Alicia Ault

CHICAGO – Depression prevalence may be as high as 30% in transformed migraine, according to a preliminary analysis of the American Migraine Prevalence and Prevention study presented on June 8 at the American Headache Society meeting.

By contrast, only 6%–7% of the U.S. general population has depression, said Dawn C. Buse, Ph.D., director of psychology at the Montefiore Headache Center at the Montefiore Medical Center in the Bronx.

Dr. Buse presented the analysis on behalf of colleagues at the Albert Einstein College of Medicine, New York; the Vedanta Research in Chapel Hill, N.C.; and the Diamond Headache Clinic in Chicago.

The American Migraine Prevalence and Prevention (AMPP) study is an ongoing multisite survey that began in 2004 when a random sample of 120,000 households was mailed self-administered headache questionnaires. Of the 162,576 individuals who responded, 30,721 self-reported severe headaches. A follow-up survey was sent in 2005 to a random subsample of 24,000 of the headache sufferers.

The data presented by Dr. Buse came from the follow-up survey. Respondents were asked for body mass index, and to respond to the Migraine Disability Assessment (MIDAS) questionnaire and the Patient Health Questionnaire-Nine Item Depressive Scale (PHQ-9).

The goal was to determine the relationship among depression, headache type, BMI, and disability.

Data were analyzed from 3,840 (16%) respondents whose scores placed them in the moderately-severe or severe major depression category.

Depression rates were highest in patients with transformed migraine, at 30% (1,152 patients), followed by chronic daily headache at about 20% (768 patients). Eighteen percent (691) of migraine patients had depression, followed by 15% (576) of other types of headache, 13% (500) of tension headache and 12% (461) of probable migraine.

Among patients with depression, 25% were morbidly obese, while 19% were underweight, Dr. Buse said.

Depression increased with rising disability. Only 11% of depressed patients had MIDAS Grade 1 disability, compared with 33% of those with MIDAS grade 4 disability, Dr. Buse said.

Because AMPP is a cross-sectional study, it cannot get at the mechanisms for these interrelationships, she said, adding that she and her colleagues currently are collecting data on medications used, and psychiatric and other comorbidities, and will be following this population for at least another survey, so there may be opportunities for cause-effect analyses in the future.

The AMPP study was supported by the National Headache Foundation through a grant from Ortho-McNeil. Dr. Buse reported that that she consults for Ortho-McNeil and Allergan Pharmaceuticals.

CHICAGO – Depression prevalence may be as high as 30% in transformed migraine, according to a preliminary analysis of the American Migraine Prevalence and Prevention study presented on June 8 at the American Headache Society meeting.

By contrast, only 6%–7% of the U.S. general population has depression, said Dawn C. Buse, Ph.D., director of psychology at the Montefiore Headache Center at the Montefiore Medical Center in the Bronx.

Dr. Buse presented the analysis on behalf of colleagues at the Albert Einstein College of Medicine, New York; the Vedanta Research in Chapel Hill, N.C.; and the Diamond Headache Clinic in Chicago.

The American Migraine Prevalence and Prevention (AMPP) study is an ongoing multisite survey that began in 2004 when a random sample of 120,000 households was mailed self-administered headache questionnaires. Of the 162,576 individuals who responded, 30,721 self-reported severe headaches. A follow-up survey was sent in 2005 to a random subsample of 24,000 of the headache sufferers.

The data presented by Dr. Buse came from the follow-up survey. Respondents were asked for body mass index, and to respond to the Migraine Disability Assessment (MIDAS) questionnaire and the Patient Health Questionnaire-Nine Item Depressive Scale (PHQ-9).

The goal was to determine the relationship among depression, headache type, BMI, and disability.

Data were analyzed from 3,840 (16%) respondents whose scores placed them in the moderately-severe or severe major depression category.

Depression rates were highest in patients with transformed migraine, at 30% (1,152 patients), followed by chronic daily headache at about 20% (768 patients). Eighteen percent (691) of migraine patients had depression, followed by 15% (576) of other types of headache, 13% (500) of tension headache and 12% (461) of probable migraine.

Among patients with depression, 25% were morbidly obese, while 19% were underweight, Dr. Buse said.

Depression increased with rising disability. Only 11% of depressed patients had MIDAS Grade 1 disability, compared with 33% of those with MIDAS grade 4 disability, Dr. Buse said.

Because AMPP is a cross-sectional study, it cannot get at the mechanisms for these interrelationships, she said, adding that she and her colleagues currently are collecting data on medications used, and psychiatric and other comorbidities, and will be following this population for at least another survey, so there may be opportunities for cause-effect analyses in the future.

The AMPP study was supported by the National Headache Foundation through a grant from Ortho-McNeil. Dr. Buse reported that that she consults for Ortho-McNeil and Allergan Pharmaceuticals.

CHICAGO – Depression prevalence may be as high as 30% in transformed migraine, according to a preliminary analysis of the American Migraine Prevalence and Prevention study presented on June 8 at the American Headache Society meeting.

By contrast, only 6%–7% of the U.S. general population has depression, said Dawn C. Buse, Ph.D., director of psychology at the Montefiore Headache Center at the Montefiore Medical Center in the Bronx.

Dr. Buse presented the analysis on behalf of colleagues at the Albert Einstein College of Medicine, New York; the Vedanta Research in Chapel Hill, N.C.; and the Diamond Headache Clinic in Chicago.

The American Migraine Prevalence and Prevention (AMPP) study is an ongoing multisite survey that began in 2004 when a random sample of 120,000 households was mailed self-administered headache questionnaires. Of the 162,576 individuals who responded, 30,721 self-reported severe headaches. A follow-up survey was sent in 2005 to a random subsample of 24,000 of the headache sufferers.

The data presented by Dr. Buse came from the follow-up survey. Respondents were asked for body mass index, and to respond to the Migraine Disability Assessment (MIDAS) questionnaire and the Patient Health Questionnaire-Nine Item Depressive Scale (PHQ-9).

The goal was to determine the relationship among depression, headache type, BMI, and disability.

Data were analyzed from 3,840 (16%) respondents whose scores placed them in the moderately-severe or severe major depression category.

Depression rates were highest in patients with transformed migraine, at 30% (1,152 patients), followed by chronic daily headache at about 20% (768 patients). Eighteen percent (691) of migraine patients had depression, followed by 15% (576) of other types of headache, 13% (500) of tension headache and 12% (461) of probable migraine.

Among patients with depression, 25% were morbidly obese, while 19% were underweight, Dr. Buse said.

Depression increased with rising disability. Only 11% of depressed patients had MIDAS Grade 1 disability, compared with 33% of those with MIDAS grade 4 disability, Dr. Buse said.

Because AMPP is a cross-sectional study, it cannot get at the mechanisms for these interrelationships, she said, adding that she and her colleagues currently are collecting data on medications used, and psychiatric and other comorbidities, and will be following this population for at least another survey, so there may be opportunities for cause-effect analyses in the future.

The AMPP study was supported by the National Headache Foundation through a grant from Ortho-McNeil. Dr. Buse reported that that she consults for Ortho-McNeil and Allergan Pharmaceuticals.

CHICAGO – Major depressive disorder, bipolar disorder, panic disorder, and social phobia were diagnosed twice as often in those with migraine as in those without headache in a major Canadian population survey, Dr. Nathalie Jette said at the American Headache Society meeting.

The data came from the Canadian Community Health Survey, which was conducted in 2002, said Dr. Jette, of the clinical neurosciences department at the University of Calgary, Alta.

Many studies have shown an association between migraine and psychiatric conditions; the goal of this study was to determine potential impact on health outcomes and implications for health policies in Canada, Dr. Jette said. Patients with migraine and psychiatric comorbidities tend to use more health resources; identifying them can lead to more preventive treatment and better-targeted therapies, Dr. Jette said.

Some 36,984 Canadian residents were randomly selected for the survey. Of these, 70% agreed to participate; all the subjects were interviewed at home by trained interviewers, she said.

Dr. Jette said that he estimated lifetime prevalence of migraine in Canada is 7%–17%. In the survey, 15% of women and 6% of men self-reported that they had physician-diagnosed migraine. Mental health was assessed using the World Health Mental Composite International Diagnostic Interview.

As has been seen in other studies, migraine was most prevalent among lower-income respondents. Married respondents were less likely to have migraine than were those who were widowed, separated, or divorced, Dr. Jette said.

Psychiatric comorbidities were twice as common in those with migraine than in those without. After assessing the data, the researchers found that the higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographics.

Major depression and bipolar disorder were more common among migraineurs. Middle- and higher-income respondents were less likely to have either condition, regardless of headache status, Dr. Jette said.

The authors also analyzed survey data on health-related outcomes, including 2-week disability, restrictions on activities, quality of life, and use of mental health care. They found that patients with a combination of migraine and major depressive disorder, bipolar disorder, panic disorder, or social phobia had a reduced likelihood of a good health outcome.

The study's strengths included its high participation rate and that it was a representative sample, said Dr. Jette, who reported no conflicts of interest. But, she noted, it did not use International Classification of Headache Disorder (ICHD) criteria, and it is cross-sectional, which she said limits inference on causal mechanisms for the relationship between migraine and psychiatric conditions.

CHICAGO – Major depressive disorder, bipolar disorder, panic disorder, and social phobia were diagnosed twice as often in those with migraine as in those without headache in a major Canadian population survey, Dr. Nathalie Jette said at the American Headache Society meeting.

The data came from the Canadian Community Health Survey, which was conducted in 2002, said Dr. Jette, of the clinical neurosciences department at the University of Calgary, Alta.

