Joel B. Finkelstein

WASHINGTON — Eliminating "the stupid clipboard" may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. "As the industry begins to test these interoperability specifications we know there are going to be refinements."

"What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care," said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said.

"There are knowledge barriers, there are cost barriers. There is just so much information to digest," said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. "The policy is well ahead of the practicality," he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — Eliminating "the stupid clipboard" may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. "As the industry begins to test these interoperability specifications we know there are going to be refinements."

"What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care," said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said.

"There are knowledge barriers, there are cost barriers. There is just so much information to digest," said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. "The policy is well ahead of the practicality," he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — Eliminating "the stupid clipboard" may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. "As the industry begins to test these interoperability specifications we know there are going to be refinements."

"What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care," said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said.

"There are knowledge barriers, there are cost barriers. There is just so much information to digest," said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. "The policy is well ahead of the practicality," he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

"The next big change in health care will be patients managing their own care," said John Goodman, Ph.D., who is the president of the National Center for Policy Analysis.

"Last year, 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers," he said.

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

"Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system," he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers "retail health care" through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse-practitioners and physician assistants trained to deal with a limited number of conditions, including routine infectious diseases, and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

"You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur," he quipped.

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers.

The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

"On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an emergency department," he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. "Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions."

The program is only possible because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

"We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services," he said.

WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

"The next big change in health care will be patients managing their own care," said John Goodman, Ph.D., who is the president of the National Center for Policy Analysis.

"Last year, 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers," he said.

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

"Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system," he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers "retail health care" through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse-practitioners and physician assistants trained to deal with a limited number of conditions, including routine infectious diseases, and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

"You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur," he quipped.

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers.

The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

"On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an emergency department," he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. "Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions."

The program is only possible because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

"We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services," he said.

WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

"The next big change in health care will be patients managing their own care," said John Goodman, Ph.D., who is the president of the National Center for Policy Analysis.

"Last year, 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers," he said.

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

"Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system," he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers "retail health care" through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse-practitioners and physician assistants trained to deal with a limited number of conditions, including routine infectious diseases, and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

"You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur," he quipped.

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers.

The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

"On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an emergency department," he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. "Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions."

The program is only possible because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

"We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services," he said.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Department of Health and Human Services contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards—a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record—whittling that number down to 30, he explained.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records (EHR) or other information technology, he said. “There are knowledge barriers, there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health IT does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia. The University's 500-physician group practice has spent 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies won't pay a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Department of Health and Human Services contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards—a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record—whittling that number down to 30, he explained.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records (EHR) or other information technology, he said. “There are knowledge barriers, there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health IT does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia. The University's 500-physician group practice has spent 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies won't pay a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Department of Health and Human Services contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards—a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record—whittling that number down to 30, he explained.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records (EHR) or other information technology, he said. “There are knowledge barriers, there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health IT does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia. The University's 500-physician group practice has spent 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies won't pay a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

The panel sifted through 700 standards, including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said.

“There are knowledge barriers; there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, said Dr. Halamka. The next step is to work out a logical time frame for compliance, what the incremental phases are along the way and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

The panel sifted through 700 standards, including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said.

“There are knowledge barriers; there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, said Dr. Halamka. The next step is to work out a logical time frame for compliance, what the incremental phases are along the way and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

The panel sifted through 700 standards, including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said.

“There are knowledge barriers; there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, said Dr. Halamka. The next step is to work out a logical time frame for compliance, what the incremental phases are along the way and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records conforming to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said. “There are knowledge barriers, there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way, and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records conforming to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said. “There are knowledge barriers, there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way, and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records conforming to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, he said. “There are knowledge barriers, there are cost barriers. There is just so much information to digest,” said Dr. Barr, adding that it is extremely difficult for these physicians to figure all this out while running their practices.

But health information technology does pay for itself, and as reimbursement becomes increasingly pegged to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way, and how to test compliance.

The ability of hospitals to maintain ambulatory training for medical residents seems to be in doubt with the departure of Dr. Mark McClellan as head of the Centers for Medicare and Medicaid Services. Dr. McClellan left without resolving an issue that has led to retroactive payment denials in recent years.

In 2003, the CMS officially changed the definition of what constituted acceptable charges that hospitals could send to Medicare for the training of medical residents with volunteer faculty in the community. That change has led program intermediaries to deny payment for costs related to ambulatory training time.

“Many hospitals are no longer offering educational experiences at ambulatory sites as a result of the confusing and inequitable regulations being enforced. Some teaching hospitals may be forced to eliminate training programs,” according to a letter that more than 100 physician and hospital groups sent to lawmakers.

Groups that represent primary care physicians worry that the policy will undermine efforts to increase the number of primary care physicians. In discussions with the agency, CMS officials have offered little more than modest concessions that fail to address the underlying problem, they said.

Over the summer, Dr. McClellan told CMS's Practicing Physicians Advisory Council that the agency would explore solutions to the impasse. And during a Senate hearing in the fall, he vowed to address the issue personally before he left CMS.

But despite those promises, Dr. McClellan departed the agency on Oct. 15 without resolving the issue. Leslie Norwalk, acting CMS administrator, was also questioned about the payment denials during the PPAC meeting, but seemed unaware of the problem.

Dr. McClellan also announced during the Senate hearing that the agency had suspended the policy. However, CMS did not comment for this article, nor did it provide any details about how long that suspension might last, or state whether the policy will ultimately be changed.

Sen. Susan Collins (R-Maine) has urged her colleagues to adopt a legislative fix during the lame-duck Congressional session.

“While we appreciate CMS's efforts to try to lend clarity to a difficult and poorly understood policy, we are concerned that the direction they are taking does little to resolve the underlying issues and remains, in our opinion, in direct conflict with Congressional intent. We are also concerned that CMS regulations continue to impose undue regulatory burdens on teaching hospitals that impede rather than encourage training in non-hospital settings,” Sen. Collins wrote in a “Dear Colleague” letter.

However, it is not clear whether the CMS policy even complies with existing law—specifically the 1999 Balanced Budget Act—which contains provisions designed to encourage rural and out-of-hospital experiences in residency training. Even more recently, the Medicare Modernization Act contained a 1-year moratorium on just these kinds of payment denials, according to Sen. Collins.

