Alicia Ault

WASHINGTON — A withdrawal time of 6 minutes is adequate for reaching adenoma detection rates recommended by the American Society for Gastrointestinal Endoscopy, according to a large, single-institution study presented at the annual Digestive Disease Week.

The investigators performed a database analysis that confirmed previous studies that showed that a 6-minute withdrawal time during screening colonoscopy is adequate to reach detection rates of 25% in men and 15% in women over the age of 50. These rates were recommended by the U.S. Multisociety Task Force on Colorectal Cancer in 2002, and a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006.

The previous studies demonstrated close correlations between withdrawal time and polyp detection, said Dr. Gavin C. Harewood of Beaumont Hospital in Dublin. “The longer one takes to withdraw during colonoscopy, the higher the polyp or adenoma detection rate,” he said.

Dr. Harewood, formerly of the Mayo Clinic in Rochester, Minn., and his colleagues there reviewed the data from all outpatient colonoscopies performed at the clinic in 2003. They examined the mean withdrawal time for negative procedures and the individual polyp detection rate. Forty-three endoscopists performed 10,955 procedures, of which 9,528 were performed on patients over age 50.

The mean withdrawal time was 7 minutes for men and 6.3 minutes for women.

Polyps were detected in 4,311 patients (45.2%). The researchers analyzed the histology of a random sample of 50 polyps and found that 56% contained adenomatous tissue. By dividing the minimum recommended adenoma detection rates of 25% and 15% by 0.56, the researchers found that the minimum polyp detection rate was 45% for men and 27% for women.

The withdrawal time that corresponded to a detection rate of 45% in men was just over 6 minutes. For women, a 4.3-minute withdrawal time corresponded with the 27% detection rate.

The authors “conclude that 6 minutes is a minimum acceptable withdrawal time for colonoscopy, as it appears to correlate with the minimum recommended adenoma detection rate,” said Dr. Harewood.

Histology data were not available for all the polyps, and the study was not restricted to screening colonoscopies. In addition, the results are from a tertiary referral center, “which does limit the external validity of these findings,” he said.

Also, Dr. Harewood said, “withdrawal time [is] only part of the equation.” Some fast endoscopists may have high detection rates, while some slow practitioners might be sloppy, he said. He added, however, that the evidence is “compelling” that “withdrawal time correlates with detection.”

WASHINGTON — A withdrawal time of 6 minutes is adequate for reaching adenoma detection rates recommended by the American Society for Gastrointestinal Endoscopy, according to a large, single-institution study presented at the annual Digestive Disease Week.

The investigators performed a database analysis that confirmed previous studies that showed that a 6-minute withdrawal time during screening colonoscopy is adequate to reach detection rates of 25% in men and 15% in women over the age of 50. These rates were recommended by the U.S. Multisociety Task Force on Colorectal Cancer in 2002, and a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006.

The previous studies demonstrated close correlations between withdrawal time and polyp detection, said Dr. Gavin C. Harewood of Beaumont Hospital in Dublin. “The longer one takes to withdraw during colonoscopy, the higher the polyp or adenoma detection rate,” he said.

Dr. Harewood, formerly of the Mayo Clinic in Rochester, Minn., and his colleagues there reviewed the data from all outpatient colonoscopies performed at the clinic in 2003. They examined the mean withdrawal time for negative procedures and the individual polyp detection rate. Forty-three endoscopists performed 10,955 procedures, of which 9,528 were performed on patients over age 50.

The mean withdrawal time was 7 minutes for men and 6.3 minutes for women.

Polyps were detected in 4,311 patients (45.2%). The researchers analyzed the histology of a random sample of 50 polyps and found that 56% contained adenomatous tissue. By dividing the minimum recommended adenoma detection rates of 25% and 15% by 0.56, the researchers found that the minimum polyp detection rate was 45% for men and 27% for women.

The withdrawal time that corresponded to a detection rate of 45% in men was just over 6 minutes. For women, a 4.3-minute withdrawal time corresponded with the 27% detection rate.

The authors “conclude that 6 minutes is a minimum acceptable withdrawal time for colonoscopy, as it appears to correlate with the minimum recommended adenoma detection rate,” said Dr. Harewood.

Histology data were not available for all the polyps, and the study was not restricted to screening colonoscopies. In addition, the results are from a tertiary referral center, “which does limit the external validity of these findings,” he said.

Also, Dr. Harewood said, “withdrawal time [is] only part of the equation.” Some fast endoscopists may have high detection rates, while some slow practitioners might be sloppy, he said. He added, however, that the evidence is “compelling” that “withdrawal time correlates with detection.”

WASHINGTON — A withdrawal time of 6 minutes is adequate for reaching adenoma detection rates recommended by the American Society for Gastrointestinal Endoscopy, according to a large, single-institution study presented at the annual Digestive Disease Week.

The investigators performed a database analysis that confirmed previous studies that showed that a 6-minute withdrawal time during screening colonoscopy is adequate to reach detection rates of 25% in men and 15% in women over the age of 50. These rates were recommended by the U.S. Multisociety Task Force on Colorectal Cancer in 2002, and a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006.

The previous studies demonstrated close correlations between withdrawal time and polyp detection, said Dr. Gavin C. Harewood of Beaumont Hospital in Dublin. “The longer one takes to withdraw during colonoscopy, the higher the polyp or adenoma detection rate,” he said.

Dr. Harewood, formerly of the Mayo Clinic in Rochester, Minn., and his colleagues there reviewed the data from all outpatient colonoscopies performed at the clinic in 2003. They examined the mean withdrawal time for negative procedures and the individual polyp detection rate. Forty-three endoscopists performed 10,955 procedures, of which 9,528 were performed on patients over age 50.

The mean withdrawal time was 7 minutes for men and 6.3 minutes for women.

Polyps were detected in 4,311 patients (45.2%). The researchers analyzed the histology of a random sample of 50 polyps and found that 56% contained adenomatous tissue. By dividing the minimum recommended adenoma detection rates of 25% and 15% by 0.56, the researchers found that the minimum polyp detection rate was 45% for men and 27% for women.

The withdrawal time that corresponded to a detection rate of 45% in men was just over 6 minutes. For women, a 4.3-minute withdrawal time corresponded with the 27% detection rate.

The authors “conclude that 6 minutes is a minimum acceptable withdrawal time for colonoscopy, as it appears to correlate with the minimum recommended adenoma detection rate,” said Dr. Harewood.

Histology data were not available for all the polyps, and the study was not restricted to screening colonoscopies. In addition, the results are from a tertiary referral center, “which does limit the external validity of these findings,” he said.