Many studies have shown an association between migraine and psychiatric conditions; the goal of this study was to determine potential impact on health outcomes and implications for health policies in Canada, Dr. Jette said. Patients with migraine and psychiatric comorbidities tend to use more health resources; identifying them can lead to more preventive treatment and better-targeted therapies, Dr. Jette said.

Some 36,984 Canadian residents were randomly selected for the survey. Of these, 70% agreed to participate; all the subjects were interviewed at home by trained interviewers, she said.

Dr. Jette said that he estimated lifetime prevalence of migraine in Canada is 7%–17%. In the survey, 15% of women and 6% of men self-reported that they had physician-diagnosed migraine. Mental health was assessed using the World Health Mental Composite International Diagnostic Interview.

As has been seen in other studies, migraine was most prevalent among lower-income respondents. Married respondents were less likely to have migraine than were those who were widowed, separated, or divorced, Dr. Jette said.

Psychiatric comorbidities were twice as common in those with migraine than in those without. After assessing the data, the researchers found that the higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographics.

Major depression and bipolar disorder were more common among migraineurs. Middle- and higher-income respondents were less likely to have either condition, regardless of headache status, Dr. Jette said.

The authors also analyzed survey data on health-related outcomes, including 2-week disability, restrictions on activities, quality of life, and use of mental health care. They found that patients with a combination of migraine and major depressive disorder, bipolar disorder, panic disorder, or social phobia had a reduced likelihood of a good health outcome.

The study's strengths included its high participation rate and that it was a representative sample, said Dr. Jette, who reported no conflicts of interest. But, she noted, it did not use International Classification of Headache Disorder (ICHD) criteria, and it is cross-sectional, which she said limits inference on causal mechanisms for the relationship between migraine and psychiatric conditions.

CHICAGO – Major depressive disorder, bipolar disorder, panic disorder, and social phobia were diagnosed twice as often in those with migraine as in those without headache in a major Canadian population survey, Dr. Nathalie Jette said at the American Headache Society meeting.

The data came from the Canadian Community Health Survey, which was conducted in 2002, said Dr. Jette, of the clinical neurosciences department at the University of Calgary, Alta.

Many studies have shown an association between migraine and psychiatric conditions; the goal of this study was to determine potential impact on health outcomes and implications for health policies in Canada, Dr. Jette said. Patients with migraine and psychiatric comorbidities tend to use more health resources; identifying them can lead to more preventive treatment and better-targeted therapies, Dr. Jette said.

Some 36,984 Canadian residents were randomly selected for the survey. Of these, 70% agreed to participate; all the subjects were interviewed at home by trained interviewers, she said.

Dr. Jette said that he estimated lifetime prevalence of migraine in Canada is 7%–17%. In the survey, 15% of women and 6% of men self-reported that they had physician-diagnosed migraine. Mental health was assessed using the World Health Mental Composite International Diagnostic Interview.

As has been seen in other studies, migraine was most prevalent among lower-income respondents. Married respondents were less likely to have migraine than were those who were widowed, separated, or divorced, Dr. Jette said.

Psychiatric comorbidities were twice as common in those with migraine than in those without. After assessing the data, the researchers found that the higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographics.

Major depression and bipolar disorder were more common among migraineurs. Middle- and higher-income respondents were less likely to have either condition, regardless of headache status, Dr. Jette said.

The authors also analyzed survey data on health-related outcomes, including 2-week disability, restrictions on activities, quality of life, and use of mental health care. They found that patients with a combination of migraine and major depressive disorder, bipolar disorder, panic disorder, or social phobia had a reduced likelihood of a good health outcome.

The study's strengths included its high participation rate and that it was a representative sample, said Dr. Jette, who reported no conflicts of interest. But, she noted, it did not use International Classification of Headache Disorder (ICHD) criteria, and it is cross-sectional, which she said limits inference on causal mechanisms for the relationship between migraine and psychiatric conditions.

NEW ORLEANS – New-onset depression after hip fracture is fairly common and may be explained in part by certain polymorphisms of the serotonin 1A and 2A receptors, Dr. Eric J. Lenze said in a poster presented at the annual meeting of the American Association for Geriatric Psychiatry.

He and his associates undertook the study to determine whether people with a given vulnerability gene might be more susceptible to late-life depression onset, and hip fracture was considered a good laboratory, Dr. Lenze, of the psychiatry department at the University of Pittsburgh, said in an interview.

Since serotonin is part of the stress response system, the investigators posited that a variation in those receptors might predict a depression response, he added.

They examined 145 older women (median age 81 years) hospitalized after a hip fracture and followed them for a year. Depression and functional status were measured by the Geriatric Depression Scale, the Physical Activities of Daily Living scale, and the Instrumental Activities of Daily Living (IADL) scale. Serum samples also were obtained. The women were genotyped for the risk allele for the two serotonin receptors: 5HTR1A and 5HTR2A.

Women with one to two copies of the risk allele for 5HTR1A had more depression and poorer IADL scores than women without the allele. Dr. Lenze noted the link between depression and bad outcomes.

Interestingly, women with one to two copies of the risk allele for the 2A receptor did not have a higher risk of depression, and they had higher IADL scores after hip fracture, he said.

Dr. Lenze said that the 2A finding might indicate some adaptability afforded by this allele in the 2A receptor, which might help explain why some elderly people are more resistant to the impact of injuries or disease.

The researchers aim to replicate the findings in a larger study and also use them as a springboard to possibly develop a model to help clinicians determine who is at risk for new-onset depression after hip fracture, said Dr. Lenze.

NEW ORLEANS – New-onset depression after hip fracture is fairly common and may be explained in part by certain polymorphisms of the serotonin 1A and 2A receptors, Dr. Eric J. Lenze said in a poster presented at the annual meeting of the American Association for Geriatric Psychiatry.

He and his associates undertook the study to determine whether people with a given vulnerability gene might be more susceptible to late-life depression onset, and hip fracture was considered a good laboratory, Dr. Lenze, of the psychiatry department at the University of Pittsburgh, said in an interview.

Since serotonin is part of the stress response system, the investigators posited that a variation in those receptors might predict a depression response, he added.

They examined 145 older women (median age 81 years) hospitalized after a hip fracture and followed them for a year. Depression and functional status were measured by the Geriatric Depression Scale, the Physical Activities of Daily Living scale, and the Instrumental Activities of Daily Living (IADL) scale. Serum samples also were obtained. The women were genotyped for the risk allele for the two serotonin receptors: 5HTR1A and 5HTR2A.

Women with one to two copies of the risk allele for 5HTR1A had more depression and poorer IADL scores than women without the allele. Dr. Lenze noted the link between depression and bad outcomes.

Interestingly, women with one to two copies of the risk allele for the 2A receptor did not have a higher risk of depression, and they had higher IADL scores after hip fracture, he said.

Dr. Lenze said that the 2A finding might indicate some adaptability afforded by this allele in the 2A receptor, which might help explain why some elderly people are more resistant to the impact of injuries or disease.

The researchers aim to replicate the findings in a larger study and also use them as a springboard to possibly develop a model to help clinicians determine who is at risk for new-onset depression after hip fracture, said Dr. Lenze.

NEW ORLEANS – New-onset depression after hip fracture is fairly common and may be explained in part by certain polymorphisms of the serotonin 1A and 2A receptors, Dr. Eric J. Lenze said in a poster presented at the annual meeting of the American Association for Geriatric Psychiatry.

He and his associates undertook the study to determine whether people with a given vulnerability gene might be more susceptible to late-life depression onset, and hip fracture was considered a good laboratory, Dr. Lenze, of the psychiatry department at the University of Pittsburgh, said in an interview.

Since serotonin is part of the stress response system, the investigators posited that a variation in those receptors might predict a depression response, he added.

They examined 145 older women (median age 81 years) hospitalized after a hip fracture and followed them for a year. Depression and functional status were measured by the Geriatric Depression Scale, the Physical Activities of Daily Living scale, and the Instrumental Activities of Daily Living (IADL) scale. Serum samples also were obtained. The women were genotyped for the risk allele for the two serotonin receptors: 5HTR1A and 5HTR2A.

Women with one to two copies of the risk allele for 5HTR1A had more depression and poorer IADL scores than women without the allele. Dr. Lenze noted the link between depression and bad outcomes.

Interestingly, women with one to two copies of the risk allele for the 2A receptor did not have a higher risk of depression, and they had higher IADL scores after hip fracture, he said.

Dr. Lenze said that the 2A finding might indicate some adaptability afforded by this allele in the 2A receptor, which might help explain why some elderly people are more resistant to the impact of injuries or disease.

The researchers aim to replicate the findings in a larger study and also use them as a springboard to possibly develop a model to help clinicians determine who is at risk for new-onset depression after hip fracture, said Dr. Lenze.

NEW ORLEANS – Adherence with medication regimens is poor among the mentally ill and tends to worsen as those patients age, but there are ways to help patients stick to their regimens, several speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

There are not a lot of data on the elderly mentally ill and drug adherence, but a review of 39 studies published since 1980 that included patients of all ages estimated that the mean rate of nonadherence with antipsychotics was about 50% (J. Clin. Psychiatry 2002;63:892), said Dr. Dilip V. Jeste, distinguished professor of psychiatry and neurosciences at the University of California, San Diego.

While age was not a consistent risk factor for nonadherence, age might still contribute, he said.

Another study looked at adherence to antipsychotics and to medications for hypertension and hyperlipidemia in middle-aged elderly patients with schizophrenia. The authors found that the patients were as nonadherent with antipsychotics as with the medications for medical conditions, with fill rates ranging from 52% to 64% (Psychosom. Med. 2003;65:156). Nonadherence takes many different forms, Dr. Jeste said. A study of Medicaid beneficiaries with schizophrenia found that 41% were fully adherent, 16% were partially adherent, 24% were nonadherent, and 19% were excess fillers (Am. J. Psychiatry 2004;161:692), he said.

