press briefing highlighting persistent gaps in vaccination coverage for the most vulnerable populations—children and the elderly. The officials also encouraged providers to be more aggressive in offering pneumococcal vaccine to patients over age 65.

Influenza leads to 36,000 deaths and 200,000 hospitalizations each year. It disproportionately affects the very young, and those with chronic disease. For instance, influenza may trigger up to 92,000 cardiac deaths per year, according to the National Foundation for Infectious Diseases, which sponsored the briefing.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said that manufacturers are on track to deliver about 132 million doses of influenza vaccine this season, which would be the largest amount of vaccine ever produced. Although manufacturers could run into problems delivering those doses, as has happened in the past, "every indication is that the supply is not going to be the rate-limiting step for us," she said.

The biggest hurdle in raising vaccination rates is misperceptions among providers and patients, she and others noted during the briefing.

Many patients mistakenly believe that influenza vaccination causes illness. "It does not cause flu in any way, shape, or form," Dr. Gerberding said, calling on physicians to help dispel this myth.

Influenza vaccination rates are below goal for high-risk patients aged 18-49 (30%), healthy adults aged 50-64 (37%), and all adults over age 65 (69%), according to data from the 2005-2006 flu season, which was presented by Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division at the CDC's National Center for Immunization. During the 2005-2006 flu season, only 21% of children aged 6 months to 2 years received the two doses required for full vaccination coverage. The rates were published in the Morbidity and Mortality Weekly Report (2007 Sept. 21;56[37]:953–9).

CMS Acting Administrator Kerry Weems pointed out that Medicare recipients can receive flu shots free of charge. Medicare reimbursement for the shots will increase 5% in the upcoming season, to %13.22 for the most-used version and %17.37 for the preservative-free shot. The administration fee, which will be %19.33 in 2007, has not yet been calculated for 2008, Mr. Weems said.

Dr. Ardis Hoven, an infectious disease specialist and member of the American Medical Association's Board of Trustees, urged providers to extend their time frame for vaccination. Health care providers typically focus their vaccination efforts during October and November, but influenza usually peaks in February. Doses often remain available after November but go unused.

In 2006, 120 million doses were produced and 102 million were distributed, Dr. Santoli said.

"Health care professionals and their patients must work together to make sure every opportunity to discuss influenza immunization… is used," Dr. Hoven said.

Health care workers, including physicians, have almost the lowest rates of vaccination. The CDC does not have data for the 2005-2006 flu season, but over the 10 previous seasons, only about 40% of health workers were vaccinated annually, Dr. Santoli said.

WASHINGTON — For the second year in a row, federal officials and professional societies are urging health care providers to administer influenza vaccination beyond the traditional months of October and November.

A record number of doses will be available, they said at a press briefing highlighting persistent gaps in vaccination coverage for the most vulnerable populations—children and the elderly. The officials also encouraged providers to be more aggressive in offering pneumococcal vaccine to patients over age 65.

Influenza leads to 36,000 deaths and 200,000 hospitalizations each year. It disproportionately affects the very young, and those with chronic disease. For instance, influenza may trigger up to 92,000 cardiac deaths per year, according to the National Foundation for Infectious Diseases, which sponsored the briefing.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said that manufacturers are on track to deliver about 132 million doses of influenza vaccine this season, which would be the largest amount of vaccine ever produced. Although manufacturers could run into problems delivering those doses, as has happened in the past, "every indication is that the supply is not going to be the rate-limiting step for us," she said.

The biggest hurdle in raising vaccination rates is misperceptions among providers and patients, she and others noted during the briefing.

Many patients mistakenly believe that influenza vaccination causes illness. "It does not cause flu in any way, shape, or form," Dr. Gerberding said, calling on physicians to help dispel this myth.

Influenza vaccination rates are below goal for high-risk patients aged 18-49 (30%), healthy adults aged 50-64 (37%), and all adults over age 65 (69%), according to data from the 2005-2006 flu season, which was presented by Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division at the CDC's National Center for Immunization. During the 2005-2006 flu season, only 21% of children aged 6 months to 2 years received the two doses required for full vaccination coverage. The rates were published in the Morbidity and Mortality Weekly Report (2007 Sept. 21;56[37]:953–9).

CMS Acting Administrator Kerry Weems pointed out that Medicare recipients can receive flu shots free of charge. Medicare reimbursement for the shots will increase 5% in the upcoming season, to %13.22 for the most-used version and %17.37 for the preservative-free shot. The administration fee, which will be %19.33 in 2007, has not yet been calculated for 2008, Mr. Weems said.

Dr. Ardis Hoven, an infectious disease specialist and member of the American Medical Association's Board of Trustees, urged providers to extend their time frame for vaccination. Health care providers typically focus their vaccination efforts during October and November, but influenza usually peaks in February. Doses often remain available after November but go unused.

In 2006, 120 million doses were produced and 102 million were distributed, Dr. Santoli said.

"Health care professionals and their patients must work together to make sure every opportunity to discuss influenza immunization… is used," Dr. Hoven said.

Health care workers, including physicians, have almost the lowest rates of vaccination. The CDC does not have data for the 2005-2006 flu season, but over the 10 previous seasons, only about 40% of health workers were vaccinated annually, Dr. Santoli said.

The Food and Drug Administration approved the nasal influenza vaccine FluMist for children aged 2-5 years, which could help push up childhood vaccination rates.

FluMist manufacturer MedImmune Inc. said that it anticipated shipping the vaccine to physicians and health care providers almost immediately.

The Centers for Disease Control and Prevention (CDC) currently recommends that all children aged 6 months to 5 years be vaccinated against influenza. The trivalent FluMist vaccine has previously been approved only for healthy children over age 5 years and for adults aged 18-49 years.

