Joel B. Finkelstein

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

“Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials. They started taking this seriously,” said Dr. Bruce Siegel, who is director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it serves. “Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken,” said Adventist Healthcare President William Robertson at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.

“A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences,” she said.

Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities.

One of the group's programs, the Community Health Worker/Promotoras Network is made up of respected members of the Hispanic community who provide education and outreach to their peers. Ms. Lemus described promotoras as people who “are always concerned about other people. … They are people with a heart to serve.”

The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.

“I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?” Mr. Barnes said.

Now, thanks to the impetus of Mr. Barnes and the efforts of the mayor and fire chief of Columbus, any resident can stop by a fire house and have their blood sugar checked between 9:00 a.m and 9:00 p.m.

Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.

Though home grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

“Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials. They started taking this seriously,” said Dr. Bruce Siegel, who is director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it serves. “Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken,” said Adventist Healthcare President William Robertson at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.

“A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences,” she said.

Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities.

One of the group's programs, the Community Health Worker/Promotoras Network is made up of respected members of the Hispanic community who provide education and outreach to their peers. Ms. Lemus described promotoras as people who “are always concerned about other people. … They are people with a heart to serve.”

The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.

“I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?” Mr. Barnes said.

Now, thanks to the impetus of Mr. Barnes and the efforts of the mayor and fire chief of Columbus, any resident can stop by a fire house and have their blood sugar checked between 9:00 a.m and 9:00 p.m.

Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.

Though home grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

“Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials. They started taking this seriously,” said Dr. Bruce Siegel, who is director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it serves. “Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken,” said Adventist Healthcare President William Robertson at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.

“A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences,” she said.

Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities.

One of the group's programs, the Community Health Worker/Promotoras Network is made up of respected members of the Hispanic community who provide education and outreach to their peers. Ms. Lemus described promotoras as people who “are always concerned about other people. … They are people with a heart to serve.”

The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.

“I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?” Mr. Barnes said.

Now, thanks to the impetus of Mr. Barnes and the efforts of the mayor and fire chief of Columbus, any resident can stop by a fire house and have their blood sugar checked between 9:00 a.m and 9:00 p.m.

Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.

Though home grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.

WASHINGTON — Physicians may never embrace pay for performance with open arms, but they do need to get in the game.

That was the message delivered by policy experts speaking at the annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance "as something that is coming down the pike, and they're getting ready for that," said Melony Sorbero, Ph.D., a researcher with the RAND Corporation.

In recent interviews that were conducted by RAND as part of the organization's studies of existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

"Hospitals have an organizational framework, staff, and systems to be able to respond to these programs," said Cheryl Damberg, Ph.D., a senior researcher with RAND.

For hospitals, the question about pay-for-performance programs is how many measures are being requested and what the technical requirements are for reporting the data.

For physicians, the problem is a fundamental one: How will they collect the data in the first place?

"Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are," said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while a total of only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one of the efforts targeting physicians. The organization recently completed a study to determine whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

"We want to make sure that the measures that are going into our composites are fair and reliable," said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study of physician ranking looked at the treatment of a single medical condition—hypertension—a focus that was key in formulating the patient survey questions, she said.

The questions that are used to survey patients aren't "the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease," said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly based on the patient surveys, she said.

One lesson of the study may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another lesson may be that it is important for physicians to have a structure within which these performance measures become relevant.

In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

"A lot of what we have learned from hospital systems is transferring over to medical homes. But it is a big challenge," she noted.

"We have … quite a few physicians who are in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections," Dr. Lipner said.

WASHINGTON — Physicians may never embrace pay for performance with open arms, but they do need to get in the game.

That was the message delivered by policy experts speaking at the annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance "as something that is coming down the pike, and they're getting ready for that," said Melony Sorbero, Ph.D., a researcher with the RAND Corporation.

In recent interviews that were conducted by RAND as part of the organization's studies of existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

"Hospitals have an organizational framework, staff, and systems to be able to respond to these programs," said Cheryl Damberg, Ph.D., a senior researcher with RAND.

For hospitals, the question about pay-for-performance programs is how many measures are being requested and what the technical requirements are for reporting the data.

