Joel B. Finkelstein

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate among 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 in this country,” said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

Dr. Sutton is the latest director of the $45 million effort to expand the use of HIV testing; that effort has suffered from revolving leadership, however, and has so far not had overwhelming impact, according to the AIDS community.

“Test everyone and treat everyone. Those are probably the two things we can do right now,” said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

An HIV test costs approximately $15, which is relatively inexpensive, Dr. Bartlett said, pointing out that it is highly accurate and detects a disease that is lethal if not treated and manageable when it is.

It's a “dream test,” yet it's not being used, 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.

That the test is underused translates to more transmission. The rate of infection is four- to fivefold higher among individuals who don't know they have the disease. Currently, 40% of the people who test positive for HIV have had the infection for 8–10 years, he noted.

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said.

In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing, so that they can be addressed. “A lot of issues have to do with stigma and how we get people to the next level,” she said.

Latino patients face the same barriers and more, given the inherent stigma created 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.

“Latinos are the only minority group to see a doubling of HIV infection due to heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. And research in rural Mexico is indicating that most of the women who have AIDS there are married. We're seeing the same pattern here,” she said.

For both Latinos and African Americans, the message is the same: By getting tested and treated, they can do something not only for their families and their communities, but for themselves as well.

“We see that 86% of our [federal] dollars have been spent on biomedical solutions, and those people who are receiving testing and care are doing very, very well. If we could get everyone into testing and care, we know that we would make a difference,” Dr. Rios-Ellis said.

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate among 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 in this country,” said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

Dr. Sutton is the latest director of the $45 million effort to expand the use of HIV testing; that effort has suffered from revolving leadership, however, and has so far not had overwhelming impact, according to the AIDS community.

“Test everyone and treat everyone. Those are probably the two things we can do right now,” said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

An HIV test costs approximately $15, which is relatively inexpensive, Dr. Bartlett said, pointing out that it is highly accurate and detects a disease that is lethal if not treated and manageable when it is.

It's a “dream test,” yet it's not being used, 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.

That the test is underused translates to more transmission. The rate of infection is four- to fivefold higher among individuals who don't know they have the disease. Currently, 40% of the people who test positive for HIV have had the infection for 8–10 years, he noted.

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said.

In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing, so that they can be addressed. “A lot of issues have to do with stigma and how we get people to the next level,” she said.

Latino patients face the same barriers and more, given the inherent stigma created 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.

“Latinos are the only minority group to see a doubling of HIV infection due to heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. And research in rural Mexico is indicating that most of the women who have AIDS there are married. We're seeing the same pattern here,” she said.

For both Latinos and African Americans, the message is the same: By getting tested and treated, they can do something not only for their families and their communities, but for themselves as well.

“We see that 86% of our [federal] dollars have been spent on biomedical solutions, and those people who are receiving testing and care are doing very, very well. If we could get everyone into testing and care, we know that we would make a difference,” Dr. Rios-Ellis said.

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate among 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 in this country,” said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

Dr. Sutton is the latest director of the $45 million effort to expand the use of HIV testing; that effort has suffered from revolving leadership, however, and has so far not had overwhelming impact, according to the AIDS community.

“Test everyone and treat everyone. Those are probably the two things we can do right now,” said Dr. John Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

An HIV test costs approximately $15, which is relatively inexpensive, Dr. Bartlett said, pointing out that it is highly accurate and detects a disease that is lethal if not treated and manageable when it is.

It's a “dream test,” yet it's not being used, 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.

That the test is underused translates to more transmission. The rate of infection is four- to fivefold higher among individuals who don't know they have the disease. Currently, 40% of the people who test positive for HIV have had the infection for 8–10 years, he noted.

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said.

In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing, so that they can be addressed. “A lot of issues have to do with stigma and how we get people to the next level,” she said.

Latino patients face the same barriers and more, given the inherent stigma created 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.

“Latinos are the only minority group to see a doubling of HIV infection due to heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. And research in rural Mexico is indicating that most of the women who have AIDS there are married. We're seeing the same pattern here,” she said.

For both Latinos and African Americans, the message is the same: By getting tested and treated, they can do something not only for their families and their communities, but for themselves as well.

“We see that 86% of our [federal] dollars have been spent on biomedical solutions, and those people who are receiving testing and care are doing very, very well. If we could get everyone into testing and care, we know that we would make a difference,” Dr. Rios-Ellis said.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements.

“The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kans.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members, who complained their staffs have spent hours digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association, and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars' worth of claims.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

Preliminary trends suggest that most of the claims being rejected for having legacy identifiers have the outdated numbers for secondary providers. Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get them off the Web-based registry for the identifiers.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements.

