Alicia Ault

Counsel patients up to age 24 years on the merits of avoiding sun exposure to reduce the risk of skin cancers, the U.S. Preventive Services Task Force recommended May 8. The task force stopped short making the same recommendation for patients older than 24 years, saying that the evidence is not sufficient "to assess the balance of benefits and harms."

The panel noted in its recommendations the prevalence of skin cancer – affecting more than 2 million Americans yearly – and the rising incidence of can melanoma, with 70,000 cases in 2011 and about 8,800 deaths. The USPSTF said there was "convincing" evidence that ultraviolet radiation exposure during childhood and youth is linked to "a moderately increased risk for skin cancer later in life," but that for adults the evidence is only adequate, and, it is associated with just a small increase in risk.

There are potential downsides to counseling – for instance, it might lead kids to be less active – but no studies showed such a decrease, according to the task force’s recommendations. The document also noted that studies need to be done on whether sun exposure avoidance leads to lower vitamin D levels in adults.

The American Academy of Dermatology Association praised the recommendation for children and adolescents. "However, we firmly believe that behavior counseling is essential for all populations, including the adult population," said AADA President Daniel M. Siegel, in a statement. "Given this, we will continue our efforts to educate the public on skin cancer prevention, and encourage our members to conduct additional research in this important area," he said.

Counsel patients up to age 24 years on the merits of avoiding sun exposure to reduce the risk of skin cancers, the U.S. Preventive Services Task Force recommended May 8. The task force stopped short making the same recommendation for patients older than 24 years, saying that the evidence is not sufficient "to assess the balance of benefits and harms."

The panel noted in its recommendations the prevalence of skin cancer – affecting more than 2 million Americans yearly – and the rising incidence of can melanoma, with 70,000 cases in 2011 and about 8,800 deaths. The USPSTF said there was "convincing" evidence that ultraviolet radiation exposure during childhood and youth is linked to "a moderately increased risk for skin cancer later in life," but that for adults the evidence is only adequate, and, it is associated with just a small increase in risk.

There are potential downsides to counseling – for instance, it might lead kids to be less active – but no studies showed such a decrease, according to the task force’s recommendations. The document also noted that studies need to be done on whether sun exposure avoidance leads to lower vitamin D levels in adults.

The American Academy of Dermatology Association praised the recommendation for children and adolescents. "However, we firmly believe that behavior counseling is essential for all populations, including the adult population," said AADA President Daniel M. Siegel, in a statement. "Given this, we will continue our efforts to educate the public on skin cancer prevention, and encourage our members to conduct additional research in this important area," he said.

Counsel patients up to age 24 years on the merits of avoiding sun exposure to reduce the risk of skin cancers, the U.S. Preventive Services Task Force recommended May 8. The task force stopped short making the same recommendation for patients older than 24 years, saying that the evidence is not sufficient "to assess the balance of benefits and harms."

The panel noted in its recommendations the prevalence of skin cancer – affecting more than 2 million Americans yearly – and the rising incidence of can melanoma, with 70,000 cases in 2011 and about 8,800 deaths. The USPSTF said there was "convincing" evidence that ultraviolet radiation exposure during childhood and youth is linked to "a moderately increased risk for skin cancer later in life," but that for adults the evidence is only adequate, and, it is associated with just a small increase in risk.

There are potential downsides to counseling – for instance, it might lead kids to be less active – but no studies showed such a decrease, according to the task force’s recommendations. The document also noted that studies need to be done on whether sun exposure avoidance leads to lower vitamin D levels in adults.

The American Academy of Dermatology Association praised the recommendation for children and adolescents. "However, we firmly believe that behavior counseling is essential for all populations, including the adult population," said AADA President Daniel M. Siegel, in a statement. "Given this, we will continue our efforts to educate the public on skin cancer prevention, and encourage our members to conduct additional research in this important area," he said.

The Institute of Medicine is urging all Americans to come together to systematically attack the "obesity epidemic." In a report released May 8, a blue-ribbon panel convened by the IOM made five basic recommendations to fast-forward progress on curbing the nation’s growing girth.

Panel vice chair William Purcell called the recommendations "straightforward, direct goals" to not only combat obesity, but to hopefully end the problem. The panel recommended:

• integrating physical activity every day in every way for everybody.

• making healthy foods available everywhere.

• marketing what matters for a healthy life.

• activating employers and health care professionals.

• strengthening schools as "the heart of life."

The recommendations are part of the committee’s report, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation."

The 16-member committee, made up of nutrition, obesity, and marketing experts; epidemiologists; and behaviorists, among others, said that all of the recommendations – and strategies to put them into place – hinge upon each other for success.

"We need to do it all, we need to do it now, and it involves all of us," said Mr. Purcell, an attorney and former Nashville mayor, at a plenary session on the report at the meeting.

"Obesity is both an individual and societal concern, and it will take action from all of us – individuals, communities, and the nation as a whole – to achieve a healthier society," said IOM president Harvey V. Fineberg, in a statement.

In putting together its report, the IOM committee reviewed 10 years worth of data and some 800 of previous recommendations. The scope of the problem has become very evident, panel members said.

About one-third of American adults are obese, and 17% of children are obese. Among certain racial and ethnic groups, especially blacks and Latinos, the number is even higher, according to the report. The committee estimated the annual cost of obesity-related illness at $190.2 billion, or nearly 21% of annual health spending.

Panel chair Dan Glickman said that rising costs were as likely as any other factor to push policy makers, health professionals and community leaders into action.

"We are increasing our debt by about $1 trillion a year and the biggest part of that is health care costs. We can’t sustain that," said Mr. Glickman, former Secretary of Agriculture and currently executive director of congressional programs at the Aspen Institute.

Mr. Glickman also said that business has become more engaged in trying to tackle obesity, which was not the case 10-15 years ago.

"We’ve known the problems are severe, but society has to reach a point where it’s ready to tackle them and I think we’re much closer to that than we have been," he said.

The panel’s outlined a series of strategies to address obesity in a variety of environments.

For instance, the panel suggested how schools could find ways to encourage more physical activity and serve healthier meals to students. And, schools should provide food literacy or nutrition education classes, they recommended.

Further, governments should seek ways to reduce consumption of sugar-sweetened beverages especially by children, and possibly even should prohibit serving them to kids. The panel also called for development of standards on how food and drink are marketed to children.

Health care providers should adopt standards of practice for prevention, screening, diagnosis, and treatment of obesity, and should be advocates for greater access to physical activity in their communities, according to the report. Employers should also be advocates for better lifestyles, the panel said.

Special attention was given to how all of these strategies could be applied to low-income Americans and minorities.

For instance, the lowest-cost foods are often the least healthy and most calorie dense; people in low-income communities often rely on those foods because they are inexpensive, according to panel member Shiriki K. Kumanyika, Ph.D., of the University of Pennsylvania, Philadelphia.

The panel also noted that the mix of retail outlets in low-income and certain racial communities drives people toward less healthy eating.

Marketing efforts surrounding some less-healthful food choices seek to make those foods more appealing to minorities; ads for high-calorie foods are much more prevalent in minority communities than in white communities, Dr. Kumanyika added, who added that this is especially true of marketing to black and Latino children.

"We have to be thinking about transforming the environments to get rid of the inequities," she said.

The IOM report is the first to pull together recommendations that target everything from how communities are laid out and built, to how food and beverages are marketed to how schools and work places can encourage healthier living, Jamie F. Chriqui, Ph.D., of the University of Illinois, Chicago.

She said "It’s going to take a collective effort," and that "it’s not just about food, it’s not just about physical activity, it’s about the entire environment and what we can do."

The panel advocated a number of strategies to get to the goals outlined in the recommendations. Some examples include:

• Institute physical activity requirements for child care and early-childhood education programs.

• Find ways to provide tax credits or financing arrangements to encourage retailers and distributors of healthy food to go into so-called food deserts, those areas that are underserved.

• Require all restaurants to list calorie counts on menus and food boards.

• Require that all students from kindergarten through 12th grade have 60 minutes of physical activity a day at school.

The IOM panel’s report is only part of a joint effort to raise the nation’s awareness of the obesity problem and to seek potential solutions. The effort was funded by the Robert Wood Johnson Foundation, Kaiser Permanente, and the Michael and Susan Dell Foundation.

Cable channel HBO approached the IOM about making a documentary series about obesity. The two-part film, called "The Weight of the Nation," was produced in conjunction with the IOM, the Centers for Disease Control and Prevention, and the National Institutes of Health and will be shown on May 14 and 15.

A companion book (New York: St. Martin’s Press, 2012) was cowritten by IOM executive officer Judith Salerno; John Hoffman, the documentary’s executive producer; and Alexandra Moss, the documentary’s coproducer.

The Institute of Medicine is urging all Americans to come together to systematically attack the "obesity epidemic." In a report released May 8, a blue-ribbon panel convened by the IOM made five basic recommendations to fast-forward progress on curbing the nation’s growing girth.

Panel vice chair William Purcell called the recommendations "straightforward, direct goals" to not only combat obesity, but to hopefully end the problem. The panel recommended:

• integrating physical activity every day in every way for everybody.

• making healthy foods available everywhere.

• marketing what matters for a healthy life.

• activating employers and health care professionals.

• strengthening schools as "the heart of life."

The recommendations are part of the committee’s report, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation."

The 16-member committee, made up of nutrition, obesity, and marketing experts; epidemiologists; and behaviorists, among others, said that all of the recommendations – and strategies to put them into place – hinge upon each other for success.

"We need to do it all, we need to do it now, and it involves all of us," said Mr. Purcell, an attorney and former Nashville mayor, at a plenary session on the report at the meeting.

"Obesity is both an individual and societal concern, and it will take action from all of us – individuals, communities, and the nation as a whole – to achieve a healthier society," said IOM president Harvey V. Fineberg, in a statement.

In putting together its report, the IOM committee reviewed 10 years worth of data and some 800 of previous recommendations. The scope of the problem has become very evident, panel members said.

About one-third of American adults are obese, and 17% of children are obese. Among certain racial and ethnic groups, especially blacks and Latinos, the number is even higher, according to the report. The committee estimated the annual cost of obesity-related illness at $190.2 billion, or nearly 21% of annual health spending.

Panel chair Dan Glickman said that rising costs were as likely as any other factor to push policy makers, health professionals and community leaders into action.

"We are increasing our debt by about $1 trillion a year and the biggest part of that is health care costs. We can’t sustain that," said Mr. Glickman, former Secretary of Agriculture and currently executive director of congressional programs at the Aspen Institute.

Mr. Glickman also said that business has become more engaged in trying to tackle obesity, which was not the case 10-15 years ago.

"We’ve known the problems are severe, but society has to reach a point where it’s ready to tackle them and I think we’re much closer to that than we have been," he said.

The panel’s outlined a series of strategies to address obesity in a variety of environments.

For instance, the panel suggested how schools could find ways to encourage more physical activity and serve healthier meals to students. And, schools should provide food literacy or nutrition education classes, they recommended.

Further, governments should seek ways to reduce consumption of sugar-sweetened beverages especially by children, and possibly even should prohibit serving them to kids. The panel also called for development of standards on how food and drink are marketed to children.

Health care providers should adopt standards of practice for prevention, screening, diagnosis, and treatment of obesity, and should be advocates for greater access to physical activity in their communities, according to the report. Employers should also be advocates for better lifestyles, the panel said.

Special attention was given to how all of these strategies could be applied to low-income Americans and minorities.

For instance, the lowest-cost foods are often the least healthy and most calorie dense; people in low-income communities often rely on those foods because they are inexpensive, according to panel member Shiriki K. Kumanyika, Ph.D., of the University of Pennsylvania, Philadelphia.

The panel also noted that the mix of retail outlets in low-income and certain racial communities drives people toward less healthy eating.

Marketing efforts surrounding some less-healthful food choices seek to make those foods more appealing to minorities; ads for high-calorie foods are much more prevalent in minority communities than in white communities, Dr. Kumanyika added, who added that this is especially true of marketing to black and Latino children.

"We have to be thinking about transforming the environments to get rid of the inequities," she said.

The IOM report is the first to pull together recommendations that target everything from how communities are laid out and built, to how food and beverages are marketed to how schools and work places can encourage healthier living, Jamie F. Chriqui, Ph.D., of the University of Illinois, Chicago.

She said "It’s going to take a collective effort," and that "it’s not just about food, it’s not just about physical activity, it’s about the entire environment and what we can do."

The panel advocated a number of strategies to get to the goals outlined in the recommendations. Some examples include:

• Institute physical activity requirements for child care and early-childhood education programs.

• Find ways to provide tax credits or financing arrangements to encourage retailers and distributors of healthy food to go into so-called food deserts, those areas that are underserved.

• Require all restaurants to list calorie counts on menus and food boards.