For physicians, the problem is a fundamental one: How will they collect the data in the first place?

"Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are," said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while a total of only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one of the efforts targeting physicians. The organization recently completed a study to determine whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

"We want to make sure that the measures that are going into our composites are fair and reliable," said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study of physician ranking looked at the treatment of a single medical condition—hypertension—a focus that was key in formulating the patient survey questions, she said.

The questions that are used to survey patients aren't "the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease," said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly based on the patient surveys, she said.

One lesson of the study may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another lesson may be that it is important for physicians to have a structure within which these performance measures become relevant.

In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

"A lot of what we have learned from hospital systems is transferring over to medical homes. But it is a big challenge," she noted.

"We have … quite a few physicians who are in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections," Dr. Lipner said.

WASHINGTON — Physicians may never embrace pay for performance with open arms, but they do need to get in the game.

That was the message delivered by policy experts speaking at the annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance "as something that is coming down the pike, and they're getting ready for that," said Melony Sorbero, Ph.D., a researcher with the RAND Corporation.

In recent interviews that were conducted by RAND as part of the organization's studies of existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

"Hospitals have an organizational framework, staff, and systems to be able to respond to these programs," said Cheryl Damberg, Ph.D., a senior researcher with RAND.

For hospitals, the question about pay-for-performance programs is how many measures are being requested and what the technical requirements are for reporting the data.

For physicians, the problem is a fundamental one: How will they collect the data in the first place?

"Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are," said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while a total of only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one of the efforts targeting physicians. The organization recently completed a study to determine whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

"We want to make sure that the measures that are going into our composites are fair and reliable," said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study of physician ranking looked at the treatment of a single medical condition—hypertension—a focus that was key in formulating the patient survey questions, she said.

The questions that are used to survey patients aren't "the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease," said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly based on the patient surveys, she said.

One lesson of the study may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another lesson may be that it is important for physicians to have a structure within which these performance measures become relevant.

In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

"A lot of what we have learned from hospital systems is transferring over to medical homes. But it is a big challenge," she noted.

"We have … quite a few physicians who are in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections," Dr. Lipner said.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

“Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously,” said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it serves. “Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken,” said Adventist Healthcare President William Robertson at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues. While understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities.

One of the group's programs, the Community Health Worker/Promotoras Network is made up of respected members of the Hispanic community who provide education and outreach to their peers. The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's high diabetes rates.

“I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?” Mr. Barnes said. Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, residents can stop by a fire house and have their blood sugar checked between 9 a.m and 9 p.m.

Officials in San Antonio, Tex., took similar steps to ensure widely needed services are readily available when they set up a twice weekly immunization clinic at Goodwill stores. The program was so successful that immunizations are now available 5 days a week. Though home grown, these strategies can be adapted to other communities, as well, according to Ms. Lemus.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

“Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously,” said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it serves. “Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken,” said Adventist Healthcare President William Robertson at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues. While understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities.

One of the group's programs, the Community Health Worker/Promotoras Network is made up of respected members of the Hispanic community who provide education and outreach to their peers. The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's high diabetes rates.

“I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?” Mr. Barnes said. Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, residents can stop by a fire house and have their blood sugar checked between 9 a.m and 9 p.m.

Officials in San Antonio, Tex., took similar steps to ensure widely needed services are readily available when they set up a twice weekly immunization clinic at Goodwill stores. The program was so successful that immunizations are now available 5 days a week. Though home grown, these strategies can be adapted to other communities, as well, according to Ms. Lemus.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

“Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously,” said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it serves. “Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken,” said Adventist Healthcare President William Robertson at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues. While understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities.

One of the group's programs, the Community Health Worker/Promotoras Network is made up of respected members of the Hispanic community who provide education and outreach to their peers. The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's high diabetes rates.

“I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?” Mr. Barnes said. Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, residents can stop by a fire house and have their blood sugar checked between 9 a.m and 9 p.m.

Officials in San Antonio, Tex., took similar steps to ensure widely needed services are readily available when they set up a twice weekly immunization clinic at Goodwill stores. The program was so successful that immunizations are now available 5 days a week. Though home grown, these strategies can be adapted to other communities, as well, according to Ms. Lemus.