“The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kans.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members, who complained their staffs have spent hours digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association, and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars' worth of claims.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

Preliminary trends suggest that most of the claims being rejected for having legacy identifiers have the outdated numbers for secondary providers. Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get them off the Web-based registry for the identifiers.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements.

“The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kans.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members, who complained their staffs have spent hours digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association, and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars' worth of claims.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

Preliminary trends suggest that most of the claims being rejected for having legacy identifiers have the outdated numbers for secondary providers. Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get them off the Web-based registry for the identifiers.

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,” he said.

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,” he said.

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,” he said.

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 – Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier–despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare.

According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements.

“The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association, and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

WASHINGTON – Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier–despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare.

According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements.

“The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association, and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

WASHINGTON – Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier–despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare.

According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements.

“The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association, and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements. “The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross of Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems. The American Medical Association, the Medical Group Management Association, and the American Hospital Association later delivered a similar message in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

Preliminary trends suggest that most of the claims being rejected for having legacy identifiers have the outdated numbers for secondary providers. Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get it off the Web-based registry for the identifiers. However, there have also been early reports of the network being overwhelmed by demand.

If neither approach works, physicians can put their own NPI in place of the secondary providers to avoid having the claim automatically rejected, according to CMS guidance.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements. “The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross of Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems. The American Medical Association, the Medical Group Management Association, and the American Hospital Association later delivered a similar message in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

Preliminary trends suggest that most of the claims being rejected for having legacy identifiers have the outdated numbers for secondary providers. Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get it off the Web-based registry for the identifiers. However, there have also been early reports of the network being overwhelmed by demand.

If neither approach works, physicians can put their own NPI in place of the secondary providers to avoid having the claim automatically rejected, according to CMS guidance.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their own concerns and tribulations in working toward compliance with the NPI requirements. “The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“We went through about 2 months of rejections and the same situation you heard about before where our cash flow went down to zilch. It's been a major, major headache in our office and they're still trying to get those numbers,” said PPAC member Dr. Jeffrey Ross of Houston.

The physicians made several recommendations to CMS staff, such as delaying the move to NPI-only or, at the very least, closely monitoring implementation for potential problems. The American Medical Association, the Medical Group Management Association, and the American Hospital Association later delivered a similar message in a letter to Health and Human Services Secretary Mike Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the 1 year NPI contingency time frame at this time. Doing so will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, suggesting that as of the end of April, 10% of claims were being submitted without an NPI and close to 70% were carrying a legacy number for a secondary provider, potentially affecting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, there have been few complaints to Medicare so far, according to a Medicare official.

Preliminary trends suggest that most of the claims being rejected for having legacy identifiers have the outdated numbers for secondary providers. Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get it off the Web-based registry for the identifiers. However, there have also been early reports of the network being overwhelmed by demand.

If neither approach works, physicians can put their own NPI in place of the secondary providers to avoid having the claim automatically rejected, according to CMS guidance.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many of them are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their concerns aboutworking toward compliance with the NPI requirements. “The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“It's been a major, major headache,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS, such as delaying the move to NPI-only or at least closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Michael Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the one-year NPI contingency time frame. [It] will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, which suggests that as of the end of April, 10% of claims were being submitted without an NPI, and close to 70% were carrying a legacy number for a secondary provider, potentially impacting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, a Medicare official said there have been few complaints to Medicare so far.

Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get it off the Web-based registry for the identifiers. However, there have also been early reports of the network being overwhelmed by demand.

If neither approach works, physicians can put their own NPI in place of the secondary provider's to avoid having the claim rejected, according to CMS guidance.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many of them are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their concerns aboutworking toward compliance with the NPI requirements. “The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“It's been a major, major headache,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS, such as delaying the move to NPI-only or at least closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Michael Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the one-year NPI contingency time frame. [It] will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, which suggests that as of the end of April, 10% of claims were being submitted without an NPI, and close to 70% were carrying a legacy number for a secondary provider, potentially impacting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, a Medicare official said there have been few complaints to Medicare so far.

Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get it off the Web-based registry for the identifiers. However, there have also been early reports of the network being overwhelmed by demand.

If neither approach works, physicians can put their own NPI in place of the secondary provider's to avoid having the claim rejected, according to CMS guidance.

WASHINGTON — Medicare has stopped accepting claims that contain outdated provider identifying numbers, even if the claims also include a National Provider Identifier, despite concerns voiced by physician groups that many of them are still not ready.

The original deadline for switching to exclusive use of the National Provider Identifier (NPI) was May 23, 2007, but the Centers for Medicare and Medicaid Services gave the medical community another year to prepare. According to the agency's statistics before the deadline, nearly 99% of claims were already being submitted with an NPI. However, a much lower number, about 37%, were being submitted without a legacy number as well.