• Require that all students from kindergarten through 12th grade have 60 minutes of physical activity a day at school.

The IOM panel’s report is only part of a joint effort to raise the nation’s awareness of the obesity problem and to seek potential solutions. The effort was funded by the Robert Wood Johnson Foundation, Kaiser Permanente, and the Michael and Susan Dell Foundation.

Cable channel HBO approached the IOM about making a documentary series about obesity. The two-part film, called "The Weight of the Nation," was produced in conjunction with the IOM, the Centers for Disease Control and Prevention, and the National Institutes of Health and will be shown on May 14 and 15.

A companion book (New York: St. Martin’s Press, 2012) was cowritten by IOM executive officer Judith Salerno; John Hoffman, the documentary’s executive producer; and Alexandra Moss, the documentary’s coproducer.

The Institute of Medicine is urging all Americans to come together to systematically attack the "obesity epidemic." In a report released May 8, a blue-ribbon panel convened by the IOM made five basic recommendations to fast-forward progress on curbing the nation’s growing girth.

Panel vice chair William Purcell called the recommendations "straightforward, direct goals" to not only combat obesity, but to hopefully end the problem. The panel recommended:

• integrating physical activity every day in every way for everybody.

• making healthy foods available everywhere.

• marketing what matters for a healthy life.

• activating employers and health care professionals.

• strengthening schools as "the heart of life."

The recommendations are part of the committee’s report, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation."

The 16-member committee, made up of nutrition, obesity, and marketing experts; epidemiologists; and behaviorists, among others, said that all of the recommendations – and strategies to put them into place – hinge upon each other for success.

"We need to do it all, we need to do it now, and it involves all of us," said Mr. Purcell, an attorney and former Nashville mayor, at a plenary session on the report at the meeting.

"Obesity is both an individual and societal concern, and it will take action from all of us – individuals, communities, and the nation as a whole – to achieve a healthier society," said IOM president Harvey V. Fineberg, in a statement.

In putting together its report, the IOM committee reviewed 10 years worth of data and some 800 of previous recommendations. The scope of the problem has become very evident, panel members said.

About one-third of American adults are obese, and 17% of children are obese. Among certain racial and ethnic groups, especially blacks and Latinos, the number is even higher, according to the report. The committee estimated the annual cost of obesity-related illness at $190.2 billion, or nearly 21% of annual health spending.

Panel chair Dan Glickman said that rising costs were as likely as any other factor to push policy makers, health professionals and community leaders into action.

"We are increasing our debt by about $1 trillion a year and the biggest part of that is health care costs. We can’t sustain that," said Mr. Glickman, former Secretary of Agriculture and currently executive director of congressional programs at the Aspen Institute.

Mr. Glickman also said that business has become more engaged in trying to tackle obesity, which was not the case 10-15 years ago.

"We’ve known the problems are severe, but society has to reach a point where it’s ready to tackle them and I think we’re much closer to that than we have been," he said.

The panel’s outlined a series of strategies to address obesity in a variety of environments.

For instance, the panel suggested how schools could find ways to encourage more physical activity and serve healthier meals to students. And, schools should provide food literacy or nutrition education classes, they recommended.

Further, governments should seek ways to reduce consumption of sugar-sweetened beverages especially by children, and possibly even should prohibit serving them to kids. The panel also called for development of standards on how food and drink are marketed to children.

Health care providers should adopt standards of practice for prevention, screening, diagnosis, and treatment of obesity, and should be advocates for greater access to physical activity in their communities, according to the report. Employers should also be advocates for better lifestyles, the panel said.

Special attention was given to how all of these strategies could be applied to low-income Americans and minorities.

For instance, the lowest-cost foods are often the least healthy and most calorie dense; people in low-income communities often rely on those foods because they are inexpensive, according to panel member Shiriki K. Kumanyika, Ph.D., of the University of Pennsylvania, Philadelphia.

The panel also noted that the mix of retail outlets in low-income and certain racial communities drives people toward less healthy eating.

Marketing efforts surrounding some less-healthful food choices seek to make those foods more appealing to minorities; ads for high-calorie foods are much more prevalent in minority communities than in white communities, Dr. Kumanyika added, who added that this is especially true of marketing to black and Latino children.

"We have to be thinking about transforming the environments to get rid of the inequities," she said.

The IOM report is the first to pull together recommendations that target everything from how communities are laid out and built, to how food and beverages are marketed to how schools and work places can encourage healthier living, Jamie F. Chriqui, Ph.D., of the University of Illinois, Chicago.

She said "It’s going to take a collective effort," and that "it’s not just about food, it’s not just about physical activity, it’s about the entire environment and what we can do."

The panel advocated a number of strategies to get to the goals outlined in the recommendations. Some examples include:

• Institute physical activity requirements for child care and early-childhood education programs.

• Find ways to provide tax credits or financing arrangements to encourage retailers and distributors of healthy food to go into so-called food deserts, those areas that are underserved.

• Require all restaurants to list calorie counts on menus and food boards.

• Require that all students from kindergarten through 12th grade have 60 minutes of physical activity a day at school.

The IOM panel’s report is only part of a joint effort to raise the nation’s awareness of the obesity problem and to seek potential solutions. The effort was funded by the Robert Wood Johnson Foundation, Kaiser Permanente, and the Michael and Susan Dell Foundation.

Cable channel HBO approached the IOM about making a documentary series about obesity. The two-part film, called "The Weight of the Nation," was produced in conjunction with the IOM, the Centers for Disease Control and Prevention, and the National Institutes of Health and will be shown on May 14 and 15.

A companion book (New York: St. Martin’s Press, 2012) was cowritten by IOM executive officer Judith Salerno; John Hoffman, the documentary’s executive producer; and Alexandra Moss, the documentary’s coproducer.

When it comes to Americans’ widening waistlines, the next 2 decades may serve up a side order of good news – and a heaping helping of bad news.

The good news: The rate of increase in the number of obese Americans may level off by 2030, leading to a lower prevalence of obesity than previously estimated.

© okeyphotos/iStockphoto.com

The bad news: The number of obese Americans will still climb by a third in that period, while the nation’s tally of superobese – those who are more than 80 pounds overweight – will more than double.

The result: The cost to the nation from obesity-related morbidity and mortality will be massive, according to Eric Finkelstein, Ph.D., lead author of a study published online May 7 in the American Journal of Preventive Medicine.

By 2030, the United States will see a 33% increase in the prevalence of obesity and a 130% increase in the prevalence of severe obesity, predicted Dr. Finkelstein of the Duke Global Health Institute, Durham, N.C., and deputy director of the Health Services Research Program at Duke-NUS Graduate Medical School in Singapore, and his associates.

Previous studies had suggested that 51% of the U.S. population would be considered obese by that decade. But the model created by Dr. Finkelstein and his colleagues at Duke and the Centers for Disease Control and Prevention puts the U.S. obesity rate at 42% by 2030.

A total of 11% of the nation will be considered severely obese, compared with 5% now, Dr. Finkelstein predicted at a press briefing.

Those numbers aren’t carved in stone, however.

Dr. Finkelstein called his paper’s numbers "reasonable estimates as to what the future will hold," but he added that "predicting obesity is tricky."

To create their predictive model, the researchers used data from the Behavioral Risk Factor Surveillance System (BRFSS) covering the years 1990-2008.

They added variables that might affect the rate of obesity, including unemployment rates; prices for alcohol, gas, and fast food; prices of groceries relative to non–grocery items; prices of healthier foods relative to less-healthy foods; access to the Internet; and the number of fast-food and full-service restaurants/10,000 people. Those data were drawn from the U.S. Bureau of Labor Statistics, the American Chamber of Commerce Research Association, and the Census of Retail Trade.

The analysis showed that no single variable was the cause of obesity, said Dr. Finkelstein. In fact, the study’s variables probably only explain about 5% of obesity he added. Other studies have suggested that as much as 70% of obesity is genetically determined.

The investigators noted several limitations to their predictive model, including the fact that it assumes the variables used will remain constant. In addition, the BRFSS relies on self-reported height and weight. The researchers attempted to counter that by adjusting for potential underreporting.

Getting at obesity’s causes now could help lower obesity rates later, the researchers said.

Childhood obesity may be a major risk factor for obesity later in life, noted Dr. Finkelstein and coauthor Dr. William Dietz. A child’s school environment has been shown to play a predominant role in pediatric obesity, added Dr. Finkelstein.

"Keeping obesity rates level could yield a savings of nearly $550 billion in medical expenditures over the next 2 decades," Dr. Finkelstein said in a statement.

Bending the obesity curve slightly downward would deliver more benefits.

"Even a 1% decrease from the predicted trend would lead to 2.6 million fewer obese adults in 2020 and 2.9 million fewer obese adults in 2030," the study’s authors explained.

The study’s authors reported no conflicts of interest.

When it comes to Americans’ widening waistlines, the next 2 decades may serve up a side order of good news – and a heaping helping of bad news.

The good news: The rate of increase in the number of obese Americans may level off by 2030, leading to a lower prevalence of obesity than previously estimated.

© okeyphotos/iStockphoto.com

The bad news: The number of obese Americans will still climb by a third in that period, while the nation’s tally of superobese – those who are more than 80 pounds overweight – will more than double.

The result: The cost to the nation from obesity-related morbidity and mortality will be massive, according to Eric Finkelstein, Ph.D., lead author of a study published online May 7 in the American Journal of Preventive Medicine.

By 2030, the United States will see a 33% increase in the prevalence of obesity and a 130% increase in the prevalence of severe obesity, predicted Dr. Finkelstein of the Duke Global Health Institute, Durham, N.C., and deputy director of the Health Services Research Program at Duke-NUS Graduate Medical School in Singapore, and his associates.

Previous studies had suggested that 51% of the U.S. population would be considered obese by that decade. But the model created by Dr. Finkelstein and his colleagues at Duke and the Centers for Disease Control and Prevention puts the U.S. obesity rate at 42% by 2030.

A total of 11% of the nation will be considered severely obese, compared with 5% now, Dr. Finkelstein predicted at a press briefing.

Those numbers aren’t carved in stone, however.

Dr. Finkelstein called his paper’s numbers "reasonable estimates as to what the future will hold," but he added that "predicting obesity is tricky."

To create their predictive model, the researchers used data from the Behavioral Risk Factor Surveillance System (BRFSS) covering the years 1990-2008.

They added variables that might affect the rate of obesity, including unemployment rates; prices for alcohol, gas, and fast food; prices of groceries relative to non–grocery items; prices of healthier foods relative to less-healthy foods; access to the Internet; and the number of fast-food and full-service restaurants/10,000 people. Those data were drawn from the U.S. Bureau of Labor Statistics, the American Chamber of Commerce Research Association, and the Census of Retail Trade.

The analysis showed that no single variable was the cause of obesity, said Dr. Finkelstein. In fact, the study’s variables probably only explain about 5% of obesity he added. Other studies have suggested that as much as 70% of obesity is genetically determined.

The investigators noted several limitations to their predictive model, including the fact that it assumes the variables used will remain constant. In addition, the BRFSS relies on self-reported height and weight. The researchers attempted to counter that by adjusting for potential underreporting.

Getting at obesity’s causes now could help lower obesity rates later, the researchers said.

Childhood obesity may be a major risk factor for obesity later in life, noted Dr. Finkelstein and coauthor Dr. William Dietz. A child’s school environment has been shown to play a predominant role in pediatric obesity, added Dr. Finkelstein.

"Keeping obesity rates level could yield a savings of nearly $550 billion in medical expenditures over the next 2 decades," Dr. Finkelstein said in a statement.

Bending the obesity curve slightly downward would deliver more benefits.

"Even a 1% decrease from the predicted trend would lead to 2.6 million fewer obese adults in 2020 and 2.9 million fewer obese adults in 2030," the study’s authors explained.

The study’s authors reported no conflicts of interest.

When it comes to Americans’ widening waistlines, the next 2 decades may serve up a side order of good news – and a heaping helping of bad news.

The good news: The rate of increase in the number of obese Americans may level off by 2030, leading to a lower prevalence of obesity than previously estimated.

© okeyphotos/iStockphoto.com

The bad news: The number of obese Americans will still climb by a third in that period, while the nation’s tally of superobese – those who are more than 80 pounds overweight – will more than double.

The result: The cost to the nation from obesity-related morbidity and mortality will be massive, according to Eric Finkelstein, Ph.D., lead author of a study published online May 7 in the American Journal of Preventive Medicine.

By 2030, the United States will see a 33% increase in the prevalence of obesity and a 130% increase in the prevalence of severe obesity, predicted Dr. Finkelstein of the Duke Global Health Institute, Durham, N.C., and deputy director of the Health Services Research Program at Duke-NUS Graduate Medical School in Singapore, and his associates.