The CMS policy of denying payments to hospitals for ambulatory training actually dates back to a definition change contained in a rule proposed in 1999. The rule's drafters decided that time spent training under volunteer physicians in the community did not meet requirements that hospitals pay virtually all of the supervisory costs when residents rotate to nonhospital sites. Although that rule was not finalized until 2003, audits by Medicare intermediaries that led to retroactive denials started as early as 2002.

Dr. McClellan denied that the rejected payments amounted to millions of dollars, but hospital groups have warned that the policy is having a chilling effect on ambulatory training programs.

“The situation is dire. These programs will close if we can't get this resolved,” Sen. Collins warned.

The ability of hospitals to maintain ambulatory training for medical residents seems to be in doubt with the departure of Dr. Mark McClellan as head of the Centers for Medicare and Medicaid Services. Dr. McClellan left without resolving an issue that has led to retroactive payment denials in recent years.

In 2003, the CMS officially changed the definition of what constituted acceptable charges that hospitals could send to Medicare for the training of medical residents with volunteer faculty in the community. That change has led program intermediaries to deny payment for costs related to ambulatory training time.

“Many hospitals are no longer offering educational experiences at ambulatory sites as a result of the confusing and inequitable regulations being enforced. Some teaching hospitals may be forced to eliminate training programs,” according to a letter that more than 100 physician and hospital groups sent to lawmakers.

Groups that represent primary care physicians worry that the policy will undermine efforts to increase the number of primary care physicians. In discussions with the agency, CMS officials have offered little more than modest concessions that fail to address the underlying problem, they said.

Over the summer, Dr. McClellan told CMS's Practicing Physicians Advisory Council that the agency would explore solutions to the impasse. And during a Senate hearing in the fall, he vowed to address the issue personally before he left CMS.

But despite those promises, Dr. McClellan departed the agency on Oct. 15 without resolving the issue. Leslie Norwalk, acting CMS administrator, was also questioned about the payment denials during the PPAC meeting, but seemed unaware of the problem.

Dr. McClellan also announced during the Senate hearing that the agency had suspended the policy. However, CMS did not comment for this article, nor did it provide any details about how long that suspension might last, or state whether the policy will ultimately be changed.

Sen. Susan Collins (R-Maine) has urged her colleagues to adopt a legislative fix during the lame-duck Congressional session.

“While we appreciate CMS's efforts to try to lend clarity to a difficult and poorly understood policy, we are concerned that the direction they are taking does little to resolve the underlying issues and remains, in our opinion, in direct conflict with Congressional intent. We are also concerned that CMS regulations continue to impose undue regulatory burdens on teaching hospitals that impede rather than encourage training in non-hospital settings,” Sen. Collins wrote in a “Dear Colleague” letter.

However, it is not clear whether the CMS policy even complies with existing law—specifically the 1999 Balanced Budget Act—which contains provisions designed to encourage rural and out-of-hospital experiences in residency training. Even more recently, the Medicare Modernization Act contained a 1-year moratorium on just these kinds of payment denials, according to Sen. Collins.

The CMS policy of denying payments to hospitals for ambulatory training actually dates back to a definition change contained in a rule proposed in 1999. The rule's drafters decided that time spent training under volunteer physicians in the community did not meet requirements that hospitals pay virtually all of the supervisory costs when residents rotate to nonhospital sites. Although that rule was not finalized until 2003, audits by Medicare intermediaries that led to retroactive denials started as early as 2002.

Dr. McClellan denied that the rejected payments amounted to millions of dollars, but hospital groups have warned that the policy is having a chilling effect on ambulatory training programs.

“The situation is dire. These programs will close if we can't get this resolved,” Sen. Collins warned.

The ability of hospitals to maintain ambulatory training for medical residents seems to be in doubt with the departure of Dr. Mark McClellan as head of the Centers for Medicare and Medicaid Services. Dr. McClellan left without resolving an issue that has led to retroactive payment denials in recent years.

In 2003, the CMS officially changed the definition of what constituted acceptable charges that hospitals could send to Medicare for the training of medical residents with volunteer faculty in the community. That change has led program intermediaries to deny payment for costs related to ambulatory training time.

“Many hospitals are no longer offering educational experiences at ambulatory sites as a result of the confusing and inequitable regulations being enforced. Some teaching hospitals may be forced to eliminate training programs,” according to a letter that more than 100 physician and hospital groups sent to lawmakers.

Groups that represent primary care physicians worry that the policy will undermine efforts to increase the number of primary care physicians. In discussions with the agency, CMS officials have offered little more than modest concessions that fail to address the underlying problem, they said.

Over the summer, Dr. McClellan told CMS's Practicing Physicians Advisory Council that the agency would explore solutions to the impasse. And during a Senate hearing in the fall, he vowed to address the issue personally before he left CMS.

But despite those promises, Dr. McClellan departed the agency on Oct. 15 without resolving the issue. Leslie Norwalk, acting CMS administrator, was also questioned about the payment denials during the PPAC meeting, but seemed unaware of the problem.

Dr. McClellan also announced during the Senate hearing that the agency had suspended the policy. However, CMS did not comment for this article, nor did it provide any details about how long that suspension might last, or state whether the policy will ultimately be changed.

Sen. Susan Collins (R-Maine) has urged her colleagues to adopt a legislative fix during the lame-duck Congressional session.

“While we appreciate CMS's efforts to try to lend clarity to a difficult and poorly understood policy, we are concerned that the direction they are taking does little to resolve the underlying issues and remains, in our opinion, in direct conflict with Congressional intent. We are also concerned that CMS regulations continue to impose undue regulatory burdens on teaching hospitals that impede rather than encourage training in non-hospital settings,” Sen. Collins wrote in a “Dear Colleague” letter.

However, it is not clear whether the CMS policy even complies with existing law—specifically the 1999 Balanced Budget Act—which contains provisions designed to encourage rural and out-of-hospital experiences in residency training. Even more recently, the Medicare Modernization Act contained a 1-year moratorium on just these kinds of payment denials, according to Sen. Collins.