Dr. Sarah Long, chief of infectious diseases at St.Christopher's Hospital for Children in Philadelphia, said that the new FluMist approval is likely to spur higher vaccination rates. But, she added, physicians probably will not widely use the vaccine in young children until the CDC's Advisory Committee on Immunization Practices recommends it for the approved populations.

Without an ACIP endorsement, insurers are reluctant to reimburse for a vaccine, Dr. Long, a member of the American Academy of Pediatrics committee on infectious diseases, said in an interview.

That recommendation is likely to come at ACIP's next meeting in late October, as FluMist's likely approval for use in young children had been discussed at its last meeting, Dr. Long said.

The AAP and the CDC agree that children of all ages are vastly undervaccinated. The CDC just issued vaccination statistics on children aged 6-23 months. Overall, only 21% of children under the age of 2 years received full vaccination coverage—that is, two doses—in the 2005-2006 flu season, Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division in the CDC's National Immunization Program, said at a press briefing on the upcoming flu season convened by the National Foundation for Infectious Diseases that occurred as the FluMist approval was granted.

FluMist joins two other vaccines currently approved for use in young children. Sanofi Pasteur's Fluzone is indicated for anyone over 6 months of age, and Novartis' Fluvirin for anyone aged 4 years or older.

But only FluMist offers the ease of nasal administration. "This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot," said Dr. Jesse L. Goodman, director of the Food and Drug Administration's Center for Biologics Evaluation and Research in a statement.

The approval was based on a pivotal study of 4,000 children aged 2-5 years who received the live attenuated vaccine during the 2004-2005 flu season. According to MedImmune, there was a 54% reduction in influenza in children given FluMist, compared with those who received a traditional injection.

The FluMist vaccine is contraindicated in those with asthma, children under age 2 years, and children under age 5 years who have recurrent wheezing because there is an increased risk of exacerbation of that symptom. It also should not be given to children receiving concomitant aspirin, or therapy containing aspirin, according to MedImmune.

The company will charge %17.95 per dose this flu season.

The Food and Drug Administration approved the nasal influenza vaccine FluMist for children aged 2-5 years, which could help push up childhood vaccination rates.

FluMist manufacturer MedImmune Inc. said that it anticipated shipping the vaccine to physicians and health care providers almost immediately.

The Centers for Disease Control and Prevention (CDC) currently recommends that all children aged 6 months to 5 years be vaccinated against influenza. The trivalent FluMist vaccine has previously been approved only for healthy children over age 5 years and for adults aged 18-49 years.

Dr. Sarah Long, chief of infectious diseases at St.Christopher's Hospital for Children in Philadelphia, said that the new FluMist approval is likely to spur higher vaccination rates. But, she added, physicians probably will not widely use the vaccine in young children until the CDC's Advisory Committee on Immunization Practices recommends it for the approved populations.

Without an ACIP endorsement, insurers are reluctant to reimburse for a vaccine, Dr. Long, a member of the American Academy of Pediatrics committee on infectious diseases, said in an interview.

That recommendation is likely to come at ACIP's next meeting in late October, as FluMist's likely approval for use in young children had been discussed at its last meeting, Dr. Long said.

The AAP and the CDC agree that children of all ages are vastly undervaccinated. The CDC just issued vaccination statistics on children aged 6-23 months. Overall, only 21% of children under the age of 2 years received full vaccination coverage—that is, two doses—in the 2005-2006 flu season, Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division in the CDC's National Immunization Program, said at a press briefing on the upcoming flu season convened by the National Foundation for Infectious Diseases that occurred as the FluMist approval was granted.

FluMist joins two other vaccines currently approved for use in young children. Sanofi Pasteur's Fluzone is indicated for anyone over 6 months of age, and Novartis' Fluvirin for anyone aged 4 years or older.

But only FluMist offers the ease of nasal administration. "This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot," said Dr. Jesse L. Goodman, director of the Food and Drug Administration's Center for Biologics Evaluation and Research in a statement.

The approval was based on a pivotal study of 4,000 children aged 2-5 years who received the live attenuated vaccine during the 2004-2005 flu season. According to MedImmune, there was a 54% reduction in influenza in children given FluMist, compared with those who received a traditional injection.

The FluMist vaccine is contraindicated in those with asthma, children under age 2 years, and children under age 5 years who have recurrent wheezing because there is an increased risk of exacerbation of that symptom. It also should not be given to children receiving concomitant aspirin, or therapy containing aspirin, according to MedImmune.

The company will charge %17.95 per dose this flu season.

The Food and Drug Administration approved the nasal influenza vaccine FluMist for children aged 2-5 years, which could help push up childhood vaccination rates.

FluMist manufacturer MedImmune Inc. said that it anticipated shipping the vaccine to physicians and health care providers almost immediately.

The Centers for Disease Control and Prevention (CDC) currently recommends that all children aged 6 months to 5 years be vaccinated against influenza. The trivalent FluMist vaccine has previously been approved only for healthy children over age 5 years and for adults aged 18-49 years.

Dr. Sarah Long, chief of infectious diseases at St.Christopher's Hospital for Children in Philadelphia, said that the new FluMist approval is likely to spur higher vaccination rates. But, she added, physicians probably will not widely use the vaccine in young children until the CDC's Advisory Committee on Immunization Practices recommends it for the approved populations.

Without an ACIP endorsement, insurers are reluctant to reimburse for a vaccine, Dr. Long, a member of the American Academy of Pediatrics committee on infectious diseases, said in an interview.

That recommendation is likely to come at ACIP's next meeting in late October, as FluMist's likely approval for use in young children had been discussed at its last meeting, Dr. Long said.