Previous studies had suggested that 51% of the U.S. population would be considered obese by that decade. But the model created by Dr. Finkelstein and his colleagues at Duke and the Centers for Disease Control and Prevention puts the U.S. obesity rate at 42% by 2030.

A total of 11% of the nation will be considered severely obese, compared with 5% now, Dr. Finkelstein predicted at a press briefing.

Those numbers aren’t carved in stone, however.

Dr. Finkelstein called his paper’s numbers "reasonable estimates as to what the future will hold," but he added that "predicting obesity is tricky."

To create their predictive model, the researchers used data from the Behavioral Risk Factor Surveillance System (BRFSS) covering the years 1990-2008.

They added variables that might affect the rate of obesity, including unemployment rates; prices for alcohol, gas, and fast food; prices of groceries relative to non–grocery items; prices of healthier foods relative to less-healthy foods; access to the Internet; and the number of fast-food and full-service restaurants/10,000 people. Those data were drawn from the U.S. Bureau of Labor Statistics, the American Chamber of Commerce Research Association, and the Census of Retail Trade.

The analysis showed that no single variable was the cause of obesity, said Dr. Finkelstein. In fact, the study’s variables probably only explain about 5% of obesity he added. Other studies have suggested that as much as 70% of obesity is genetically determined.

The investigators noted several limitations to their predictive model, including the fact that it assumes the variables used will remain constant. In addition, the BRFSS relies on self-reported height and weight. The researchers attempted to counter that by adjusting for potential underreporting.

Getting at obesity’s causes now could help lower obesity rates later, the researchers said.

Childhood obesity may be a major risk factor for obesity later in life, noted Dr. Finkelstein and coauthor Dr. William Dietz. A child’s school environment has been shown to play a predominant role in pediatric obesity, added Dr. Finkelstein.

"Keeping obesity rates level could yield a savings of nearly $550 billion in medical expenditures over the next 2 decades," Dr. Finkelstein said in a statement.

Bending the obesity curve slightly downward would deliver more benefits.

"Even a 1% decrease from the predicted trend would lead to 2.6 million fewer obese adults in 2020 and 2.9 million fewer obese adults in 2030," the study’s authors explained.

The study’s authors reported no conflicts of interest.

NEW ORLEANS – Annual Medicare wellness exams are being unperformed, resulting in lost opportunities and revenue, according to Dr. Mary M. Newman.

In 2011, more than 32 million Medicare beneficiaries in the traditional program (excluding Medicare Advantage) received one or more of the covered services, which are free for enrollees. They include the "Welcome to Medicare," or Initial Preventive Physical Examination (IPPE); the annual wellness visit; and other preventive services that may occur outside those visits. So far in 2012, 8.9 million enrollees have received a free service, including 562,000 who had an annual wellness visit. That’s up from the 312,809 beneficiaries who received the wellness visit during the first 3 months of 2011, according to the Centers for Medicare and Medicaid Services.

The program got off to a slow start because of an awareness gap, Dr. Newman said. Also, correctly coding and billing for the visits takes practice. An electronic health record aids in delivering the benefits consistently and well.

Dr. Newman, an internist at a group practice in Lutherville, Md., explained that Medicare pays about $166 for the initial wellness visit, with subsequent visits paid at a slightly lower rate. The typical office visit for a Medicare patient is reimbursed at about $70. In addition, the CMS is paying a slight premium for the wellness visits starting this year because the agency is now requiring the completion of a health risk assessment for each beneficiary.

Before the Affordable Care Act, only one preventive/wellness visit was covered for beneficiaries during their lifetime. Now, the IPPE visit initiates a continuum of care, with an update on the care plan and screenings on an annual basis. The IPPE visit, which must be used in the first 12 months after a beneficiary is enrolled, includes a medical/surgical history; review of current medications and supplements; family history; history of alcohol, tobacco, and illicit drug use; and discussion of diet and physical activity. Risk factors for depression should be reviewed and functional ability assessed.

The basic physical exam covers blood pressure, vision, weight, and height. Written or verbal end of life planning should be offered, and recommended screenings and vaccinations should be checked. The findings are used to compile a written care plan, complete with recommendations for screening or other preventive services. Annual wellness visits then follow, but annual visits also can occur without having first had the IPPE, according to the CMS.

The IPPE is billed using the G0402 visit code and the V.70 diagnosis code, said Dr. Newman. The first annual wellness visit is billed using the G0438 code, and each subsequent visit uses the G0439 code. The wellness visit can be conducted by a physician or any medical professional working under a physician’s supervision.

Before each visit, Dr. Newman’s practice staff verifies that patients are eligible for either the IPPE or the annual wellness visit and explains the visit and what’s covered. Patients are also encouraged to fill out a form they can download from the practice’s website that helps them organize their medication list, family history, and names of all current physicians.

During the initial wellness visit, Dr. Newman conducts a two-question depression screen and a four-question functional assessment. She has patients walk the hallway as she observes them for motor skill, balance, and other functional measures. After discussing preventive care and advance directives, assessing risk factors, and taking vital signs, she issues a written care plan.

The plan includes a list of risk factors and conditions; referrals for screening tests and, as appropriate, nutritional counseling, smoking cessation, fall prevention, and weight loss; a screening schedule for 5-10 years; and end of life planning. It is updated at each subsequent wellness visit. This is where an EHR can really help, she noted. Ask the vendor to embed the wellness elements, and that way it can be simply updated.

In addition to the wellness visits, a host of preventive services are covered, but there are rules for how the services are delivered, she said. For instance, beneficiaries can receive a one-time screen for abdominal aortic aneurysms; the referral must be made during the first year someone is on Medicare, and they must have certain specific risk factors.

Bone density tests are covered every 2 years. Beneficiaries are liable for 20% of the service if the physician does not accept assignment. New benefits added in 2012 include screening and counseling for alcohol misuse and for sexually transmitted diseases for high-risk patients. Once-a-year screening for depression is covered; if the patient is depressed, the physician must have a care plan.

The new intensive obesity therapy coverage is a "terrific benefit," said Dr. Newman. If a patient has a body mass index of more than 30, the physician can see the patient weekly for the first month, then biweekly for months 2-6, and monthly after that, out to a year. "This is a real advance," she said.

Finally, there is the health risk assessment, which is used to collect self-reported information about the beneficiary. The process takes no more than 20 minutes. It overlaps with some of the assessments conducted during the wellness visit, but is still required.

Dr. Newman said she uses an assessment tool that was developed by the ACP. Patients receive the tool at the front desk when they come in for a visit.

The important thing to understand about this assessment is "you don’t have to fix the problems today," said Dr. Newman. You can bring patients] back to work on components or hand off the patients to a nurse or a social worker, she said.

Also, the assessment does not have to be done completely and perfectly in 2012. The CMS has said it will allow for some variation in content for the time being and physicians will still be reimbursed for conducting the assessment.

NEW ORLEANS – Annual Medicare wellness exams are being unperformed, resulting in lost opportunities and revenue, according to Dr. Mary M. Newman.

In 2011, more than 32 million Medicare beneficiaries in the traditional program (excluding Medicare Advantage) received one or more of the covered services, which are free for enrollees. They include the "Welcome to Medicare," or Initial Preventive Physical Examination (IPPE); the annual wellness visit; and other preventive services that may occur outside those visits. So far in 2012, 8.9 million enrollees have received a free service, including 562,000 who had an annual wellness visit. That’s up from the 312,809 beneficiaries who received the wellness visit during the first 3 months of 2011, according to the Centers for Medicare and Medicaid Services.

The program got off to a slow start because of an awareness gap, Dr. Newman said. Also, correctly coding and billing for the visits takes practice. An electronic health record aids in delivering the benefits consistently and well.

Dr. Newman, an internist at a group practice in Lutherville, Md., explained that Medicare pays about $166 for the initial wellness visit, with subsequent visits paid at a slightly lower rate. The typical office visit for a Medicare patient is reimbursed at about $70. In addition, the CMS is paying a slight premium for the wellness visits starting this year because the agency is now requiring the completion of a health risk assessment for each beneficiary.

Before the Affordable Care Act, only one preventive/wellness visit was covered for beneficiaries during their lifetime. Now, the IPPE visit initiates a continuum of care, with an update on the care plan and screenings on an annual basis. The IPPE visit, which must be used in the first 12 months after a beneficiary is enrolled, includes a medical/surgical history; review of current medications and supplements; family history; history of alcohol, tobacco, and illicit drug use; and discussion of diet and physical activity. Risk factors for depression should be reviewed and functional ability assessed.

The basic physical exam covers blood pressure, vision, weight, and height. Written or verbal end of life planning should be offered, and recommended screenings and vaccinations should be checked. The findings are used to compile a written care plan, complete with recommendations for screening or other preventive services. Annual wellness visits then follow, but annual visits also can occur without having first had the IPPE, according to the CMS.

The IPPE is billed using the G0402 visit code and the V.70 diagnosis code, said Dr. Newman. The first annual wellness visit is billed using the G0438 code, and each subsequent visit uses the G0439 code. The wellness visit can be conducted by a physician or any medical professional working under a physician’s supervision.

Before each visit, Dr. Newman’s practice staff verifies that patients are eligible for either the IPPE or the annual wellness visit and explains the visit and what’s covered. Patients are also encouraged to fill out a form they can download from the practice’s website that helps them organize their medication list, family history, and names of all current physicians.

During the initial wellness visit, Dr. Newman conducts a two-question depression screen and a four-question functional assessment. She has patients walk the hallway as she observes them for motor skill, balance, and other functional measures. After discussing preventive care and advance directives, assessing risk factors, and taking vital signs, she issues a written care plan.

The plan includes a list of risk factors and conditions; referrals for screening tests and, as appropriate, nutritional counseling, smoking cessation, fall prevention, and weight loss; a screening schedule for 5-10 years; and end of life planning. It is updated at each subsequent wellness visit. This is where an EHR can really help, she noted. Ask the vendor to embed the wellness elements, and that way it can be simply updated.

In addition to the wellness visits, a host of preventive services are covered, but there are rules for how the services are delivered, she said. For instance, beneficiaries can receive a one-time screen for abdominal aortic aneurysms; the referral must be made during the first year someone is on Medicare, and they must have certain specific risk factors.

Bone density tests are covered every 2 years. Beneficiaries are liable for 20% of the service if the physician does not accept assignment. New benefits added in 2012 include screening and counseling for alcohol misuse and for sexually transmitted diseases for high-risk patients. Once-a-year screening for depression is covered; if the patient is depressed, the physician must have a care plan.

The new intensive obesity therapy coverage is a "terrific benefit," said Dr. Newman. If a patient has a body mass index of more than 30, the physician can see the patient weekly for the first month, then biweekly for months 2-6, and monthly after that, out to a year. "This is a real advance," she said.

Finally, there is the health risk assessment, which is used to collect self-reported information about the beneficiary. The process takes no more than 20 minutes. It overlaps with some of the assessments conducted during the wellness visit, but is still required.

Dr. Newman said she uses an assessment tool that was developed by the ACP. Patients receive the tool at the front desk when they come in for a visit.

The important thing to understand about this assessment is "you don’t have to fix the problems today," said Dr. Newman. You can bring patients] back to work on components or hand off the patients to a nurse or a social worker, she said.

Also, the assessment does not have to be done completely and perfectly in 2012. The CMS has said it will allow for some variation in content for the time being and physicians will still be reimbursed for conducting the assessment.

NEW ORLEANS – Annual Medicare wellness exams are being unperformed, resulting in lost opportunities and revenue, according to Dr. Mary M. Newman.

In 2011, more than 32 million Medicare beneficiaries in the traditional program (excluding Medicare Advantage) received one or more of the covered services, which are free for enrollees. They include the "Welcome to Medicare," or Initial Preventive Physical Examination (IPPE); the annual wellness visit; and other preventive services that may occur outside those visits. So far in 2012, 8.9 million enrollees have received a free service, including 562,000 who had an annual wellness visit. That’s up from the 312,809 beneficiaries who received the wellness visit during the first 3 months of 2011, according to the Centers for Medicare and Medicaid Services.

The program got off to a slow start because of an awareness gap, Dr. Newman said. Also, correctly coding and billing for the visits takes practice. An electronic health record aids in delivering the benefits consistently and well.

Dr. Newman, an internist at a group practice in Lutherville, Md., explained that Medicare pays about $166 for the initial wellness visit, with subsequent visits paid at a slightly lower rate. The typical office visit for a Medicare patient is reimbursed at about $70. In addition, the CMS is paying a slight premium for the wellness visits starting this year because the agency is now requiring the completion of a health risk assessment for each beneficiary.