Adherence is affected by many factors, including side effects and the cost and complexity of the regimen, said Lawrence D. Cohen, Pharm.D., professor of pharmacotherapy at Washington State University, Spokane.

To get at the root of adherence issues, psychiatrists should assess mood, cognition, vision, mobility, and ability to pay for the prescription, said Dr. George T. Grossberg, director of the division of geriatric psychiatry at St. Louis University.

Adherence can be assessed through patient self-reports, but most overestimate their adherence, Dr. Jeste said. Caregivers may also be a source of information, but most don't observe the patient on a day-to-day basis, he said. Pill counts are not very accurate, because patients can throw the medication away.

He often uses the Brief Evaluation of Medication Influences and Beliefs, which was developed by a colleague (J. Clin. Psychopharmacol. 2004;24:404). The patient self-administers the eight-item test, which can be done in the waiting room in less than 5 minutes. The scores can be correlated with pharmacy refill records and Drug Attitude Inventory Scores, Dr. Jeste said.

To improve adherence, strike an alliance with your patients, Dr. Cohen said. That includes educating patients and families about the medications and emphasizing their value. “Patients have to believe that the medications or treatments we're suggesting are valuable, are worth their costs, even if they have adverse events,” he said.

Dr. Grossberg agreed that collaboration is important. He advocates what he calls “AIDES”–assessment, individualizing the regimen, choosing appropriate documentation, providing ongoing education tailored to the individual's age and needs, and continuing supervision after initiation.

Electronic caps, unit dosing, blister packs, and pillboxes with timers or calendars can also help, Dr. Grossberg said. He also encourages patients to keep a medication list in their purse or wallet. Telephone follow-up reminders from the physician office are very effective, he said.

Dr. Grossberg is a consultant for Bristol-Myers Squibb, Forest Pharmaceuticals, Janssen, Novartis, Organon, Sanofi-Aventis, Sepracor Inc., and Takeda Pharmaceuticals North America Inc. In addition, he receives grants or support from Abbott Laboratories, AstraZeneca, Eunoe Inc., Forest, GlaxoSmithKline, Myriad, Novartis, Ono Pharmaceutical Co., Pfizer Inc., and Wyeth.

Dr. Jeste is a consultant for Bristol-Myers, Janssen, Otsuka America Pharmaceutical, Solvay Pharmaceuticals, and Wyeth, and he receives other financial support from AstraZeneca, Bristol-Myers, Eli Lilly & Co., and Janssen.

Dr. Cohen is a consultant with Eli Lilly, Solvay, and Wyeth and is on the speakers' bureau for AstraZeneca, Eli Lilly, Forest, GlaxoSmithKline, Janssen, and Sepracor.

NEW ORLEANS – Adherence with medication regimens is poor among the mentally ill and tends to worsen as those patients age, but there are ways to help patients stick to their regimens, several speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

There are not a lot of data on the elderly mentally ill and drug adherence, but a review of 39 studies published since 1980 that included patients of all ages estimated that the mean rate of nonadherence with antipsychotics was about 50% (J. Clin. Psychiatry 2002;63:892), said Dr. Dilip V. Jeste, distinguished professor of psychiatry and neurosciences at the University of California, San Diego.

While age was not a consistent risk factor for nonadherence, age might still contribute, he said.

Another study looked at adherence to antipsychotics and to medications for hypertension and hyperlipidemia in middle-aged elderly patients with schizophrenia. The authors found that the patients were as nonadherent with antipsychotics as with the medications for medical conditions, with fill rates ranging from 52% to 64% (Psychosom. Med. 2003;65:156). Nonadherence takes many different forms, Dr. Jeste said. A study of Medicaid beneficiaries with schizophrenia found that 41% were fully adherent, 16% were partially adherent, 24% were nonadherent, and 19% were excess fillers (Am. J. Psychiatry 2004;161:692), he said.

Adherence is affected by many factors, including side effects and the cost and complexity of the regimen, said Lawrence D. Cohen, Pharm.D., professor of pharmacotherapy at Washington State University, Spokane.

To get at the root of adherence issues, psychiatrists should assess mood, cognition, vision, mobility, and ability to pay for the prescription, said Dr. George T. Grossberg, director of the division of geriatric psychiatry at St. Louis University.

Adherence can be assessed through patient self-reports, but most overestimate their adherence, Dr. Jeste said. Caregivers may also be a source of information, but most don't observe the patient on a day-to-day basis, he said. Pill counts are not very accurate, because patients can throw the medication away.

He often uses the Brief Evaluation of Medication Influences and Beliefs, which was developed by a colleague (J. Clin. Psychopharmacol. 2004;24:404). The patient self-administers the eight-item test, which can be done in the waiting room in less than 5 minutes. The scores can be correlated with pharmacy refill records and Drug Attitude Inventory Scores, Dr. Jeste said.

To improve adherence, strike an alliance with your patients, Dr. Cohen said. That includes educating patients and families about the medications and emphasizing their value. “Patients have to believe that the medications or treatments we're suggesting are valuable, are worth their costs, even if they have adverse events,” he said.

Dr. Grossberg agreed that collaboration is important. He advocates what he calls “AIDES”–assessment, individualizing the regimen, choosing appropriate documentation, providing ongoing education tailored to the individual's age and needs, and continuing supervision after initiation.

Electronic caps, unit dosing, blister packs, and pillboxes with timers or calendars can also help, Dr. Grossberg said. He also encourages patients to keep a medication list in their purse or wallet. Telephone follow-up reminders from the physician office are very effective, he said.

Dr. Grossberg is a consultant for Bristol-Myers Squibb, Forest Pharmaceuticals, Janssen, Novartis, Organon, Sanofi-Aventis, Sepracor Inc., and Takeda Pharmaceuticals North America Inc. In addition, he receives grants or support from Abbott Laboratories, AstraZeneca, Eunoe Inc., Forest, GlaxoSmithKline, Myriad, Novartis, Ono Pharmaceutical Co., Pfizer Inc., and Wyeth.

Dr. Jeste is a consultant for Bristol-Myers, Janssen, Otsuka America Pharmaceutical, Solvay Pharmaceuticals, and Wyeth, and he receives other financial support from AstraZeneca, Bristol-Myers, Eli Lilly & Co., and Janssen.

Dr. Cohen is a consultant with Eli Lilly, Solvay, and Wyeth and is on the speakers' bureau for AstraZeneca, Eli Lilly, Forest, GlaxoSmithKline, Janssen, and Sepracor.

NEW ORLEANS – Adherence with medication regimens is poor among the mentally ill and tends to worsen as those patients age, but there are ways to help patients stick to their regimens, several speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

There are not a lot of data on the elderly mentally ill and drug adherence, but a review of 39 studies published since 1980 that included patients of all ages estimated that the mean rate of nonadherence with antipsychotics was about 50% (J. Clin. Psychiatry 2002;63:892), said Dr. Dilip V. Jeste, distinguished professor of psychiatry and neurosciences at the University of California, San Diego.

While age was not a consistent risk factor for nonadherence, age might still contribute, he said.

Another study looked at adherence to antipsychotics and to medications for hypertension and hyperlipidemia in middle-aged elderly patients with schizophrenia. The authors found that the patients were as nonadherent with antipsychotics as with the medications for medical conditions, with fill rates ranging from 52% to 64% (Psychosom. Med. 2003;65:156). Nonadherence takes many different forms, Dr. Jeste said. A study of Medicaid beneficiaries with schizophrenia found that 41% were fully adherent, 16% were partially adherent, 24% were nonadherent, and 19% were excess fillers (Am. J. Psychiatry 2004;161:692), he said.

Adherence is affected by many factors, including side effects and the cost and complexity of the regimen, said Lawrence D. Cohen, Pharm.D., professor of pharmacotherapy at Washington State University, Spokane.

To get at the root of adherence issues, psychiatrists should assess mood, cognition, vision, mobility, and ability to pay for the prescription, said Dr. George T. Grossberg, director of the division of geriatric psychiatry at St. Louis University.

Adherence can be assessed through patient self-reports, but most overestimate their adherence, Dr. Jeste said. Caregivers may also be a source of information, but most don't observe the patient on a day-to-day basis, he said. Pill counts are not very accurate, because patients can throw the medication away.

He often uses the Brief Evaluation of Medication Influences and Beliefs, which was developed by a colleague (J. Clin. Psychopharmacol. 2004;24:404). The patient self-administers the eight-item test, which can be done in the waiting room in less than 5 minutes. The scores can be correlated with pharmacy refill records and Drug Attitude Inventory Scores, Dr. Jeste said.

To improve adherence, strike an alliance with your patients, Dr. Cohen said. That includes educating patients and families about the medications and emphasizing their value. “Patients have to believe that the medications or treatments we're suggesting are valuable, are worth their costs, even if they have adverse events,” he said.

Dr. Grossberg agreed that collaboration is important. He advocates what he calls “AIDES”–assessment, individualizing the regimen, choosing appropriate documentation, providing ongoing education tailored to the individual's age and needs, and continuing supervision after initiation.

Electronic caps, unit dosing, blister packs, and pillboxes with timers or calendars can also help, Dr. Grossberg said. He also encourages patients to keep a medication list in their purse or wallet. Telephone follow-up reminders from the physician office are very effective, he said.

Dr. Grossberg is a consultant for Bristol-Myers Squibb, Forest Pharmaceuticals, Janssen, Novartis, Organon, Sanofi-Aventis, Sepracor Inc., and Takeda Pharmaceuticals North America Inc. In addition, he receives grants or support from Abbott Laboratories, AstraZeneca, Eunoe Inc., Forest, GlaxoSmithKline, Myriad, Novartis, Ono Pharmaceutical Co., Pfizer Inc., and Wyeth.