Just days before the deadline, members of Medicare's Practicing Physicians Advisory Council voiced their concerns aboutworking toward compliance with the NPI requirements. “The potential of claims not being paid looms large,” said Dr. Arthur Snow, a PPAC member and family physician from Shawnee Mission, Kan.

Previous deadlines, such as the March 1 requirement to use an NPI for all primary provider fields, have already created payment backlogs, said several PPAC members who complained they have dedicated hours of staff time to digging up NPI numbers manually because their software has not been updated to meet the new requirements.

“It's been a major, major headache,” said PPAC member Dr. Jeffrey Ross, a physician and podiatrist from Houston.

The physicians made several recommendations to CMS, such as delaying the move to NPI-only or at least closely monitoring implementation for potential problems.

The American Medical Association, the Medical Group Management Association and the American Hospital Association delivered a similar message a couple of days later in a letter to Health and Human Services Secretary Michael Leavitt.

“Although we and our members have worked diligently and invested significant time and resources to comply with the NPI deadline, the health care industry is not well served by terminating the one-year NPI contingency time frame. [It] will only make what has been a complex undertaking, an exceedingly disruptive transition,” the groups wrote.

The letter cites an analysis by Emdeon Business Services, the nation's largest medical claims clearinghouse, which suggests that as of the end of April, 10% of claims were being submitted without an NPI, and close to 70% were carrying a legacy number for a secondary provider, potentially impacting billions of dollars worth of claims for Emdeon alone.

Although it is still too early to know whether the NPI-only policy will lead to delays in reimbursement, a Medicare official said there have been few complaints to Medicare so far.

Medicare has been advising physicians to either contact secondary providers for their NPI numbers or to get it off the Web-based registry for the identifiers. However, there have also been early reports of the network being overwhelmed by demand.

If neither approach works, physicians can put their own NPI in place of the secondary provider's to avoid having the claim rejected, according to CMS guidance.

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate among 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 in this country,” said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

Dr. Sutton is the latest director of the $45 million effort to expand the use of HIV testing; that effort has suffered from revolving leadership, however, and has so far not had overwhelming impact, according to the AIDS community.

“Test everyone and treat everyone. Those are probably the two things we can do right now,” said Dr. John Bartlett, chief of the division of infectious diseases at the Johns Hopkins University, Baltimore.

An HIV test costs approximately $15, which is relatively inexpensive, Dr. Bartlett said, pointing out that it is highly accurate and detects a disease that is lethal if not treated and manageable when it is.

It's a “dream test,” yet it's not being used, 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.

That the test is underused translates to more transmission. The rate of infection is four- to fivefold higher among individuals who don't know they have the disease. Currently, 40% of the people who test positive for HIV have had the infection for 8–10 years, he noted.

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said.

In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing.

“A lot of issues have to do with stigma and how we get people to the next level,” she said.

Latino patients face the same barriers and more, given the inherent stigma created by the immigration debate, said Britt Rios-Ellis, Ph.D., who is 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.

“Latinos are the only minority group to see a doubling of HIV infection due to heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. And research in rural Mexico is indicating that most of the women who have AIDS there are married. We're seeing the same pattern here,” she said.

For both Latinos and African Americans, the message is the same: By getting tested and treated, they can do something not only for their families and their communities, but for themselves as well.

“We see that 86% of our [federal] dollars have been spent on biomedical solutions, and those people who are receiving testing and care are doing very, very well. If we could get everyone into testing and care, we know that we would make a difference,” Dr. Rios-Ellis commented.

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate among 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 in this country,” said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

Dr. Sutton is the latest director of the $45 million effort to expand the use of HIV testing; that effort has suffered from revolving leadership, however, and has so far not had overwhelming impact, according to the AIDS community.

“Test everyone and treat everyone. Those are probably the two things we can do right now,” said Dr. John Bartlett, chief of the division of infectious diseases at the Johns Hopkins University, Baltimore.

An HIV test costs approximately $15, which is relatively inexpensive, Dr. Bartlett said, pointing out that it is highly accurate and detects a disease that is lethal if not treated and manageable when it is.

It's a “dream test,” yet it's not being used, 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.

That the test is underused translates to more transmission. The rate of infection is four- to fivefold higher among individuals who don't know they have the disease. Currently, 40% of the people who test positive for HIV have had the infection for 8–10 years, he noted.

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said.

In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing.

“A lot of issues have to do with stigma and how we get people to the next level,” she said.

Latino patients face the same barriers and more, given the inherent stigma created by the immigration debate, said Britt Rios-Ellis, Ph.D., who is 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.

“Latinos are the only minority group to see a doubling of HIV infection due to heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. And research in rural Mexico is indicating that most of the women who have AIDS there are married. We're seeing the same pattern here,” she said.