Before the Affordable Care Act, only one preventive/wellness visit was covered for beneficiaries during their lifetime. Now, the IPPE visit initiates a continuum of care, with an update on the care plan and screenings on an annual basis. The IPPE visit, which must be used in the first 12 months after a beneficiary is enrolled, includes a medical/surgical history; review of current medications and supplements; family history; history of alcohol, tobacco, and illicit drug use; and discussion of diet and physical activity. Risk factors for depression should be reviewed and functional ability assessed.

The basic physical exam covers blood pressure, vision, weight, and height. Written or verbal end of life planning should be offered, and recommended screenings and vaccinations should be checked. The findings are used to compile a written care plan, complete with recommendations for screening or other preventive services. Annual wellness visits then follow, but annual visits also can occur without having first had the IPPE, according to the CMS.

The IPPE is billed using the G0402 visit code and the V.70 diagnosis code, said Dr. Newman. The first annual wellness visit is billed using the G0438 code, and each subsequent visit uses the G0439 code. The wellness visit can be conducted by a physician or any medical professional working under a physician’s supervision.

Before each visit, Dr. Newman’s practice staff verifies that patients are eligible for either the IPPE or the annual wellness visit and explains the visit and what’s covered. Patients are also encouraged to fill out a form they can download from the practice’s website that helps them organize their medication list, family history, and names of all current physicians.

During the initial wellness visit, Dr. Newman conducts a two-question depression screen and a four-question functional assessment. She has patients walk the hallway as she observes them for motor skill, balance, and other functional measures. After discussing preventive care and advance directives, assessing risk factors, and taking vital signs, she issues a written care plan.

The plan includes a list of risk factors and conditions; referrals for screening tests and, as appropriate, nutritional counseling, smoking cessation, fall prevention, and weight loss; a screening schedule for 5-10 years; and end of life planning. It is updated at each subsequent wellness visit. This is where an EHR can really help, she noted. Ask the vendor to embed the wellness elements, and that way it can be simply updated.

In addition to the wellness visits, a host of preventive services are covered, but there are rules for how the services are delivered, she said. For instance, beneficiaries can receive a one-time screen for abdominal aortic aneurysms; the referral must be made during the first year someone is on Medicare, and they must have certain specific risk factors.

Bone density tests are covered every 2 years. Beneficiaries are liable for 20% of the service if the physician does not accept assignment. New benefits added in 2012 include screening and counseling for alcohol misuse and for sexually transmitted diseases for high-risk patients. Once-a-year screening for depression is covered; if the patient is depressed, the physician must have a care plan.

The new intensive obesity therapy coverage is a "terrific benefit," said Dr. Newman. If a patient has a body mass index of more than 30, the physician can see the patient weekly for the first month, then biweekly for months 2-6, and monthly after that, out to a year. "This is a real advance," she said.

Finally, there is the health risk assessment, which is used to collect self-reported information about the beneficiary. The process takes no more than 20 minutes. It overlaps with some of the assessments conducted during the wellness visit, but is still required.

Dr. Newman said she uses an assessment tool that was developed by the ACP. Patients receive the tool at the front desk when they come in for a visit.

The important thing to understand about this assessment is "you don’t have to fix the problems today," said Dr. Newman. You can bring patients] back to work on components or hand off the patients to a nurse or a social worker, she said.

Also, the assessment does not have to be done completely and perfectly in 2012. The CMS has said it will allow for some variation in content for the time being and physicians will still be reimbursed for conducting the assessment.

NEW ORLEANS – The American College of Physicians has issued a policy paper containing at least a dozen recommendations to help reform the Medicare program, including support for having wealthier beneficiaries pay higher premiums and for giving the federal government the ability to negotiate drug prices.

The time to act is now, as the Medicare Trust Fund is due to run out of money in 2024, said ACP President Dr. Virginia Hood at the organization’s annual meeting. But the ACP will not advocate for any reform that would threaten beneficiaries’ access to, or quality of, care, she said.

Alicia Ault/IMNG Medical Media

"Difficult choices must be made to ensure the program’s solvency, but not at the expense of patients’ health," said Dr. Hood at a press briefing.

Robert Doherty, the ACP’s senior vice president of governmental affairs and public policy, said that Medicare had become a political football. "Republicans and Democrats alike are engaging in a war of words about Medicare, trying to scare voters into believing that the other party will destroy the program," he said at the briefing.

But neither party is facing up to the facts, said Mr. Doherty. Given rising health costs, an aging population, and increased cost-shifting to beneficiaries, the program "can’t continue as it is," he said. "Change is coming, change is necessary," Mr. Doherty said.

He and Dr. Hood said that the ACP’s recommendations for reform could help find cost savings, improve value, and protect access to care.

The ACP recommended finding ways to accelerate adoption of the patient-centered medical home concept. But it expressed concern about proposals to transform Medicare from a defined benefit to a defined contribution program. Also known as "premium support," this concept has been advanced by Rep. Paul Ryan (R-Wisc.) and has the backing of many of his GOP colleagues in the House of Representatives.

But, said Dr. Hood, "too little is known today about the impact of a Medicare premium support program on patient access to care." She added, "It’s concerning that with such little information that risky decisions would be made to transition away from the current guaranteed benefit structure."

Instead, the ACP proposes testing such a system. The College also said that the Medicare eligibility age should not be raised unless affordable, comprehensive insurance is made available to those who would now have to wait.

"Advancing the Medicare eligibility age could result in tens of millions of seniors having no access to affordable coverage from age 65 to 67, adding to the ranks of the uninsured," Mr. Doherty said.

The organization recommended that Congress instead give Medicare the authority to redesign benefits, coverage, and cost-sharing so that high-value services are rewarded and lower-value services – which might be not only inappropriate but also harmful – be given less coverage or lower reimbursement.

The ACP waded into somewhat controversial waters by urging Medicare to cover advance planning for patients with terminal illnesses. Payment for the voluntary discussions was included in the Affordable Care Act, but after Republicans said that such counseling might lead to rationing of care – or "death panels" – the Obama administration retracted a rule defining the benefit.

"Voluntary advance care planning should be covered and reimbursed by Medicare to encourage patient-physician engagement and ensure that patients are informed of their palliative and hospice care options," Mr. Doherty said.

Finally, the ACP urged an overhaul of the authority of the Independent Payment Advisory Board. Congress should have the right to approve or disapprove of the IPAB’s recommendations "by a simple majority," according to the policy paper.

Overall, "I do believe that the politicians have to show some leadership," said Mr. Doherty. Both parties need to talk responsibly "about the challenges to sustaining Medicare," and not just talk of "ending Medicare as we know it," he added. Because, he said, "Medicare as we know it is not sustainable. It’s going to have to change."

NEW ORLEANS – The American College of Physicians has issued a policy paper containing at least a dozen recommendations to help reform the Medicare program, including support for having wealthier beneficiaries pay higher premiums and for giving the federal government the ability to negotiate drug prices.

The time to act is now, as the Medicare Trust Fund is due to run out of money in 2024, said ACP President Dr. Virginia Hood at the organization’s annual meeting. But the ACP will not advocate for any reform that would threaten beneficiaries’ access to, or quality of, care, she said.

Alicia Ault/IMNG Medical Media

"Difficult choices must be made to ensure the program’s solvency, but not at the expense of patients’ health," said Dr. Hood at a press briefing.

Robert Doherty, the ACP’s senior vice president of governmental affairs and public policy, said that Medicare had become a political football. "Republicans and Democrats alike are engaging in a war of words about Medicare, trying to scare voters into believing that the other party will destroy the program," he said at the briefing.

But neither party is facing up to the facts, said Mr. Doherty. Given rising health costs, an aging population, and increased cost-shifting to beneficiaries, the program "can’t continue as it is," he said. "Change is coming, change is necessary," Mr. Doherty said.

He and Dr. Hood said that the ACP’s recommendations for reform could help find cost savings, improve value, and protect access to care.

The ACP recommended finding ways to accelerate adoption of the patient-centered medical home concept. But it expressed concern about proposals to transform Medicare from a defined benefit to a defined contribution program. Also known as "premium support," this concept has been advanced by Rep. Paul Ryan (R-Wisc.) and has the backing of many of his GOP colleagues in the House of Representatives.

But, said Dr. Hood, "too little is known today about the impact of a Medicare premium support program on patient access to care." She added, "It’s concerning that with such little information that risky decisions would be made to transition away from the current guaranteed benefit structure."

Instead, the ACP proposes testing such a system. The College also said that the Medicare eligibility age should not be raised unless affordable, comprehensive insurance is made available to those who would now have to wait.

"Advancing the Medicare eligibility age could result in tens of millions of seniors having no access to affordable coverage from age 65 to 67, adding to the ranks of the uninsured," Mr. Doherty said.

The organization recommended that Congress instead give Medicare the authority to redesign benefits, coverage, and cost-sharing so that high-value services are rewarded and lower-value services – which might be not only inappropriate but also harmful – be given less coverage or lower reimbursement.

The ACP waded into somewhat controversial waters by urging Medicare to cover advance planning for patients with terminal illnesses. Payment for the voluntary discussions was included in the Affordable Care Act, but after Republicans said that such counseling might lead to rationing of care – or "death panels" – the Obama administration retracted a rule defining the benefit.

"Voluntary advance care planning should be covered and reimbursed by Medicare to encourage patient-physician engagement and ensure that patients are informed of their palliative and hospice care options," Mr. Doherty said.

Finally, the ACP urged an overhaul of the authority of the Independent Payment Advisory Board. Congress should have the right to approve or disapprove of the IPAB’s recommendations "by a simple majority," according to the policy paper.

Overall, "I do believe that the politicians have to show some leadership," said Mr. Doherty. Both parties need to talk responsibly "about the challenges to sustaining Medicare," and not just talk of "ending Medicare as we know it," he added. Because, he said, "Medicare as we know it is not sustainable. It’s going to have to change."

NEW ORLEANS – The American College of Physicians has issued a policy paper containing at least a dozen recommendations to help reform the Medicare program, including support for having wealthier beneficiaries pay higher premiums and for giving the federal government the ability to negotiate drug prices.

The time to act is now, as the Medicare Trust Fund is due to run out of money in 2024, said ACP President Dr. Virginia Hood at the organization’s annual meeting. But the ACP will not advocate for any reform that would threaten beneficiaries’ access to, or quality of, care, she said.

Alicia Ault/IMNG Medical Media

"Difficult choices must be made to ensure the program’s solvency, but not at the expense of patients’ health," said Dr. Hood at a press briefing.

Robert Doherty, the ACP’s senior vice president of governmental affairs and public policy, said that Medicare had become a political football. "Republicans and Democrats alike are engaging in a war of words about Medicare, trying to scare voters into believing that the other party will destroy the program," he said at the briefing.

But neither party is facing up to the facts, said Mr. Doherty. Given rising health costs, an aging population, and increased cost-shifting to beneficiaries, the program "can’t continue as it is," he said. "Change is coming, change is necessary," Mr. Doherty said.

He and Dr. Hood said that the ACP’s recommendations for reform could help find cost savings, improve value, and protect access to care.

The ACP recommended finding ways to accelerate adoption of the patient-centered medical home concept. But it expressed concern about proposals to transform Medicare from a defined benefit to a defined contribution program. Also known as "premium support," this concept has been advanced by Rep. Paul Ryan (R-Wisc.) and has the backing of many of his GOP colleagues in the House of Representatives.

But, said Dr. Hood, "too little is known today about the impact of a Medicare premium support program on patient access to care." She added, "It’s concerning that with such little information that risky decisions would be made to transition away from the current guaranteed benefit structure."

Instead, the ACP proposes testing such a system. The College also said that the Medicare eligibility age should not be raised unless affordable, comprehensive insurance is made available to those who would now have to wait.

"Advancing the Medicare eligibility age could result in tens of millions of seniors having no access to affordable coverage from age 65 to 67, adding to the ranks of the uninsured," Mr. Doherty said.

The organization recommended that Congress instead give Medicare the authority to redesign benefits, coverage, and cost-sharing so that high-value services are rewarded and lower-value services – which might be not only inappropriate but also harmful – be given less coverage or lower reimbursement.

The ACP waded into somewhat controversial waters by urging Medicare to cover advance planning for patients with terminal illnesses. Payment for the voluntary discussions was included in the Affordable Care Act, but after Republicans said that such counseling might lead to rationing of care – or "death panels" – the Obama administration retracted a rule defining the benefit.

"Voluntary advance care planning should be covered and reimbursed by Medicare to encourage patient-physician engagement and ensure that patients are informed of their palliative and hospice care options," Mr. Doherty said.

Finally, the ACP urged an overhaul of the authority of the Independent Payment Advisory Board. Congress should have the right to approve or disapprove of the IPAB’s recommendations "by a simple majority," according to the policy paper.

Overall, "I do believe that the politicians have to show some leadership," said Mr. Doherty. Both parties need to talk responsibly "about the challenges to sustaining Medicare," and not just talk of "ending Medicare as we know it," he added. Because, he said, "Medicare as we know it is not sustainable. It’s going to have to change."