Dr. Jeste is a consultant for Bristol-Myers, Janssen, Otsuka America Pharmaceutical, Solvay Pharmaceuticals, and Wyeth, and he receives other financial support from AstraZeneca, Bristol-Myers, Eli Lilly & Co., and Janssen.

Dr. Cohen is a consultant with Eli Lilly, Solvay, and Wyeth and is on the speakers' bureau for AstraZeneca, Eli Lilly, Forest, GlaxoSmithKline, Janssen, and Sepracor.

NEW ORLEANS – The dizzying array of scales available for measuring dementia and mental illness in the elderly can be whittled down to create an essential picture of an individual patient. Most importantly, these scales can be used to establish a baseline to monitor progression or worsening and to meet federal documentation requirements in nursing homes, speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

“You should choose scales that are brief, easy to score and have proven validity and reliability,” said Dr. Allan Anderson, director of geriatric psychiatry at Shore Behavioral Health Services, Cambridge, Md.

Scales can enhance clinical practice and measure the effectiveness of psychiatric treatments, Dr. Anderson said.

Deborah Weber helps administer scales to patients at Shore Behavioral Health. Usually, she said, she spends an hour or more with patients and their caregivers. The tests are not used to make a diagnosis, she said.

The Mini-Mental Status Exam is one of the most frequently administered scales at Shore Behavioral Health, Ms. Weber said. Although this is a common exam measuring cognitive ability, it has some limitations. Patients have to be fluent in English, or they may not do well, she said, adding that they also have to be literate. If they can't spell “world” forward, then they won't be able to spell it backward, she notes. The MMSE usually only takes 10 minutes to administer, but, she said, “don't rush the patient–some patients take longer.”

Ms. Weber also uses several executive function tests, which occasionally require family or caregiver input. Examples include the Tinker Toy Test, Tower of Hanoi, and Proteus Mazes. Failure doesn't automatically mean dementia, she said, noting that medical illness or other mental disorders can interfere with executive function. Fluency tests–such as asking patients to categorize items–are also good ways to measure executive function, she said.

The clinician-administered CLOX test, developed by Dr. Donald Royall, has rapidly gained followers, Ms. Weber said. It is a good test, but “it's important that you understand the nuances of this scoring,” she said.

To measure depression, she uses the Geriatric Depression and the Cornell Scale for Depression in Dementia. Independence can be assessed with the Physical Self-Maintenance Scale or the Functional Activities Questionnaire, which takes only 5–10 minutes to complete, rating the patient's abilities in 10 areas.

Another test she likes is the Dementia Rating Scale II, which is clinician administered and computer scored, measuring competency in attention, initiation/preservation, construction, conceptualization, and memory. However, this test is not sensitive enough to detect mild forms of dementia in people who are intelligent or well educated, Ms. Weber said.

The choice of scales should be based on each patient's specific needs, she said. However, each battery should measure memory, executive function, and activities of daily living, she said.

For nursing home patients, there are several scales that will help establish a baseline of behavior and help meet federal documentation requirements under the Omnibus Reconciliation Act, said Dr. Alan Siegal of the department of psychiatry at Yale University, New Haven, Conn.

The Behave-AD can be done in as little as 10 minutes once the test-giver is familiar with the format, he said. This exam should be given by certified nurses' aides, as nurses are generally too overwhelmed, Dr. Siegal said.

The patient is asked questions covering behaviors over the last 2 weeks in seven domains: paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness, diurnal rhythm disturbances, affective disturbances, and anxieties and phobias. There are 25 questions with answers rated from 0 to 3. The staff is then asked to assign a global rating from 0 (not at all troubling to the caregiver or dangerous to the patient) to 3 (severely troubling or dangerous).

The scale establishes a baseline documenting the behaviors that led to a medication, or some other intervention, he said.

Another useful scale is the Cohen Mansfield Agitation Inventory. It provides “a wonderful thesaurus for 'agitation,'” Dr. Siegal said. It also allows the caregiver to give the physician a descriptive picture of what's happening with the patient. It only takes about 10–15 minutes to complete. The short form rates 14 areas of distressed behavior, including hitting, verbal aggression, grabbing, constant requests for attention, repetitive sentences, weird laughter, and hiding or hoarding things. The frequency of these behaviors is tabulated on a 5-point scale, from never to a few times an hour. Documenting the initial frequency allows the institution and the clinician to show what progress has occurred after a few weeks of intervention, he said.

Another scale that rates frequency and severity of behaviors is the Neuropsychiatric Inventory for Nursing Homes. The NPI is a little more difficult to complete but becomes easier with experience, Dr. Siegal said.

It has good concurrent reliability with both the Hamilton Depression Scale and the Behave-AD, he said, measuring behaviors in 12 domains. If the symptom has been present within the past month, the rater answers yes and then rates the frequency and severity on a 4-point scale and caregiver distress on a 0–5 scale. These scales are often used to establish baselines for medication-based intervention, but pharmaceuticals are not always necessary, Dr. Siegal said.

Sometimes, it's as simple as giving the patient a little attention, asking them how they are doing, and acquiescing to some requests, no matter how delusional they might seem. This approach can head off escalation and the need for a pharmacologic intervention, he said.

NEW ORLEANS – The dizzying array of scales available for measuring dementia and mental illness in the elderly can be whittled down to create an essential picture of an individual patient. Most importantly, these scales can be used to establish a baseline to monitor progression or worsening and to meet federal documentation requirements in nursing homes, speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

“You should choose scales that are brief, easy to score and have proven validity and reliability,” said Dr. Allan Anderson, director of geriatric psychiatry at Shore Behavioral Health Services, Cambridge, Md.

Scales can enhance clinical practice and measure the effectiveness of psychiatric treatments, Dr. Anderson said.

Deborah Weber helps administer scales to patients at Shore Behavioral Health. Usually, she said, she spends an hour or more with patients and their caregivers. The tests are not used to make a diagnosis, she said.

The Mini-Mental Status Exam is one of the most frequently administered scales at Shore Behavioral Health, Ms. Weber said. Although this is a common exam measuring cognitive ability, it has some limitations. Patients have to be fluent in English, or they may not do well, she said, adding that they also have to be literate. If they can't spell “world” forward, then they won't be able to spell it backward, she notes. The MMSE usually only takes 10 minutes to administer, but, she said, “don't rush the patient–some patients take longer.”

Ms. Weber also uses several executive function tests, which occasionally require family or caregiver input. Examples include the Tinker Toy Test, Tower of Hanoi, and Proteus Mazes. Failure doesn't automatically mean dementia, she said, noting that medical illness or other mental disorders can interfere with executive function. Fluency tests–such as asking patients to categorize items–are also good ways to measure executive function, she said.

The clinician-administered CLOX test, developed by Dr. Donald Royall, has rapidly gained followers, Ms. Weber said. It is a good test, but “it's important that you understand the nuances of this scoring,” she said.

To measure depression, she uses the Geriatric Depression and the Cornell Scale for Depression in Dementia. Independence can be assessed with the Physical Self-Maintenance Scale or the Functional Activities Questionnaire, which takes only 5–10 minutes to complete, rating the patient's abilities in 10 areas.

Another test she likes is the Dementia Rating Scale II, which is clinician administered and computer scored, measuring competency in attention, initiation/preservation, construction, conceptualization, and memory. However, this test is not sensitive enough to detect mild forms of dementia in people who are intelligent or well educated, Ms. Weber said.

The choice of scales should be based on each patient's specific needs, she said. However, each battery should measure memory, executive function, and activities of daily living, she said.

For nursing home patients, there are several scales that will help establish a baseline of behavior and help meet federal documentation requirements under the Omnibus Reconciliation Act, said Dr. Alan Siegal of the department of psychiatry at Yale University, New Haven, Conn.

The Behave-AD can be done in as little as 10 minutes once the test-giver is familiar with the format, he said. This exam should be given by certified nurses' aides, as nurses are generally too overwhelmed, Dr. Siegal said.

The patient is asked questions covering behaviors over the last 2 weeks in seven domains: paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness, diurnal rhythm disturbances, affective disturbances, and anxieties and phobias. There are 25 questions with answers rated from 0 to 3. The staff is then asked to assign a global rating from 0 (not at all troubling to the caregiver or dangerous to the patient) to 3 (severely troubling or dangerous).

The scale establishes a baseline documenting the behaviors that led to a medication, or some other intervention, he said.

Another useful scale is the Cohen Mansfield Agitation Inventory. It provides “a wonderful thesaurus for 'agitation,'” Dr. Siegal said. It also allows the caregiver to give the physician a descriptive picture of what's happening with the patient. It only takes about 10–15 minutes to complete. The short form rates 14 areas of distressed behavior, including hitting, verbal aggression, grabbing, constant requests for attention, repetitive sentences, weird laughter, and hiding or hoarding things. The frequency of these behaviors is tabulated on a 5-point scale, from never to a few times an hour. Documenting the initial frequency allows the institution and the clinician to show what progress has occurred after a few weeks of intervention, he said.

Another scale that rates frequency and severity of behaviors is the Neuropsychiatric Inventory for Nursing Homes. The NPI is a little more difficult to complete but becomes easier with experience, Dr. Siegal said.

It has good concurrent reliability with both the Hamilton Depression Scale and the Behave-AD, he said, measuring behaviors in 12 domains. If the symptom has been present within the past month, the rater answers yes and then rates the frequency and severity on a 4-point scale and caregiver distress on a 0–5 scale. These scales are often used to establish baselines for medication-based intervention, but pharmaceuticals are not always necessary, Dr. Siegal said.