For both Latinos and African Americans, the message is the same: By getting tested and treated, they can do something not only for their families and their communities, but for themselves as well.

“We see that 86% of our [federal] dollars have been spent on biomedical solutions, and those people who are receiving testing and care are doing very, very well. If we could get everyone into testing and care, we know that we would make a difference,” Dr. Rios-Ellis commented.

WASHINGTON — Widespread testing would likely blunt the high HIV infection rate among 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 in this country,” said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

Dr. Sutton is the latest director of the $45 million effort to expand the use of HIV testing; that effort has suffered from revolving leadership, however, and has so far not had overwhelming impact, according to the AIDS community.

“Test everyone and treat everyone. Those are probably the two things we can do right now,” said Dr. John Bartlett, chief of the division of infectious diseases at the Johns Hopkins University, Baltimore.

An HIV test costs approximately $15, which is relatively inexpensive, Dr. Bartlett said, pointing out that it is highly accurate and detects a disease that is lethal if not treated and manageable when it is.

It's a “dream test,” yet it's not being used, 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.

That the test is underused translates to more transmission. The rate of infection is four- to fivefold higher among individuals who don't know they have the disease. Currently, 40% of the people who test positive for HIV have had the infection for 8–10 years, he noted.

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said.

In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing.

“A lot of issues have to do with stigma and how we get people to the next level,” she said.

Latino patients face the same barriers and more, given the inherent stigma created by the immigration debate, said Britt Rios-Ellis, Ph.D., who is 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.

“Latinos are the only minority group to see a doubling of HIV infection due to heterosexual contact, from 5% to 12% for males and from 23% to 67% for females between 2001 and 2006. And research in rural Mexico is indicating that most of the women who have AIDS there are married. We're seeing the same pattern here,” she said.

For both Latinos and African Americans, the message is the same: By getting tested and treated, they can do something not only for their families and their communities, but for themselves as well.

“We see that 86% of our [federal] dollars have been spent on biomedical solutions, and those people who are receiving testing and care are doing very, very well. If we could get everyone into testing and care, we know that we would make a difference,” Dr. Rios-Ellis commented.

WASHINGTON — The shaky state of the health care system appears to be driving a sense of urgency and compromise in the debate over comprehensive reforms, lawmakers said at the American Medical Association's annual advocacy conference.

Putting partisanship behind them, a group of senators has introduced a bill “built on the fact that both Democrats and Republicans have been right on key parts of the issue,” said Sen. Ron Wyden (D-Ore.).

The Democrats have been right to insist that everybody be included, while the Republicans have been right about involving the private sector, the senator added.

The Healthy Americans Act (S. 334) would shift the responsibility, but not the cost, of purchasing private health insurance from employers to individuals in recognition of the need to modernize the employer-employee relationship. Employees want portable coverage that will follow them through jobs and employers are seeking better control over costs, he said.

“Ron Wyden has a good plan. There's a lot of it that I agree with; there's a lot I adamantly disagree with,” said Sen. Tom Coburn (R-Okla.), a practicing physician. He also noted that a key principle is “to truly create access in this country.”

Despite that seeming common ground, Sen. Coburn has sponsored a competing proposal, the Universal Health Care Choice and Access Act (S. 1019), which would similarly disentangle employers from the business of providing health insurance for their workers. The bill would allow individuals to claim the tax benefit linked to purchasing health insurance and currently only available through employer-sponsored coverage. It would also create a tax credit to, in effect, subsidize the cost of health insurance for low-income people and cap the tax cut that higher-income people get.

“Today, the very wealthy get about $18,000 worth of tax benefit and the very poor get about $100 worth of tax benefit,” according to Sen. Coburn.

Both Senators also called for increased emphasis on prevention and early detection through realignment of the reimbursement system.

The major area where the senators differed was over how much the government should be involved in setting standards both for individuals and the health care industry in general.

Sen. Coburn said that once the opportunity to access health coverage was created, it would be the responsibility of individuals to take advantage of that. In contrast, Sen. Wyden's bill would require companies to contribute to and workers to purchase health coverage. In addition, Sen. Wyden's proposal contains a guaranteed issue provision to make insurers offer coverage to all comers, whereas Sen. Coburn's preference is to rely on a free market to determine supply based on demand.

WASHINGTON — The shaky state of the health care system appears to be driving a sense of urgency and compromise in the debate over comprehensive reforms, lawmakers said at the American Medical Association's annual advocacy conference.

Putting partisanship behind them, a group of senators has introduced a bill “built on the fact that both Democrats and Republicans have been right on key parts of the issue,” said Sen. Ron Wyden (D-Ore.).

The Democrats have been right to insist that everybody be included, while the Republicans have been right about involving the private sector, the senator added.