The CMS policy of denying payments to hospitals for ambulatory training actually dates back to a definition change contained in a rule proposed in 1999. The rule's drafters decided that time spent training under volunteer physicians in the community did not meet requirements that hospitals pay virtually all of the supervisory costs when residents rotate to nonhospital sites. Although that rule was not finalized until 2003, audits by Medicare intermediaries that led to retroactive denials started as early as 2002.

Dr. McClellan denied that the rejected payments amounted to millions of dollars, but hospital groups have warned that the policy is having a chilling effect on ambulatory training programs.

“The situation is dire. These programs will close if we can't get this resolved,” Sen. Collins warned.

WASHINGTON – Members of the scientific community have raised a red flag over the apparent increasing influence of money and politics on the supposedly independent and unbiased internal workings of the Food and Drug Administration and other federal watchdog agencies.

In a confidential survey of staff scientists in the FDA's Center for Drug Evaluation and Research, 19% reported being pressured to push through a drug about which they had reservations and 66% said that they were less than wholly confident that the FDA adequately monitors the safety of drugs after they reach the market.

Across the agency, 50% of respondents said they did not believe that the FDA was headed in the right direction, according to the survey by the Union of Concerned Scientists and Public Employees for Environmental Responsibility.

In the words of one staff scientist: “The FDA is presently being stacked at every management level, including the lowest levels, based on those who will support the big companies' agenda, and the implications for safety and efficacy will be felt long into the future.”

Such influences have led to a “crisis in public confidence,” according to Dr. Steven Nissen, who until last year chaired the FDA's Cardiovascular and Renal Drugs Advisory Committee.

“We have to work a lot harder now … to keep the politicians out of the science as much as possible and to keep the commercialization of science from coloring everything we see and hear of scientific value,” he said at a panel discussion on conflict of interest on government science panels sponsored by the Center for Science in the Public Interest. CSPI is a nonprofit consumer organization focused on food, nutrition, and health issues. It is perhaps best known for its efforts to disclose the nutritional content of fast-food products.

Dr. Nissen criticized the agency's top leaders for “whining incessantly” to Congress about the burden of regulation rather than asking for more authority. “While the American people worry about the safety of drugs, the top FDA leadership tells us we need fast drug approval,” he said.

Dr. Nissen said the appointments of Lester Crawford, D.V.M., Ph.D., and Dr. Andrew von Eschenbach as acting FDA commissioner and Dr. Scott Gottlieb as FDA deputy commissioner for policy also have raised some troubling questions about conflict of interest with the agency, he said. (Dr. Crawford eventually gained Senate confirmation to his position, but resigned shortly thereafter.)

“In his role as director of the National Cancer Institute, [acting commissioner von Eschenbach] must seek FDA approval for human testing or approval of new cancer drugs, an obvious conflict of interest. Even worse, the administration has appointed Scott Gottlieb as deputy commissioner, who came to this job with no regulatory experience, directly from Wall Street where he served as a biotech analyst and stock promoter,” Dr. Nissen said.

Also speaking as part of the panel, Dr. Gottlieb refused to address those charges, but defended FDA policy that allows the agency leeway in impaneling advisory committee members who have financial ties to industry.

The advice the FDA receives from advisory committees must span the breadth of both clinical research and clinical practice, he said. “That's the kind of advice that you can only get from people who are heavily engaged in clinical trials.”

Dr. Gottlieb also announced FDA plans to revamp the advisory committee guidelines, including updated rules that determine whether members need to be recused because of a potential conflict of interest. However, it is unclear how those changes will relieve the concern, both inside and outside the agency, that these panels are being manipulated.

“I've observed that [FDA] management and [drug and device manufacturing] companies have found ways to manipulate this process in favor of approval. These methods are very subtle and would not easily be recognized,” recounted one respondent to the survey by the Union of Concerned Scientists.

The anonymous respondent went on to describe these techniques.

Within the FDA, scheduling conflicts can be used to exclude a committee member expected to oppose a drug's approval, and managers have been known to massage presentations to the committee to soften damaging findings. Drug companies have learned that by hiring experts as consultants they can deny FDA access to them, and that by hiring committee members themselves, they can force them to be excluded from voting on a company's drug.

“As advisers, we get the data that is presented to us and … you can tell where the agency wants you to go,” Dr. Nissen said. “The material you get has to be unbiased, and I'm worried that it might not be.”

WASHINGTON – Members of the scientific community have raised a red flag over the apparent increasing influence of money and politics on the supposedly independent and unbiased internal workings of the Food and Drug Administration and other federal watchdog agencies.

In a confidential survey of staff scientists in the FDA's Center for Drug Evaluation and Research, 19% reported being pressured to push through a drug about which they had reservations and 66% said that they were less than wholly confident that the FDA adequately monitors the safety of drugs after they reach the market.

Across the agency, 50% of respondents said they did not believe that the FDA was headed in the right direction, according to the survey by the Union of Concerned Scientists and Public Employees for Environmental Responsibility.

In the words of one staff scientist: “The FDA is presently being stacked at every management level, including the lowest levels, based on those who will support the big companies' agenda, and the implications for safety and efficacy will be felt long into the future.”

Such influences have led to a “crisis in public confidence,” according to Dr. Steven Nissen, who until last year chaired the FDA's Cardiovascular and Renal Drugs Advisory Committee.

“We have to work a lot harder now … to keep the politicians out of the science as much as possible and to keep the commercialization of science from coloring everything we see and hear of scientific value,” he said at a panel discussion on conflict of interest on government science panels sponsored by the Center for Science in the Public Interest. CSPI is a nonprofit consumer organization focused on food, nutrition, and health issues. It is perhaps best known for its efforts to disclose the nutritional content of fast-food products.

Dr. Nissen criticized the agency's top leaders for “whining incessantly” to Congress about the burden of regulation rather than asking for more authority. “While the American people worry about the safety of drugs, the top FDA leadership tells us we need fast drug approval,” he said.

Dr. Nissen said the appointments of Lester Crawford, D.V.M., Ph.D., and Dr. Andrew von Eschenbach as acting FDA commissioner and Dr. Scott Gottlieb as FDA deputy commissioner for policy also have raised some troubling questions about conflict of interest with the agency, he said. (Dr. Crawford eventually gained Senate confirmation to his position, but resigned shortly thereafter.)