Also, Dr. Harewood said, “withdrawal time [is] only part of the equation.” Some fast endoscopists may have high detection rates, while some slow practitioners might be sloppy, he said. He added, however, that the evidence is “compelling” that “withdrawal time correlates with detection.”

The Food and Drug Administration will allow limited use of the irritable bowel syndrome drug tegaserod.

The agent, marketed by Novartis Pharmaceuticals as Zelnorm, will now be available under a treatment investigational new drug (IND) protocol to treat IBS with constipation and chronic idiopathic constipation in women under age 55 who meet specific guidelines, according to the FDA.

“These patients must meet strict criteria and have no known or preexisting heart problems and be in critical need of this drug,” Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a written statement. “Zelnorm will remain off the market for general use,” he added.

The drug was pulled off the U.S. market in late March in response to an FDA request. At the time, the FDA said that patients taking Zelnorm had a higher risk of adverse cardiovascular events. The relative risk of serious and life-threatening events was 0.1% for Zelnorm and 0.01% for those taking placebo. However, the agency also said it would work with Novartis to find a way to make the drug available to patients who had no other alternatives.

Zelnorm was approved in the United States in 2002 for short-term treatment of women with irritable bowel syndrome with constipation. A supplemental approval was granted in 2004 for chronic constipation in men and women under age 65.

Physicians who think their patients meet the IND criteria should call Novartis at 888-669-6682. Patients or physicians can also contact the FDA's Division of Drug Information at 888-463-6332 for other options.

The Food and Drug Administration will allow limited use of the irritable bowel syndrome drug tegaserod.

The agent, marketed by Novartis Pharmaceuticals as Zelnorm, will now be available under a treatment investigational new drug (IND) protocol to treat IBS with constipation and chronic idiopathic constipation in women under age 55 who meet specific guidelines, according to the FDA.

“These patients must meet strict criteria and have no known or preexisting heart problems and be in critical need of this drug,” Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a written statement. “Zelnorm will remain off the market for general use,” he added.

The drug was pulled off the U.S. market in late March in response to an FDA request. At the time, the FDA said that patients taking Zelnorm had a higher risk of adverse cardiovascular events. The relative risk of serious and life-threatening events was 0.1% for Zelnorm and 0.01% for those taking placebo. However, the agency also said it would work with Novartis to find a way to make the drug available to patients who had no other alternatives.

Zelnorm was approved in the United States in 2002 for short-term treatment of women with irritable bowel syndrome with constipation. A supplemental approval was granted in 2004 for chronic constipation in men and women under age 65.

Physicians who think their patients meet the IND criteria should call Novartis at 888-669-6682. Patients or physicians can also contact the FDA's Division of Drug Information at 888-463-6332 for other options.

The Food and Drug Administration will allow limited use of the irritable bowel syndrome drug tegaserod.

The agent, marketed by Novartis Pharmaceuticals as Zelnorm, will now be available under a treatment investigational new drug (IND) protocol to treat IBS with constipation and chronic idiopathic constipation in women under age 55 who meet specific guidelines, according to the FDA.

“These patients must meet strict criteria and have no known or preexisting heart problems and be in critical need of this drug,” Dr. Steven Galson, director of the FDA's Center for Drug Evaluation and Research, said in a written statement. “Zelnorm will remain off the market for general use,” he added.

The drug was pulled off the U.S. market in late March in response to an FDA request. At the time, the FDA said that patients taking Zelnorm had a higher risk of adverse cardiovascular events. The relative risk of serious and life-threatening events was 0.1% for Zelnorm and 0.01% for those taking placebo. However, the agency also said it would work with Novartis to find a way to make the drug available to patients who had no other alternatives.

Zelnorm was approved in the United States in 2002 for short-term treatment of women with irritable bowel syndrome with constipation. A supplemental approval was granted in 2004 for chronic constipation in men and women under age 65.

Physicians who think their patients meet the IND criteria should call Novartis at 888-669-6682. Patients or physicians can also contact the FDA's Division of Drug Information at 888-463-6332 for other options.

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth.

Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians,” said Dr. S. William Clark III.

The rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth.

Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians,” said Dr. S. William Clark III.

The rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth.

Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians,” said Dr. S. William Clark III.

The rankings are posted at www.athenapayerview.com

ELSEVIER GLOBAL MEDICAL NEWS

Boston Scientific Settles Defib Suits

Just a month after saying it was prepared to go to trial, Boston Scientific decided to pay out $195 million to settle claims alleging that Guidant Corp. did not properly warn patients about potential harm associated with its defibrillators. Boston Scientific inherited the litigation when it bought Guidant for $27 billion in 2006. The settlement covers claims brought by 4,000 people that were consolidated in the U.S. District Court for the District of Minnesota. It also covers “an undetermined number—but not all—of additional similar claims throughout the country,” according to a statement by Boston Scientific. The settlement is much less than Boston Scientific had been banking on; the company had put aside $730 million to cover the litigation. “We are pleased by this resolution, which is in the best interest of all involved,” said Jim Tobin, Boston Scientific president and CEO, in a statement.

GAO Seeks Ultrasound Credentialing

The U.S. Government Accountability Office is urging the Centers for Medicare and Medicaid Services to consider requiring sonographers who provide Medicare-covered exams to be credentialed or to work in accredited facilities. The goal is to ensure consistent quality at a time when the cost of Medicare-covered imaging services nearly doubled, from $5.7 billion in 1999 to $10.9 billion in 2004. Much of the increase in volume and costs have been for cardiovascular-related exams, according to GAO's June 2007 report (GAO-07–734). The agency's analysis of 2005 Medicare claims found that three-quarters of the 41 million ultrasound exams covered were either echocardiograms (53% of procedures) or noninvasive vascular exams (20% of procedures).

MedPAC Imaging Report Slammed

The medical device industry trade group AdvaMed has issued a report questioning the conclusions of a Medicare Payment Advisory Commission survey on physician use of magnetic resonance imaging and computed tomography sent to Congress in mid-2006. The group said it was concerned that CMS might use the MedPAC report to set policy or pay rates. AdvaMed's report, conducted by United BioSource Corp. (UBC), claimed that MedPAC used flawed methodology. MedPAC surveyed 189 providers in 6 markets, but ultimately only included 80 providers. “The sample is far too limited to yield results that are acceptable for national estimates,” according to the UBC report. After comparing rates reported in the literature and conducting other analyses, UBC concluded that MedPAC's utilization estimates—100% or higher—“may be extraordinarily high, and there is uncertainty about what the true reasonable range is.”