Sometimes, it's as simple as giving the patient a little attention, asking them how they are doing, and acquiescing to some requests, no matter how delusional they might seem. This approach can head off escalation and the need for a pharmacologic intervention, he said.

NEW ORLEANS – The dizzying array of scales available for measuring dementia and mental illness in the elderly can be whittled down to create an essential picture of an individual patient. Most importantly, these scales can be used to establish a baseline to monitor progression or worsening and to meet federal documentation requirements in nursing homes, speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

“You should choose scales that are brief, easy to score and have proven validity and reliability,” said Dr. Allan Anderson, director of geriatric psychiatry at Shore Behavioral Health Services, Cambridge, Md.

Scales can enhance clinical practice and measure the effectiveness of psychiatric treatments, Dr. Anderson said.

Deborah Weber helps administer scales to patients at Shore Behavioral Health. Usually, she said, she spends an hour or more with patients and their caregivers. The tests are not used to make a diagnosis, she said.

The Mini-Mental Status Exam is one of the most frequently administered scales at Shore Behavioral Health, Ms. Weber said. Although this is a common exam measuring cognitive ability, it has some limitations. Patients have to be fluent in English, or they may not do well, she said, adding that they also have to be literate. If they can't spell “world” forward, then they won't be able to spell it backward, she notes. The MMSE usually only takes 10 minutes to administer, but, she said, “don't rush the patient–some patients take longer.”

Ms. Weber also uses several executive function tests, which occasionally require family or caregiver input. Examples include the Tinker Toy Test, Tower of Hanoi, and Proteus Mazes. Failure doesn't automatically mean dementia, she said, noting that medical illness or other mental disorders can interfere with executive function. Fluency tests–such as asking patients to categorize items–are also good ways to measure executive function, she said.

The clinician-administered CLOX test, developed by Dr. Donald Royall, has rapidly gained followers, Ms. Weber said. It is a good test, but “it's important that you understand the nuances of this scoring,” she said.

To measure depression, she uses the Geriatric Depression and the Cornell Scale for Depression in Dementia. Independence can be assessed with the Physical Self-Maintenance Scale or the Functional Activities Questionnaire, which takes only 5–10 minutes to complete, rating the patient's abilities in 10 areas.

Another test she likes is the Dementia Rating Scale II, which is clinician administered and computer scored, measuring competency in attention, initiation/preservation, construction, conceptualization, and memory. However, this test is not sensitive enough to detect mild forms of dementia in people who are intelligent or well educated, Ms. Weber said.

The choice of scales should be based on each patient's specific needs, she said. However, each battery should measure memory, executive function, and activities of daily living, she said.

For nursing home patients, there are several scales that will help establish a baseline of behavior and help meet federal documentation requirements under the Omnibus Reconciliation Act, said Dr. Alan Siegal of the department of psychiatry at Yale University, New Haven, Conn.

The Behave-AD can be done in as little as 10 minutes once the test-giver is familiar with the format, he said. This exam should be given by certified nurses' aides, as nurses are generally too overwhelmed, Dr. Siegal said.

The patient is asked questions covering behaviors over the last 2 weeks in seven domains: paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness, diurnal rhythm disturbances, affective disturbances, and anxieties and phobias. There are 25 questions with answers rated from 0 to 3. The staff is then asked to assign a global rating from 0 (not at all troubling to the caregiver or dangerous to the patient) to 3 (severely troubling or dangerous).

The scale establishes a baseline documenting the behaviors that led to a medication, or some other intervention, he said.

Another useful scale is the Cohen Mansfield Agitation Inventory. It provides “a wonderful thesaurus for 'agitation,'” Dr. Siegal said. It also allows the caregiver to give the physician a descriptive picture of what's happening with the patient. It only takes about 10–15 minutes to complete. The short form rates 14 areas of distressed behavior, including hitting, verbal aggression, grabbing, constant requests for attention, repetitive sentences, weird laughter, and hiding or hoarding things. The frequency of these behaviors is tabulated on a 5-point scale, from never to a few times an hour. Documenting the initial frequency allows the institution and the clinician to show what progress has occurred after a few weeks of intervention, he said.

Another scale that rates frequency and severity of behaviors is the Neuropsychiatric Inventory for Nursing Homes. The NPI is a little more difficult to complete but becomes easier with experience, Dr. Siegal said.

It has good concurrent reliability with both the Hamilton Depression Scale and the Behave-AD, he said, measuring behaviors in 12 domains. If the symptom has been present within the past month, the rater answers yes and then rates the frequency and severity on a 4-point scale and caregiver distress on a 0–5 scale. These scales are often used to establish baselines for medication-based intervention, but pharmaceuticals are not always necessary, Dr. Siegal said.

Sometimes, it's as simple as giving the patient a little attention, asking them how they are doing, and acquiescing to some requests, no matter how delusional they might seem. This approach can head off escalation and the need for a pharmacologic intervention, he said.

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 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 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 rankings are posted at www.athenapayerview.com

Sunscreen Claim Crackdown Urged

The Food and Drug Administration needs to stop sunscreen manufacturers from making "false and misleading" claims about their products, according to a petition filed by the Connecticut Attorney General. "Products with false labels give consumers a false sense of security—screening out UVB rays that cause burning or reddening, but possibly not UVA rays that damage deeper layers of the skin, where they can lead to melanoma and other deadly cancers," said Attorney General Richard Blumenthal in a statement. Mr. Blumenthal said the FDA was supposed to implement rules in 1999 that would have prohibited sunscreen makers from claiming their products "block all harmful rays," or are "waterproof," or have SPF ratings above 30. Also, there is no rating system for UVA rays, but many sunscreen makers advertise UVA protection, Mr. Blumenthal pointed out. While an FDA spokeswoman said the agency cannot comment on the petition, she did say a sunscreen regulation addressing UVA testing and labeling as well as other issues is in final clearance at the agency.

D.C. Tops in Sun Savvy

The nation's capital has been ranked No. 1 in terms of its population's knowledge of sun safety, according to a survey from the American Academy of Dermatology. Nearly half of Washington residents said that people do not look healthier with a tan, 66% knew that a base tan is not a healthy way to protect skin from sun damage, and 68% knew that it is not smarter to tan indoors using a tanning bed. Residents of New York City were the second-most knowledgeable, followed by Miami, Tampa, Los Angeles, Dallas, Salt Lake City, San Francisco, and a three-way tie among Idaho, Atlanta, and Philadelphia. Despite its sunny, warm climate year-round, Miami managed to come in third because 45% of residents there did not get a tan last year, according to the AAD. Attitudes and behaviors varied widely. Overall, a majority of Americans (73%) agreed that people looked more attractive with a tan, 42% said they had sunbathed in the last year, and 65% got a tan last year. But 65% knew that sun exposure during childhood is related to skin cancer in adulthood, and 58% knew that indoor tanning is not smarter. The results were based on an online survey of 3,342 randomly selected men and women in 32 U.S. metropolitan areas and states that was conducted in February.

Ranbaxy Buys BMS Derm Brands

Ranbaxy Laboratories Inc. has purchased 13 dermatology products from Bristol-Myers Squibb: Balnetar, Desquam-E, Desquam-X, Eurax, Exelderm, Halog, Kenalog Spray, Lac-Hydrin, Lowila, Pernox, Sebulex, Ultravate, and Westcort. The products are used for acne, dermatitis, psoriasis, fungal infections, and scabies. Ranbaxy, a subsidiary of the India-based Ranbaxy Laboratories Ltd., has what it calls the largest-selling isotretinoin formulation, Sotret. In a statement, Venkat Krishnan, Ranbaxy's regional director for North America said that the acquisition would help the company build its dermatology franchise, and, "it enables Ranbaxy to establish an immediate presence in the high-value segments of dermatitis, psoriasis, antifungals, and scabies," he said. Ranbaxy will start promoting the products immediately, according to a company spokeswoman.

New FDA Risk Panel

Following an Institute of Medicine recommendation, the Food and Drug Administration has created a new advisory committee that will be charged with helping the agency better communicate the risks and benefits of pharmaceuticals and other products it regulates. In 2006, the IOM's report, The Future of Drug Safety: Promoting and Protecting the Health of the Public, urged Congress to establish a new advisory panel that would weigh in on FDA's communications about safety and efficacy to health care providers and the public. The agency found an administrative process that let it establish the committee without congressional action. FDA is now seeking 15 members to serve on the Risk Communication Advisory Committee, including experts on risk communication, social marketing, health literacy, journalism, bioethics, and cultural competency.

DTC Ads Still Fall Short

Direct-to-consumer (DTC) advertisements emphasize individual drugs over conditions, don't do enough to emphasize risk, and minimize the importance of underlying health issues, according to a panel that reviewed such advertisements for the Pharmaceutical Research and Manufacturers of America. The review was undertaken to determine if consumer-directed marketing is meeting PhRMA's voluntary guiding principles, which were adopted in 2005 to address "many of the concerns publicly expressed about DTC advertising." The four volunteer panelists—a pharmacist, a nurse, and two family physicians—also urged drug makers to include more information in their ads about assistance programs that provide low-cost or free medications. In a separate report, PhRMA said that comments it received from consumers on DTC ads indicated that many were confused about the ads' contents and thought they did not present a balance of risks and benefits. The organization received 458 comments from July to December 2006, mostly from consumers; 10% were from health professionals. The comments go to PhRMA's Office of Accountability, which forwards them for responses from individual drug makers.