WASHINGTON — A panel of Medicare advisors warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative was created under a provision of 2006 tax relief and offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI, although about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

“We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies,” Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. “The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting.”

Dr. Straube announced at the meeting that the CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members.

“I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site,” said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M. “It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications.” A solo practitioner, Dr. Smith said she spent 1–2 hours a week trying to comply with the reporting requirement only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that the CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public.

“If you are going to put [those] data up there, you need to advise the physician community, with ample notice,” Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public. “I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable.”

WASHINGTON — A panel of Medicare advisors warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative was created under a provision of 2006 tax relief and offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI, although about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

“We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies,” Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. “The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting.”

Dr. Straube announced at the meeting that the CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members.

“I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site,” said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M. “It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications.” A solo practitioner, Dr. Smith said she spent 1–2 hours a week trying to comply with the reporting requirement only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that the CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public.

“If you are going to put [those] data up there, you need to advise the physician community, with ample notice,” Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public. “I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable.”

WASHINGTON — A panel of Medicare advisors warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative was created under a provision of 2006 tax relief and offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI, although about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

“We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies,” Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. “The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting.”

Dr. Straube announced at the meeting that the CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members.

“I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site,” said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M. “It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications.” A solo practitioner, Dr. Smith said she spent 1–2 hours a week trying to comply with the reporting requirement only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that the CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public.

“If you are going to put [those] data up there, you need to advise the physician community, with ample notice,” Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public. “I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable.”

WASHINGTON — Physicians may never embrace pay for performance with open arms, but they need to get in the game. That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the RAND Corporation.

In recent interviews conducted by RAND as part of studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior researcher with RAND.

For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?

“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.

The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.

One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.

WASHINGTON — Physicians may never embrace pay for performance with open arms, but they need to get in the game. That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the RAND Corporation.

In recent interviews conducted by RAND as part of studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior researcher with RAND.

For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?

“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.

The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.

One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.

WASHINGTON — Physicians may never embrace pay for performance with open arms, but they need to get in the game. That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the RAND Corporation.

In recent interviews conducted by RAND as part of studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior researcher with RAND.

For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?

“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.

The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.

One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.

WASHINGTON – Physicians may never embrace pay for performance with open arms, but they do need to get in the game.

That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the Rand Corporation.

In recent interviews conducted by Rand for studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior Rand researcher.

For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?

“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.

The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.

One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.

WASHINGTON – Physicians may never embrace pay for performance with open arms, but they do need to get in the game.

That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the Rand Corporation.

In recent interviews conducted by Rand for studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior Rand researcher.

For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?

“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.

The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.

One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.

WASHINGTON – Physicians may never embrace pay for performance with open arms, but they do need to get in the game.

That was the message delivered by policy experts speaking at meeting of annual research meeting of AcademyHealth.

Hospitals have viewed pay for performance “as something that is coming down the pike, and they're getting ready for that,” said Melony Sorbero, Ph.D., a researcher with the Rand Corporation.

In recent interviews conducted by Rand for studies on existing pay-for-performance programs, hospital staff expressed much less resistance than did physicians.

“Hospitals have an organizational framework, staff, and systems to be able to respond to these programs,” said Cheryl Damberg, Ph.D., a senior Rand researcher.

For hospitals, the question is how many measures are being requested and what the technical requirements are for reporting the data. For physicians, the problem is a fundamental: How will they collect the data in the first place?

“Physicians for the most part lack the infrastructure. Their data systems aren't anywhere near what hospital data systems are,” said Dr. Damberg.

However, physicians do have opportunities to get involved with the development of pay-for-performance measures. There are hundreds of pay-for-performance experiments currently engaging physicians, while only about 40 programs are aimed at hospitals, said Dr. Sorbero.

The American Board of Internal Medicine is behind one such effort targeting physicians. The organization recently completed a study to see whether physicians can be ranked based on a combination of chart reviews, patient surveys, and practice system surveys. They assessed the consistency of those data individually and together.

“We want to make sure that the measures that are going into our composites are fair and reliable,” said Rebecca Lipner, Ph.D., vice president of psychometrics and research analysis at ABIM.