The AAP and the CDC agree that children of all ages are vastly undervaccinated. The CDC just issued vaccination statistics on children aged 6-23 months. Overall, only 21% of children under the age of 2 years received full vaccination coverage—that is, two doses—in the 2005-2006 flu season, Dr. Jeanne M. Santoli, deputy director of the Immunization Services Division in the CDC's National Immunization Program, said at a press briefing on the upcoming flu season convened by the National Foundation for Infectious Diseases that occurred as the FluMist approval was granted.

FluMist joins two other vaccines currently approved for use in young children. Sanofi Pasteur's Fluzone is indicated for anyone over 6 months of age, and Novartis' Fluvirin for anyone aged 4 years or older.

But only FluMist offers the ease of nasal administration. "This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot," said Dr. Jesse L. Goodman, director of the Food and Drug Administration's Center for Biologics Evaluation and Research in a statement.

The approval was based on a pivotal study of 4,000 children aged 2-5 years who received the live attenuated vaccine during the 2004-2005 flu season. According to MedImmune, there was a 54% reduction in influenza in children given FluMist, compared with those who received a traditional injection.

The FluMist vaccine is contraindicated in those with asthma, children under age 2 years, and children under age 5 years who have recurrent wheezing because there is an increased risk of exacerbation of that symptom. It also should not be given to children receiving concomitant aspirin, or therapy containing aspirin, according to MedImmune.

The company will charge %17.95 per dose this flu season.

WASHINGTON — A receiving hospital with specialized capabilities has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation narrowly approved by the Emergency Medical Treatment and Labor Act Technical Advisory Group in September at its seventh and final meeting.

The EMTALA Technical Advisory Group has been meeting during the last 30 months to help the Department of Health and Human Services improve guidance on and enforcement of the statute.

If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the panel's recommendation, it's likely the EMTALA interpretive guidelines would be altered, or that a new regulation would be issued under the statute, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, Neptune, N.J.

The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a catheterization lab. The four CMS officials on the panel all voted in favor of the recommendation.

But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske said he was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.

Dr. Charlotte S. Yeh, a panelist from the CMs' regional office in Boston, said that the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.

The clarification from the technical advisory group will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.

The responsibilities of a receiving hospital were just one issue on a laundry list of concerns discussed and voted on at the 2-day meeting.

The advisory group made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians. And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.

The committee also discussed and voted on issues regarding patients with psychiatric and behavioral disorders. They urged the CMS to refine medical screening exams so they determine if an individual is gravely disabled, suicidal, or homicidal. Even if a patient is determined to be in one of those states, that does not mean that he or she has an emergency medical condition, the advisory group said.

In addition, according to the committee, the use of chemical or physical restraints does not constitute stabilization of an emergency medical condition. EMTALA still applies, unless a hospital or physician can demonstrate that the patient is stabilized irrespective of the restraints.

At a meeting earlier this year, the panel had recommended to the CMS that its charter be extended for another year. The issue was taken up again at its final meeting, but the panelists acknowledged that only Congress can extend the advisory group's charter.

Even so, the panel recommended that the HHS secretary recognize its contributions and that its mission be continued in some fashion. Ongoing review of EMTALA is necessary, said Dr. James Nepola, an advisory group member and a professor of orthopedic surgery at the University of Iowa Hospitals and Clinics in Iowa City.

The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.

“I think the EMTALA TAG did a significant amount of good work to improve the EMTALA law, regulations, and interpretative guidelines,” he said. “Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”

WASHINGTON — A receiving hospital with specialized capabilities has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation narrowly approved by the Emergency Medical Treatment and Labor Act Technical Advisory Group in September at its seventh and final meeting.

The EMTALA Technical Advisory Group has been meeting during the last 30 months to help the Department of Health and Human Services improve guidance on and enforcement of the statute.

If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the panel's recommendation, it's likely the EMTALA interpretive guidelines would be altered, or that a new regulation would be issued under the statute, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, Neptune, N.J.

The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a catheterization lab. The four CMS officials on the panel all voted in favor of the recommendation.

But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske said he was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.

Dr. Charlotte S. Yeh, a panelist from the CMs' regional office in Boston, said that the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.

The clarification from the technical advisory group will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.

The responsibilities of a receiving hospital were just one issue on a laundry list of concerns discussed and voted on at the 2-day meeting.

The advisory group made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians. And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.

The committee also discussed and voted on issues regarding patients with psychiatric and behavioral disorders. They urged the CMS to refine medical screening exams so they determine if an individual is gravely disabled, suicidal, or homicidal. Even if a patient is determined to be in one of those states, that does not mean that he or she has an emergency medical condition, the advisory group said.

In addition, according to the committee, the use of chemical or physical restraints does not constitute stabilization of an emergency medical condition. EMTALA still applies, unless a hospital or physician can demonstrate that the patient is stabilized irrespective of the restraints.

At a meeting earlier this year, the panel had recommended to the CMS that its charter be extended for another year. The issue was taken up again at its final meeting, but the panelists acknowledged that only Congress can extend the advisory group's charter.

Even so, the panel recommended that the HHS secretary recognize its contributions and that its mission be continued in some fashion. Ongoing review of EMTALA is necessary, said Dr. James Nepola, an advisory group member and a professor of orthopedic surgery at the University of Iowa Hospitals and Clinics in Iowa City.

The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.

“I think the EMTALA TAG did a significant amount of good work to improve the EMTALA law, regulations, and interpretative guidelines,” he said. “Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”

WASHINGTON — A receiving hospital with specialized capabilities has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation narrowly approved by the Emergency Medical Treatment and Labor Act Technical Advisory Group in September at its seventh and final meeting.

The EMTALA Technical Advisory Group has been meeting during the last 30 months to help the Department of Health and Human Services improve guidance on and enforcement of the statute.