The Healthy Americans Act (S. 334) would shift the responsibility, but not the cost, of purchasing private health insurance from employers to individuals in recognition of the need to modernize the employer-employee relationship. Employees want portable coverage that will follow them through jobs and employers are seeking better control over costs, he said.

“Ron Wyden has a good plan. There's a lot of it that I agree with; there's a lot I adamantly disagree with,” said Sen. Tom Coburn (R-Okla.), a practicing physician. He also noted that a key principle is “to truly create access in this country.”

Despite that seeming common ground, Sen. Coburn has sponsored a competing proposal, the Universal Health Care Choice and Access Act (S. 1019), which would similarly disentangle employers from the business of providing health insurance for their workers. The bill would allow individuals to claim the tax benefit linked to purchasing health insurance and currently only available through employer-sponsored coverage. It would also create a tax credit to, in effect, subsidize the cost of health insurance for low-income people and cap the tax cut that higher-income people get.

“Today, the very wealthy get about $18,000 worth of tax benefit and the very poor get about $100 worth of tax benefit,” according to Sen. Coburn.

Both Senators also called for increased emphasis on prevention and early detection through realignment of the reimbursement system.

The major area where the senators differed was over how much the government should be involved in setting standards both for individuals and the health care industry in general.

Sen. Coburn said that once the opportunity to access health coverage was created, it would be the responsibility of individuals to take advantage of that. In contrast, Sen. Wyden's bill would require companies to contribute to and workers to purchase health coverage. In addition, Sen. Wyden's proposal contains a guaranteed issue provision to make insurers offer coverage to all comers, whereas Sen. Coburn's preference is to rely on a free market to determine supply based on demand.

WASHINGTON — The shaky state of the health care system appears to be driving a sense of urgency and compromise in the debate over comprehensive reforms, lawmakers said at the American Medical Association's annual advocacy conference.

Putting partisanship behind them, a group of senators has introduced a bill “built on the fact that both Democrats and Republicans have been right on key parts of the issue,” said Sen. Ron Wyden (D-Ore.).

The Democrats have been right to insist that everybody be included, while the Republicans have been right about involving the private sector, the senator added.

The Healthy Americans Act (S. 334) would shift the responsibility, but not the cost, of purchasing private health insurance from employers to individuals in recognition of the need to modernize the employer-employee relationship. Employees want portable coverage that will follow them through jobs and employers are seeking better control over costs, he said.

“Ron Wyden has a good plan. There's a lot of it that I agree with; there's a lot I adamantly disagree with,” said Sen. Tom Coburn (R-Okla.), a practicing physician. He also noted that a key principle is “to truly create access in this country.”

Despite that seeming common ground, Sen. Coburn has sponsored a competing proposal, the Universal Health Care Choice and Access Act (S. 1019), which would similarly disentangle employers from the business of providing health insurance for their workers. The bill would allow individuals to claim the tax benefit linked to purchasing health insurance and currently only available through employer-sponsored coverage. It would also create a tax credit to, in effect, subsidize the cost of health insurance for low-income people and cap the tax cut that higher-income people get.

“Today, the very wealthy get about $18,000 worth of tax benefit and the very poor get about $100 worth of tax benefit,” according to Sen. Coburn.

Both Senators also called for increased emphasis on prevention and early detection through realignment of the reimbursement system.

The major area where the senators differed was over how much the government should be involved in setting standards both for individuals and the health care industry in general.

Sen. Coburn said that once the opportunity to access health coverage was created, it would be the responsibility of individuals to take advantage of that. In contrast, Sen. Wyden's bill would require companies to contribute to and workers to purchase health coverage. In addition, Sen. Wyden's proposal contains a guaranteed issue provision to make insurers offer coverage to all comers, whereas Sen. Coburn's preference is to rely on a free market to determine supply based on demand.

WASHINGTON — Physicians can look for another short-term update to the sustainable growth rate this year as lawmakers struggle under substantial fiscal constraints, members of Congress told physicians at the American Medical Association's national advocacy conference.

A permanent fix would be best for “everyone in this room and for the older Americans under the Medicare system [but] my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.). Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

“If under the law, the physicians are set to receive a 10% cut, if we restore that 10%, we have to come up with the money somewhere. That's why the solutions generally tend to be short term,” said Sen. Jon Kyl, (R-Ariz.), who serves on the Finance Committee.

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets. That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.”

He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

That fact underscores the need for physicians to get involved in advocating for themselves, said Rep. Berkley. “Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it.”

WASHINGTON — Physicians can look for another short-term update to the sustainable growth rate this year as lawmakers struggle under substantial fiscal constraints, members of Congress told physicians at the American Medical Association's national advocacy conference.