“In his role as director of the National Cancer Institute, [acting commissioner von Eschenbach] must seek FDA approval for human testing or approval of new cancer drugs, an obvious conflict of interest. Even worse, the administration has appointed Scott Gottlieb as deputy commissioner, who came to this job with no regulatory experience, directly from Wall Street where he served as a biotech analyst and stock promoter,” Dr. Nissen said.

Also speaking as part of the panel, Dr. Gottlieb refused to address those charges, but defended FDA policy that allows the agency leeway in impaneling advisory committee members who have financial ties to industry.

The advice the FDA receives from advisory committees must span the breadth of both clinical research and clinical practice, he said. “That's the kind of advice that you can only get from people who are heavily engaged in clinical trials.”

Dr. Gottlieb also announced FDA plans to revamp the advisory committee guidelines, including updated rules that determine whether members need to be recused because of a potential conflict of interest. However, it is unclear how those changes will relieve the concern, both inside and outside the agency, that these panels are being manipulated.

“I've observed that [FDA] management and [drug and device manufacturing] companies have found ways to manipulate this process in favor of approval. These methods are very subtle and would not easily be recognized,” recounted one respondent to the survey by the Union of Concerned Scientists.

The anonymous respondent went on to describe these techniques.

Within the FDA, scheduling conflicts can be used to exclude a committee member expected to oppose a drug's approval, and managers have been known to massage presentations to the committee to soften damaging findings. Drug companies have learned that by hiring experts as consultants they can deny FDA access to them, and that by hiring committee members themselves, they can force them to be excluded from voting on a company's drug.

“As advisers, we get the data that is presented to us and … you can tell where the agency wants you to go,” Dr. Nissen said. “The material you get has to be unbiased, and I'm worried that it might not be.”

WASHINGTON – Members of the scientific community have raised a red flag over the apparent increasing influence of money and politics on the supposedly independent and unbiased internal workings of the Food and Drug Administration and other federal watchdog agencies.

In a confidential survey of staff scientists in the FDA's Center for Drug Evaluation and Research, 19% reported being pressured to push through a drug about which they had reservations and 66% said that they were less than wholly confident that the FDA adequately monitors the safety of drugs after they reach the market.

Across the agency, 50% of respondents said they did not believe that the FDA was headed in the right direction, according to the survey by the Union of Concerned Scientists and Public Employees for Environmental Responsibility.

In the words of one staff scientist: “The FDA is presently being stacked at every management level, including the lowest levels, based on those who will support the big companies' agenda, and the implications for safety and efficacy will be felt long into the future.”

Such influences have led to a “crisis in public confidence,” according to Dr. Steven Nissen, who until last year chaired the FDA's Cardiovascular and Renal Drugs Advisory Committee.

“We have to work a lot harder now … to keep the politicians out of the science as much as possible and to keep the commercialization of science from coloring everything we see and hear of scientific value,” he said at a panel discussion on conflict of interest on government science panels sponsored by the Center for Science in the Public Interest. CSPI is a nonprofit consumer organization focused on food, nutrition, and health issues. It is perhaps best known for its efforts to disclose the nutritional content of fast-food products.

Dr. Nissen criticized the agency's top leaders for “whining incessantly” to Congress about the burden of regulation rather than asking for more authority. “While the American people worry about the safety of drugs, the top FDA leadership tells us we need fast drug approval,” he said.

Dr. Nissen said the appointments of Lester Crawford, D.V.M., Ph.D., and Dr. Andrew von Eschenbach as acting FDA commissioner and Dr. Scott Gottlieb as FDA deputy commissioner for policy also have raised some troubling questions about conflict of interest with the agency, he said. (Dr. Crawford eventually gained Senate confirmation to his position, but resigned shortly thereafter.)

“In his role as director of the National Cancer Institute, [acting commissioner von Eschenbach] must seek FDA approval for human testing or approval of new cancer drugs, an obvious conflict of interest. Even worse, the administration has appointed Scott Gottlieb as deputy commissioner, who came to this job with no regulatory experience, directly from Wall Street where he served as a biotech analyst and stock promoter,” Dr. Nissen said.

Also speaking as part of the panel, Dr. Gottlieb refused to address those charges, but defended FDA policy that allows the agency leeway in impaneling advisory committee members who have financial ties to industry.

The advice the FDA receives from advisory committees must span the breadth of both clinical research and clinical practice, he said. “That's the kind of advice that you can only get from people who are heavily engaged in clinical trials.”

Dr. Gottlieb also announced FDA plans to revamp the advisory committee guidelines, including updated rules that determine whether members need to be recused because of a potential conflict of interest. However, it is unclear how those changes will relieve the concern, both inside and outside the agency, that these panels are being manipulated.

“I've observed that [FDA] management and [drug and device manufacturing] companies have found ways to manipulate this process in favor of approval. These methods are very subtle and would not easily be recognized,” recounted one respondent to the survey by the Union of Concerned Scientists.

The anonymous respondent went on to describe these techniques.

Within the FDA, scheduling conflicts can be used to exclude a committee member expected to oppose a drug's approval, and managers have been known to massage presentations to the committee to soften damaging findings. Drug companies have learned that by hiring experts as consultants they can deny FDA access to them, and that by hiring committee members themselves, they can force them to be excluded from voting on a company's drug.

“As advisers, we get the data that is presented to us and … you can tell where the agency wants you to go,” Dr. Nissen said. “The material you get has to be unbiased, and I'm worried that it might not be.”

The ability of hospitals to maintain ambulatory training for medical residents seems to be in doubt with the departure of Dr. Mark McClellan as head of the Centers for Medicare and Medicaid Services. Dr. McClellan left without resolving an issue that has led to retroactive payment denials in recent years.

In 2003, the CMS officially changed the definition of what constituted acceptable charges that hospitals could send to Medicare for the training of medical residents with volunteer faculty in the community. That change has led program intermediaries to deny payment for costs related to ambulatory training time.

“Many hospitals are no longer offering educational experiences at ambulatory sites as a result of the confusing and inequitable regulations being enforced. Some teaching hospitals may be forced to eliminate training programs,” according to a letter that more than 100 physician and hospital groups sent to lawmakers.