If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the panel's recommendation, it's likely the EMTALA interpretive guidelines would be altered, or that a new regulation would be issued under the statute, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, Neptune, N.J.

The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a catheterization lab. The four CMS officials on the panel all voted in favor of the recommendation.

But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske said he was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.

Dr. Charlotte S. Yeh, a panelist from the CMs' regional office in Boston, said that the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.

The clarification from the technical advisory group will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.

The responsibilities of a receiving hospital were just one issue on a laundry list of concerns discussed and voted on at the 2-day meeting.

The advisory group made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians. And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.

The committee also discussed and voted on issues regarding patients with psychiatric and behavioral disorders. They urged the CMS to refine medical screening exams so they determine if an individual is gravely disabled, suicidal, or homicidal. Even if a patient is determined to be in one of those states, that does not mean that he or she has an emergency medical condition, the advisory group said.

In addition, according to the committee, the use of chemical or physical restraints does not constitute stabilization of an emergency medical condition. EMTALA still applies, unless a hospital or physician can demonstrate that the patient is stabilized irrespective of the restraints.

At a meeting earlier this year, the panel had recommended to the CMS that its charter be extended for another year. The issue was taken up again at its final meeting, but the panelists acknowledged that only Congress can extend the advisory group's charter.

Even so, the panel recommended that the HHS secretary recognize its contributions and that its mission be continued in some fashion. Ongoing review of EMTALA is necessary, said Dr. James Nepola, an advisory group member and a professor of orthopedic surgery at the University of Iowa Hospitals and Clinics in Iowa City.

The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.

“I think the EMTALA TAG did a significant amount of good work to improve the EMTALA law, regulations, and interpretative guidelines,” he said. “Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”

Soon after President Bush delivered on his promise to veto the bipartisan reauthorization of the State Children's Health Insurance Program (SCHIP) on Oct. 3, Democrats in the U.S. House vowed to round up the votes needed to override the veto.

Professional medical societies and advocacy groups said they would join in the battle. “If SCHIP is not reauthorized, millions of children will be denied basic health care needs. … We are asking Congress to override your veto,” Dr. David C. Dale, president of the American College of Physicians, said in a letter to the White House.

In a statement, Dr. Edward L. Langston, board chair of the American Medical Association, called the veto disappointing. “The number of uninsured kids has increased by nearly 1 million over the past year, and action must be taken to reverse this trend.”

Families USA Executive Director Ron Pollack said that even if the House is not successful in overriding the veto, the SCHIP legislation will eventually be approved. “I think there will be increasing pressure on the White House to offer concessions to get this adopted,” Mr. Pollack said in an interview, noting that every round of votes against SCHIP will prove increasingly embarrassing to Republican lawmakers.

Advocates have some time to make their case—SCHIP, which expired Sept. 30, is able to tap funds appropriated as part of a continuing resolution that was approved by Congress to keep the government running until Nov. 16.

The SCHIP program currently covers an estimated 6 million children; the package that was passed by the House and Senate (H.R. 976) and vetoed by the president would have added $35 billion in funding to the program, increasing the enrollment by as many as 4 million children. The new funding was to come from an increase in the excise tax on tobacco.

The package introduced several new elements, including dental benefits and mental health parity. States also would have been given the ability to seek a waiver to extend coverage to low-income pregnant women. And the Department of Health and Human Services was directed to develop a core set of measures to track quality in the Medicaid and SCHIP programs.

The president had signaled his intention to veto, saying that the initial package passed by the House would be a step toward government-run health care and would give coverage to higher-income children. Those children might drop private coverage to join SCHIP, Mr. Bush said.

The final package acknowledged that the program might be overreaching and directed the Government Accountability Office to study and share best practices in states that have successfully prevented children from higher-income families from dropping private coverage. That may have been the only point of convergence for the White House and Congress.

Soon after President Bush delivered on his promise to veto the bipartisan reauthorization of the State Children's Health Insurance Program (SCHIP) on Oct. 3, Democrats in the U.S. House vowed to round up the votes needed to override the veto.

Professional medical societies and advocacy groups said they would join in the battle. “If SCHIP is not reauthorized, millions of children will be denied basic health care needs. … We are asking Congress to override your veto,” Dr. David C. Dale, president of the American College of Physicians, said in a letter to the White House.

In a statement, Dr. Edward L. Langston, board chair of the American Medical Association, called the veto disappointing. “The number of uninsured kids has increased by nearly 1 million over the past year, and action must be taken to reverse this trend.”

Families USA Executive Director Ron Pollack said that even if the House is not successful in overriding the veto, the SCHIP legislation will eventually be approved. “I think there will be increasing pressure on the White House to offer concessions to get this adopted,” Mr. Pollack said in an interview, noting that every round of votes against SCHIP will prove increasingly embarrassing to Republican lawmakers.

Advocates have some time to make their case—SCHIP, which expired Sept. 30, is able to tap funds appropriated as part of a continuing resolution that was approved by Congress to keep the government running until Nov. 16.

The SCHIP program currently covers an estimated 6 million children; the package that was passed by the House and Senate (H.R. 976) and vetoed by the president would have added $35 billion in funding to the program, increasing the enrollment by as many as 4 million children. The new funding was to come from an increase in the excise tax on tobacco.

The package introduced several new elements, including dental benefits and mental health parity. States also would have been given the ability to seek a waiver to extend coverage to low-income pregnant women. And the Department of Health and Human Services was directed to develop a core set of measures to track quality in the Medicaid and SCHIP programs.

The president had signaled his intention to veto, saying that the initial package passed by the House would be a step toward government-run health care and would give coverage to higher-income children. Those children might drop private coverage to join SCHIP, Mr. Bush said.