A permanent fix would be best for “everyone in this room and for the older Americans under the Medicare system [but] my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.). Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

“If under the law, the physicians are set to receive a 10% cut, if we restore that 10%, we have to come up with the money somewhere. That's why the solutions generally tend to be short term,” said Sen. Jon Kyl, (R-Ariz.), who serves on the Finance Committee.

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets. That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.”

He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

That fact underscores the need for physicians to get involved in advocating for themselves, said Rep. Berkley. “Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it.”

WASHINGTON — Physicians can look for another short-term update to the sustainable growth rate this year as lawmakers struggle under substantial fiscal constraints, members of Congress told physicians at the American Medical Association's national advocacy conference.

A permanent fix would be best for “everyone in this room and for the older Americans under the Medicare system [but] my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.). Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

“If under the law, the physicians are set to receive a 10% cut, if we restore that 10%, we have to come up with the money somewhere. That's why the solutions generally tend to be short term,” said Sen. Jon Kyl, (R-Ariz.), who serves on the Finance Committee.

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets. That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.”

He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

That fact underscores the need for physicians to get involved in advocating for themselves, said Rep. Berkley. “Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it.”

WASHINGTON — A group of roving physicians wants to offer Medicare a money-back guarantee the program can't refuse.

Members of the American Academy of Home Care Physicians, a 10-year-old specialty society with a little less than a thousand members, met recently to discuss legislation being considered by Congress that would pay them a negotiated fee to direct a team of nurses and other professionals to care for patients with multiple chronic conditions in their homes.

The catch: If the physicians don't save Medicare at least 5%, then they will have to pay the government back some or all of their fee to make up the difference.

“If you make a bad bet, you risk 5% of the dollar. If you're taking patients who cost $50,000 a year on average, you're risking about [$2,500] a year,” said Dr. Kevin Jackson, a house-call physician in Phoenix, Ariz., and a member of AAHCP's board.

But taking that risk can also pay off. After Medicare gets its 5%, the physician gets to keep 80% of whatever money they save on these patients. There was ample evidence presented at the meeting to suggest that the savings are out there for physicians who effectively manage these patients, keeping them out of the hospital or nursing home where medical support becomes much more expensive.

Dr. Steven L. Philips, president and chief executive officer of Geriatric Care of Nevada in Reno, reported that physicians in that state have been experimenting with this model for the past 10 years, culminating in a project last year that yielded savings of nearly 13% or $1.4 million per 1,000 patients.

In Philadelphia, comprehensive management of medically complex, homebound patients enrolled in a house-call program lead to an average savings of $33,000 per Medicare patient, according to Dr. Bruce Kinosian, of the city's Hospital of the University of Pennsylvania. And in Ohio, a similar program, within a couple years of being launched now saves more than $600,000 annually because of shorter hospital stays and reductions in inappropriate and redundant services through better coordination of care, said Brent T. Feorene, president of House Call Solutions in Westlake, Ohio.

In addition, in the middle of the nation's capital, a team of physicians, nurses, social workers, and office staff have been providing home-based care to more than 600 patients with a budget of $1.6 million generated through a combination of fee-for-services charges, philanthropy, and operational support from the local hospital.

“We get no formal credit for downstream revenue, and we actually were able to measure it. It was about $10 million in net revenue to the hospital, which is probably a million in pure profit—that was 2006. But that doesn't go toward our budget,” said Dr. Eric De Jonge, director of geriatrics at the Washington Hospital Center.

However, under the Independence at Home (IAH) model physicians would get credit and some of the cash from those savings.

“This payment system is going to happen. It may be IAH; it may not be exactly IAH, but it's going to happen. Because, as we have all heard, Medicare literally is going to go broke. So unless they change the payment system, they're not going to have the money to take care of people and that politically is not tenable,” Dr. De Jonge said.

Supporters of the proposal hope to attach it to a bill that lawmakers will have to pass this year. Given that the doctors are promising to cost less than what Medicare is already paying for these patients, it seems like a good bet that it may make it into law.

“There is a huge amount of excess in Medicare, wasted, harmful care. [Those data are] driving what [the Congressional Budget Office] and Congress is doing right now [on Medicare reform]. And it's driving them right toward IAH,” Dr. De Jonge said.

Under the current legislative language, an Independence at Home demonstration project would be restricted to a very specific patient population, those with two or more chronic conditions including heart failure, diabetes, COPD, ischemic heart disease, peripheral arterial disease, stroke, Alzheimer's disease and other dementias, pressure ulcers, and hypertension. They also need to have been in the hospital, emergency department, or other intensive facility within the past 12 months and need help to perform two or more daily activities.