Sunscreen Claim Crackdown Urged

The Food and Drug Administration needs to stop sunscreen manufacturers from making "false and misleading" claims about their products, according to a petition filed by the Connecticut Attorney General. "Products with false labels give consumers a false sense of security—screening out UVB rays that cause burning or reddening, but possibly not UVA rays that damage deeper layers of the skin, where they can lead to melanoma and other deadly cancers," said Attorney General Richard Blumenthal in a statement. Mr. Blumenthal said the FDA was supposed to implement rules in 1999 that would have prohibited sunscreen makers from claiming their products "block all harmful rays," or are "waterproof," or have SPF ratings above 30. Also, there is no rating system for UVA rays, but many sunscreen makers advertise UVA protection, Mr. Blumenthal pointed out. While an FDA spokeswoman said the agency cannot comment on the petition, she did say a sunscreen regulation addressing UVA testing and labeling as well as other issues is in final clearance at the agency.

D.C. Tops in Sun Savvy

The nation's capital has been ranked No. 1 in terms of its population's knowledge of sun safety, according to a survey from the American Academy of Dermatology. Nearly half of Washington residents said that people do not look healthier with a tan, 66% knew that a base tan is not a healthy way to protect skin from sun damage, and 68% knew that it is not smarter to tan indoors using a tanning bed. Residents of New York City were the second-most knowledgeable, followed by Miami, Tampa, Los Angeles, Dallas, Salt Lake City, San Francisco, and a three-way tie among Idaho, Atlanta, and Philadelphia. Despite its sunny, warm climate year-round, Miami managed to come in third because 45% of residents there did not get a tan last year, according to the AAD. Attitudes and behaviors varied widely. Overall, a majority of Americans (73%) agreed that people looked more attractive with a tan, 42% said they had sunbathed in the last year, and 65% got a tan last year. But 65% knew that sun exposure during childhood is related to skin cancer in adulthood, and 58% knew that indoor tanning is not smarter. The results were based on an online survey of 3,342 randomly selected men and women in 32 U.S. metropolitan areas and states that was conducted in February.

Ranbaxy Buys BMS Derm Brands

Ranbaxy Laboratories Inc. has purchased 13 dermatology products from Bristol-Myers Squibb: Balnetar, Desquam-E, Desquam-X, Eurax, Exelderm, Halog, Kenalog Spray, Lac-Hydrin, Lowila, Pernox, Sebulex, Ultravate, and Westcort. The products are used for acne, dermatitis, psoriasis, fungal infections, and scabies. Ranbaxy, a subsidiary of the India-based Ranbaxy Laboratories Ltd., has what it calls the largest-selling isotretinoin formulation, Sotret. In a statement, Venkat Krishnan, Ranbaxy's regional director for North America said that the acquisition would help the company build its dermatology franchise, and, "it enables Ranbaxy to establish an immediate presence in the high-value segments of dermatitis, psoriasis, antifungals, and scabies," he said. Ranbaxy will start promoting the products immediately, according to a company spokeswoman.

New FDA Risk Panel

Following an Institute of Medicine recommendation, the Food and Drug Administration has created a new advisory committee that will be charged with helping the agency better communicate the risks and benefits of pharmaceuticals and other products it regulates. In 2006, the IOM's report, The Future of Drug Safety: Promoting and Protecting the Health of the Public, urged Congress to establish a new advisory panel that would weigh in on FDA's communications about safety and efficacy to health care providers and the public. The agency found an administrative process that let it establish the committee without congressional action. FDA is now seeking 15 members to serve on the Risk Communication Advisory Committee, including experts on risk communication, social marketing, health literacy, journalism, bioethics, and cultural competency.

DTC Ads Still Fall Short

Direct-to-consumer (DTC) advertisements emphasize individual drugs over conditions, don't do enough to emphasize risk, and minimize the importance of underlying health issues, according to a panel that reviewed such advertisements for the Pharmaceutical Research and Manufacturers of America. The review was undertaken to determine if consumer-directed marketing is meeting PhRMA's voluntary guiding principles, which were adopted in 2005 to address "many of the concerns publicly expressed about DTC advertising." The four volunteer panelists—a pharmacist, a nurse, and two family physicians—also urged drug makers to include more information in their ads about assistance programs that provide low-cost or free medications. In a separate report, PhRMA said that comments it received from consumers on DTC ads indicated that many were confused about the ads' contents and thought they did not present a balance of risks and benefits. The organization received 458 comments from July to December 2006, mostly from consumers; 10% were from health professionals. The comments go to PhRMA's Office of Accountability, which forwards them for responses from individual drug makers.

Sunscreen Claim Crackdown Urged

The Food and Drug Administration needs to stop sunscreen manufacturers from making "false and misleading" claims about their products, according to a petition filed by the Connecticut Attorney General. "Products with false labels give consumers a false sense of security—screening out UVB rays that cause burning or reddening, but possibly not UVA rays that damage deeper layers of the skin, where they can lead to melanoma and other deadly cancers," said Attorney General Richard Blumenthal in a statement. Mr. Blumenthal said the FDA was supposed to implement rules in 1999 that would have prohibited sunscreen makers from claiming their products "block all harmful rays," or are "waterproof," or have SPF ratings above 30. Also, there is no rating system for UVA rays, but many sunscreen makers advertise UVA protection, Mr. Blumenthal pointed out. While an FDA spokeswoman said the agency cannot comment on the petition, she did say a sunscreen regulation addressing UVA testing and labeling as well as other issues is in final clearance at the agency.

D.C. Tops in Sun Savvy

The nation's capital has been ranked No. 1 in terms of its population's knowledge of sun safety, according to a survey from the American Academy of Dermatology. Nearly half of Washington residents said that people do not look healthier with a tan, 66% knew that a base tan is not a healthy way to protect skin from sun damage, and 68% knew that it is not smarter to tan indoors using a tanning bed. Residents of New York City were the second-most knowledgeable, followed by Miami, Tampa, Los Angeles, Dallas, Salt Lake City, San Francisco, and a three-way tie among Idaho, Atlanta, and Philadelphia. Despite its sunny, warm climate year-round, Miami managed to come in third because 45% of residents there did not get a tan last year, according to the AAD. Attitudes and behaviors varied widely. Overall, a majority of Americans (73%) agreed that people looked more attractive with a tan, 42% said they had sunbathed in the last year, and 65% got a tan last year. But 65% knew that sun exposure during childhood is related to skin cancer in adulthood, and 58% knew that indoor tanning is not smarter. The results were based on an online survey of 3,342 randomly selected men and women in 32 U.S. metropolitan areas and states that was conducted in February.

Ranbaxy Buys BMS Derm Brands

Ranbaxy Laboratories Inc. has purchased 13 dermatology products from Bristol-Myers Squibb: Balnetar, Desquam-E, Desquam-X, Eurax, Exelderm, Halog, Kenalog Spray, Lac-Hydrin, Lowila, Pernox, Sebulex, Ultravate, and Westcort. The products are used for acne, dermatitis, psoriasis, fungal infections, and scabies. Ranbaxy, a subsidiary of the India-based Ranbaxy Laboratories Ltd., has what it calls the largest-selling isotretinoin formulation, Sotret. In a statement, Venkat Krishnan, Ranbaxy's regional director for North America said that the acquisition would help the company build its dermatology franchise, and, "it enables Ranbaxy to establish an immediate presence in the high-value segments of dermatitis, psoriasis, antifungals, and scabies," he said. Ranbaxy will start promoting the products immediately, according to a company spokeswoman.

New FDA Risk Panel

Following an Institute of Medicine recommendation, the Food and Drug Administration has created a new advisory committee that will be charged with helping the agency better communicate the risks and benefits of pharmaceuticals and other products it regulates. In 2006, the IOM's report, The Future of Drug Safety: Promoting and Protecting the Health of the Public, urged Congress to establish a new advisory panel that would weigh in on FDA's communications about safety and efficacy to health care providers and the public. The agency found an administrative process that let it establish the committee without congressional action. FDA is now seeking 15 members to serve on the Risk Communication Advisory Committee, including experts on risk communication, social marketing, health literacy, journalism, bioethics, and cultural competency.

DTC Ads Still Fall Short

Direct-to-consumer (DTC) advertisements emphasize individual drugs over conditions, don't do enough to emphasize risk, and minimize the importance of underlying health issues, according to a panel that reviewed such advertisements for the Pharmaceutical Research and Manufacturers of America. The review was undertaken to determine if consumer-directed marketing is meeting PhRMA's voluntary guiding principles, which were adopted in 2005 to address "many of the concerns publicly expressed about DTC advertising." The four volunteer panelists—a pharmacist, a nurse, and two family physicians—also urged drug makers to include more information in their ads about assistance programs that provide low-cost or free medications. In a separate report, PhRMA said that comments it received from consumers on DTC ads indicated that many were confused about the ads' contents and thought they did not present a balance of risks and benefits. The organization received 458 comments from July to December 2006, mostly from consumers; 10% were from health professionals. The comments go to PhRMA's Office of Accountability, which forwards them for responses from individual drug makers.

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. It 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.

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.

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. 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.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans, resulting in a growing number of physicians no longer accepting new Medicaid patients,” said Jonathan Bush, Athena- Health chairman and CEO. The rankings are 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. It 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.

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.

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. 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.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans, resulting in a growing number of physicians no longer accepting new Medicaid patients,” said Jonathan Bush, Athena- Health chairman and CEO. The rankings are 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. It 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.

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.

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. 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.

“We are seeing disturbing administrative process breakdowns with some state Medicaid plans, resulting in a growing number of physicians no longer accepting new Medicaid patients,” said Jonathan Bush, Athena- Health chairman and CEO. The rankings are at www.athenapayerview.com

WASHINGTON — Proton pump inhibitors do not improve most symptoms of supraesophageal reflux, according to a community-based study presented at the annual Digestive Disease Week meeting.