The study looked solely at the treatment of hypertension, a focus that was key in formulating the patient survey questions, she said.

The questions aren't “the general 'do you like your physician?' or 'do you get good access to care?' They're all about how does the physician give care for your specific disease,” said Dr. Lipner.

However, ABIM found that there was wide variation across the sets of measures and, depending on how they were combined, an individual physician's rank could swing by more than three quartiles. For example, a physician could do well based on his chart and systems data, but do poorly on the patient surveys, she said.

One lesson may be that devising a reliable measure of physician performance is not a simple thing to do, Dr. Damberg suggested.

Another may be that physicians need a structure within which these measures become relevant. In that sense, medical homes can be seen as an attempt to give a framework to practice settings outside the hospital, said Dr. Lipner.

“A lot of what we have learned from the hospitals systems is transferring over to that medical home. But it is a big challenge. We have… quite a few physicians in solo practice. They are really by themselves, and we always underestimate how many physicians are working by themselves without an infrastructure, without peer connections,” she said.

WASHINGTON — A panel of Medicare advisers warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative, created under a provision of 2006 tax relief, offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI; about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

“We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies,” Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. “The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting.”

Dr. Straube announced at the meeting that CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members.

“I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site,” said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M.

“It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications,” Dr. Smith said. A solo practitioner, she said she spent 1–2 hours a week trying to comply with the reporting requirements, only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public.

“If you are going to put [those] data up there, you need to advise the physician community, with ample notice,” Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public.

“I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable,” he said.

WASHINGTON — A panel of Medicare advisers warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative, created under a provision of 2006 tax relief, offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI; about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

“We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies,” Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. “The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting.”

Dr. Straube announced at the meeting that CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members.

“I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site,” said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M.

“It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications,” Dr. Smith said. A solo practitioner, she said she spent 1–2 hours a week trying to comply with the reporting requirements, only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public.

“If you are going to put [those] data up there, you need to advise the physician community, with ample notice,” Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public.

“I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable,” he said.

WASHINGTON — A panel of Medicare advisers warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative, created under a provision of 2006 tax relief, offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI; about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

“We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies,” Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. “The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting.”

Dr. Straube announced at the meeting that CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members.

“I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site,” said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M.

“It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications,” Dr. Smith said. A solo practitioner, she said she spent 1–2 hours a week trying to comply with the reporting requirements, only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public.

“If you are going to put [those] data up there, you need to advise the physician community, with ample notice,” Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public.

“I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable,” he said.

WASHINGTON — A panel of Medicare advisers warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative was created under a provision of 2006 tax relief and offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI, although about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

"We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies," Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. "The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting."

Dr. Straube announced at the meeting that the CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members. "I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site," said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M.

"It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications," said Dr. Smith. A solo practitioner, Dr. Smith said that she spent 1-2 hours a week trying to comply with the reporting requirement only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that the CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public. "If you are going to put [those] data up there, you need to advise the physician community, with ample notice," Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public. "I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable," he said.

WASHINGTON — A panel of Medicare advisers warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative was created under a provision of 2006 tax relief and offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI, although about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

"We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies," Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. "The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting."

Dr. Straube announced at the meeting that the CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members. "I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site," said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M.

"It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications," said Dr. Smith. A solo practitioner, Dr. Smith said that she spent 1-2 hours a week trying to comply with the reporting requirement only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that the CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public. "If you are going to put [those] data up there, you need to advise the physician community, with ample notice," Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public. "I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable," he said.

WASHINGTON — A panel of Medicare advisers warned agency officials against moving forward with a proposal to make public a list of doctors participating in a voluntary federal quality reporting effort.

The Physician Quality Reporting Initiative was created under a provision of 2006 tax relief and offers physicians a 1.5% Medicare bonus for sending data on several quality measures to the Centers for Medicare and Medicaid Services. So far, about 16% of Medicare participating physicians have elected to participate in PQRI, although about half of those who are not participating see fewer than 50 Medicare patients a year, according to agency officials.