In a poll of senior citizens released April 23, a majority reported that their physicians were not offering recommended evidence-based services such as asking about recent falls or seeking to verify medications being taken.

The poll of 1,028 Americans aged 65 years and older, conducted by Lake Research Partners for the John A. Hartford Foundation, took place in late February and early March and has a margin of error of plus or minus 3.1 percentage points. Among other questions, the respondents were asked if their physicians had offered seven basic services that are typical of good geriatric care, Chris Langston, Ph.D., a program director at the foundation, said in a press briefing.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Chris Langston said.

The vast majority of those surveyed – 93% – said that they saw their primary care physician regularly. Among the respondents, 82% had one to nine physician visits annually, with half reporting three to nine visits per year. Ninety-six percent said they were completely or somewhat satisfied with their care.

And yet, only 7% of respondents said they’d received all seven services generally considered to be good care. Just over half had received none or only one.

In addition to assessing the risk for falling and reviewing medications, seniors were asked whether their physicians told them how to avoid falling, screened them for depression, provided referrals to community-based health resources, discussed their ability to perform routine daily activities such as shopping, and determined whether they needed help with personal tasks such as showering.

The results of the poll are "extremely interesting and confirmatory of other work looking at doctors’ actual practice," said Dr. Rosanne Leipzig, a professor of geriatrics and palliative medicine at Mount Sinai School of Medicine, New York.

Of particular concern, she said, was the finding that a third of those surveyed said that a physician had not sat down with them to review all their medications and supplements. A huge number of adverse events result from medication errors and misadventures, especially among older patients. These "data are very compelling in identifying a problem that is real," she said in the briefing.

About a third of patients said their physicians had asked them in the last year whether they’d had a fall, or if they were having any depression or other mood issue. A fifth or less said they had been asked if they had problems with activities of daily living, or that their physicians had referred them to nonmedical help in the community. Only 19% said their doctors had discussed fall prevention with them in the past year.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Langston said.

When the data were broken out by various age cohorts, the results were not much different, even for older, and, theoretically, more frail people over age 80, said Tresa Undem of Lake Research Partners, a research firm. For instance, 75% of those over 80 said fall prevention had not been discussed in the last year.

Many seniors were not aware that they were eligible for an annual Medicare wellness visit, in which the physician discusses various aspects of care and offers many of the seven services. It is entirely free for the beneficiary and pays four to five times the regular Medicare physician office rate. Fifty-four percent of seniors said they had not heard of it and 72% said they had not received such a visit in the previous year.

Seniors might be confused about the benefit, however, as Medicare shows higher uptake rates than reflected in the poll, said Ms. Undem.

The poll also asked the seniors if they thought they would receive better care if physicians and nurses had more training in geriatrics. Two-thirds said yes. Most also supported a requirement for geriatrics training in nursing and medical school.

Dr. Leipzig noted that it’s difficult to convince physicians to go into geriatrics. Only about 300 physicians train in the field each year. She said that other physicians should receive specialty instruction in geriatrics to help alleviate the shortage.

But given the time intensity of caring for older Americans – and the low level of reimbursement – it will be an uphill battle, she said. The typical $45 office visit fee "doesn’t even come close to allowing someone to make a living," she said.

The Hartford Foundation is a private, nonprofit philanthropy focused on health care needs of older Americans.

In a poll of senior citizens released April 23, a majority reported that their physicians were not offering recommended evidence-based services such as asking about recent falls or seeking to verify medications being taken.

The poll of 1,028 Americans aged 65 years and older, conducted by Lake Research Partners for the John A. Hartford Foundation, took place in late February and early March and has a margin of error of plus or minus 3.1 percentage points. Among other questions, the respondents were asked if their physicians had offered seven basic services that are typical of good geriatric care, Chris Langston, Ph.D., a program director at the foundation, said in a press briefing.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Chris Langston said.

The vast majority of those surveyed – 93% – said that they saw their primary care physician regularly. Among the respondents, 82% had one to nine physician visits annually, with half reporting three to nine visits per year. Ninety-six percent said they were completely or somewhat satisfied with their care.

And yet, only 7% of respondents said they’d received all seven services generally considered to be good care. Just over half had received none or only one.

In addition to assessing the risk for falling and reviewing medications, seniors were asked whether their physicians told them how to avoid falling, screened them for depression, provided referrals to community-based health resources, discussed their ability to perform routine daily activities such as shopping, and determined whether they needed help with personal tasks such as showering.

The results of the poll are "extremely interesting and confirmatory of other work looking at doctors’ actual practice," said Dr. Rosanne Leipzig, a professor of geriatrics and palliative medicine at Mount Sinai School of Medicine, New York.

Of particular concern, she said, was the finding that a third of those surveyed said that a physician had not sat down with them to review all their medications and supplements. A huge number of adverse events result from medication errors and misadventures, especially among older patients. These "data are very compelling in identifying a problem that is real," she said in the briefing.

About a third of patients said their physicians had asked them in the last year whether they’d had a fall, or if they were having any depression or other mood issue. A fifth or less said they had been asked if they had problems with activities of daily living, or that their physicians had referred them to nonmedical help in the community. Only 19% said their doctors had discussed fall prevention with them in the past year.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Langston said.

When the data were broken out by various age cohorts, the results were not much different, even for older, and, theoretically, more frail people over age 80, said Tresa Undem of Lake Research Partners, a research firm. For instance, 75% of those over 80 said fall prevention had not been discussed in the last year.

Many seniors were not aware that they were eligible for an annual Medicare wellness visit, in which the physician discusses various aspects of care and offers many of the seven services. It is entirely free for the beneficiary and pays four to five times the regular Medicare physician office rate. Fifty-four percent of seniors said they had not heard of it and 72% said they had not received such a visit in the previous year.

Seniors might be confused about the benefit, however, as Medicare shows higher uptake rates than reflected in the poll, said Ms. Undem.

The poll also asked the seniors if they thought they would receive better care if physicians and nurses had more training in geriatrics. Two-thirds said yes. Most also supported a requirement for geriatrics training in nursing and medical school.

Dr. Leipzig noted that it’s difficult to convince physicians to go into geriatrics. Only about 300 physicians train in the field each year. She said that other physicians should receive specialty instruction in geriatrics to help alleviate the shortage.

But given the time intensity of caring for older Americans – and the low level of reimbursement – it will be an uphill battle, she said. The typical $45 office visit fee "doesn’t even come close to allowing someone to make a living," she said.

The Hartford Foundation is a private, nonprofit philanthropy focused on health care needs of older Americans.

In a poll of senior citizens released April 23, a majority reported that their physicians were not offering recommended evidence-based services such as asking about recent falls or seeking to verify medications being taken.

The poll of 1,028 Americans aged 65 years and older, conducted by Lake Research Partners for the John A. Hartford Foundation, took place in late February and early March and has a margin of error of plus or minus 3.1 percentage points. Among other questions, the respondents were asked if their physicians had offered seven basic services that are typical of good geriatric care, Chris Langston, Ph.D., a program director at the foundation, said in a press briefing.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Chris Langston said.

The vast majority of those surveyed – 93% – said that they saw their primary care physician regularly. Among the respondents, 82% had one to nine physician visits annually, with half reporting three to nine visits per year. Ninety-six percent said they were completely or somewhat satisfied with their care.

And yet, only 7% of respondents said they’d received all seven services generally considered to be good care. Just over half had received none or only one.

In addition to assessing the risk for falling and reviewing medications, seniors were asked whether their physicians told them how to avoid falling, screened them for depression, provided referrals to community-based health resources, discussed their ability to perform routine daily activities such as shopping, and determined whether they needed help with personal tasks such as showering.

The results of the poll are "extremely interesting and confirmatory of other work looking at doctors’ actual practice," said Dr. Rosanne Leipzig, a professor of geriatrics and palliative medicine at Mount Sinai School of Medicine, New York.

Of particular concern, she said, was the finding that a third of those surveyed said that a physician had not sat down with them to review all their medications and supplements. A huge number of adverse events result from medication errors and misadventures, especially among older patients. These "data are very compelling in identifying a problem that is real," she said in the briefing.

About a third of patients said their physicians had asked them in the last year whether they’d had a fall, or if they were having any depression or other mood issue. A fifth or less said they had been asked if they had problems with activities of daily living, or that their physicians had referred them to nonmedical help in the community. Only 19% said their doctors had discussed fall prevention with them in the past year.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Langston said.

When the data were broken out by various age cohorts, the results were not much different, even for older, and, theoretically, more frail people over age 80, said Tresa Undem of Lake Research Partners, a research firm. For instance, 75% of those over 80 said fall prevention had not been discussed in the last year.

Many seniors were not aware that they were eligible for an annual Medicare wellness visit, in which the physician discusses various aspects of care and offers many of the seven services. It is entirely free for the beneficiary and pays four to five times the regular Medicare physician office rate. Fifty-four percent of seniors said they had not heard of it and 72% said they had not received such a visit in the previous year.

Seniors might be confused about the benefit, however, as Medicare shows higher uptake rates than reflected in the poll, said Ms. Undem.

The poll also asked the seniors if they thought they would receive better care if physicians and nurses had more training in geriatrics. Two-thirds said yes. Most also supported a requirement for geriatrics training in nursing and medical school.

Dr. Leipzig noted that it’s difficult to convince physicians to go into geriatrics. Only about 300 physicians train in the field each year. She said that other physicians should receive specialty instruction in geriatrics to help alleviate the shortage.

But given the time intensity of caring for older Americans – and the low level of reimbursement – it will be an uphill battle, she said. The typical $45 office visit fee "doesn’t even come close to allowing someone to make a living," she said.

The Hartford Foundation is a private, nonprofit philanthropy focused on health care needs of older Americans.

NEW ORLEANS – The American College of Physicians has joined with Consumer Reports to create a series of guidelines designed to help consumers understand the risks and benefits – and costs – of diagnostic tests and therapies.

The collaboration is an extension of the ACP’s High Value, Cost-Conscious Care Initiative, Dr. Steven Weinberger, executive vice president and CEO of the ACP, said at a press briefing announcing the collaboration.

"Patients are clearly one of the audiences for our High Value, Cost-Conscious Care campaign and it is therefore important to have the appropriate vehicle to get information to them, and Consumer Reports is an absolutely wonderful opportunity for us," said Dr. Weinberger.

According to Consumer Reports vice president and editorial director Kevin McKean, the publication is one of the ten biggest magazines in America, with 4 million paying customers every month, and is the largest paid-content website in the world with 3.5 million online subscribers.

Everything Consumer Reports disseminates to the public will be based on the ACP’s evidence-based clinical practice guidelines. Those guidelines go through rigorous and multiple layers of review, and are published in the Annals of Internal Medicine.

The first two reports for the public will be "Imaging tests for lower-back pain," and "Choosing a type 2 diabetes drug." The back pain report is based on the ACP guidelines published April 17, 2012, in the Annals of Internal Medicine (2011;154:181-9).

As noted in the ACP guidelines, the two-page paper that is scheduled to appear in Consumer Reports recommends against immediately seeking imaging procedures for most acute-onset back pain. The report outlines some cases in which imaging might be warranted, and suggests approaches for treating back pain in the first few weeks after onset.

The two-page diabetes report for consumers makes the argument that metformin is often the best and most cost-effective drug. It also makes suggestions for managing diabetes through lifestyle changes. That report is based on a clinical practice guideline published Feb. 7, 2012, in the Annals of Internal Medicine (2012;156:218-31).

Both articles include an explanatory box stating that the information provided is to be used in discussion with a health care provider, and that it is not a substitute for professional medical advice.

The partnership with the ACP is "absolutely crucial" to Consumer Reports’ mission to be more focused on health care, Mr. McKean said. The ACP is an impressive partner because of its experience, its focus on evidence-based medicine, and "its willingness to confront the cost issue."

Dr. John Santa, director of the Consumer Reports Health Ratings Center, acknowledged that recommendations to use fewer services may not be immediately embraced by the public. "Consumer perceptions are very strong that more health care is better, [and] that more-expensive health care is better," he said at the briefing.

The guidelines will be easy to understand, and will be produced in Spanish and in low literacy versions, said Dr. Santa. Supporting videos will be posted on the Consumer Reports website. Additionally, all of the information will be available in PDF format, even to nonsubscribers of Consumer Reports. Some of the information may also appear as articles in the print magazine

Consumer Reports also is partnering with a network of organizations, including the AARP, the National Business Group on Health, and the Service Employees International Union, according to Dr. Santa. "Each of those [organizations] has committed over the next 2 or 3 years to distribute to their audience topics they feel are of interest," reaching perhaps another 1 million consumers.