Joint Commission Announces Goals

The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals allow caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.

Boston Scientific Settles Defib Suits

Just a month after saying it was prepared to go to trial, Boston Scientific decided to pay out $195 million to settle claims alleging that Guidant Corp. did not properly warn patients about potential harm associated with its defibrillators. Boston Scientific inherited the litigation when it bought Guidant for $27 billion in 2006. The settlement covers claims brought by 4,000 people that were consolidated in the U.S. District Court for the District of Minnesota. It also covers “an undetermined number—but not all—of additional similar claims throughout the country,” according to a statement by Boston Scientific. The settlement is much less than Boston Scientific had been banking on; the company had put aside $730 million to cover the litigation. “We are pleased by this resolution, which is in the best interest of all involved,” said Jim Tobin, Boston Scientific president and CEO, in a statement.

GAO Seeks Ultrasound Credentialing

The U.S. Government Accountability Office is urging the Centers for Medicare and Medicaid Services to consider requiring sonographers who provide Medicare-covered exams to be credentialed or to work in accredited facilities. The goal is to ensure consistent quality at a time when the cost of Medicare-covered imaging services nearly doubled, from $5.7 billion in 1999 to $10.9 billion in 2004. Much of the increase in volume and costs have been for cardiovascular-related exams, according to GAO's June 2007 report (GAO-07–734). The agency's analysis of 2005 Medicare claims found that three-quarters of the 41 million ultrasound exams covered were either echocardiograms (53% of procedures) or noninvasive vascular exams (20% of procedures).

MedPAC Imaging Report Slammed

The medical device industry trade group AdvaMed has issued a report questioning the conclusions of a Medicare Payment Advisory Commission survey on physician use of magnetic resonance imaging and computed tomography sent to Congress in mid-2006. The group said it was concerned that CMS might use the MedPAC report to set policy or pay rates. AdvaMed's report, conducted by United BioSource Corp. (UBC), claimed that MedPAC used flawed methodology. MedPAC surveyed 189 providers in 6 markets, but ultimately only included 80 providers. “The sample is far too limited to yield results that are acceptable for national estimates,” according to the UBC report. After comparing rates reported in the literature and conducting other analyses, UBC concluded that MedPAC's utilization estimates—100% or higher—“may be extraordinarily high, and there is uncertainty about what the true reasonable range is.”

Joint Commission Announces Goals

The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals allow caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.

Boston Scientific Settles Defib Suits

Just a month after saying it was prepared to go to trial, Boston Scientific decided to pay out $195 million to settle claims alleging that Guidant Corp. did not properly warn patients about potential harm associated with its defibrillators. Boston Scientific inherited the litigation when it bought Guidant for $27 billion in 2006. The settlement covers claims brought by 4,000 people that were consolidated in the U.S. District Court for the District of Minnesota. It also covers “an undetermined number—but not all—of additional similar claims throughout the country,” according to a statement by Boston Scientific. The settlement is much less than Boston Scientific had been banking on; the company had put aside $730 million to cover the litigation. “We are pleased by this resolution, which is in the best interest of all involved,” said Jim Tobin, Boston Scientific president and CEO, in a statement.

GAO Seeks Ultrasound Credentialing

The U.S. Government Accountability Office is urging the Centers for Medicare and Medicaid Services to consider requiring sonographers who provide Medicare-covered exams to be credentialed or to work in accredited facilities. The goal is to ensure consistent quality at a time when the cost of Medicare-covered imaging services nearly doubled, from $5.7 billion in 1999 to $10.9 billion in 2004. Much of the increase in volume and costs have been for cardiovascular-related exams, according to GAO's June 2007 report (GAO-07–734). The agency's analysis of 2005 Medicare claims found that three-quarters of the 41 million ultrasound exams covered were either echocardiograms (53% of procedures) or noninvasive vascular exams (20% of procedures).

MedPAC Imaging Report Slammed

The medical device industry trade group AdvaMed has issued a report questioning the conclusions of a Medicare Payment Advisory Commission survey on physician use of magnetic resonance imaging and computed tomography sent to Congress in mid-2006. The group said it was concerned that CMS might use the MedPAC report to set policy or pay rates. AdvaMed's report, conducted by United BioSource Corp. (UBC), claimed that MedPAC used flawed methodology. MedPAC surveyed 189 providers in 6 markets, but ultimately only included 80 providers. “The sample is far too limited to yield results that are acceptable for national estimates,” according to the UBC report. After comparing rates reported in the literature and conducting other analyses, UBC concluded that MedPAC's utilization estimates—100% or higher—“may be extraordinarily high, and there is uncertainty about what the true reasonable range is.”

Joint Commission Announces Goals

The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) will require health care institutions to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy as part of its 2008 National Patient Safety Goals. The new requirement applies to hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The 2008 safety goals also include a new requirement that addresses the recognition of and response to unexpected deterioration in a patient's condition. Under this requirement, hospitals allow caregivers to directly request and obtain assistance from specially trained individuals if and when a patient's condition worsens. Full implementation of both requirements is targeted for January 2009.

The Centers for Medicare and Medicaid Services is amending its diagnostic ultrasound policy to allow coverage of Doppler monitoring of cardiac output in ventilated patients in intensive care and operative patients with a need for intraoperative fluid optimization.

The agency said that new studies had come to light that led it to reverse its previous decision against national coverage of the monitoring.

“As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to reevaluate our position on this important noninvasive method of caring for patients in intensive care situations,” CMS Acting Administrator Leslie V. Norwalk said in a statement.

Deltex Medical Group PLC, the Chichester, England-based company that makes the monitoring equipment, petitioned CMS last year to revisit its coverage decision. According to Deltex, the earlier CMS decision was made before its device, the CardioQ, was commercially available. The CardioQ was approved by the Food and Drug Administration under the 510(k) process in 2003.

CMS agreed with Deltex that there was now sufficient evidence to support coverage. The agency found a number of prospective, randomized studies showing that when compared with standard cardiac output (CO) monitoring, patients managed with the less invasive esophageal Doppler monitoring “had adequate CO, shorter hospital length of stays … and, generally, decreased complications.”

The CardioQ system uses a disposable ultrasound probe inserted into the patient's esophagus. It determines circulating blood volume, a crucial measure during surgery or for ventilated patients in the ICU. The measure is used to guide intravenous fluid replacement and drug therapy.