"We have had in place for a number of years public reporting of quality information and now cost information for a number of settings, hospitals most prominently, dialysis facilities, nursing homes, and home health agencies," Dr. Barry Straube, CMS chief medical officer, said at a meeting of the Practicing Physicians Advisory Council. "The agency, the [Health and Human Services] department, the White House, [lawmakers], and many consumer advocates and employers would like for us and everyone to start focusing more on physician office public reporting."

Dr. Straube announced at the meeting that the CMS was considering whether to publish the names of physicians who have agreed to participate in the PQRI as well as to indicate whether those physicians were paid the incentive, a proxy for whether they met or exceeded the agency's reporting requirements.

That proposal didn't sit well with several PPAC members. "I'm concerned that you are taking these PQRI data that were presented to the physician community for one reason and now you're taking that information garnered out of that and you're going to put it on a Web site," said Dr. Tye Ouzounian, an orthopedic surgeon in Tarzana, Calif.

Publishing the names of PQRI participants could create a public perception that physicians who are not on the list are not quality providers, he told Dr. Straube.

The perception might be even worse for those physicians who chose to participate, but were not able to fully comply, said Dr. Fredrica Smith, an internist in Los Alamos, N.M.

"It's not that they are not listed as having participated. They are listed as participating and failing, which has horrible implications," said Dr. Smith. A solo practitioner, Dr. Smith said that she spent 1-2 hours a week trying to comply with the reporting requirement only to be left confused by them.

CMS officials told the council that they were applying the reporting requirements flexibly and that they expected most physicians who chose to participate to receive the incentive payment.

Despite such assurances, PPAC recommended that the CMS give physicians and their colleagues enough lead time to consider whether they want to participate in the initiative, knowing their participation will be published, before that information is made available to the public. "If you are going to put [those] data up there, you need to advise the physician community, with ample notice," Dr. Ouzounian said.

Dr. Straube said he understood council members' concerns, but that it was inevitable, given the push for transparency, that such information will some day be made public. "I suspect that this is going to happen sometime in the future. I don't see how the physician office setting will not have some need to be publicly accountable," he said.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

"Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously," said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it found that it serves.

"Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken," said Adventist Healthcare President William Robertson at a meeting that was sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.

"A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences," Ms. Lemus commented.

Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities, she noted.

One of the group's programs, the Community Health Worker/Promotoras Network, comprises respected members of the Hispanic community who provide education and outreach to their peers.

Ms. Lemus described promotoras as people who "are always concerned about other people …. They are people with a heart to serve."

The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.

"I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?" Mr. Barnes said.

Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, any resident can stop by one of the fire houses and have their blood sugar checked between 9:00 a.m and 9:00 p.m.

Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.

Though home-grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

"Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously," said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it found that it serves.

"Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken," said Adventist Healthcare President William Robertson at a meeting that was sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.

"A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences," Ms. Lemus commented.

Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities, she noted.

One of the group's programs, the Community Health Worker/Promotoras Network, comprises respected members of the Hispanic community who provide education and outreach to their peers.

Ms. Lemus described promotoras as people who "are always concerned about other people …. They are people with a heart to serve."

The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.

"I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?" Mr. Barnes said.

Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, any resident can stop by one of the fire houses and have their blood sugar checked between 9:00 a.m and 9:00 p.m.

Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.

Though home-grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.

WASHINGTON — Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.

Often, language is the first component that needs to be addressed.

The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.

The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.

"Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously," said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.

In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it found that it serves.

"Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken," said Adventist Healthcare President William Robertson at a meeting that was sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.

Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.

"A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences," Ms. Lemus commented.

Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities, she noted.

One of the group's programs, the Community Health Worker/Promotoras Network, comprises respected members of the Hispanic community who provide education and outreach to their peers.

Ms. Lemus described promotoras as people who "are always concerned about other people …. They are people with a heart to serve."

The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.

Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.

"I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?" Mr. Barnes said.

Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, any resident can stop by one of the fire houses and have their blood sugar checked between 9:00 a.m and 9:00 p.m.

Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.

Though home-grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate in African Americans and Latinos, but little money and effort have been put into prevention, experts said at the National Minority Quality Forum's 2008 Leadership Summit.