The final package acknowledged that the program might be overreaching and directed the Government Accountability Office to study and share best practices in states that have successfully prevented children from higher-income families from dropping private coverage. That may have been the only point of convergence for the White House and Congress.

Soon after President Bush delivered on his promise to veto the bipartisan reauthorization of the State Children's Health Insurance Program (SCHIP) on Oct. 3, Democrats in the U.S. House vowed to round up the votes needed to override the veto.

Professional medical societies and advocacy groups said they would join in the battle. “If SCHIP is not reauthorized, millions of children will be denied basic health care needs. … We are asking Congress to override your veto,” Dr. David C. Dale, president of the American College of Physicians, said in a letter to the White House.

In a statement, Dr. Edward L. Langston, board chair of the American Medical Association, called the veto disappointing. “The number of uninsured kids has increased by nearly 1 million over the past year, and action must be taken to reverse this trend.”

Families USA Executive Director Ron Pollack said that even if the House is not successful in overriding the veto, the SCHIP legislation will eventually be approved. “I think there will be increasing pressure on the White House to offer concessions to get this adopted,” Mr. Pollack said in an interview, noting that every round of votes against SCHIP will prove increasingly embarrassing to Republican lawmakers.

Advocates have some time to make their case—SCHIP, which expired Sept. 30, is able to tap funds appropriated as part of a continuing resolution that was approved by Congress to keep the government running until Nov. 16.

The SCHIP program currently covers an estimated 6 million children; the package that was passed by the House and Senate (H.R. 976) and vetoed by the president would have added $35 billion in funding to the program, increasing the enrollment by as many as 4 million children. The new funding was to come from an increase in the excise tax on tobacco.

The package introduced several new elements, including dental benefits and mental health parity. States also would have been given the ability to seek a waiver to extend coverage to low-income pregnant women. And the Department of Health and Human Services was directed to develop a core set of measures to track quality in the Medicaid and SCHIP programs.

The president had signaled his intention to veto, saying that the initial package passed by the House would be a step toward government-run health care and would give coverage to higher-income children. Those children might drop private coverage to join SCHIP, Mr. Bush said.

The final package acknowledged that the program might be overreaching and directed the Government Accountability Office to study and share best practices in states that have successfully prevented children from higher-income families from dropping private coverage. That may have been the only point of convergence for the White House and Congress.

WASHINGTON — The increasing need for endoscopists may be partially met by training midlevel providers such as nurse-endoscopists, according to a gastroenterologist who has embarked on a training program and presented his early findings at the annual Digestive Disease Week.

Dr. Jan Koornstra, of the University Medical Center Groningen (the Netherlands), presented results of the first 100 colonoscopies performed by two nurses who completed the training. Their results were compared with those of a first-year gastroenterology fellow.

The two nurses were already part of the endoscopy team and volunteered for training. There were no special selection criteria or minimum standards for participation, Dr. Koornstra said.

Initially, the nurses were trained on a simulator. They were also given textbook instruction on the relevant theoretical background on colonoscopy. The nurses were also given Game Boy devices to help them improve hand-eye coordination at home. They then started performing two to three flexible sigmoidoscopies and colonoscopies per week.

Competence was assessed by measuring the unassisted cecal intubation rate and time. The nurses were given 30 minutes to reach the cecum. After each procedure, patients were interviewed about pain or discomfort; responses were rated on a 10-point visual analog scale. They were also asked to rate their overall satisfaction.

Dr. Koornstra and his colleagues evaluated the first 100 procedures for each nurse-endoscopist. They included only complete colonoscopies (that is, those in which the cecum could be reached) and diagnostic procedures. Therapeutic procedures and patients with previous large-bowel surgery were excluded.

The procedure results were split into four quarters. For the first 25 procedures, the cecal intubation rates were 70% for the nurses and 60% for the fellow. By the final 25 procedures, rates had improved to 96% for the nurses and 90% for the fellow.

For nurses, the mean intubation time was 14 minutes for the first 25 procedures, gradually decreasing to 12–13 minutes for the final quarter. Results were similar for the fellow, Dr. Koornstra said.

Pain decreased from a score of 3.1 on the 10-point scale to a score of 2 for the final quarter, and discomfort decreased from 1.7 to 0.2. There were virtually no differences on these measures between the nurses and the fellow, he said.

Patients were generally satisfied with the procedures. Abnormalities were identified in about half of the cases, all of which were correctly recognized by the nurses, Dr. Koornstra said.

“Although our data may be a bit premature, I believe our training program for nurse-performed colonoscopy is safe and effective,” at least regarding the nurses' acquisition of technical skills and competency, he said.

WASHINGTON — The increasing need for endoscopists may be partially met by training midlevel providers such as nurse-endoscopists, according to a gastroenterologist who has embarked on a training program and presented his early findings at the annual Digestive Disease Week.

Dr. Jan Koornstra, of the University Medical Center Groningen (the Netherlands), presented results of the first 100 colonoscopies performed by two nurses who completed the training. Their results were compared with those of a first-year gastroenterology fellow.

The two nurses were already part of the endoscopy team and volunteered for training. There were no special selection criteria or minimum standards for participation, Dr. Koornstra said.

Initially, the nurses were trained on a simulator. They were also given textbook instruction on the relevant theoretical background on colonoscopy. The nurses were also given Game Boy devices to help them improve hand-eye coordination at home. They then started performing two to three flexible sigmoidoscopies and colonoscopies per week.

Competence was assessed by measuring the unassisted cecal intubation rate and time. The nurses were given 30 minutes to reach the cecum. After each procedure, patients were interviewed about pain or discomfort; responses were rated on a 10-point visual analog scale. They were also asked to rate their overall satisfaction.