The Centers for Medicare and Medicaid Services is amending its diagnostic ultrasound policy to allow coverage of Doppler monitoring of cardiac output in ventilated patients in intensive care and operative patients with a need for intraoperative fluid optimization.

The agency said that new studies had come to light that led it to reverse its previous decision against national coverage of the monitoring.

“As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to reevaluate our position on this important noninvasive method of caring for patients in intensive care situations,” CMS Acting Administrator Leslie V. Norwalk said in a statement.

Deltex Medical Group PLC, the Chichester, England-based company that makes the monitoring equipment, petitioned CMS last year to revisit its coverage decision. According to Deltex, the earlier CMS decision was made before its device, the CardioQ, was commercially available. The CardioQ was approved by the Food and Drug Administration under the 510(k) process in 2003.

CMS agreed with Deltex that there was now sufficient evidence to support coverage. The agency found a number of prospective, randomized studies showing that when compared with standard cardiac output (CO) monitoring, patients managed with the less invasive esophageal Doppler monitoring “had adequate CO, shorter hospital length of stays … and, generally, decreased complications.”

The CardioQ system uses a disposable ultrasound probe inserted into the patient's esophagus. It determines circulating blood volume, a crucial measure during surgery or for ventilated patients in the ICU. The measure is used to guide intravenous fluid replacement and drug therapy.

The Centers for Medicare and Medicaid Services is amending its diagnostic ultrasound policy to allow coverage of Doppler monitoring of cardiac output in ventilated patients in intensive care and operative patients with a need for intraoperative fluid optimization.

The agency said that new studies had come to light that led it to reverse its previous decision against national coverage of the monitoring.

“As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to reevaluate our position on this important noninvasive method of caring for patients in intensive care situations,” CMS Acting Administrator Leslie V. Norwalk said in a statement.

Deltex Medical Group PLC, the Chichester, England-based company that makes the monitoring equipment, petitioned CMS last year to revisit its coverage decision. According to Deltex, the earlier CMS decision was made before its device, the CardioQ, was commercially available. The CardioQ was approved by the Food and Drug Administration under the 510(k) process in 2003.

CMS agreed with Deltex that there was now sufficient evidence to support coverage. The agency found a number of prospective, randomized studies showing that when compared with standard cardiac output (CO) monitoring, patients managed with the less invasive esophageal Doppler monitoring “had adequate CO, shorter hospital length of stays … and, generally, decreased complications.”

The CardioQ system uses a disposable ultrasound probe inserted into the patient's esophagus. It determines circulating blood volume, a crucial measure during surgery or for ventilated patients in the ICU. The measure is used to guide intravenous fluid replacement and drug therapy.

Most Substance Abusers Work

A new survey by the Substance Abuse and Mental Health Services Administration shows that most of the nation's 16.4 million illicit drug users and 15 million heavy alcohol users are employed full time. The report, available at SAMHSA's Web site, is compiled from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. The data are somewhat misleading in that full-time workers account for two-thirds of the survey population, so most substance users will be employed, according to SAMHSA. Illicit drug use was highest among the cohort aged 18–25 years, at 19%, compared with 10% for those aged 26–34 years, 7% for those aged 35–49 years, and 3% for those aged 50–64 years. The highest rates of current use were among food service workers (17%) and construction workers (15%). Alcohol use was highest among construction, mining, excavation, and drilling workers (18%), and installation, maintenance, and repair workers (15%).

Psychologist Prescribing Vetoed

Hawaii Gov. Linda Lingle (R) has vetoed a bill that would have allowed psychologists to prescribe medications. SB 1004 was opposed by the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and five consumer mental health organizations, according to the AACAP. In an editorial about the legislation published in the Honolulu Advertiser in early July, AMA board member Dr. Jeremy Lazarus said, “This bill would allow health care professionals who have not undergone extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients.”

Army to Educate on Mental Health

The U.S. Army is beginning a program aimed at having every soldier–and his or her family–learn the symptoms of mild traumatic brain injury and posttraumatic stress disorder and to help them seek treatment. The goal is for all active duty and reserve military personnel to receive training by mid-October. The Army will use what it calls a “chain-teaching” method, with education coming down the chain of command. Leaders can retrieve materials–consisting of a 35-page guide and video and slide shows–at

www.army.mil

Alzheimer's Programs Recognized

The Alzheimer's Foundation of America recently awarded “Excellence in Care” status to two dementia care programs that met standards for high performance. The two programs, both based in New York City, are the first to receive this designation. The Alzheimer's Foundation of America began the program last November and to date has trained about 40 specialists to conduct on-site evaluations and to work with facilities to improve performance and adopt best practices. The recognized facilities are the 80th Street Residence, which is an assisted living facility, and Ozanam Hall, which is a skilled geriatric and short-term rehabilitation facility. More information on the recognition program is available at

www.excellenceincare.org

Overseas Drug Purchases Unabated

Two new reports suggest that despite multiple warnings, Americans are continuing to buy pharmaceuticals from overseas, mostly through the Internet. A new survey by the Pharmaceutical Research and Manufacturers of America shows that more than 5 million adults–or more than 2% of the U.S. population–have recently purchased prescription drugs from another country, such as Canada or Mexico. The vast majority said they were looking for the best price, but about half decided to import because they didn't have a prescription. Overseas shoppers were more likely to be younger than age 35, to be Hispanic, to live in a southern border state, and to spend more out-of-pocket money on prescription drugs than did nonimporters, PhRMA reported. Most of the products were for chronic ailments. Separately, the Food and Drug Administration said that consumers often can get the same products for less money in the United States. New data from examinations of foreign mail shipments show that 45% of the imports were available here as generics, many for $4 each. Among the drugs being imported that were cheaper here, according to the FDA, were atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin, and warfarin.

CMS Releases Medicaid Rule

CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments made to pharmacies for generic drugs were much higher than the amount pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.

Most Substance Abusers Work

A new survey by the Substance Abuse and Mental Health Services Administration shows that most of the nation's 16.4 million illicit drug users and 15 million heavy alcohol users are employed full time. The report, available at SAMHSA's Web site, is compiled from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. The data are somewhat misleading in that full-time workers account for two-thirds of the survey population, so most substance users will be employed, according to SAMHSA. Illicit drug use was highest among the cohort aged 18–25 years, at 19%, compared with 10% for those aged 26–34 years, 7% for those aged 35–49 years, and 3% for those aged 50–64 years. The highest rates of current use were among food service workers (17%) and construction workers (15%). Alcohol use was highest among construction, mining, excavation, and drilling workers (18%), and installation, maintenance, and repair workers (15%).