“African Americans and Latinos suffer disproportionately from the HIV/AIDS epidemic,” said Dr. Madeline Sutton, of the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention. She is the latest director of the $45 million effort to expand the use of HIV testing. But that effort, say some in the AIDScommunity, has suffered from revolving leadership, and has so far not had overwhelming impact.

“Test everyone and treat everyone,” said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

The test is relatively inexpensive at about $15, he said. It's a “dream test” that's highly accurate and detects a disease that is lethal if not treated and manageable when it is, yet it's not being used.

And its underuse translates to more transmission. The rate of infection is notably higher in those who don't know they have the disease. In those testing positive, 40% have been infected for 8–10 years, he said at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

For African Americans, it's not clearly genetics or behavior that is leading to the rise in the infection rate, Dr. Sutton said. The CDC's effort is based on better understanding the barriers to testing. “A lot of issues have to do with stigma.”

Latino patients face similar barriers and more, given the stigma fuelled by the immigration debate, said Britt Rios-Ellis, Ph.D., director of the Center for Latino Community Health, Evaluation, and Leadership Training, a partnership between the National Council of La Raza and California State University, Long Beach “They are the only minority group to see a doubling of HIV infection [from] heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. In rural Mexico, most women with AIDS are married. We're seeing the same pattern here. If we could get everyone into testing and care, [it] would make a difference.”

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate in African Americans and Latinos, but little money and effort have been put into prevention, experts said at the National Minority Quality Forum's 2008 Leadership Summit.

“African Americans and Latinos suffer disproportionately from the HIV/AIDS epidemic,” said Dr. Madeline Sutton, of the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention. She is the latest director of the $45 million effort to expand the use of HIV testing. But that effort, say some in the AIDScommunity, has suffered from revolving leadership, and has so far not had overwhelming impact.

“Test everyone and treat everyone,” said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

The test is relatively inexpensive at about $15, he said. It's a “dream test” that's highly accurate and detects a disease that is lethal if not treated and manageable when it is, yet it's not being used.

And its underuse translates to more transmission. The rate of infection is notably higher in those who don't know they have the disease. In those testing positive, 40% have been infected for 8–10 years, he said at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

For African Americans, it's not clearly genetics or behavior that is leading to the rise in the infection rate, Dr. Sutton said. The CDC's effort is based on better understanding the barriers to testing. “A lot of issues have to do with stigma.”

Latino patients face similar barriers and more, given the stigma fuelled by the immigration debate, said Britt Rios-Ellis, Ph.D., director of the Center for Latino Community Health, Evaluation, and Leadership Training, a partnership between the National Council of La Raza and California State University, Long Beach “They are the only minority group to see a doubling of HIV infection [from] heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. In rural Mexico, most women with AIDS are married. We're seeing the same pattern here. If we could get everyone into testing and care, [it] would make a difference.”

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate in African Americans and Latinos, but little money and effort have been put into prevention, experts said at the National Minority Quality Forum's 2008 Leadership Summit.

“African Americans and Latinos suffer disproportionately from the HIV/AIDS epidemic,” said Dr. Madeline Sutton, of the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention. She is the latest director of the $45 million effort to expand the use of HIV testing. But that effort, say some in the AIDScommunity, has suffered from revolving leadership, and has so far not had overwhelming impact.

“Test everyone and treat everyone,” said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

The test is relatively inexpensive at about $15, he said. It's a “dream test” that's highly accurate and detects a disease that is lethal if not treated and manageable when it is, yet it's not being used.

And its underuse translates to more transmission. The rate of infection is notably higher in those who don't know they have the disease. In those testing positive, 40% have been infected for 8–10 years, he said at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

For African Americans, it's not clearly genetics or behavior that is leading to the rise in the infection rate, Dr. Sutton said. The CDC's effort is based on better understanding the barriers to testing. “A lot of issues have to do with stigma.”

Latino patients face similar barriers and more, given the stigma fuelled by the immigration debate, said Britt Rios-Ellis, Ph.D., director of the Center for Latino Community Health, Evaluation, and Leadership Training, a partnership between the National Council of La Raza and California State University, Long Beach “They are the only minority group to see a doubling of HIV infection [from] heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. In rural Mexico, most women with AIDS are married. We're seeing the same pattern here. If we could get everyone into testing and care, [it] would make a difference.”