Organizations representing primary care physicians worry that the policy will undermine efforts to increase the number of primary care physicians.

In discussions with the agency, CMS officials have offered little more than modest concessions that fail to address the underlying problem, they said.

Over the summer, Dr. McClellan told CMS's Practicing Physicians Advisory Council that the agency would explore solutions to the impasse. And during a Senate hearing in the fall, he vowed to address the issue personally before he left CMS.

However, in spite of those promises, Dr. McClellan departed the agency on Oct. 15 without resolving the issue. Leslie Norwalk, acting CMS administrator, was also questioned about the payment denials during the PPAC meeting, but seemed unaware of the problem.

Dr. McClellan also announced during the Senate hearing that the agency had suspended the policy. However, CMS did not comment for this article, nor did it provide any details about how long that suspension might last, or state whether the policy will ultimately be changed.

Sen. Susan Collins (R-Maine) has urged her colleagues to adopt a legislative fix during the lame-duck Congressional session. “While we appreciate CMS's efforts to try to lend clarity to a difficult and poorly understood policy, we are concerned that the direction they are taking does little to resolve the underlying issues and remains, in our opinion, in direct conflict with Congressional intent. We are also concerned that CMS regulations continue to impose undue regulatory burdens on teaching hospitals that impede rather than encourage training in non-hospital settings,” Sen. Collins wrote in a “Dear Colleague” letter.

However, it is not clear whether the CMS policy even complies with existing law—specifically the 1999 Balanced Budget Act—which contains provisions designed to encourage rural and out-of-hospital experiences in residency training. And even more recently, the Medicare Modernization Act contained a 1-year moratorium on just these kinds of payment denials, Sen. Collins said.

The CMS policy of denying payments to hospitals for ambulatory training actually dates back to a definition change contained in a rule proposed in 1999. The rule's drafters decided that time spent training under volunteer physicians in the community did not meet requirements that hospitals pay virtually all of the supervisory costs when residents rotate to nonhospital sites. Although that rule was not finalized until 2003, audits by Medicare intermediaries that led to retroactive denials started as early as in 2002.

Dr. McClellan denied that the rejected payments amounted to millions of dollars, but hospital groups have warned that the policy is having a chilling effect on ambulatory training programs.

“The situation is dire. These programs will close if we can't get this resolved,” Sen. Collins warned.

The ability of hospitals to maintain ambulatory training for medical residents seems to be in doubt with the departure of Dr. Mark McClellan as head of the Centers for Medicare and Medicaid Services. Dr. McClellan left without resolving an issue that has led to retroactive payment denials in recent years.

In 2003, the CMS officially changed the definition of what constituted acceptable charges that hospitals could send to Medicare for the training of medical residents with volunteer faculty in the community. That change has led program intermediaries to deny payment for costs related to ambulatory training time.

“Many hospitals are no longer offering educational experiences at ambulatory sites as a result of the confusing and inequitable regulations being enforced. Some teaching hospitals may be forced to eliminate training programs,” according to a letter that more than 100 physician and hospital groups sent to lawmakers.

Organizations representing primary care physicians worry that the policy will undermine efforts to increase the number of primary care physicians.

In discussions with the agency, CMS officials have offered little more than modest concessions that fail to address the underlying problem, they said.

Over the summer, Dr. McClellan told CMS's Practicing Physicians Advisory Council that the agency would explore solutions to the impasse. And during a Senate hearing in the fall, he vowed to address the issue personally before he left CMS.

However, in spite of those promises, Dr. McClellan departed the agency on Oct. 15 without resolving the issue. Leslie Norwalk, acting CMS administrator, was also questioned about the payment denials during the PPAC meeting, but seemed unaware of the problem.

Dr. McClellan also announced during the Senate hearing that the agency had suspended the policy. However, CMS did not comment for this article, nor did it provide any details about how long that suspension might last, or state whether the policy will ultimately be changed.

Sen. Susan Collins (R-Maine) has urged her colleagues to adopt a legislative fix during the lame-duck Congressional session. “While we appreciate CMS's efforts to try to lend clarity to a difficult and poorly understood policy, we are concerned that the direction they are taking does little to resolve the underlying issues and remains, in our opinion, in direct conflict with Congressional intent. We are also concerned that CMS regulations continue to impose undue regulatory burdens on teaching hospitals that impede rather than encourage training in non-hospital settings,” Sen. Collins wrote in a “Dear Colleague” letter.

However, it is not clear whether the CMS policy even complies with existing law—specifically the 1999 Balanced Budget Act—which contains provisions designed to encourage rural and out-of-hospital experiences in residency training. And even more recently, the Medicare Modernization Act contained a 1-year moratorium on just these kinds of payment denials, Sen. Collins said.

The CMS policy of denying payments to hospitals for ambulatory training actually dates back to a definition change contained in a rule proposed in 1999. The rule's drafters decided that time spent training under volunteer physicians in the community did not meet requirements that hospitals pay virtually all of the supervisory costs when residents rotate to nonhospital sites. Although that rule was not finalized until 2003, audits by Medicare intermediaries that led to retroactive denials started as early as in 2002.

Dr. McClellan denied that the rejected payments amounted to millions of dollars, but hospital groups have warned that the policy is having a chilling effect on ambulatory training programs.

“The situation is dire. These programs will close if we can't get this resolved,” Sen. Collins warned.

The ability of hospitals to maintain ambulatory training for medical residents seems to be in doubt with the departure of Dr. Mark McClellan as head of the Centers for Medicare and Medicaid Services. Dr. McClellan left without resolving an issue that has led to retroactive payment denials in recent years.

In 2003, the CMS officially changed the definition of what constituted acceptable charges that hospitals could send to Medicare for the training of medical residents with volunteer faculty in the community. That change has led program intermediaries to deny payment for costs related to ambulatory training time.

“Many hospitals are no longer offering educational experiences at ambulatory sites as a result of the confusing and inequitable regulations being enforced. Some teaching hospitals may be forced to eliminate training programs,” according to a letter that more than 100 physician and hospital groups sent to lawmakers.

Organizations representing primary care physicians worry that the policy will undermine efforts to increase the number of primary care physicians.

In discussions with the agency, CMS officials have offered little more than modest concessions that fail to address the underlying problem, they said.