Psychologist Prescribing Vetoed

Hawaii Gov. Linda Lingle (R) has vetoed a bill that would have allowed psychologists to prescribe medications. SB 1004 was opposed by the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and five consumer mental health organizations, according to the AACAP. In an editorial about the legislation published in the Honolulu Advertiser in early July, AMA board member Dr. Jeremy Lazarus said, “This bill would allow health care professionals who have not undergone extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients.”

Army to Educate on Mental Health

The U.S. Army is beginning a program aimed at having every soldier–and his or her family–learn the symptoms of mild traumatic brain injury and posttraumatic stress disorder and to help them seek treatment. The goal is for all active duty and reserve military personnel to receive training by mid-October. The Army will use what it calls a “chain-teaching” method, with education coming down the chain of command. Leaders can retrieve materials–consisting of a 35-page guide and video and slide shows–at

www.army.mil

Alzheimer's Programs Recognized

The Alzheimer's Foundation of America recently awarded “Excellence in Care” status to two dementia care programs that met standards for high performance. The two programs, both based in New York City, are the first to receive this designation. The Alzheimer's Foundation of America began the program last November and to date has trained about 40 specialists to conduct on-site evaluations and to work with facilities to improve performance and adopt best practices. The recognized facilities are the 80th Street Residence, which is an assisted living facility, and Ozanam Hall, which is a skilled geriatric and short-term rehabilitation facility. More information on the recognition program is available at

www.excellenceincare.org

Overseas Drug Purchases Unabated

Two new reports suggest that despite multiple warnings, Americans are continuing to buy pharmaceuticals from overseas, mostly through the Internet. A new survey by the Pharmaceutical Research and Manufacturers of America shows that more than 5 million adults–or more than 2% of the U.S. population–have recently purchased prescription drugs from another country, such as Canada or Mexico. The vast majority said they were looking for the best price, but about half decided to import because they didn't have a prescription. Overseas shoppers were more likely to be younger than age 35, to be Hispanic, to live in a southern border state, and to spend more out-of-pocket money on prescription drugs than did nonimporters, PhRMA reported. Most of the products were for chronic ailments. Separately, the Food and Drug Administration said that consumers often can get the same products for less money in the United States. New data from examinations of foreign mail shipments show that 45% of the imports were available here as generics, many for $4 each. Among the drugs being imported that were cheaper here, according to the FDA, were atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin, and warfarin.

CMS Releases Medicaid Rule

CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments made to pharmacies for generic drugs were much higher than the amount pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.

Most Substance Abusers Work

A new survey by the Substance Abuse and Mental Health Services Administration shows that most of the nation's 16.4 million illicit drug users and 15 million heavy alcohol users are employed full time. The report, available at SAMHSA's Web site, is compiled from the 2002, 2003, and 2004 National Surveys on Drug Use and Health. The data are somewhat misleading in that full-time workers account for two-thirds of the survey population, so most substance users will be employed, according to SAMHSA. Illicit drug use was highest among the cohort aged 18–25 years, at 19%, compared with 10% for those aged 26–34 years, 7% for those aged 35–49 years, and 3% for those aged 50–64 years. The highest rates of current use were among food service workers (17%) and construction workers (15%). Alcohol use was highest among construction, mining, excavation, and drilling workers (18%), and installation, maintenance, and repair workers (15%).

Psychologist Prescribing Vetoed

Hawaii Gov. Linda Lingle (R) has vetoed a bill that would have allowed psychologists to prescribe medications. SB 1004 was opposed by the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and five consumer mental health organizations, according to the AACAP. In an editorial about the legislation published in the Honolulu Advertiser in early July, AMA board member Dr. Jeremy Lazarus said, “This bill would allow health care professionals who have not undergone extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients.”

Army to Educate on Mental Health

The U.S. Army is beginning a program aimed at having every soldier–and his or her family–learn the symptoms of mild traumatic brain injury and posttraumatic stress disorder and to help them seek treatment. The goal is for all active duty and reserve military personnel to receive training by mid-October. The Army will use what it calls a “chain-teaching” method, with education coming down the chain of command. Leaders can retrieve materials–consisting of a 35-page guide and video and slide shows–at

www.army.mil

Alzheimer's Programs Recognized

The Alzheimer's Foundation of America recently awarded “Excellence in Care” status to two dementia care programs that met standards for high performance. The two programs, both based in New York City, are the first to receive this designation. The Alzheimer's Foundation of America began the program last November and to date has trained about 40 specialists to conduct on-site evaluations and to work with facilities to improve performance and adopt best practices. The recognized facilities are the 80th Street Residence, which is an assisted living facility, and Ozanam Hall, which is a skilled geriatric and short-term rehabilitation facility. More information on the recognition program is available at

www.excellenceincare.org

Overseas Drug Purchases Unabated

Two new reports suggest that despite multiple warnings, Americans are continuing to buy pharmaceuticals from overseas, mostly through the Internet. A new survey by the Pharmaceutical Research and Manufacturers of America shows that more than 5 million adults–or more than 2% of the U.S. population–have recently purchased prescription drugs from another country, such as Canada or Mexico. The vast majority said they were looking for the best price, but about half decided to import because they didn't have a prescription. Overseas shoppers were more likely to be younger than age 35, to be Hispanic, to live in a southern border state, and to spend more out-of-pocket money on prescription drugs than did nonimporters, PhRMA reported. Most of the products were for chronic ailments. Separately, the Food and Drug Administration said that consumers often can get the same products for less money in the United States. New data from examinations of foreign mail shipments show that 45% of the imports were available here as generics, many for $4 each. Among the drugs being imported that were cheaper here, according to the FDA, were atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin, and warfarin.

CMS Releases Medicaid Rule

CMS has unveiled a new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments. As part of the new regulation, states will be required to collect information from physicians about prescription drugs administered in their offices so that the state can collect any rebates offered by drug manufacturers on those products. The final rule will take effect Oct. 1. The regulation is expected to save states and the federal government $8.4 billion over the next 5 years, but even with the change, the Medicaid program still is expected to spend $140 billion for drugs over the same time period. The change is in part a reaction to a series of reports showing that Medicaid payments made to pharmacies for generic drugs were much higher than the amount pharmacies actually were paying for the drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest markup, creating an incentive to dispense those drugs.

WASHINGTON — People who are overweight or obese appear to take advantage of colorectal cancer screening opportunities at the same rate as normal-weight Americans.

Several studies have indicated that people with a higher body mass index (BMI) do not seek out screening for breast and colon cancer.