Dr. Weinberger said it was premature to discuss what topics might be covered in future collaborations, or when those consumer guidelines would appear. But ACP’s clinical guidelines committee will select the topics, which could include imaging for headache and the appropriateness of cancer screening.

Dr. Santa said that Consumer Reports was already working on a version of the ACP’s colorectal screening guidelines published March 6, 2012, as a guidance statement (Ann. Intern. Med. 2012;156:378-86).

NEW ORLEANS – The American College of Physicians has joined with Consumer Reports to create a series of guidelines designed to help consumers understand the risks and benefits – and costs – of diagnostic tests and therapies.

The collaboration is an extension of the ACP’s High Value, Cost-Conscious Care Initiative, Dr. Steven Weinberger, executive vice president and CEO of the ACP, said at a press briefing announcing the collaboration.

"Patients are clearly one of the audiences for our High Value, Cost-Conscious Care campaign and it is therefore important to have the appropriate vehicle to get information to them, and Consumer Reports is an absolutely wonderful opportunity for us," said Dr. Weinberger.

According to Consumer Reports vice president and editorial director Kevin McKean, the publication is one of the ten biggest magazines in America, with 4 million paying customers every month, and is the largest paid-content website in the world with 3.5 million online subscribers.

Everything Consumer Reports disseminates to the public will be based on the ACP’s evidence-based clinical practice guidelines. Those guidelines go through rigorous and multiple layers of review, and are published in the Annals of Internal Medicine.

The first two reports for the public will be "Imaging tests for lower-back pain," and "Choosing a type 2 diabetes drug." The back pain report is based on the ACP guidelines published April 17, 2012, in the Annals of Internal Medicine (2011;154:181-9).

As noted in the ACP guidelines, the two-page paper that is scheduled to appear in Consumer Reports recommends against immediately seeking imaging procedures for most acute-onset back pain. The report outlines some cases in which imaging might be warranted, and suggests approaches for treating back pain in the first few weeks after onset.

The two-page diabetes report for consumers makes the argument that metformin is often the best and most cost-effective drug. It also makes suggestions for managing diabetes through lifestyle changes. That report is based on a clinical practice guideline published Feb. 7, 2012, in the Annals of Internal Medicine (2012;156:218-31).

Both articles include an explanatory box stating that the information provided is to be used in discussion with a health care provider, and that it is not a substitute for professional medical advice.

The partnership with the ACP is "absolutely crucial" to Consumer Reports’ mission to be more focused on health care, Mr. McKean said. The ACP is an impressive partner because of its experience, its focus on evidence-based medicine, and "its willingness to confront the cost issue."

Dr. John Santa, director of the Consumer Reports Health Ratings Center, acknowledged that recommendations to use fewer services may not be immediately embraced by the public. "Consumer perceptions are very strong that more health care is better, [and] that more-expensive health care is better," he said at the briefing.

The guidelines will be easy to understand, and will be produced in Spanish and in low literacy versions, said Dr. Santa. Supporting videos will be posted on the Consumer Reports website. Additionally, all of the information will be available in PDF format, even to nonsubscribers of Consumer Reports. Some of the information may also appear as articles in the print magazine

Consumer Reports also is partnering with a network of organizations, including the AARP, the National Business Group on Health, and the Service Employees International Union, according to Dr. Santa. "Each of those [organizations] has committed over the next 2 or 3 years to distribute to their audience topics they feel are of interest," reaching perhaps another 1 million consumers.

Dr. Weinberger said it was premature to discuss what topics might be covered in future collaborations, or when those consumer guidelines would appear. But ACP’s clinical guidelines committee will select the topics, which could include imaging for headache and the appropriateness of cancer screening.

Dr. Santa said that Consumer Reports was already working on a version of the ACP’s colorectal screening guidelines published March 6, 2012, as a guidance statement (Ann. Intern. Med. 2012;156:378-86).

NEW ORLEANS – The American College of Physicians has joined with Consumer Reports to create a series of guidelines designed to help consumers understand the risks and benefits – and costs – of diagnostic tests and therapies.

The collaboration is an extension of the ACP’s High Value, Cost-Conscious Care Initiative, Dr. Steven Weinberger, executive vice president and CEO of the ACP, said at a press briefing announcing the collaboration.

"Patients are clearly one of the audiences for our High Value, Cost-Conscious Care campaign and it is therefore important to have the appropriate vehicle to get information to them, and Consumer Reports is an absolutely wonderful opportunity for us," said Dr. Weinberger.

According to Consumer Reports vice president and editorial director Kevin McKean, the publication is one of the ten biggest magazines in America, with 4 million paying customers every month, and is the largest paid-content website in the world with 3.5 million online subscribers.

Everything Consumer Reports disseminates to the public will be based on the ACP’s evidence-based clinical practice guidelines. Those guidelines go through rigorous and multiple layers of review, and are published in the Annals of Internal Medicine.

The first two reports for the public will be "Imaging tests for lower-back pain," and "Choosing a type 2 diabetes drug." The back pain report is based on the ACP guidelines published April 17, 2012, in the Annals of Internal Medicine (2011;154:181-9).

As noted in the ACP guidelines, the two-page paper that is scheduled to appear in Consumer Reports recommends against immediately seeking imaging procedures for most acute-onset back pain. The report outlines some cases in which imaging might be warranted, and suggests approaches for treating back pain in the first few weeks after onset.

The two-page diabetes report for consumers makes the argument that metformin is often the best and most cost-effective drug. It also makes suggestions for managing diabetes through lifestyle changes. That report is based on a clinical practice guideline published Feb. 7, 2012, in the Annals of Internal Medicine (2012;156:218-31).

Both articles include an explanatory box stating that the information provided is to be used in discussion with a health care provider, and that it is not a substitute for professional medical advice.

The partnership with the ACP is "absolutely crucial" to Consumer Reports’ mission to be more focused on health care, Mr. McKean said. The ACP is an impressive partner because of its experience, its focus on evidence-based medicine, and "its willingness to confront the cost issue."

Dr. John Santa, director of the Consumer Reports Health Ratings Center, acknowledged that recommendations to use fewer services may not be immediately embraced by the public. "Consumer perceptions are very strong that more health care is better, [and] that more-expensive health care is better," he said at the briefing.

The guidelines will be easy to understand, and will be produced in Spanish and in low literacy versions, said Dr. Santa. Supporting videos will be posted on the Consumer Reports website. Additionally, all of the information will be available in PDF format, even to nonsubscribers of Consumer Reports. Some of the information may also appear as articles in the print magazine

Consumer Reports also is partnering with a network of organizations, including the AARP, the National Business Group on Health, and the Service Employees International Union, according to Dr. Santa. "Each of those [organizations] has committed over the next 2 or 3 years to distribute to their audience topics they feel are of interest," reaching perhaps another 1 million consumers.

Dr. Weinberger said it was premature to discuss what topics might be covered in future collaborations, or when those consumer guidelines would appear. But ACP’s clinical guidelines committee will select the topics, which could include imaging for headache and the appropriateness of cancer screening.

Dr. Santa said that Consumer Reports was already working on a version of the ACP’s colorectal screening guidelines published March 6, 2012, as a guidance statement (Ann. Intern. Med. 2012;156:378-86).

The risk of cardiotoxicity is five times higher in breast cancer patients given trastuzumab than in those receiving a standard chemotherapy regimen alone, according to a new systematic review from the Cochrane Collaboration.

The review found that regimens containing trastuzumab (Herceptin) significantly increased congestive heart failure and left ventricular ejection fraction (LVEF) decline, with relative risks of 5.11 and 1.83, respectively, in women with HER2-positive early and locally advanced breast cancer (Cochrane Database Syst. Rev. 2012;4 [doi: 10.1002/14651858.CD006243.pub2]).

However, trastuzumab regimens also significantly increased overall and disease-free survival, with hazard ratios of 0.66 and 0.60, respectively, noted Dr. Lorenzo Moja of the University of Milan and his coauthors. All these results were highly significant, with P values ranging from less than .0008 for risk of LVEF decline to less than .00001 for the others.

In a plain-language summary comparing trastuzumab-containing regimens with standard therapy alone in 1,000 women, the investigators wrote that 33 more women would have their lives prolonged with trastuzumab (933 women vs. 900 women with standard therapy alone). However, about 26 in 1,000 women taking trastuzumab would have serious heart toxicity, which is 21 more than the group treated with standard therapy alone.

Trastuzumab’s cardiotoxic effects have been well known, but the magnitude of the effect reported in the systematic review may be larger than what people have thought, commented Dr. Daniel J. Lenihan, director of clinical research in the cardiovascular medicine division at Vanderbilt University, Nashville, Tenn., in an interview.

And that risk may be even greater in the world outside of clinical studies, said Dr. Melinda Telli of Stanford (Calif.) University. The patients in the studies included in the systematic review were younger, and none had baseline cardiac disease, observed Dr. Telli, also in an interview.

Another issue: In practice, oncologists are offering trastuzumab to women at lower risk for cancer recurrence than those in the trials. Thus, she said, "it’s more likely the risks are underestimated in this Cochrane review."

Although the data in the systematic review were previously published, having them encapsulated – along with a number of scenarios outlining potential risks and benefits in women with different cancer recurrence and cardiac risk factors – is a significant addition to the literature, said Dr. Telli.

Cochrane reviews are known for being thorough and balanced. This review began by looking at about 3,900 studies; after applying exclusion criteria, the list was winnowed down to 35 publications that covered 8 randomized controlled clinical trials enrolling 11,991 women. A little more than 7,000 women were assigned to a trastuzumab-containing arm, and 4,971 women to a regimen without trastuzumab. The median age in the trials was 49 years. Pre- and postmenopausal women were included, but those with metastatic disease or preexisting heart conditions were excluded.

The review concluded that high-risk women with few cardiac risk factors would benefit from trastuzumab, while those at lower risk "must be carefully evaluated," adding, "The oncologist should share the decision with the patient concerning whether and how to start the treatment."

Dr. Lenihan said he was concerned that the potential cardiotoxicity might cause oncologists to steer away from trastuzumab. He is a proponent of a multidisciplinary team that involves a cardiologist at the outset of therapy.

If cardiac effects develop, "the key is not to ignore it, but to pay attention," said Dr. Lenihan, who is also president of the International CardiOncology Society USA/Canada.

Early identification enables rapid treatment, which can stabilize or correct the heart issues, he said. That allows patients to return to their cancer therapy.

Dr. Lenihan and his colleagues at Vanderbilt University are currently conducting a study testing various cardiac biomarkers to detect toxicity during chemotherapy.

It is still unknown, however, whether the cardiotoxicity that develops during therapy is ultimately reversible, or becomes a lifelong issue. While the ejection fraction may recover after withdrawal of trastuzumab, at least one study – the Herceptin Adjuvant (HERA) trial – has shown that some women had long-term loss of heart muscle cells, said Dr. Telli.

"So we know that the heart is taking a hit," she said, adding that the trastuzumab damage is not "some sort of reversible thing."

The key, she said, is for oncologists to weigh the risks and benefits individually in each patient.

A targeted therapy, trastuzumab is approved for treatment of HER2-positive breast cancer and of metastatic HER2-positive adenocarcinoma of the stomach or gastroesophageal junction. About 20% of tumors in women with early breast cancer are HER2-positive.

Dr. Telli reported no conflicts of interest. Dr. Lenihan reported receiving consulting fees from Roche and AstraZeneca and research support from Acorda.

The risk of cardiotoxicity is five times higher in breast cancer patients given trastuzumab than in those receiving a standard chemotherapy regimen alone, according to a new systematic review from the Cochrane Collaboration.

The review found that regimens containing trastuzumab (Herceptin) significantly increased congestive heart failure and left ventricular ejection fraction (LVEF) decline, with relative risks of 5.11 and 1.83, respectively, in women with HER2-positive early and locally advanced breast cancer (Cochrane Database Syst. Rev. 2012;4 [doi: 10.1002/14651858.CD006243.pub2]).

However, trastuzumab regimens also significantly increased overall and disease-free survival, with hazard ratios of 0.66 and 0.60, respectively, noted Dr. Lorenzo Moja of the University of Milan and his coauthors. All these results were highly significant, with P values ranging from less than .0008 for risk of LVEF decline to less than .00001 for the others.

In a plain-language summary comparing trastuzumab-containing regimens with standard therapy alone in 1,000 women, the investigators wrote that 33 more women would have their lives prolonged with trastuzumab (933 women vs. 900 women with standard therapy alone). However, about 26 in 1,000 women taking trastuzumab would have serious heart toxicity, which is 21 more than the group treated with standard therapy alone.

Trastuzumab’s cardiotoxic effects have been well known, but the magnitude of the effect reported in the systematic review may be larger than what people have thought, commented Dr. Daniel J. Lenihan, director of clinical research in the cardiovascular medicine division at Vanderbilt University, Nashville, Tenn., in an interview.