Over the summer, Dr. McClellan told CMS's Practicing Physicians Advisory Council that the agency would explore solutions to the impasse. And during a Senate hearing in the fall, he vowed to address the issue personally before he left CMS.

However, in spite of those promises, Dr. McClellan departed the agency on Oct. 15 without resolving the issue. Leslie Norwalk, acting CMS administrator, was also questioned about the payment denials during the PPAC meeting, but seemed unaware of the problem.

Dr. McClellan also announced during the Senate hearing that the agency had suspended the policy. However, CMS did not comment for this article, nor did it provide any details about how long that suspension might last, or state whether the policy will ultimately be changed.

Sen. Susan Collins (R-Maine) has urged her colleagues to adopt a legislative fix during the lame-duck Congressional session. “While we appreciate CMS's efforts to try to lend clarity to a difficult and poorly understood policy, we are concerned that the direction they are taking does little to resolve the underlying issues and remains, in our opinion, in direct conflict with Congressional intent. We are also concerned that CMS regulations continue to impose undue regulatory burdens on teaching hospitals that impede rather than encourage training in non-hospital settings,” Sen. Collins wrote in a “Dear Colleague” letter.

However, it is not clear whether the CMS policy even complies with existing law—specifically the 1999 Balanced Budget Act—which contains provisions designed to encourage rural and out-of-hospital experiences in residency training. And even more recently, the Medicare Modernization Act contained a 1-year moratorium on just these kinds of payment denials, Sen. Collins said.

The CMS policy of denying payments to hospitals for ambulatory training actually dates back to a definition change contained in a rule proposed in 1999. The rule's drafters decided that time spent training under volunteer physicians in the community did not meet requirements that hospitals pay virtually all of the supervisory costs when residents rotate to nonhospital sites. Although that rule was not finalized until 2003, audits by Medicare intermediaries that led to retroactive denials started as early as in 2002.

Dr. McClellan denied that the rejected payments amounted to millions of dollars, but hospital groups have warned that the policy is having a chilling effect on ambulatory training programs.

“The situation is dire. These programs will close if we can't get this resolved,” Sen. Collins warned.

WASHINGTON — The failure to address low physician pay and looming reimbursement cuts in the Medicare program is starting to affect beneficiaries, members of Medicare's Practicing Physicians Advisory Council said at a recent meeting of the council.

PPAC member Dr. Vincent J. Bufalino, a cardiologist from Naperville, Ill., offered an example to the attendees. "We have in our community the beginnings of physicians walking away from Medicare. Four of the busiest internists in town have said 'No' and ripped up their [Medicare] agreement," Dr. Bufalino said.

Although the Centers for Medicare and Medicaid Services tracks physician participation, such trends might not reveal the whole picture, he added.

Half of the physicians in Dr. Bufalino's community are no longer accepting new Medicare patients, he said. Although the CMS still counts them as participating in the program, the trend is having a profound effect on beneficiaries' access to physician services.

"We don't think that participation rates, assignment rates, really reflect what is going on," Dr. Bufalino told CMS Deputy Administrator Leslie Norwalk.

The CMS has to rely on the numbers gathered by physician groups, Ms. Norwalk responded.

"I suspect that the best way to go about this is probably at the state level where you would ask your state medical society to survey members and let us know what it is that you see. … It may help inform the debate," Ms. Norwalk suggested, noting that administration officials are legally barred from telling people to lobby Congress.

Lawmakers will have to be the ones to make changes to the current mechanism for updating physician payments. Based on the sustained growth rate (SGR) formula, mandated by the Balanced Budget Act of 1997, physicians are currently slated for a 5.1% cut in reimbursement starting Jan. 1. In past years, Congress has averted cuts or given doctors a small raise.

PPAC members urged CMS officials to use what influence they have to encourage lawmakers to do so again based on the recommendation from the Medicare Payment Advisory Commission that physician pay be increased by 2.8% in 2007.

"If you look at the data from 2001 to 2007, physicians' costs are up 18%, yet Medicare payments are down 5%. … Only physicians are subject to arbitrary spending cuts. Hospitals have had a 3.7% update; nursing homes, a 3.1%; [and] Medicare Advantage now gets 111% of the fee-for-service rate and is slated for another 4.8% increase," said PPAC member M. LeRoy Sprang, an ob.gyn. from Evanston, Ill.

Quality is an important part of the equation, said Dr. Tom Valuck, a medical officer at the CMS Center for Medicare Management.

"We're not talking about arbitrary cost cutting for necessary services. We're talking about taking waste out of the system," said Dr. Valuck, who described to PPAC the agency's efforts to develop cost-of-care and quality-of-care reports to measure physician performance.

"If you have two physicians achieving the same level of quality, but one can do it at half the cost, that physician is twice as efficient," he explained.

PPAC members encouraged CMS officials to keep in mind that as physicians strive to improve quality and lower costs, they should also be recognized for savings that may show up in other parts of the program, such as reduced hospital spending due to more preventive screening or disease management services provided in doctors' offices.

WASHINGTON — The failure to address low physician pay and looming reimbursement cuts in the Medicare program is starting to affect beneficiaries, members of Medicare's Practicing Physicians Advisory Council said at a recent meeting of the council.

PPAC member Dr. Vincent J. Bufalino, a cardiologist from Naperville, Ill., offered an example to the attendees. "We have in our community the beginnings of physicians walking away from Medicare. Four of the busiest internists in town have said 'No' and ripped up their [Medicare] agreement," Dr. Bufalino said.

Although the Centers for Medicare and Medicaid Services tracks physician participation, such trends might not reveal the whole picture, he added.

Half of the physicians in Dr. Bufalino's community are no longer accepting new Medicare patients, he said. Although the CMS still counts them as participating in the program, the trend is having a profound effect on beneficiaries' access to physician services.

"We don't think that participation rates, assignment rates, really reflect what is going on," Dr. Bufalino told CMS Deputy Administrator Leslie Norwalk.

The CMS has to rely on the numbers gathered by physician groups, Ms. Norwalk responded.

"I suspect that the best way to go about this is probably at the state level where you would ask your state medical society to survey members and let us know what it is that you see. … It may help inform the debate," Ms. Norwalk suggested, noting that administration officials are legally barred from telling people to lobby Congress.