But Dr. Deborah A. Fisher, of Duke University, Durham, N.C., and Durham Veterans Affairs Medical Center, and her colleagues determined that overweight and obese residents of North Carolina access fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy at the same rate as those who are normal weight.

At the annual Digestive Disease Week, she presented an analysis of the North Carolina Colon Cancer Study, a case-control population-based study. The study used height and weight measurements to calculate BMI, but information about colon cancer screening was self-reported by patients.

The primary outcome was whether the patient was current for any colon cancer screening test, which included a fecal occult blood test in the past year, a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a barium enema within the past 5 years.

Among the 928 patients, the average age was 67 years; 29% were normal weight (BMI 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%, the authors said.

The overall screening rate of 61% was comparable to other populations that have been studied, she said. Thus, the differences in screening behavior between obese and normal-weight people seen with other cancers may not be true of colorectal cancers, she said.

Dr. Fisher suggested that the increased risk of colorectal cancer in obese people that has been documented in several studies “may be due to biology and not lower screening rates in this group.”

Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

WASHINGTON — People who are overweight or obese appear to take advantage of colorectal cancer screening opportunities at the same rate as normal-weight Americans.

Several studies have indicated that people with a higher body mass index (BMI) do not seek out screening for breast and colon cancer.

But Dr. Deborah A. Fisher, of Duke University, Durham, N.C., and Durham Veterans Affairs Medical Center, and her colleagues determined that overweight and obese residents of North Carolina access fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy at the same rate as those who are normal weight.

At the annual Digestive Disease Week, she presented an analysis of the North Carolina Colon Cancer Study, a case-control population-based study. The study used height and weight measurements to calculate BMI, but information about colon cancer screening was self-reported by patients.

The primary outcome was whether the patient was current for any colon cancer screening test, which included a fecal occult blood test in the past year, a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a barium enema within the past 5 years.

Among the 928 patients, the average age was 67 years; 29% were normal weight (BMI 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%, the authors said.

The overall screening rate of 61% was comparable to other populations that have been studied, she said. Thus, the differences in screening behavior between obese and normal-weight people seen with other cancers may not be true of colorectal cancers, she said.

Dr. Fisher suggested that the increased risk of colorectal cancer in obese people that has been documented in several studies “may be due to biology and not lower screening rates in this group.”

Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

WASHINGTON — People who are overweight or obese appear to take advantage of colorectal cancer screening opportunities at the same rate as normal-weight Americans.

Several studies have indicated that people with a higher body mass index (BMI) do not seek out screening for breast and colon cancer.

But Dr. Deborah A. Fisher, of Duke University, Durham, N.C., and Durham Veterans Affairs Medical Center, and her colleagues determined that overweight and obese residents of North Carolina access fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy at the same rate as those who are normal weight.

At the annual Digestive Disease Week, she presented an analysis of the North Carolina Colon Cancer Study, a case-control population-based study. The study used height and weight measurements to calculate BMI, but information about colon cancer screening was self-reported by patients.

The primary outcome was whether the patient was current for any colon cancer screening test, which included a fecal occult blood test in the past year, a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a barium enema within the past 5 years.

Among the 928 patients, the average age was 67 years; 29% were normal weight (BMI 18–24.9 kg/m

Across all the BMI categories, the percentage of those who had undergone screening ranged from 54% to 67%, the authors said.

The overall screening rate of 61% was comparable to other populations that have been studied, she said. Thus, the differences in screening behavior between obese and normal-weight people seen with other cancers may not be true of colorectal cancers, she said.

Dr. Fisher suggested that the increased risk of colorectal cancer in obese people that has been documented in several studies “may be due to biology and not lower screening rates in this group.”

Dr. Fisher reported no disclosures. The study was supported by a National Institutes of Health grant.

Bill Seeks Increased IVIG Pay

Legislation seeking to increase reimbursement for intravenous immunoglobulin (IVIG) has been introduced in the U.S. House of Representatives. Patient groups and IVIG manufacturers have said that Medicare's current coverage is so low that many physicians have stopped administering the therapy. A patient survey by the Immune Deficiency Foundation found that since January 2005, almost half of surveyed Medicare beneficiaries with primary immunodeficiency diseases had their treatments postponed by a physician, and 26% had serious health consequences because of the delays. About 10,000 Medicare beneficiaries receive IVIG, according to the House legislation H.R. 2914. The bill would increase payment for IVIG and for ancillary services. It would also maintain the preadministration fee physicians have been receiving and provide management fees for home IVIG infusion. H.R. 2914 was introduced by Rep. Kevin Brady (R-Tex.) and, as of press time, had 17 cosponsors, but no companion legislation in the Senate.

Accutane Suits Advancing …

With the first verdict rendered in the approximately 400 suits pending against Accutane (isotretinoin), several more cases are headed for court this fall. In late May, a New Jersey Superior Court jury found Accutane manufacturer Roche guilty of failing to warn users of a risk of inflammatory bowel disorder. The jury awarded $2.5 million in compensatory damages and $119,000 in medical expenses to 36-year-old Andrew McCarrell, an Alabama resident who claimed he developed IBD after taking the drug for 4 months. The jury did not award punitive damages. A second suit was due to go to trial in Madison County, Ill., in April, but has now been rescheduled for Oct. 15. In that case, the plaintiff is alleging that Accutane caused his Crohn's disease. Another suit is due to be heard in Pensacola, Fla., in September.

While Another Is Dropped

Meanwhile, the plaintiffs in another high-profile Accutane suit have dropped their efforts to prove that the Roche drug led their teenaged relative to commit suicide. Julia Bishop and Karen Johnson, the mother and grandmother of Charles Bishop, asked the U.S. District Court in Tampa to dismiss the suit they had brought alleging that Accutane had driven the then-15-year-old to fly a stolen Cessna airplane into a skyscraper in Tampa in early 2002. The crash garnered worldwide attention as it occurred just months after Sept. 11, 2001. Mr. Bishop also left a note expressing support for Osama bin Laden. According to reports in the Tampa media, Mr. Bishop's mother and grandmother said they were too exhausted to continue to pursue the suit.

Lupus Grants Awarded

The Department of Defense's Congressionally Directed Medical Research Program awarded more than $2 million in the form of two grants for research on lupus and lupus biomarkers. The grants will fund investigations in mouse models, but the findings could lead to human advances. Researchers at the Medical University of South Carolina in Charleston will experiment with targeting a certain cascade of proteins in a mouse model to target certain areas where lupus causes tissue damage and to minimize immune suppression in other areas of the body. Grant recipients at the Feinstein Institute for Medical Research at the North Shore Medical Center in Manhasset, N.Y., will examine estrogen's role in triggering lupus activity in certain mouse models but not in others. That research could have long-term implications for testing patients with lupus for hormonal disorders.