Dr. Koornstra and his colleagues evaluated the first 100 procedures for each nurse-endoscopist. They included only complete colonoscopies (that is, those in which the cecum could be reached) and diagnostic procedures. Therapeutic procedures and patients with previous large-bowel surgery were excluded.

The procedure results were split into four quarters. For the first 25 procedures, the cecal intubation rates were 70% for the nurses and 60% for the fellow. By the final 25 procedures, rates had improved to 96% for the nurses and 90% for the fellow.

For nurses, the mean intubation time was 14 minutes for the first 25 procedures, gradually decreasing to 12–13 minutes for the final quarter. Results were similar for the fellow, Dr. Koornstra said.

Pain decreased from a score of 3.1 on the 10-point scale to a score of 2 for the final quarter, and discomfort decreased from 1.7 to 0.2. There were virtually no differences on these measures between the nurses and the fellow, he said.

Patients were generally satisfied with the procedures. Abnormalities were identified in about half of the cases, all of which were correctly recognized by the nurses, Dr. Koornstra said.

“Although our data may be a bit premature, I believe our training program for nurse-performed colonoscopy is safe and effective,” at least regarding the nurses' acquisition of technical skills and competency, he said.

WASHINGTON — The increasing need for endoscopists may be partially met by training midlevel providers such as nurse-endoscopists, according to a gastroenterologist who has embarked on a training program and presented his early findings at the annual Digestive Disease Week.

Dr. Jan Koornstra, of the University Medical Center Groningen (the Netherlands), presented results of the first 100 colonoscopies performed by two nurses who completed the training. Their results were compared with those of a first-year gastroenterology fellow.

The two nurses were already part of the endoscopy team and volunteered for training. There were no special selection criteria or minimum standards for participation, Dr. Koornstra said.

Initially, the nurses were trained on a simulator. They were also given textbook instruction on the relevant theoretical background on colonoscopy. The nurses were also given Game Boy devices to help them improve hand-eye coordination at home. They then started performing two to three flexible sigmoidoscopies and colonoscopies per week.

Competence was assessed by measuring the unassisted cecal intubation rate and time. The nurses were given 30 minutes to reach the cecum. After each procedure, patients were interviewed about pain or discomfort; responses were rated on a 10-point visual analog scale. They were also asked to rate their overall satisfaction.

Dr. Koornstra and his colleagues evaluated the first 100 procedures for each nurse-endoscopist. They included only complete colonoscopies (that is, those in which the cecum could be reached) and diagnostic procedures. Therapeutic procedures and patients with previous large-bowel surgery were excluded.

The procedure results were split into four quarters. For the first 25 procedures, the cecal intubation rates were 70% for the nurses and 60% for the fellow. By the final 25 procedures, rates had improved to 96% for the nurses and 90% for the fellow.

For nurses, the mean intubation time was 14 minutes for the first 25 procedures, gradually decreasing to 12–13 minutes for the final quarter. Results were similar for the fellow, Dr. Koornstra said.

Pain decreased from a score of 3.1 on the 10-point scale to a score of 2 for the final quarter, and discomfort decreased from 1.7 to 0.2. There were virtually no differences on these measures between the nurses and the fellow, he said.

Patients were generally satisfied with the procedures. Abnormalities were identified in about half of the cases, all of which were correctly recognized by the nurses, Dr. Koornstra said.

“Although our data may be a bit premature, I believe our training program for nurse-performed colonoscopy is safe and effective,” at least regarding the nurses' acquisition of technical skills and competency, he said.

In issuing the third phase of the final regulations implementing the physician self-referral rule, also known as the Stark law, the Center for Medicare and Medicaid Services has returned to a stance it held in the first phase.

The Stark law governs whether, how, and when it is acceptable for physicians to refer patients to hospitals, laboratories, imaging facilities, or other entities in which they may have an ownership interest.

Under the new rule, known as Stark III, published in the Federal Register Sept. 5, physicians will be considered to be “standing in the shoes” of the group practice when their investment arrangements are evaluated for compliance, according to several attorneys.

This reversion back to the initial Stark policy is among the most important changes in the 516-page document, said Daniel H. Melvin, a partner in the health law department of McDermott, Will & Emery's Chicago office. As a result, “the application of exceptions will be different going forward,” Mr. Melvin said in an interview.

That means that most physicians who have referral arrangements will have “a lot of contracts that will have to be looked at and possibly revised,” said Amy E. Nordeng, a counsel in the government affairs office of the Medical Group Management Association. Ms. Nordeng agreed that the return to the “stand in the shoes” view was the most significant component of Stark III.

Under Stark II—an interim policy that began in 2004—physicians were considered to be individuals, outside of their practices. Exceptions to the law were evaluated using an indirect compensation analysis, which ended up being onerous and was the subject of many complaints to CMS. In comments on Stark II, physician groups, hospitals, and other facilities (called designated health services, or DHS entities under the Stark law) urged CMS to revert to the old policy. CMS itself came to see the indirect compensation analysis as a loophole that allowed potentially questionable investment arrangements to slip through, said Mr. Melvin.

In the Stark III rule, CMS wrote that the change in policy means that, “many compensation arrangements that were analyzed under Phase II as indirect compensation arrangements are now analyzed as direct compensation arrangements that must comply with an applicable exception for direct compensation arrangements.”

There were several other notable changes in Stark III. The regulations clarify that physicians who administer pharmaceuticals under Medicare Part B (such as chemotherapy or infusions) or who prescribe physical therapy, occupational therapy, and speech-language pathology, are entitled to get direct productivity credit for those orders, said Mr. Melvin.

The clarification applies to those two ancillary services only, not to radiology or laboratories, or other services typically offered in-house, he said.