“We wanted to make sure that we got the costliest, sickest patients we possibly could. Why? Because the higher-cost these patients are, the easier it is to show savings,” James Pyles, Esq., a partner at Powers, Pyles, Sutter and Verville, a Washington-based law firm that specializes in the health care and educational industries, told the small gathering of physicians.

Most of the savings are expected to come from keeping these chronically ill patients out of the emergency room and the hospital. Better management of their multiple conditions means that they are less likely to become acutely ill or if they do, a home-care physician can often provide urgent care services in the home. Also, by having more medical support in the home, patients can often be released from the hospital a day or two earlier than they otherwise would be.

“We are taking a system that discriminates against the costliest patients, managed care doesn't want them, most physicians don't want them, nobody wants these people because they're train wrecks. We take those people and we make them the most desirable people in the system,” said Mr. Pyles, who also serves on the AAHCP board of directors.

WASHINGTON — A group of roving physicians wants to offer Medicare a money-back guarantee the program can't refuse.

Members of the American Academy of Home Care Physicians, a 10-year-old specialty society with a little less than a thousand members, met recently to discuss legislation being considered by Congress that would pay them a negotiated fee to direct a team of nurses and other professionals to care for patients with multiple chronic conditions in their homes.

The catch: If the physicians don't save Medicare at least 5%, then they will have to pay the government back some or all of their fee to make up the difference.

“If you make a bad bet, you risk 5% of the dollar. If you're taking patients who cost $50,000 a year on average, you're risking about [$2,500] a year,” said Dr. Kevin Jackson, a house-call physician in Phoenix, Ariz., and a member of AAHCP's board.

But taking that risk can also pay off. After Medicare gets its 5%, the physician gets to keep 80% of whatever money they save on these patients. There was ample evidence presented at the meeting to suggest that the savings are out there for physicians who effectively manage these patients, keeping them out of the hospital or nursing home where medical support becomes much more expensive.

Dr. Steven L. Philips, president and chief executive officer of Geriatric Care of Nevada in Reno, reported that physicians in that state have been experimenting with this model for the past 10 years, culminating in a project last year that yielded savings of nearly 13% or $1.4 million per 1,000 patients.

In Philadelphia, comprehensive management of medically complex, homebound patients enrolled in a house-call program lead to an average savings of $33,000 per Medicare patient, according to Dr. Bruce Kinosian, of the city's Hospital of the University of Pennsylvania. And in Ohio, a similar program, within a couple years of being launched now saves more than $600,000 annually because of shorter hospital stays and reductions in inappropriate and redundant services through better coordination of care, said Brent T. Feorene, president of House Call Solutions in Westlake, Ohio.

In addition, in the middle of the nation's capital, a team of physicians, nurses, social workers, and office staff have been providing home-based care to more than 600 patients with a budget of $1.6 million generated through a combination of fee-for-services charges, philanthropy, and operational support from the local hospital.

“We get no formal credit for downstream revenue, and we actually were able to measure it. It was about $10 million in net revenue to the hospital, which is probably a million in pure profit—that was 2006. But that doesn't go toward our budget,” said Dr. Eric De Jonge, director of geriatrics at the Washington Hospital Center.

However, under the Independence at Home (IAH) model physicians would get credit and some of the cash from those savings.

“This payment system is going to happen. It may be IAH; it may not be exactly IAH, but it's going to happen. Because, as we have all heard, Medicare literally is going to go broke. So unless they change the payment system, they're not going to have the money to take care of people and that politically is not tenable,” Dr. De Jonge said.

Supporters of the proposal hope to attach it to a bill that lawmakers will have to pass this year. Given that the doctors are promising to cost less than what Medicare is already paying for these patients, it seems like a good bet that it may make it into law.

“There is a huge amount of excess in Medicare, wasted, harmful care. [Those data are] driving what [the Congressional Budget Office] and Congress is doing right now [on Medicare reform]. And it's driving them right toward IAH,” Dr. De Jonge said.

Under the current legislative language, an Independence at Home demonstration project would be restricted to a very specific patient population, those with two or more chronic conditions including heart failure, diabetes, COPD, ischemic heart disease, peripheral arterial disease, stroke, Alzheimer's disease and other dementias, pressure ulcers, and hypertension. They also need to have been in the hospital, emergency department, or other intensive facility within the past 12 months and need help to perform two or more daily activities.

“We wanted to make sure that we got the costliest, sickest patients we possibly could. Why? Because the higher-cost these patients are, the easier it is to show savings,” James Pyles, Esq., a partner at Powers, Pyles, Sutter and Verville, a Washington-based law firm that specializes in the health care and educational industries, told the small gathering of physicians.

Most of the savings are expected to come from keeping these chronically ill patients out of the emergency room and the hospital. Better management of their multiple conditions means that they are less likely to become acutely ill or if they do, a home-care physician can often provide urgent care services in the home. Also, by having more medical support in the home, patients can often be released from the hospital a day or two earlier than they otherwise would be.