CDC: 43 Million Lack Coverage

Nearly 15% of Americans—43.6 million—lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18–64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patient welfare. "There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA board member Dr. Peter Carmel in a statement. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care." The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

Bill Seeks Increased IVIG Pay

Legislation seeking to increase reimbursement for intravenous immunoglobulin (IVIG) has been introduced in the U.S. House of Representatives. Patient groups and IVIG manufacturers have said that Medicare's current coverage is so low that many physicians have stopped administering the therapy. A patient survey by the Immune Deficiency Foundation found that since January 2005, almost half of surveyed Medicare beneficiaries with primary immunodeficiency diseases had their treatments postponed by a physician, and 26% had serious health consequences because of the delays. About 10,000 Medicare beneficiaries receive IVIG, according to the House legislation H.R. 2914. The bill would increase payment for IVIG and for ancillary services. It would also maintain the preadministration fee physicians have been receiving and provide management fees for home IVIG infusion. H.R. 2914 was introduced by Rep. Kevin Brady (R-Tex.) and, as of press time, had 17 cosponsors, but no companion legislation in the Senate.

Accutane Suits Advancing …

With the first verdict rendered in the approximately 400 suits pending against Accutane (isotretinoin), several more cases are headed for court this fall. In late May, a New Jersey Superior Court jury found Accutane manufacturer Roche guilty of failing to warn users of a risk of inflammatory bowel disorder. The jury awarded $2.5 million in compensatory damages and $119,000 in medical expenses to 36-year-old Andrew McCarrell, an Alabama resident who claimed he developed IBD after taking the drug for 4 months. The jury did not award punitive damages. A second suit was due to go to trial in Madison County, Ill., in April, but has now been rescheduled for Oct. 15. In that case, the plaintiff is alleging that Accutane caused his Crohn's disease. Another suit is due to be heard in Pensacola, Fla., in September.

While Another Is Dropped

Meanwhile, the plaintiffs in another high-profile Accutane suit have dropped their efforts to prove that the Roche drug led their teenaged relative to commit suicide. Julia Bishop and Karen Johnson, the mother and grandmother of Charles Bishop, asked the U.S. District Court in Tampa to dismiss the suit they had brought alleging that Accutane had driven the then-15-year-old to fly a stolen Cessna airplane into a skyscraper in Tampa in early 2002. The crash garnered worldwide attention as it occurred just months after Sept. 11, 2001. Mr. Bishop also left a note expressing support for Osama bin Laden. According to reports in the Tampa media, Mr. Bishop's mother and grandmother said they were too exhausted to continue to pursue the suit.

Lupus Grants Awarded

The Department of Defense's Congressionally Directed Medical Research Program awarded more than $2 million in the form of two grants for research on lupus and lupus biomarkers. The grants will fund investigations in mouse models, but the findings could lead to human advances. Researchers at the Medical University of South Carolina in Charleston will experiment with targeting a certain cascade of proteins in a mouse model to target certain areas where lupus causes tissue damage and to minimize immune suppression in other areas of the body. Grant recipients at the Feinstein Institute for Medical Research at the North Shore Medical Center in Manhasset, N.Y., will examine estrogen's role in triggering lupus activity in certain mouse models but not in others. That research could have long-term implications for testing patients with lupus for hormonal disorders.

CDC: 43 Million Lack Coverage

Nearly 15% of Americans—43.6 million—lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18–64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patient welfare. "There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA board member Dr. Peter Carmel in a statement. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care." The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

Bill Seeks Increased IVIG Pay

Legislation seeking to increase reimbursement for intravenous immunoglobulin (IVIG) has been introduced in the U.S. House of Representatives. Patient groups and IVIG manufacturers have said that Medicare's current coverage is so low that many physicians have stopped administering the therapy. A patient survey by the Immune Deficiency Foundation found that since January 2005, almost half of surveyed Medicare beneficiaries with primary immunodeficiency diseases had their treatments postponed by a physician, and 26% had serious health consequences because of the delays. About 10,000 Medicare beneficiaries receive IVIG, according to the House legislation H.R. 2914. The bill would increase payment for IVIG and for ancillary services. It would also maintain the preadministration fee physicians have been receiving and provide management fees for home IVIG infusion. H.R. 2914 was introduced by Rep. Kevin Brady (R-Tex.) and, as of press time, had 17 cosponsors, but no companion legislation in the Senate.

Accutane Suits Advancing …

With the first verdict rendered in the approximately 400 suits pending against Accutane (isotretinoin), several more cases are headed for court this fall. In late May, a New Jersey Superior Court jury found Accutane manufacturer Roche guilty of failing to warn users of a risk of inflammatory bowel disorder. The jury awarded $2.5 million in compensatory damages and $119,000 in medical expenses to 36-year-old Andrew McCarrell, an Alabama resident who claimed he developed IBD after taking the drug for 4 months. The jury did not award punitive damages. A second suit was due to go to trial in Madison County, Ill., in April, but has now been rescheduled for Oct. 15. In that case, the plaintiff is alleging that Accutane caused his Crohn's disease. Another suit is due to be heard in Pensacola, Fla., in September.

While Another Is Dropped

Meanwhile, the plaintiffs in another high-profile Accutane suit have dropped their efforts to prove that the Roche drug led their teenaged relative to commit suicide. Julia Bishop and Karen Johnson, the mother and grandmother of Charles Bishop, asked the U.S. District Court in Tampa to dismiss the suit they had brought alleging that Accutane had driven the then-15-year-old to fly a stolen Cessna airplane into a skyscraper in Tampa in early 2002. The crash garnered worldwide attention as it occurred just months after Sept. 11, 2001. Mr. Bishop also left a note expressing support for Osama bin Laden. According to reports in the Tampa media, Mr. Bishop's mother and grandmother said they were too exhausted to continue to pursue the suit.

Lupus Grants Awarded

The Department of Defense's Congressionally Directed Medical Research Program awarded more than $2 million in the form of two grants for research on lupus and lupus biomarkers. The grants will fund investigations in mouse models, but the findings could lead to human advances. Researchers at the Medical University of South Carolina in Charleston will experiment with targeting a certain cascade of proteins in a mouse model to target certain areas where lupus causes tissue damage and to minimize immune suppression in other areas of the body. Grant recipients at the Feinstein Institute for Medical Research at the North Shore Medical Center in Manhasset, N.Y., will examine estrogen's role in triggering lupus activity in certain mouse models but not in others. That research could have long-term implications for testing patients with lupus for hormonal disorders.