CMS also lifted the prohibition on noncompete agreements. Under Stark II, practices could not impose noncompete agreements on physician recruits. Now, practices can bar competition for up to 2 years, but it's not clear how far, geographically, that noncompete can extend, said Mr. Melvin.

With the new rule, practices have to “go back and look at everything,” including how their physicians are being compensated and the arrangements the practice may have for equipment and leasing or services with hospitals or other DHS entities, he said.

The final Stark rule goes into effect Dec. 5.

In issuing the third phase of the final regulations implementing the physician self-referral rule, also known as the Stark law, the Center for Medicare and Medicaid Services has returned to a stance it held in the first phase.

The Stark law governs whether, how, and when it is acceptable for physicians to refer patients to hospitals, laboratories, imaging facilities, or other entities in which they may have an ownership interest.

Under the new rule, known as Stark III, published in the Federal Register Sept. 5, physicians will be considered to be “standing in the shoes” of the group practice when their investment arrangements are evaluated for compliance, according to several attorneys.

This reversion back to the initial Stark policy is among the most important changes in the 516-page document, said Daniel H. Melvin, a partner in the health law department of McDermott, Will & Emery's Chicago office. As a result, “the application of exceptions will be different going forward,” Mr. Melvin said in an interview.

That means that most physicians who have referral arrangements will have “a lot of contracts that will have to be looked at and possibly revised,” said Amy E. Nordeng, a counsel in the government affairs office of the Medical Group Management Association. Ms. Nordeng agreed that the return to the “stand in the shoes” view was the most significant component of Stark III.

Under Stark II—an interim policy that began in 2004—physicians were considered to be individuals, outside of their practices. Exceptions to the law were evaluated using an indirect compensation analysis, which ended up being onerous and was the subject of many complaints to CMS. In comments on Stark II, physician groups, hospitals, and other facilities (called designated health services, or DHS entities under the Stark law) urged CMS to revert to the old policy. CMS itself came to see the indirect compensation analysis as a loophole that allowed potentially questionable investment arrangements to slip through, said Mr. Melvin.

In the Stark III rule, CMS wrote that the change in policy means that, “many compensation arrangements that were analyzed under Phase II as indirect compensation arrangements are now analyzed as direct compensation arrangements that must comply with an applicable exception for direct compensation arrangements.”

There were several other notable changes in Stark III. The regulations clarify that physicians who administer pharmaceuticals under Medicare Part B (such as chemotherapy or infusions) or who prescribe physical therapy, occupational therapy, and speech-language pathology, are entitled to get direct productivity credit for those orders, said Mr. Melvin.

The clarification applies to those two ancillary services only, not to radiology or laboratories, or other services typically offered in-house, he said.

CMS also lifted the prohibition on noncompete agreements. Under Stark II, practices could not impose noncompete agreements on physician recruits. Now, practices can bar competition for up to 2 years, but it's not clear how far, geographically, that noncompete can extend, said Mr. Melvin.

With the new rule, practices have to “go back and look at everything,” including how their physicians are being compensated and the arrangements the practice may have for equipment and leasing or services with hospitals or other DHS entities, he said.

The final Stark rule goes into effect Dec. 5.

In issuing the third phase of the final regulations implementing the physician self-referral rule, also known as the Stark law, the Center for Medicare and Medicaid Services has returned to a stance it held in the first phase.

The Stark law governs whether, how, and when it is acceptable for physicians to refer patients to hospitals, laboratories, imaging facilities, or other entities in which they may have an ownership interest.

Under the new rule, known as Stark III, published in the Federal Register Sept. 5, physicians will be considered to be “standing in the shoes” of the group practice when their investment arrangements are evaluated for compliance, according to several attorneys.

This reversion back to the initial Stark policy is among the most important changes in the 516-page document, said Daniel H. Melvin, a partner in the health law department of McDermott, Will & Emery's Chicago office. As a result, “the application of exceptions will be different going forward,” Mr. Melvin said in an interview.

That means that most physicians who have referral arrangements will have “a lot of contracts that will have to be looked at and possibly revised,” said Amy E. Nordeng, a counsel in the government affairs office of the Medical Group Management Association. Ms. Nordeng agreed that the return to the “stand in the shoes” view was the most significant component of Stark III.

Under Stark II—an interim policy that began in 2004—physicians were considered to be individuals, outside of their practices. Exceptions to the law were evaluated using an indirect compensation analysis, which ended up being onerous and was the subject of many complaints to CMS. In comments on Stark II, physician groups, hospitals, and other facilities (called designated health services, or DHS entities under the Stark law) urged CMS to revert to the old policy. CMS itself came to see the indirect compensation analysis as a loophole that allowed potentially questionable investment arrangements to slip through, said Mr. Melvin.

In the Stark III rule, CMS wrote that the change in policy means that, “many compensation arrangements that were analyzed under Phase II as indirect compensation arrangements are now analyzed as direct compensation arrangements that must comply with an applicable exception for direct compensation arrangements.”

There were several other notable changes in Stark III. The regulations clarify that physicians who administer pharmaceuticals under Medicare Part B (such as chemotherapy or infusions) or who prescribe physical therapy, occupational therapy, and speech-language pathology, are entitled to get direct productivity credit for those orders, said Mr. Melvin.

The clarification applies to those two ancillary services only, not to radiology or laboratories, or other services typically offered in-house, he said.

CMS also lifted the prohibition on noncompete agreements. Under Stark II, practices could not impose noncompete agreements on physician recruits. Now, practices can bar competition for up to 2 years, but it's not clear how far, geographically, that noncompete can extend, said Mr. Melvin.

With the new rule, practices have to “go back and look at everything,” including how their physicians are being compensated and the arrangements the practice may have for equipment and leasing or services with hospitals or other DHS entities, he said.

The final Stark rule goes into effect Dec. 5.