Lawmakers will have to be the ones to make changes to the current mechanism for updating physician payments. Based on the sustained growth rate (SGR) formula, mandated by the Balanced Budget Act of 1997, physicians are currently slated for a 5.1% cut in reimbursement starting Jan. 1. In past years, Congress has averted cuts or given doctors a small raise.

PPAC members urged CMS officials to use what influence they have to encourage lawmakers to do so again based on the recommendation from the Medicare Payment Advisory Commission that physician pay be increased by 2.8% in 2007.

"If you look at the data from 2001 to 2007, physicians' costs are up 18%, yet Medicare payments are down 5%. … Only physicians are subject to arbitrary spending cuts. Hospitals have had a 3.7% update; nursing homes, a 3.1%; [and] Medicare Advantage now gets 111% of the fee-for-service rate and is slated for another 4.8% increase," said PPAC member M. LeRoy Sprang, an ob.gyn. from Evanston, Ill.

Quality is an important part of the equation, said Dr. Tom Valuck, a medical officer at the CMS Center for Medicare Management.

"We're not talking about arbitrary cost cutting for necessary services. We're talking about taking waste out of the system," said Dr. Valuck, who described to PPAC the agency's efforts to develop cost-of-care and quality-of-care reports to measure physician performance.

"If you have two physicians achieving the same level of quality, but one can do it at half the cost, that physician is twice as efficient," he explained.

PPAC members encouraged CMS officials to keep in mind that as physicians strive to improve quality and lower costs, they should also be recognized for savings that may show up in other parts of the program, such as reduced hospital spending due to more preventive screening or disease management services provided in doctors' offices.

WASHINGTON — The failure to address low physician pay and looming reimbursement cuts in the Medicare program is starting to affect beneficiaries, members of Medicare's Practicing Physicians Advisory Council said at a recent meeting of the council.

PPAC member Dr. Vincent J. Bufalino, a cardiologist from Naperville, Ill., offered an example to the attendees. "We have in our community the beginnings of physicians walking away from Medicare. Four of the busiest internists in town have said 'No' and ripped up their [Medicare] agreement," Dr. Bufalino said.

Although the Centers for Medicare and Medicaid Services tracks physician participation, such trends might not reveal the whole picture, he added.

Half of the physicians in Dr. Bufalino's community are no longer accepting new Medicare patients, he said. Although the CMS still counts them as participating in the program, the trend is having a profound effect on beneficiaries' access to physician services.

"We don't think that participation rates, assignment rates, really reflect what is going on," Dr. Bufalino told CMS Deputy Administrator Leslie Norwalk.

The CMS has to rely on the numbers gathered by physician groups, Ms. Norwalk responded.

"I suspect that the best way to go about this is probably at the state level where you would ask your state medical society to survey members and let us know what it is that you see. … It may help inform the debate," Ms. Norwalk suggested, noting that administration officials are legally barred from telling people to lobby Congress.

Lawmakers will have to be the ones to make changes to the current mechanism for updating physician payments. Based on the sustained growth rate (SGR) formula, mandated by the Balanced Budget Act of 1997, physicians are currently slated for a 5.1% cut in reimbursement starting Jan. 1. In past years, Congress has averted cuts or given doctors a small raise.

PPAC members urged CMS officials to use what influence they have to encourage lawmakers to do so again based on the recommendation from the Medicare Payment Advisory Commission that physician pay be increased by 2.8% in 2007.

"If you look at the data from 2001 to 2007, physicians' costs are up 18%, yet Medicare payments are down 5%. … Only physicians are subject to arbitrary spending cuts. Hospitals have had a 3.7% update; nursing homes, a 3.1%; [and] Medicare Advantage now gets 111% of the fee-for-service rate and is slated for another 4.8% increase," said PPAC member M. LeRoy Sprang, an ob.gyn. from Evanston, Ill.

Quality is an important part of the equation, said Dr. Tom Valuck, a medical officer at the CMS Center for Medicare Management.

"We're not talking about arbitrary cost cutting for necessary services. We're talking about taking waste out of the system," said Dr. Valuck, who described to PPAC the agency's efforts to develop cost-of-care and quality-of-care reports to measure physician performance.

"If you have two physicians achieving the same level of quality, but one can do it at half the cost, that physician is twice as efficient," he explained.

PPAC members encouraged CMS officials to keep in mind that as physicians strive to improve quality and lower costs, they should also be recognized for savings that may show up in other parts of the program, such as reduced hospital spending due to more preventive screening or disease management services provided in doctors' offices.

WASHINGTON — The failure to address low physician pay and looming reimbursement cuts in the Medicare program is starting to affect beneficiaries, members of Medicare's Practicing Physicians Advisory Council said at their recent meeting.

PPAC member Dr. Vincent J. Bufalino, a cardiologist from Naperville, Ill., offered an example to the council. “We have in our community the beginnings of physicians walking away from Medicare. Four of the busiest internists in town have said 'No' and ripped up their [Medicare] agreement,” Dr. Bufalino said.

Although the Centers for Medicare and Medicaid Services tracks physician participation, such trends might not reveal the whole picture, he added. Half of the physicians in Dr. Bufalino's community are no longer accepting new Medicare patients, he said. Although the CMS still counts them as participating in the program, the trend is having a profound effect on beneficiaries' access to physician services.

“We don't think that participation rates, assignment rates, really reflect what is going on,” Dr. Bufalino told CMS Deputy Administrator Leslie Norwalk.

The CMS has to rely on the numbers gathered by physician groups, she responded. “I suspect that the best way to go about this is probably at the state level where you would ask your state medical society to survey members and let us know what it is that you see. … It may help inform the debate,” Ms. Norwalk suggested, noting that administration officials are barred from telling people to lobby Congress.

Lawmakers will have to be the ones to make changes to the current mechanism for updating physician payments. Based on the sustained growth rate (SGR) formula, mandated by the Balanced Budget Act of 1997, physicians are currently slated for a 5.1% cut in reimbursement starting Jan. 1. In past years, Congress has averted cuts or given doctors a small raise.