The study's aim was to determine which symptoms resolve completely with PPI therapy, and thus may be reflective of supraesophageal reflux, said Dr. Laura M. Iuga, an otolaryngologist at Mayo Clinic in Rochester, Minn., who presented the study on behalf of her colleagues.

She and her colleagues recruited study subjects from southern Minnesota through radio and print advertising, and also from Mayo's outpatient primary care and otolaryngology clinics. To be eligible, patients had to have at least one of the six chronic symptoms—chronic dry hacking cough, globus sensations, hoarseness, nocturnal cough, sore throat, and throat clearing. Patients were asked to complete the Supraesophageal Reflux Questionnaire and the Reflux Symptom Index.

After randomization, 302 patients received esomeprazole (Nexium) 40 mg twice daily, and 127 received a placebo for 6 months. The study ran from March 2005 until August 2006.

In the intent-to-treat analysis, the 112 patients who withdrew or stopped early (25% of those in each arm) were labeled as incomplete responders. A complete response was lack of symptoms at 3, 4, 5, and 6 months.

As expected, many subjects had complete resolution of their heartburn with PPI therapy, Dr. Iuga noted. About half those taking esomeprazole responded. Overall, patients with heartburn at baseline were 15 times more likely to achieve complete symptom response with esomeprazole than with placebo. “This symptom served as a positive control in the study, indicating enough power to detect a treatment effect,” she said.

There was also a statistically significant difference in throat clearing among patients with that symptom, but only 7% of those in the esomeprazole arm and 1% in the placebo group had improvement, “indicating that the majority of people with throat clearing did not achieve a response,” she said.

The study was supported by a grant from AstraZeneca's Investigator-Sponsored Study Program.

WASHINGTON — Proton pump inhibitors do not improve most symptoms of supraesophageal reflux, according to a community-based study presented at the annual Digestive Disease Week meeting.

The study's aim was to determine which symptoms resolve completely with PPI therapy, and thus may be reflective of supraesophageal reflux, said Dr. Laura M. Iuga, an otolaryngologist at Mayo Clinic in Rochester, Minn., who presented the study on behalf of her colleagues.

She and her colleagues recruited study subjects from southern Minnesota through radio and print advertising, and also from Mayo's outpatient primary care and otolaryngology clinics. To be eligible, patients had to have at least one of the six chronic symptoms—chronic dry hacking cough, globus sensations, hoarseness, nocturnal cough, sore throat, and throat clearing. Patients were asked to complete the Supraesophageal Reflux Questionnaire and the Reflux Symptom Index.

After randomization, 302 patients received esomeprazole (Nexium) 40 mg twice daily, and 127 received a placebo for 6 months. The study ran from March 2005 until August 2006.

In the intent-to-treat analysis, the 112 patients who withdrew or stopped early (25% of those in each arm) were labeled as incomplete responders. A complete response was lack of symptoms at 3, 4, 5, and 6 months.

As expected, many subjects had complete resolution of their heartburn with PPI therapy, Dr. Iuga noted. About half those taking esomeprazole responded. Overall, patients with heartburn at baseline were 15 times more likely to achieve complete symptom response with esomeprazole than with placebo. “This symptom served as a positive control in the study, indicating enough power to detect a treatment effect,” she said.

There was also a statistically significant difference in throat clearing among patients with that symptom, but only 7% of those in the esomeprazole arm and 1% in the placebo group had improvement, “indicating that the majority of people with throat clearing did not achieve a response,” she said.

The study was supported by a grant from AstraZeneca's Investigator-Sponsored Study Program.

WASHINGTON — Proton pump inhibitors do not improve most symptoms of supraesophageal reflux, according to a community-based study presented at the annual Digestive Disease Week meeting.

The study's aim was to determine which symptoms resolve completely with PPI therapy, and thus may be reflective of supraesophageal reflux, said Dr. Laura M. Iuga, an otolaryngologist at Mayo Clinic in Rochester, Minn., who presented the study on behalf of her colleagues.

She and her colleagues recruited study subjects from southern Minnesota through radio and print advertising, and also from Mayo's outpatient primary care and otolaryngology clinics. To be eligible, patients had to have at least one of the six chronic symptoms—chronic dry hacking cough, globus sensations, hoarseness, nocturnal cough, sore throat, and throat clearing. Patients were asked to complete the Supraesophageal Reflux Questionnaire and the Reflux Symptom Index.

After randomization, 302 patients received esomeprazole (Nexium) 40 mg twice daily, and 127 received a placebo for 6 months. The study ran from March 2005 until August 2006.

In the intent-to-treat analysis, the 112 patients who withdrew or stopped early (25% of those in each arm) were labeled as incomplete responders. A complete response was lack of symptoms at 3, 4, 5, and 6 months.

As expected, many subjects had complete resolution of their heartburn with PPI therapy, Dr. Iuga noted. About half those taking esomeprazole responded. Overall, patients with heartburn at baseline were 15 times more likely to achieve complete symptom response with esomeprazole than with placebo. “This symptom served as a positive control in the study, indicating enough power to detect a treatment effect,” she said.

There was also a statistically significant difference in throat clearing among patients with that symptom, but only 7% of those in the esomeprazole arm and 1% in the placebo group had improvement, “indicating that the majority of people with throat clearing did not achieve a response,” she said.

The study was supported by a grant from AstraZeneca's Investigator-Sponsored Study Program.

Starting in April 2008, retailers and suppliers in 10 metropolitan areas who sell certain durable medical equipment will have to become accredited and enter a competitive bidding process, according to a final rule issued by the Centers for Medicare and Medicaid Services.

Unlike other entities, physicians may opt out of competitive bidding and accreditation, but they will still have to accept a single payment for the durable medical equipment (DME) item instead of a fee schedule-based payment, Acting CMS Administrator Leslie Norwalk said in a briefing with reporters.

The new competitive bidding program was developed to reduce Medicare's substantial DME expenditures and to decrease the out-of-pocket burden for beneficiaries, who are liable for copayments of 20%.

“The final rule we are announcing today is focused on improving both service delivery and the quality of care, while getting savings for beneficiaries and taxpayers,” Ms. Norwalk said in a statement.

She estimated that Medicare could shave $1 billion a year off its DME tab by the time the program is fully implemented in 2010.

The final rule will apply initially only to 10 categories of supplies and only to suppliers in 10 competitive bidding areas (CBAs) that have been established by CMS. Physicians, hospitals, and other entities that sell DME, prosthetics, orthotics, and certain other supplies will be required to submit bids to CMS proposing charges for the items.

Bidding will probably be open from late April until late June. CMS will evaluate the bids and then, probably in December, will award contracts to a certain number of bidders in each CBA, Ms. Norwalk said in the briefing.

Beginning in April 2008, Medicare will pay a single amount for each item in those areas instead of basing payments on a fee schedule, as it has in the past.

CMS will expand the program to 70 bidding areas in 2009, and to more CBAs, and to cover more DME items after that, Ms. Norwalk said.

The new process was required by the Medicare Prescription Drug Improvement and Modernization Act of 2003. CMS outlined its intentions in a proposed rule in August 2006. It also gathered data from two pilot studies that ran from 1999 to 2002 in San Antonio and in Polk County, Fla., Ms. Norwalk said. After incorporating public comments and experience from the pilot, CMS published the final rule in the Federal Register.

Suppliers in the following 10 areas will be the first subject to the new requirements: Charlotte-Gastonia-Concord, N.C./S.C.; Cincinnati-Middletown, Ohio/Ky./Ind.; Cleveland-Elyria-Mentor, Ohio; Dallas-Fort Worth-Arlington, Tex.; Kansas City, Mo./Kans.; Miami-Fort Lauderdale-Miami Beach, Fla.; Orlando-Kissimmee, Fla.; Pittsburgh; Riverside-San Bernardino-Ontario, Calif.; and San Juan-Caguas-Guaynabo, Puerto Rico.

The locations were selected because they are 10 of the largest Metropolitan Statistical Areas in the United States and because each area had high costs and/or high utilization of DME items in the 10 focus categories. Although New York, Los Angeles, and Chicago are among the largest Metropolitan Statistical Areas and have high costs and utilization, CMS decided to exclude those areas initially to simplify the process, Ms. Norwalk said.

The 10 categories include oxygen supplies and equipment; standard power wheelchairs, scooters, and accessories; complex rehabilitative power wheelchairs and accessories; mail-order diabetes supplies; enteral nutrients, equipment, and supplies; continuous positive airway pressure (CPAP) devices; respiratory assist devices and supplies and accessories; hospital beds and accessories; negative pressure wound therapy pumps and supplies and accessories; walkers and related accessories; and support surfaces (group 2 and 3 mattresses and overlays). In most CBAs, only nine categories will be subject to bidding in 2008. All 10 will be covered in the Miami and San Juan areas.

Since 60% of diabetic supplies are delivered through mail order, CMS decided to require those suppliers to be subject to competitive bidding. Thus, patients with diabetes will continue to have the option of mail order and it should be less costly, according to CMS. Payment for supplies obtained at a pharmacy or elsewhere will still be covered under the old Medicare fee schedule, even in the 10 CBAs, the agency said.

Blood glucose monitors are not subject to competitive bidding.

To qualify to bid, suppliers have to be accredited by 1 of 10 agencies certified by CMS. Those include the Joint Commission on Accreditation of Healthcare Organizations, the Board of Orthotist/Prosthetist Certification, and the Accreditation Commission for Health Care Inc.

Generally, bidders also have to be in good standing with Medicare, have an active National Supplier Clearinghouse number, and agree to service an entire bidding area, regardless of where a beneficiary may be located.