WASHINGTON — A receiving hospital with specialized capabilities, like a stroke center, has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation by the Emergency Medical Treatment and Labor Act Technical Advisory Group.

The EMTALA Technical Advisory Group has met regularly over the last 30 months to advise the Secretary of the Department of Health and Human Services on improving the statute.

Dr. Ralph Sacco, professor and chairman of the department of neurology at the University of Miami, commented on the recommendations. “It does make sense that acute neurological issues are treated in hospitals that are prepared to deal with acute neurological issues.” However, he added “one way we try to avert [a transfer] from ever happening is by designating stroke centers in advance and by designating [emergency medical service workers] to only take stroke patients there in the first place.”

Dr. Sacco was not a member of the advisory group.

If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the recommendation, it's likely the EMTALA interpretive guidelines would be altered, or a new regulation would be issued, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, in Neptune, N.J.

The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a stroke center or a catheterization lab. The four CMS officials on the panel all voted for the recommendation.

But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.

Dr. Sacco added, “We hope people don't abuse the system, by saying, 'this patient is unstable, let's invoke this urgent rule and move them somewhere else.'” Dr. Sacco previoulsy served as director of the Stroke and Critical Care Division at Columbia University, New York.

“The other thing that's happening that could improve the ability to stabilize cases elsewhere is telemedicine,” he added.

Dr. Charlotte S. Yeh, a panelist from the CMS, said the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.

The clarification will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.

The advisory group also made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians.

And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.

The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.

“Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”

WASHINGTON — A receiving hospital with specialized capabilities, like a stroke center, has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation by the Emergency Medical Treatment and Labor Act Technical Advisory Group.

The EMTALA Technical Advisory Group has met regularly over the last 30 months to advise the Secretary of the Department of Health and Human Services on improving the statute.

Dr. Ralph Sacco, professor and chairman of the department of neurology at the University of Miami, commented on the recommendations. “It does make sense that acute neurological issues are treated in hospitals that are prepared to deal with acute neurological issues.” However, he added “one way we try to avert [a transfer] from ever happening is by designating stroke centers in advance and by designating [emergency medical service workers] to only take stroke patients there in the first place.”

Dr. Sacco was not a member of the advisory group.

If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the recommendation, it's likely the EMTALA interpretive guidelines would be altered, or a new regulation would be issued, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, in Neptune, N.J.

The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a stroke center or a catheterization lab. The four CMS officials on the panel all voted for the recommendation.

But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.

Dr. Sacco added, “We hope people don't abuse the system, by saying, 'this patient is unstable, let's invoke this urgent rule and move them somewhere else.'” Dr. Sacco previoulsy served as director of the Stroke and Critical Care Division at Columbia University, New York.

“The other thing that's happening that could improve the ability to stabilize cases elsewhere is telemedicine,” he added.

Dr. Charlotte S. Yeh, a panelist from the CMS, said the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.

The clarification will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.

The advisory group also made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians.

And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.

The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.

“Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”

WASHINGTON — A receiving hospital with specialized capabilities, like a stroke center, has the responsibility to accept an unstable inpatient from a transferring hospital, but only if the patient had not been stabilized for the original condition requiring admittance, according to a recommendation by the Emergency Medical Treatment and Labor Act Technical Advisory Group.

The EMTALA Technical Advisory Group has met regularly over the last 30 months to advise the Secretary of the Department of Health and Human Services on improving the statute.

Dr. Ralph Sacco, professor and chairman of the department of neurology at the University of Miami, commented on the recommendations. “It does make sense that acute neurological issues are treated in hospitals that are prepared to deal with acute neurological issues.” However, he added “one way we try to avert [a transfer] from ever happening is by designating stroke centers in advance and by designating [emergency medical service workers] to only take stroke patients there in the first place.”

Dr. Sacco was not a member of the advisory group.

If the Centers for Medicare and Medicaid Services—which is charged with writing the rules for and enforcing EMTALA—follows the recommendation, it's likely the EMTALA interpretive guidelines would be altered, or a new regulation would be issued, said panel chairman Dr. David Siegel, an emergency physician and senior vice president at Meridian Health, in Neptune, N.J.

The recommended change came after heated debate over whether EMTALA should apply to any inpatient transfers to hospitals with specialized services, such as a stroke center or a catheterization lab. The four CMS officials on the panel all voted for the recommendation.

But other panelists had reservations. The change would “open up a whole new universe of potential issues,” said advisory group member Dr. John A. Kusske, chairman of the department of neurologic surgeons at University of California, Irvine, Medical Center. Dr. Kusske was concerned that if EMTALA was applied to these transfers, it might make it harder to find specialists to take on-call duty.

Dr. Sacco added, “We hope people don't abuse the system, by saying, 'this patient is unstable, let's invoke this urgent rule and move them somewhere else.'” Dr. Sacco previoulsy served as director of the Stroke and Critical Care Division at Columbia University, New York.

“The other thing that's happening that could improve the ability to stabilize cases elsewhere is telemedicine,” he added.

Dr. Charlotte S. Yeh, a panelist from the CMS, said the agency has lacked clarity on whether EMTALA applies to these circumstances, and thus has not actively enforced any complaints.

The clarification will help CMS shape its enforcement policy, said Dr. Yeh, who also is an emergency physician.

The advisory group also made a number of recommendations aimed at strengthening hospitals' ability to find and retain on-call physicians.

And it unanimously supported the recommendation that liability protection be provided to hospitals and physicians who provide EMTALA care.

The full accounting of the technical advisory group's final recommendations will be included in its final report to the HHS secretary, which should be published in the fall, Dr. Siegel said.

“Unfortunately, there are issues beyond the statute, such as reimbursement and liability, that must be addressed to ultimately solve the problem.”