And that risk may be even greater in the world outside of clinical studies, said Dr. Melinda Telli of Stanford (Calif.) University. The patients in the studies included in the systematic review were younger, and none had baseline cardiac disease, observed Dr. Telli, also in an interview.

Another issue: In practice, oncologists are offering trastuzumab to women at lower risk for cancer recurrence than those in the trials. Thus, she said, "it’s more likely the risks are underestimated in this Cochrane review."

Although the data in the systematic review were previously published, having them encapsulated – along with a number of scenarios outlining potential risks and benefits in women with different cancer recurrence and cardiac risk factors – is a significant addition to the literature, said Dr. Telli.

Cochrane reviews are known for being thorough and balanced. This review began by looking at about 3,900 studies; after applying exclusion criteria, the list was winnowed down to 35 publications that covered 8 randomized controlled clinical trials enrolling 11,991 women. A little more than 7,000 women were assigned to a trastuzumab-containing arm, and 4,971 women to a regimen without trastuzumab. The median age in the trials was 49 years. Pre- and postmenopausal women were included, but those with metastatic disease or preexisting heart conditions were excluded.

The review concluded that high-risk women with few cardiac risk factors would benefit from trastuzumab, while those at lower risk "must be carefully evaluated," adding, "The oncologist should share the decision with the patient concerning whether and how to start the treatment."

Dr. Lenihan said he was concerned that the potential cardiotoxicity might cause oncologists to steer away from trastuzumab. He is a proponent of a multidisciplinary team that involves a cardiologist at the outset of therapy.

If cardiac effects develop, "the key is not to ignore it, but to pay attention," said Dr. Lenihan, who is also president of the International CardiOncology Society USA/Canada.

Early identification enables rapid treatment, which can stabilize or correct the heart issues, he said. That allows patients to return to their cancer therapy.

Dr. Lenihan and his colleagues at Vanderbilt University are currently conducting a study testing various cardiac biomarkers to detect toxicity during chemotherapy.

It is still unknown, however, whether the cardiotoxicity that develops during therapy is ultimately reversible, or becomes a lifelong issue. While the ejection fraction may recover after withdrawal of trastuzumab, at least one study – the Herceptin Adjuvant (HERA) trial – has shown that some women had long-term loss of heart muscle cells, said Dr. Telli.

"So we know that the heart is taking a hit," she said, adding that the trastuzumab damage is not "some sort of reversible thing."

The key, she said, is for oncologists to weigh the risks and benefits individually in each patient.

A targeted therapy, trastuzumab is approved for treatment of HER2-positive breast cancer and of metastatic HER2-positive adenocarcinoma of the stomach or gastroesophageal junction. About 20% of tumors in women with early breast cancer are HER2-positive.

Dr. Telli reported no conflicts of interest. Dr. Lenihan reported receiving consulting fees from Roche and AstraZeneca and research support from Acorda.

The risk of cardiotoxicity is five times higher in breast cancer patients given trastuzumab than in those receiving a standard chemotherapy regimen alone, according to a new systematic review from the Cochrane Collaboration.

The review found that regimens containing trastuzumab (Herceptin) significantly increased congestive heart failure and left ventricular ejection fraction (LVEF) decline, with relative risks of 5.11 and 1.83, respectively, in women with HER2-positive early and locally advanced breast cancer (Cochrane Database Syst. Rev. 2012;4 [doi: 10.1002/14651858.CD006243.pub2]).

However, trastuzumab regimens also significantly increased overall and disease-free survival, with hazard ratios of 0.66 and 0.60, respectively, noted Dr. Lorenzo Moja of the University of Milan and his coauthors. All these results were highly significant, with P values ranging from less than .0008 for risk of LVEF decline to less than .00001 for the others.

In a plain-language summary comparing trastuzumab-containing regimens with standard therapy alone in 1,000 women, the investigators wrote that 33 more women would have their lives prolonged with trastuzumab (933 women vs. 900 women with standard therapy alone). However, about 26 in 1,000 women taking trastuzumab would have serious heart toxicity, which is 21 more than the group treated with standard therapy alone.

Trastuzumab’s cardiotoxic effects have been well known, but the magnitude of the effect reported in the systematic review may be larger than what people have thought, commented Dr. Daniel J. Lenihan, director of clinical research in the cardiovascular medicine division at Vanderbilt University, Nashville, Tenn., in an interview.

And that risk may be even greater in the world outside of clinical studies, said Dr. Melinda Telli of Stanford (Calif.) University. The patients in the studies included in the systematic review were younger, and none had baseline cardiac disease, observed Dr. Telli, also in an interview.

Another issue: In practice, oncologists are offering trastuzumab to women at lower risk for cancer recurrence than those in the trials. Thus, she said, "it’s more likely the risks are underestimated in this Cochrane review."

Although the data in the systematic review were previously published, having them encapsulated – along with a number of scenarios outlining potential risks and benefits in women with different cancer recurrence and cardiac risk factors – is a significant addition to the literature, said Dr. Telli.

Cochrane reviews are known for being thorough and balanced. This review began by looking at about 3,900 studies; after applying exclusion criteria, the list was winnowed down to 35 publications that covered 8 randomized controlled clinical trials enrolling 11,991 women. A little more than 7,000 women were assigned to a trastuzumab-containing arm, and 4,971 women to a regimen without trastuzumab. The median age in the trials was 49 years. Pre- and postmenopausal women were included, but those with metastatic disease or preexisting heart conditions were excluded.

The review concluded that high-risk women with few cardiac risk factors would benefit from trastuzumab, while those at lower risk "must be carefully evaluated," adding, "The oncologist should share the decision with the patient concerning whether and how to start the treatment."

Dr. Lenihan said he was concerned that the potential cardiotoxicity might cause oncologists to steer away from trastuzumab. He is a proponent of a multidisciplinary team that involves a cardiologist at the outset of therapy.

If cardiac effects develop, "the key is not to ignore it, but to pay attention," said Dr. Lenihan, who is also president of the International CardiOncology Society USA/Canada.

Early identification enables rapid treatment, which can stabilize or correct the heart issues, he said. That allows patients to return to their cancer therapy.

Dr. Lenihan and his colleagues at Vanderbilt University are currently conducting a study testing various cardiac biomarkers to detect toxicity during chemotherapy.

It is still unknown, however, whether the cardiotoxicity that develops during therapy is ultimately reversible, or becomes a lifelong issue. While the ejection fraction may recover after withdrawal of trastuzumab, at least one study – the Herceptin Adjuvant (HERA) trial – has shown that some women had long-term loss of heart muscle cells, said Dr. Telli.

"So we know that the heart is taking a hit," she said, adding that the trastuzumab damage is not "some sort of reversible thing."

The key, she said, is for oncologists to weigh the risks and benefits individually in each patient.

A targeted therapy, trastuzumab is approved for treatment of HER2-positive breast cancer and of metastatic HER2-positive adenocarcinoma of the stomach or gastroesophageal junction. About 20% of tumors in women with early breast cancer are HER2-positive.

Dr. Telli reported no conflicts of interest. Dr. Lenihan reported receiving consulting fees from Roche and AstraZeneca and research support from Acorda.

A new study finds that chemotherapy for privately insured patients is less expensive in a physician’s office than in an outpatient department at a hospital.

The same analysis, however, found that radiation therapy was more expensive in physician offices when it lasted 3 months or more. Radiation of 1 or 2 months’ duration was less costly when it was delivered in offices.

"Our study documents that chemotherapy treatment in an oncologist’s office costs less than in a hospital regardless of the length of treatment," said Eric Hammelman, a study author, in a statement. "At a time when the health care community is focused on managing costs, these findings show the importance of where care is delivered, and raise important questions about how best to manage cancer treatment," said Mr. Hammelman, who is also a vice president at Avalere Health.

The Community Oncology Alliance (COA), in partnership with the National Association of Managed Care Physicians (NAMCP) Medical Directors Institute, commissioned Avalere to do the study. Avalere analyzed data from three commercial managed care plans and a large self-funded employer. In total, the study analyzed 26,168 episodes of care for 22,204 patients.

Overall, chemotherapy that was delivered in an outpatient hospital setting cost 24% more, on average, than did chemotherapy given in a physician’s office. This was true regardless of the duration of therapy, according to the study, which controlled for age, sex, and prior history of cancer. The study did not control for other factors that might have influenced cost, such as mortality, morbidity, or type of chemotherapeutic used.

The total cost included the amount paid by the insurer and the patient’s copay or coinsurance. On an unadjusted basis, the average cost per episode for office-based therapy was $19,640, compared with $26,300 for hospital-based therapy, a difference of 34%. After applying the risk adjustment model, the difference was less, but the hospital-based therapy still cost 24% more ($35,000 compared with $28,200 for office-based care).

Older patients were more likely to be managed in an office, compared with younger patients. The majority of episodes analyzed (about 80%) were in physician offices. Overall, 11 cancers accounted for more than 90% of the episodes. In decreasing order, they were lung, prostate, genitourinary system, breast, Hodgkin’s/lymphoma, colon, digestive system, leukemia, ovarian, multiple myeloma, and rectal cancers.

Costs varied widely for those cancers, as did the differences between office and hospital treatment. The biggest gap was for genitourinary cancers; the adjusted per-episode cost was $19,592 in the hospital, compared with $8,960 in the office, a 118% difference.

Avalere offered some theories on why hospital costs were so much higher overall for chemotherapy. It found that 14 of every 100 hospital-based episodes had a hospitalization during the episode, compared with 11 of every 100 office-based episodes. There was also variation in hospital and physician office billing practices, said the authors.

For radiation therapy, about half of episodes were delivered in hospital outpatient settings. Older patients were more likely to receive office-based radiation. Again, 11 cancers accounted for the majority of treatment episodes. Breast, prostate, and lung cancers accounted for 57% of the episodes.

Overall, the unadjusted cost was $16,300 for office-based therapy, compared with $16,000 for hospital-based treatment. Treatment duration of less than 1 or 2 months was 7%-17% more expensive in the hospital, but longer episodes were 4% less expensive when they were hospital managed.

After adjustment, office-based therapy overall was $25,100, compared with $23,800 for hospital-based radiation. Again, shorter episodes were more expensive when hospital managed, but longer episodes were less expensive with hospital-based rather than office-based care.

A new study finds that chemotherapy for privately insured patients is less expensive in a physician’s office than in an outpatient department at a hospital.

The same analysis, however, found that radiation therapy was more expensive in physician offices when it lasted 3 months or more. Radiation of 1 or 2 months’ duration was less costly when it was delivered in offices.

"Our study documents that chemotherapy treatment in an oncologist’s office costs less than in a hospital regardless of the length of treatment," said Eric Hammelman, a study author, in a statement. "At a time when the health care community is focused on managing costs, these findings show the importance of where care is delivered, and raise important questions about how best to manage cancer treatment," said Mr. Hammelman, who is also a vice president at Avalere Health.

The Community Oncology Alliance (COA), in partnership with the National Association of Managed Care Physicians (NAMCP) Medical Directors Institute, commissioned Avalere to do the study. Avalere analyzed data from three commercial managed care plans and a large self-funded employer. In total, the study analyzed 26,168 episodes of care for 22,204 patients.

Overall, chemotherapy that was delivered in an outpatient hospital setting cost 24% more, on average, than did chemotherapy given in a physician’s office. This was true regardless of the duration of therapy, according to the study, which controlled for age, sex, and prior history of cancer. The study did not control for other factors that might have influenced cost, such as mortality, morbidity, or type of chemotherapeutic used.

The total cost included the amount paid by the insurer and the patient’s copay or coinsurance. On an unadjusted basis, the average cost per episode for office-based therapy was $19,640, compared with $26,300 for hospital-based therapy, a difference of 34%. After applying the risk adjustment model, the difference was less, but the hospital-based therapy still cost 24% more ($35,000 compared with $28,200 for office-based care).

Older patients were more likely to be managed in an office, compared with younger patients. The majority of episodes analyzed (about 80%) were in physician offices. Overall, 11 cancers accounted for more than 90% of the episodes. In decreasing order, they were lung, prostate, genitourinary system, breast, Hodgkin’s/lymphoma, colon, digestive system, leukemia, ovarian, multiple myeloma, and rectal cancers.

Costs varied widely for those cancers, as did the differences between office and hospital treatment. The biggest gap was for genitourinary cancers; the adjusted per-episode cost was $19,592 in the hospital, compared with $8,960 in the office, a 118% difference.

Avalere offered some theories on why hospital costs were so much higher overall for chemotherapy. It found that 14 of every 100 hospital-based episodes had a hospitalization during the episode, compared with 11 of every 100 office-based episodes. There was also variation in hospital and physician office billing practices, said the authors.