PPAC members urged CMS officials to use what influence they have to encourage lawmakers to do so again based on the recommendation from the Medicare Payment Advisory Commission that physician pay be increased by 2.8% in 2007.

“If you look at the data from 2001 to 2007, physicians' costs are up 18%, yet Medicare payments are down 5%. … Only physicians are subject to arbitrary spending cuts. Hospitals have had a 3.7% update; nursing homes, a 3.1%; [and] Medicare Advantage now gets 111% of the fee-for-service rate and is slated for another 4.8% increase,” said PPAC member M. LeRoy Sprang, an ob.gyn. from Evanston, Ill.

Quality is an important part of the equation, said Dr. Tom Valuck, a medical officer at the CMS Center for Medicare Management. “We're not talking about arbitrary cost cutting for necessary services. We're talking about taking waste out of the system.”

PPAC members asked CMS officials to keep in mind that as physicians strive to improve quality and lower costs, they should also be recognized for savings that may show up elsewhere, such as in reduced hospital spending due to more preventive screening or disease management services provided in doctors' offices.

WASHINGTON — The failure to address low physician pay and looming reimbursement cuts in the Medicare program is starting to affect beneficiaries, members of Medicare's Practicing Physicians Advisory Council said at their recent meeting.

PPAC member Dr. Vincent J. Bufalino, a cardiologist from Naperville, Ill., offered an example to the council. “We have in our community the beginnings of physicians walking away from Medicare. Four of the busiest internists in town have said 'No' and ripped up their [Medicare] agreement,” Dr. Bufalino said.

Although the Centers for Medicare and Medicaid Services tracks physician participation, such trends might not reveal the whole picture, he added. Half of the physicians in Dr. Bufalino's community are no longer accepting new Medicare patients, he said. Although the CMS still counts them as participating in the program, the trend is having a profound effect on beneficiaries' access to physician services.

“We don't think that participation rates, assignment rates, really reflect what is going on,” Dr. Bufalino told CMS Deputy Administrator Leslie Norwalk.

The CMS has to rely on the numbers gathered by physician groups, she responded. “I suspect that the best way to go about this is probably at the state level where you would ask your state medical society to survey members and let us know what it is that you see. … It may help inform the debate,” Ms. Norwalk suggested, noting that administration officials are barred from telling people to lobby Congress.

Lawmakers will have to be the ones to make changes to the current mechanism for updating physician payments. Based on the sustained growth rate (SGR) formula, mandated by the Balanced Budget Act of 1997, physicians are currently slated for a 5.1% cut in reimbursement starting Jan. 1. In past years, Congress has averted cuts or given doctors a small raise.

PPAC members urged CMS officials to use what influence they have to encourage lawmakers to do so again based on the recommendation from the Medicare Payment Advisory Commission that physician pay be increased by 2.8% in 2007.

“If you look at the data from 2001 to 2007, physicians' costs are up 18%, yet Medicare payments are down 5%. … Only physicians are subject to arbitrary spending cuts. Hospitals have had a 3.7% update; nursing homes, a 3.1%; [and] Medicare Advantage now gets 111% of the fee-for-service rate and is slated for another 4.8% increase,” said PPAC member M. LeRoy Sprang, an ob.gyn. from Evanston, Ill.

Quality is an important part of the equation, said Dr. Tom Valuck, a medical officer at the CMS Center for Medicare Management. “We're not talking about arbitrary cost cutting for necessary services. We're talking about taking waste out of the system.”

PPAC members asked CMS officials to keep in mind that as physicians strive to improve quality and lower costs, they should also be recognized for savings that may show up elsewhere, such as in reduced hospital spending due to more preventive screening or disease management services provided in doctors' offices.

WASHINGTON — The failure to address low physician pay and looming reimbursement cuts in the Medicare program is starting to affect beneficiaries, members of Medicare's Practicing Physicians Advisory Council said at their recent meeting.

PPAC member Dr. Vincent J. Bufalino, a cardiologist from Naperville, Ill., offered an example to the council. “We have in our community the beginnings of physicians walking away from Medicare. Four of the busiest internists in town have said 'No' and ripped up their [Medicare] agreement,” Dr. Bufalino said.

Although the Centers for Medicare and Medicaid Services tracks physician participation, such trends might not reveal the whole picture, he added. Half of the physicians in Dr. Bufalino's community are no longer accepting new Medicare patients, he said. Although the CMS still counts them as participating in the program, the trend is having a profound effect on beneficiaries' access to physician services.

“We don't think that participation rates, assignment rates, really reflect what is going on,” Dr. Bufalino told CMS Deputy Administrator Leslie Norwalk.

The CMS has to rely on the numbers gathered by physician groups, she responded. “I suspect that the best way to go about this is probably at the state level where you would ask your state medical society to survey members and let us know what it is that you see. … It may help inform the debate,” Ms. Norwalk suggested, noting that administration officials are barred from telling people to lobby Congress.

Lawmakers will have to be the ones to make changes to the current mechanism for updating physician payments. Based on the sustained growth rate (SGR) formula, mandated by the Balanced Budget Act of 1997, physicians are currently slated for a 5.1% cut in reimbursement starting Jan. 1. In past years, Congress has averted cuts or given doctors a small raise.

PPAC members urged CMS officials to use what influence they have to encourage lawmakers to do so again based on the recommendation from the Medicare Payment Advisory Commission that physician pay be increased by 2.8% in 2007.

“If you look at the data from 2001 to 2007, physicians' costs are up 18%, yet Medicare payments are down 5%. … Only physicians are subject to arbitrary spending cuts. Hospitals have had a 3.7% update; nursing homes, a 3.1%; [and] Medicare Advantage now gets 111% of the fee-for-service rate and is slated for another 4.8% increase,” said PPAC member M. LeRoy Sprang, an ob.gyn. from Evanston, Ill.

Quality is an important part of the equation, said Dr. Tom Valuck, a medical officer at the CMS Center for Medicare Management. “We're not talking about arbitrary cost cutting for necessary services. We're talking about taking waste out of the system.”

PPAC members asked CMS officials to keep in mind that as physicians strive to improve quality and lower costs, they should also be recognized for savings that may show up elsewhere, such as in reduced hospital spending due to more preventive screening or disease management services provided in doctors' offices.