“We are taking a system that discriminates against the costliest patients, managed care doesn't want them, most physicians don't want them, nobody wants these people because they're train wrecks. We take those people and we make them the most desirable people in the system,” said Mr. Pyles, who also serves on the AAHCP board of directors.

WASHINGTON — A group of roving physicians wants to offer Medicare a money-back guarantee the program can't refuse.

Members of the American Academy of Home Care Physicians, a 10-year-old specialty society with a little less than a thousand members, met recently to discuss legislation being considered by Congress that would pay them a negotiated fee to direct a team of nurses and other professionals to care for patients with multiple chronic conditions in their homes.

The catch: If the physicians don't save Medicare at least 5%, then they will have to pay the government back some or all of their fee to make up the difference.

“If you make a bad bet, you risk 5% of the dollar. If you're taking patients who cost $50,000 a year on average, you're risking about [$2,500] a year,” said Dr. Kevin Jackson, a house-call physician in Phoenix, Ariz., and a member of AAHCP's board.

But taking that risk can also pay off. After Medicare gets its 5%, the physician gets to keep 80% of whatever money they save on these patients. There was ample evidence presented at the meeting to suggest that the savings are out there for physicians who effectively manage these patients, keeping them out of the hospital or nursing home where medical support becomes much more expensive.

Dr. Steven L. Philips, president and chief executive officer of Geriatric Care of Nevada in Reno, reported that physicians in that state have been experimenting with this model for the past 10 years, culminating in a project last year that yielded savings of nearly 13% or $1.4 million per 1,000 patients.

In Philadelphia, comprehensive management of medically complex, homebound patients enrolled in a house-call program lead to an average savings of $33,000 per Medicare patient, according to Dr. Bruce Kinosian, of the city's Hospital of the University of Pennsylvania. And in Ohio, a similar program, within a couple years of being launched now saves more than $600,000 annually because of shorter hospital stays and reductions in inappropriate and redundant services through better coordination of care, said Brent T. Feorene, president of House Call Solutions in Westlake, Ohio.

In addition, in the middle of the nation's capital, a team of physicians, nurses, social workers, and office staff have been providing home-based care to more than 600 patients with a budget of $1.6 million generated through a combination of fee-for-services charges, philanthropy, and operational support from the local hospital.

“We get no formal credit for downstream revenue, and we actually were able to measure it. It was about $10 million in net revenue to the hospital, which is probably a million in pure profit—that was 2006. But that doesn't go toward our budget,” said Dr. Eric De Jonge, director of geriatrics at the Washington Hospital Center.

However, under the Independence at Home (IAH) model physicians would get credit and some of the cash from those savings.

“This payment system is going to happen. It may be IAH; it may not be exactly IAH, but it's going to happen. Because, as we have all heard, Medicare literally is going to go broke. So unless they change the payment system, they're not going to have the money to take care of people and that politically is not tenable,” Dr. De Jonge said.

Supporters of the proposal hope to attach it to a bill that lawmakers will have to pass this year. Given that the doctors are promising to cost less than what Medicare is already paying for these patients, it seems like a good bet that it may make it into law.

“There is a huge amount of excess in Medicare, wasted, harmful care. [Those data are] driving what [the Congressional Budget Office] and Congress is doing right now [on Medicare reform]. And it's driving them right toward IAH,” Dr. De Jonge said.

Under the current legislative language, an Independence at Home demonstration project would be restricted to a very specific patient population, those with two or more chronic conditions including heart failure, diabetes, COPD, ischemic heart disease, peripheral arterial disease, stroke, Alzheimer's disease and other dementias, pressure ulcers, and hypertension. They also need to have been in the hospital, emergency department, or other intensive facility within the past 12 months and need help to perform two or more daily activities.

“We wanted to make sure that we got the costliest, sickest patients we possibly could. Why? Because the higher-cost these patients are, the easier it is to show savings,” James Pyles, Esq., a partner at Powers, Pyles, Sutter and Verville, a Washington-based law firm that specializes in the health care and educational industries, told the small gathering of physicians.

Most of the savings are expected to come from keeping these chronically ill patients out of the emergency room and the hospital. Better management of their multiple conditions means that they are less likely to become acutely ill or if they do, a home-care physician can often provide urgent care services in the home. Also, by having more medical support in the home, patients can often be released from the hospital a day or two earlier than they otherwise would be.

“We are taking a system that discriminates against the costliest patients, managed care doesn't want them, most physicians don't want them, nobody wants these people because they're train wrecks. We take those people and we make them the most desirable people in the system,” said Mr. Pyles, who also serves on the AAHCP board of directors.