Of the winning contract slots, 30% are set aside for small suppliers—those with gross revenue of $3.5 million or less per year.

For a list of accrediting bodies, bidding criteria, and other details, see www.cms.hhs.gov/CompetitiveAcqforDMEPOS

Wheelchairs are among the DME items that will be subject to a new competitive bidding process being phased in by Medicare. ©Digital Stock 1996

Starting in April 2008, retailers and suppliers in 10 metropolitan areas who sell certain durable medical equipment will have to become accredited and enter a competitive bidding process, according to a final rule issued by the Centers for Medicare and Medicaid Services.

Unlike other entities, physicians may opt out of competitive bidding and accreditation, but they will still have to accept a single payment for the durable medical equipment (DME) item instead of a fee schedule-based payment, Acting CMS Administrator Leslie Norwalk said in a briefing with reporters.

The new competitive bidding program was developed to reduce Medicare's substantial DME expenditures and to decrease the out-of-pocket burden for beneficiaries, who are liable for copayments of 20%.

“The final rule we are announcing today is focused on improving both service delivery and the quality of care, while getting savings for beneficiaries and taxpayers,” Ms. Norwalk said in a statement.

She estimated that Medicare could shave $1 billion a year off its DME tab by the time the program is fully implemented in 2010.

The final rule will apply initially only to 10 categories of supplies and only to suppliers in 10 competitive bidding areas (CBAs) that have been established by CMS. Physicians, hospitals, and other entities that sell DME, prosthetics, orthotics, and certain other supplies will be required to submit bids to CMS proposing charges for the items.

Bidding will probably be open from late April until late June. CMS will evaluate the bids and then, probably in December, will award contracts to a certain number of bidders in each CBA, Ms. Norwalk said in the briefing.

Beginning in April 2008, Medicare will pay a single amount for each item in those areas instead of basing payments on a fee schedule, as it has in the past.

CMS will expand the program to 70 bidding areas in 2009, and to more CBAs, and to cover more DME items after that, Ms. Norwalk said.

The new process was required by the Medicare Prescription Drug Improvement and Modernization Act of 2003. CMS outlined its intentions in a proposed rule in August 2006. It also gathered data from two pilot studies that ran from 1999 to 2002 in San Antonio and in Polk County, Fla., Ms. Norwalk said. After incorporating public comments and experience from the pilot, CMS published the final rule in the Federal Register.

Suppliers in the following 10 areas will be the first subject to the new requirements: Charlotte-Gastonia-Concord, N.C./S.C.; Cincinnati-Middletown, Ohio/Ky./Ind.; Cleveland-Elyria-Mentor, Ohio; Dallas-Fort Worth-Arlington, Tex.; Kansas City, Mo./Kans.; Miami-Fort Lauderdale-Miami Beach, Fla.; Orlando-Kissimmee, Fla.; Pittsburgh; Riverside-San Bernardino-Ontario, Calif.; and San Juan-Caguas-Guaynabo, Puerto Rico.

The locations were selected because they are 10 of the largest Metropolitan Statistical Areas in the United States and because each area had high costs and/or high utilization of DME items in the 10 focus categories. Although New York, Los Angeles, and Chicago are among the largest Metropolitan Statistical Areas and have high costs and utilization, CMS decided to exclude those areas initially to simplify the process, Ms. Norwalk said.

The 10 categories include oxygen supplies and equipment; standard power wheelchairs, scooters, and accessories; complex rehabilitative power wheelchairs and accessories; mail-order diabetes supplies; enteral nutrients, equipment, and supplies; continuous positive airway pressure (CPAP) devices; respiratory assist devices and supplies and accessories; hospital beds and accessories; negative pressure wound therapy pumps and supplies and accessories; walkers and related accessories; and support surfaces (group 2 and 3 mattresses and overlays). In most CBAs, only nine categories will be subject to bidding in 2008. All 10 will be covered in the Miami and San Juan areas.

Since 60% of diabetic supplies are delivered through mail order, CMS decided to require those suppliers to be subject to competitive bidding. Thus, patients with diabetes will continue to have the option of mail order and it should be less costly, according to CMS. Payment for supplies obtained at a pharmacy or elsewhere will still be covered under the old Medicare fee schedule, even in the 10 CBAs, the agency said.

Blood glucose monitors are not subject to competitive bidding.

To qualify to bid, suppliers have to be accredited by 1 of 10 agencies certified by CMS. Those include the Joint Commission on Accreditation of Healthcare Organizations, the Board of Orthotist/Prosthetist Certification, and the Accreditation Commission for Health Care Inc.

Generally, bidders also have to be in good standing with Medicare, have an active National Supplier Clearinghouse number, and agree to service an entire bidding area, regardless of where a beneficiary may be located.

Of the winning contract slots, 30% are set aside for small suppliers—those with gross revenue of $3.5 million or less per year.

For a list of accrediting bodies, bidding criteria, and other details, see www.cms.hhs.gov/CompetitiveAcqforDMEPOS

Wheelchairs are among the DME items that will be subject to a new competitive bidding process being phased in by Medicare. ©Digital Stock 1996

Starting in April 2008, retailers and suppliers in 10 metropolitan areas who sell certain durable medical equipment will have to become accredited and enter a competitive bidding process, according to a final rule issued by the Centers for Medicare and Medicaid Services.

Unlike other entities, physicians may opt out of competitive bidding and accreditation, but they will still have to accept a single payment for the durable medical equipment (DME) item instead of a fee schedule-based payment, Acting CMS Administrator Leslie Norwalk said in a briefing with reporters.

The new competitive bidding program was developed to reduce Medicare's substantial DME expenditures and to decrease the out-of-pocket burden for beneficiaries, who are liable for copayments of 20%.

“The final rule we are announcing today is focused on improving both service delivery and the quality of care, while getting savings for beneficiaries and taxpayers,” Ms. Norwalk said in a statement.

She estimated that Medicare could shave $1 billion a year off its DME tab by the time the program is fully implemented in 2010.

The final rule will apply initially only to 10 categories of supplies and only to suppliers in 10 competitive bidding areas (CBAs) that have been established by CMS. Physicians, hospitals, and other entities that sell DME, prosthetics, orthotics, and certain other supplies will be required to submit bids to CMS proposing charges for the items.

Bidding will probably be open from late April until late June. CMS will evaluate the bids and then, probably in December, will award contracts to a certain number of bidders in each CBA, Ms. Norwalk said in the briefing.

Beginning in April 2008, Medicare will pay a single amount for each item in those areas instead of basing payments on a fee schedule, as it has in the past.

CMS will expand the program to 70 bidding areas in 2009, and to more CBAs, and to cover more DME items after that, Ms. Norwalk said.

The new process was required by the Medicare Prescription Drug Improvement and Modernization Act of 2003. CMS outlined its intentions in a proposed rule in August 2006. It also gathered data from two pilot studies that ran from 1999 to 2002 in San Antonio and in Polk County, Fla., Ms. Norwalk said. After incorporating public comments and experience from the pilot, CMS published the final rule in the Federal Register.

Suppliers in the following 10 areas will be the first subject to the new requirements: Charlotte-Gastonia-Concord, N.C./S.C.; Cincinnati-Middletown, Ohio/Ky./Ind.; Cleveland-Elyria-Mentor, Ohio; Dallas-Fort Worth-Arlington, Tex.; Kansas City, Mo./Kans.; Miami-Fort Lauderdale-Miami Beach, Fla.; Orlando-Kissimmee, Fla.; Pittsburgh; Riverside-San Bernardino-Ontario, Calif.; and San Juan-Caguas-Guaynabo, Puerto Rico.

The locations were selected because they are 10 of the largest Metropolitan Statistical Areas in the United States and because each area had high costs and/or high utilization of DME items in the 10 focus categories. Although New York, Los Angeles, and Chicago are among the largest Metropolitan Statistical Areas and have high costs and utilization, CMS decided to exclude those areas initially to simplify the process, Ms. Norwalk said.

The 10 categories include oxygen supplies and equipment; standard power wheelchairs, scooters, and accessories; complex rehabilitative power wheelchairs and accessories; mail-order diabetes supplies; enteral nutrients, equipment, and supplies; continuous positive airway pressure (CPAP) devices; respiratory assist devices and supplies and accessories; hospital beds and accessories; negative pressure wound therapy pumps and supplies and accessories; walkers and related accessories; and support surfaces (group 2 and 3 mattresses and overlays). In most CBAs, only nine categories will be subject to bidding in 2008. All 10 will be covered in the Miami and San Juan areas.

Since 60% of diabetic supplies are delivered through mail order, CMS decided to require those suppliers to be subject to competitive bidding. Thus, patients with diabetes will continue to have the option of mail order and it should be less costly, according to CMS. Payment for supplies obtained at a pharmacy or elsewhere will still be covered under the old Medicare fee schedule, even in the 10 CBAs, the agency said.

Blood glucose monitors are not subject to competitive bidding.

To qualify to bid, suppliers have to be accredited by 1 of 10 agencies certified by CMS. Those include the Joint Commission on Accreditation of Healthcare Organizations, the Board of Orthotist/Prosthetist Certification, and the Accreditation Commission for Health Care Inc.

Generally, bidders also have to be in good standing with Medicare, have an active National Supplier Clearinghouse number, and agree to service an entire bidding area, regardless of where a beneficiary may be located.

Of the winning contract slots, 30% are set aside for small suppliers—those with gross revenue of $3.5 million or less per year.

For a list of accrediting bodies, bidding criteria, and other details, see www.cms.hhs.gov/CompetitiveAcqforDMEPOS

Wheelchairs are among the DME items that will be subject to a new competitive bidding process being phased in by Medicare. ©Digital Stock 1996