For radiation therapy, about half of episodes were delivered in hospital outpatient settings. Older patients were more likely to receive office-based radiation. Again, 11 cancers accounted for the majority of treatment episodes. Breast, prostate, and lung cancers accounted for 57% of the episodes.

Overall, the unadjusted cost was $16,300 for office-based therapy, compared with $16,000 for hospital-based treatment. Treatment duration of less than 1 or 2 months was 7%-17% more expensive in the hospital, but longer episodes were 4% less expensive when they were hospital managed.

After adjustment, office-based therapy overall was $25,100, compared with $23,800 for hospital-based radiation. Again, shorter episodes were more expensive when hospital managed, but longer episodes were less expensive with hospital-based rather than office-based care.

A new study finds that chemotherapy for privately insured patients is less expensive in a physician’s office than in an outpatient department at a hospital.

The same analysis, however, found that radiation therapy was more expensive in physician offices when it lasted 3 months or more. Radiation of 1 or 2 months’ duration was less costly when it was delivered in offices.

"Our study documents that chemotherapy treatment in an oncologist’s office costs less than in a hospital regardless of the length of treatment," said Eric Hammelman, a study author, in a statement. "At a time when the health care community is focused on managing costs, these findings show the importance of where care is delivered, and raise important questions about how best to manage cancer treatment," said Mr. Hammelman, who is also a vice president at Avalere Health.

The Community Oncology Alliance (COA), in partnership with the National Association of Managed Care Physicians (NAMCP) Medical Directors Institute, commissioned Avalere to do the study. Avalere analyzed data from three commercial managed care plans and a large self-funded employer. In total, the study analyzed 26,168 episodes of care for 22,204 patients.

Overall, chemotherapy that was delivered in an outpatient hospital setting cost 24% more, on average, than did chemotherapy given in a physician’s office. This was true regardless of the duration of therapy, according to the study, which controlled for age, sex, and prior history of cancer. The study did not control for other factors that might have influenced cost, such as mortality, morbidity, or type of chemotherapeutic used.

The total cost included the amount paid by the insurer and the patient’s copay or coinsurance. On an unadjusted basis, the average cost per episode for office-based therapy was $19,640, compared with $26,300 for hospital-based therapy, a difference of 34%. After applying the risk adjustment model, the difference was less, but the hospital-based therapy still cost 24% more ($35,000 compared with $28,200 for office-based care).

Older patients were more likely to be managed in an office, compared with younger patients. The majority of episodes analyzed (about 80%) were in physician offices. Overall, 11 cancers accounted for more than 90% of the episodes. In decreasing order, they were lung, prostate, genitourinary system, breast, Hodgkin’s/lymphoma, colon, digestive system, leukemia, ovarian, multiple myeloma, and rectal cancers.

Costs varied widely for those cancers, as did the differences between office and hospital treatment. The biggest gap was for genitourinary cancers; the adjusted per-episode cost was $19,592 in the hospital, compared with $8,960 in the office, a 118% difference.

Avalere offered some theories on why hospital costs were so much higher overall for chemotherapy. It found that 14 of every 100 hospital-based episodes had a hospitalization during the episode, compared with 11 of every 100 office-based episodes. There was also variation in hospital and physician office billing practices, said the authors.

For radiation therapy, about half of episodes were delivered in hospital outpatient settings. Older patients were more likely to receive office-based radiation. Again, 11 cancers accounted for the majority of treatment episodes. Breast, prostate, and lung cancers accounted for 57% of the episodes.

Overall, the unadjusted cost was $16,300 for office-based therapy, compared with $16,000 for hospital-based treatment. Treatment duration of less than 1 or 2 months was 7%-17% more expensive in the hospital, but longer episodes were 4% less expensive when they were hospital managed.

After adjustment, office-based therapy overall was $25,100, compared with $23,800 for hospital-based radiation. Again, shorter episodes were more expensive when hospital managed, but longer episodes were less expensive with hospital-based rather than office-based care.

Although a growing number of physicians are earning federal payments for reporting quality measures or writing electronic prescriptions, nearly three-quarters of eligible physicians still aren’t taking part in the incentive programs, according to the Centers for Medicare and Medicaid Services.

In 2010, about 269,000 eligible health care professionals participated in the Physician Quality Reporting System (PQRS, formerly known as the Physician Quality Reporting Incentive program), up from 210,000 in 2009 and 153,000 in 2008. That means that 26% of the 1 million eligible professionals participated in 2010, according to CMS payment and reporting data for that year, as well as data from the Electronic Prescribing Incentive Program.

Physicians’ use of registries to report data also increased. In 2010, there were 89 CMS-qualified registries submitting data from 56,000 eligible professionals. Ninety percent of those using a registry received an incentive payment.

The agency paid out $391.6 million in incentives in 2010 for the PQRS. Eligible professionals were able to earn 2% of the CMS’s estimate for allowed charged under Medicare Part B during the reporting period.

Close to 131,000 of the 696,000 eligible professionals participated in the eRx incentive program in 2010, receiving about $271 million. In 2009, only 89,000 participated. As with PQRS, the incentive was equal to 2% of the estimate of allowed charges for service during the reporting period.

Under the PQRS program, the most frequently reported measures included performance of an electrocardiogram in the emergency department; adoption or use of electronic health records; and giving timely and appropriate antibiotics before surgery.

There were big boosts in performance for a number of measures. About 93% of physicians screened diabetics for eye-related complications and then reported it to the patients’ endocrinologist, up from 70% in 2007. Almost 100% of patients with chronic obstructive pulmonary disease were given prescriptions for bronchodilators, up from 78% in 2007.

Although the measures are supposed to make it possible for a broad range of specialties to participate, a large number of measures apply to emergency medicine and family practice. Not surprisingly, emergency physicians had the highest rate of participation, with 65%, or 32,030 of the 49,278 who were eligible, reporting on at least one measure. Almost half of anesthesiologists participated; while 16% of family physicians who were eligible participated (14,778 of 91,533). Internal medicine physicians were close behind, with just over 15% (14,427 of 92,424) participating.

Family medicine and internal medicine specialists were among the largest numbers who participated in a registry to submit data, followed by cardiologists.

Cardiologists had the highest rates and highest numbers of participants in e-prescribing. A total of 35%, or 7,994 of the 22,606 eligible cardiologists, successfully reported on at least 25 unique prescribing events. A total of 26% of family practice physicians and 24% of internists participated, making them the top specialty participants by numbers. But ophthalmology, rheumatology, and urology had higher rates of participation for their specialties.

Beginning in 2015, CMS will cut physician pay by 1.5% for those who do not satisfactorily report data under the PQRS. From 2016 on, payments will be cut by 2%.

The "downward adjustment" is already in effect this year for the e-prescribing program. Professionals who did not meet criteria will have a 1% pay cut in 2012 and a 1.5% cut in 2013. Some, however, will be exempt from the pay cut. More information on becoming exempt is available here.

Although a growing number of physicians are earning federal payments for reporting quality measures or writing electronic prescriptions, nearly three-quarters of eligible physicians still aren’t taking part in the incentive programs, according to the Centers for Medicare and Medicaid Services.

In 2010, about 269,000 eligible health care professionals participated in the Physician Quality Reporting System (PQRS, formerly known as the Physician Quality Reporting Incentive program), up from 210,000 in 2009 and 153,000 in 2008. That means that 26% of the 1 million eligible professionals participated in 2010, according to CMS payment and reporting data for that year, as well as data from the Electronic Prescribing Incentive Program.

Physicians’ use of registries to report data also increased. In 2010, there were 89 CMS-qualified registries submitting data from 56,000 eligible professionals. Ninety percent of those using a registry received an incentive payment.

The agency paid out $391.6 million in incentives in 2010 for the PQRS. Eligible professionals were able to earn 2% of the CMS’s estimate for allowed charged under Medicare Part B during the reporting period.

Close to 131,000 of the 696,000 eligible professionals participated in the eRx incentive program in 2010, receiving about $271 million. In 2009, only 89,000 participated. As with PQRS, the incentive was equal to 2% of the estimate of allowed charges for service during the reporting period.

Under the PQRS program, the most frequently reported measures included performance of an electrocardiogram in the emergency department; adoption or use of electronic health records; and giving timely and appropriate antibiotics before surgery.

There were big boosts in performance for a number of measures. About 93% of physicians screened diabetics for eye-related complications and then reported it to the patients’ endocrinologist, up from 70% in 2007. Almost 100% of patients with chronic obstructive pulmonary disease were given prescriptions for bronchodilators, up from 78% in 2007.

Although the measures are supposed to make it possible for a broad range of specialties to participate, a large number of measures apply to emergency medicine and family practice. Not surprisingly, emergency physicians had the highest rate of participation, with 65%, or 32,030 of the 49,278 who were eligible, reporting on at least one measure. Almost half of anesthesiologists participated; while 16% of family physicians who were eligible participated (14,778 of 91,533). Internal medicine physicians were close behind, with just over 15% (14,427 of 92,424) participating.

Family medicine and internal medicine specialists were among the largest numbers who participated in a registry to submit data, followed by cardiologists.

Cardiologists had the highest rates and highest numbers of participants in e-prescribing. A total of 35%, or 7,994 of the 22,606 eligible cardiologists, successfully reported on at least 25 unique prescribing events. A total of 26% of family practice physicians and 24% of internists participated, making them the top specialty participants by numbers. But ophthalmology, rheumatology, and urology had higher rates of participation for their specialties.

Beginning in 2015, CMS will cut physician pay by 1.5% for those who do not satisfactorily report data under the PQRS. From 2016 on, payments will be cut by 2%.

The "downward adjustment" is already in effect this year for the e-prescribing program. Professionals who did not meet criteria will have a 1% pay cut in 2012 and a 1.5% cut in 2013. Some, however, will be exempt from the pay cut. More information on becoming exempt is available here.

Although a growing number of physicians are earning federal payments for reporting quality measures or writing electronic prescriptions, nearly three-quarters of eligible physicians still aren’t taking part in the incentive programs, according to the Centers for Medicare and Medicaid Services.

In 2010, about 269,000 eligible health care professionals participated in the Physician Quality Reporting System (PQRS, formerly known as the Physician Quality Reporting Incentive program), up from 210,000 in 2009 and 153,000 in 2008. That means that 26% of the 1 million eligible professionals participated in 2010, according to CMS payment and reporting data for that year, as well as data from the Electronic Prescribing Incentive Program.

Physicians’ use of registries to report data also increased. In 2010, there were 89 CMS-qualified registries submitting data from 56,000 eligible professionals. Ninety percent of those using a registry received an incentive payment.

The agency paid out $391.6 million in incentives in 2010 for the PQRS. Eligible professionals were able to earn 2% of the CMS’s estimate for allowed charged under Medicare Part B during the reporting period.

Close to 131,000 of the 696,000 eligible professionals participated in the eRx incentive program in 2010, receiving about $271 million. In 2009, only 89,000 participated. As with PQRS, the incentive was equal to 2% of the estimate of allowed charges for service during the reporting period.

Under the PQRS program, the most frequently reported measures included performance of an electrocardiogram in the emergency department; adoption or use of electronic health records; and giving timely and appropriate antibiotics before surgery.

There were big boosts in performance for a number of measures. About 93% of physicians screened diabetics for eye-related complications and then reported it to the patients’ endocrinologist, up from 70% in 2007. Almost 100% of patients with chronic obstructive pulmonary disease were given prescriptions for bronchodilators, up from 78% in 2007.

Although the measures are supposed to make it possible for a broad range of specialties to participate, a large number of measures apply to emergency medicine and family practice. Not surprisingly, emergency physicians had the highest rate of participation, with 65%, or 32,030 of the 49,278 who were eligible, reporting on at least one measure. Almost half of anesthesiologists participated; while 16% of family physicians who were eligible participated (14,778 of 91,533). Internal medicine physicians were close behind, with just over 15% (14,427 of 92,424) participating.

Family medicine and internal medicine specialists were among the largest numbers who participated in a registry to submit data, followed by cardiologists.

Cardiologists had the highest rates and highest numbers of participants in e-prescribing. A total of 35%, or 7,994 of the 22,606 eligible cardiologists, successfully reported on at least 25 unique prescribing events. A total of 26% of family practice physicians and 24% of internists participated, making them the top specialty participants by numbers. But ophthalmology, rheumatology, and urology had higher rates of participation for their specialties.

Beginning in 2015, CMS will cut physician pay by 1.5% for those who do not satisfactorily report data under the PQRS. From 2016 on, payments will be cut by 2%.

The "downward adjustment" is already in effect this year for the e-prescribing program. Professionals who did not meet criteria will have a 1% pay cut in 2012 and a 1.5% cut in 2013. Some, however, will be exempt from the pay cut. More information on becoming exempt is available here.