CDC: 43 Million Lack Coverage

Nearly 15% of Americans—43.6 million—lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18–64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patient welfare. "There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics," said AMA board member Dr. Peter Carmel in a statement. "The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care." The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

BALTIMORE — Outcomes registries, not claims data, should be the basis for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.

CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, in an effort to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations were to be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.

PQRI is a hot topic among physicians. According to a Department of Health and Human Services spokeswoman, more than 600 people attended the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians could take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI

To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008. Many physicians already report on such measures to specialty societies.

The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. The STS supports the PQRI effort, but “we feel that it must go farther, and we feel that can be accomplished through the use of registries.”

This year, PQRI is structured to collect data on processes, not outcomes, he said. Registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement, Dr. Rich said. STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance). Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, he said. And input standards should be established to ensure that the data cover all patients, not just a random sample, Dr. Rich said. Finally, registries should be subject to validation and an audit mechanism.

CMS officials also heard about registries developed by the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.

In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.

More than 5,000 physicians completed a PIM in 2006, and 5,000 more are currently working on PIMs, Dr. Cary Sennett, ABIM senior vice president of strategy and clinical analytics, said at the forum.

Aetna, UnitedHealthcare, Humana, and several regional Blue Cross and Blue Shield plans have recognized PIMs as fulfilling quality improvement criteria, said Dr. Sennett, who added that ABIM supported the PQRI effort.

BALTIMORE — Outcomes registries, not claims data, should be the basis for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.

CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, in an effort to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations were to be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.

PQRI is a hot topic among physicians. According to a Department of Health and Human Services spokeswoman, more than 600 people attended the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians could take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI

To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008. Many physicians already report on such measures to specialty societies.

The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. The STS supports the PQRI effort, but “we feel that it must go farther, and we feel that can be accomplished through the use of registries.”

This year, PQRI is structured to collect data on processes, not outcomes, he said. Registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement, Dr. Rich said. STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance). Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, he said. And input standards should be established to ensure that the data cover all patients, not just a random sample, Dr. Rich said. Finally, registries should be subject to validation and an audit mechanism.

CMS officials also heard about registries developed by the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.

In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.

More than 5,000 physicians completed a PIM in 2006, and 5,000 more are currently working on PIMs, Dr. Cary Sennett, ABIM senior vice president of strategy and clinical analytics, said at the forum.

Aetna, UnitedHealthcare, Humana, and several regional Blue Cross and Blue Shield plans have recognized PIMs as fulfilling quality improvement criteria, said Dr. Sennett, who added that ABIM supported the PQRI effort.

BALTIMORE — Outcomes registries, not claims data, should be the basis for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.

CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, in an effort to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations were to be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.

PQRI is a hot topic among physicians. According to a Department of Health and Human Services spokeswoman, more than 600 people attended the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians could take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI

To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008. Many physicians already report on such measures to specialty societies.

The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. The STS supports the PQRI effort, but “we feel that it must go farther, and we feel that can be accomplished through the use of registries.”

This year, PQRI is structured to collect data on processes, not outcomes, he said. Registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement, Dr. Rich said. STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance). Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, he said. And input standards should be established to ensure that the data cover all patients, not just a random sample, Dr. Rich said. Finally, registries should be subject to validation and an audit mechanism.

CMS officials also heard about registries developed by the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.

In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.

More than 5,000 physicians completed a PIM in 2006, and 5,000 more are currently working on PIMs, Dr. Cary Sennett, ABIM senior vice president of strategy and clinical analytics, said at the forum.

Aetna, UnitedHealthcare, Humana, and several regional Blue Cross and Blue Shield plans have recognized PIMs as fulfilling quality improvement criteria, said Dr. Sennett, who added that ABIM supported the PQRI effort.

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth. Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The rankings are posted at www.athenapayerview.com

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth. Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The rankings are posted at www.athenapayerview.com

In 2006, Cigna Healthcare moved from fifth place to top ranking among national payers, and Aetna moved from fourth place to second, according to the second annual assessment of overall payment performance conducted by one of the nation's largest physician revenue management companies.

Not surprisingly, state Medicaid programs ranked near the bottom.

The performance rankings were compiled for the second year in a row by AthenaHealth, a Watertown, Mass.-based company that collects about $2 billion a year for medical providers.

AthenaHealth used claims data from 8,000 providers, representing 28 million “charge lines,” or line items. The medical services were billed in 33 states. The ranking included national payers that had at least 120,000 charge lines and regional payers with at least 20,000 charge lines.

In 2005, Humana was the top-ranked payer, followed by Medicare. A year later, Medicare held the third position, while Humana dropped to fourth. Rounding out the top eight national payers were UnitedHealth Group, WellPoint, Coventry Health Care, and CHAMPUS/Tricare.

According to AthenaHealth, there were several trends observed from year to year. In 2006, days in accounts receivable (DAR) dropped by 5%, from 36.2 days to 34.4 days. Blue Cross & Blue Shield of Rhode Island had the lowest DAR at 16.8 days. New York's Medicaid plan had the highest, at 111 days.

Payers are also asking patients to pay more up front, which places a greater collections burden on physicians. Last year, there was a 19% increase in the amount of billed charges transferred to patients, according to AthenaHealth.

The overall ranking was based on how often claims were resolved on the first pass, the denial rate, denial transparency, percentage noncompliance with national coding standards, and percentage of claims requiring medical documentation.

Denial rates ranged from a low of 4% at Cigna's southern plan to a high of 48% at Louisiana's Medicaid program. The Medicaid programs were laggards on all performance measures. The Illinois Medicaid program paid medical claims on the first attempt only about 30% of the time, and was the second slowest payer overall, with an average 103 days to pay a claim. In Texas, physicians resubmitted denied claims at least twice 47% of the time, according to AthenaHealth.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients, said Jonathan Bush, chairman and CEO of AthenaHealth.

The company said that some states have experimented with managed care as a solution to Medicaid's administrative difficulties. But in Georgia, that may have backfired. A year after patients were moved into managed care, the Medical Association of Georgia “has had to troubleshoot more than 500 complaints from physicians, most of which should have been eliminated by the Care Management Organizations shortly after the start-up,” said Dr. S. William Clark, III.

The rankings are posted at www.athenapayerview.com