Joel B. Finkelstein

WASHINGTON — Drug and device manufacturers came under scrutiny at a recent hearing of the Senate Special Committee on Aging, during which witnesses said payments to high-profile physicians appear to be more of a marketing strategy than an attempt to improve patient care.

The hearing was held in part to highlight the need to pass the Physician Payments Sunshine Act (S. 2029), which would require drug and device manufacturers to report payments to physicians. Introduced in the Senate last fall, the bill would require companies to provide physicians' names; the amounts they were paid or the value of gifts, honoraria, or travel; and the date and purpose of the payments.

“Getting enormous sums of money from a company about whose product you're writing—money that might go away if you write a negative paper—makes the research neither objective nor independent,” testified Dr. Charles Rosen, president of the Association for Ethics in Spine Surgery, a professional organization he formed to address conflicts of interest.

Dr. Rosen said he became aware of the undue influence of industry money in 2005 with marketing approval of an artificial lumbar disc replacement based on what appeared to be a poorly designed study. When he tried to raise a red flag with the Food and Drug Administration and within the surgical community, he was rebuffed. When he persisted, the chairman of his department attempted to have him fired, but instead ended up leaving under a cloud.

“Some surgeons have become inextricably beholden to suppliers,” testified Said Hilal, president of Applied Medical Resources Corp., a small device company in Orange County, Calif.

“We hear of large suppliers approaching hundreds of surgeons with invitations to become consultants. However, these physicians appear to be no more than an extension of the sales and marketing efforts,” he said.

Device makers invited to testify said that they were working to rectify past lapses.

“In this industry, the same physicians we rely on as consultants to develop or train on the safe and effective use of our products may also select products for patients. … In hindsight, it now appears that as industry expanded to meet patients' needs, the use of physician consultants may have been excessive. Such excesses fostered a degree of mistrust of the industry and physicians, and invited the understandable scrutiny of the government and other stakeholders,” testified Chad Phipps, senior vice president and general counsel for Zimmer Holdings Inc.

The company was one of five device makers that recently settled with the Department of Justice over alleged violations of antikickback laws. While none of the companies admitted wrongdoing, collectively they agreed to pay fines totaling $311 million. Each of the companies also agreed to be monitored by an independent auditing firm.

The fines are unlikely to deter the companies from continuing to foster inappropriate financial arrangements with physicians, Mr. Hilal said. “A multibillion-dollar medical supplier does not consider $40 million or $400 million in penalties, after years of violations, as painful or prohibitive,” he said.

According to testimony from the Inspector General's office at Health and Human Services, the Department of Justice is also investigating whether to pursue charges against surgeons who might have solicited kickbacks from companies. However, witnesses said that the vast majority of surgeons eschew such conflicts of interest.

Industry critics said there is a need to ensure that the information provided by companies is communicated to the public in a consumer-friendly way, while industry representatives argued that small companies should also be included in the legislation. Currently, the bill applies only to drug and device makers with annual revenues in excess of $100 million.

WASHINGTON — Drug and device manufacturers came under scrutiny at a recent hearing of the Senate Special Committee on Aging, during which witnesses said payments to high-profile physicians appear to be more of a marketing strategy than an attempt to improve patient care.

The hearing was held in part to highlight the need to pass the Physician Payments Sunshine Act (S. 2029), which would require drug and device manufacturers to report payments to physicians. Introduced in the Senate last fall, the bill would require companies to provide physicians' names; the amounts they were paid or the value of gifts, honoraria, or travel; and the date and purpose of the payments.

“Getting enormous sums of money from a company about whose product you're writing—money that might go away if you write a negative paper—makes the research neither objective nor independent,” testified Dr. Charles Rosen, president of the Association for Ethics in Spine Surgery, a professional organization he formed to address conflicts of interest.

Dr. Rosen said he became aware of the undue influence of industry money in 2005 with marketing approval of an artificial lumbar disc replacement based on what appeared to be a poorly designed study. When he tried to raise a red flag with the Food and Drug Administration and within the surgical community, he was rebuffed. When he persisted, the chairman of his department attempted to have him fired, but instead ended up leaving under a cloud.

“Some surgeons have become inextricably beholden to suppliers,” testified Said Hilal, president of Applied Medical Resources Corp., a small device company in Orange County, Calif.

“We hear of large suppliers approaching hundreds of surgeons with invitations to become consultants. However, these physicians appear to be no more than an extension of the sales and marketing efforts,” he said.

Device makers invited to testify said that they were working to rectify past lapses.

“In this industry, the same physicians we rely on as consultants to develop or train on the safe and effective use of our products may also select products for patients. … In hindsight, it now appears that as industry expanded to meet patients' needs, the use of physician consultants may have been excessive. Such excesses fostered a degree of mistrust of the industry and physicians, and invited the understandable scrutiny of the government and other stakeholders,” testified Chad Phipps, senior vice president and general counsel for Zimmer Holdings Inc.

The company was one of five device makers that recently settled with the Department of Justice over alleged violations of antikickback laws. While none of the companies admitted wrongdoing, collectively they agreed to pay fines totaling $311 million. Each of the companies also agreed to be monitored by an independent auditing firm.

The fines are unlikely to deter the companies from continuing to foster inappropriate financial arrangements with physicians, Mr. Hilal said. “A multibillion-dollar medical supplier does not consider $40 million or $400 million in penalties, after years of violations, as painful or prohibitive,” he said.

According to testimony from the Inspector General's office at Health and Human Services, the Department of Justice is also investigating whether to pursue charges against surgeons who might have solicited kickbacks from companies. However, witnesses said that the vast majority of surgeons eschew such conflicts of interest.

Industry critics said there is a need to ensure that the information provided by companies is communicated to the public in a consumer-friendly way, while industry representatives argued that small companies should also be included in the legislation. Currently, the bill applies only to drug and device makers with annual revenues in excess of $100 million.

WASHINGTON — Drug and device manufacturers came under scrutiny at a recent hearing of the Senate Special Committee on Aging, during which witnesses said payments to high-profile physicians appear to be more of a marketing strategy than an attempt to improve patient care.

The hearing was held in part to highlight the need to pass the Physician Payments Sunshine Act (S. 2029), which would require drug and device manufacturers to report payments to physicians. Introduced in the Senate last fall, the bill would require companies to provide physicians' names; the amounts they were paid or the value of gifts, honoraria, or travel; and the date and purpose of the payments.

“Getting enormous sums of money from a company about whose product you're writing—money that might go away if you write a negative paper—makes the research neither objective nor independent,” testified Dr. Charles Rosen, president of the Association for Ethics in Spine Surgery, a professional organization he formed to address conflicts of interest.

Dr. Rosen said he became aware of the undue influence of industry money in 2005 with marketing approval of an artificial lumbar disc replacement based on what appeared to be a poorly designed study. When he tried to raise a red flag with the Food and Drug Administration and within the surgical community, he was rebuffed. When he persisted, the chairman of his department attempted to have him fired, but instead ended up leaving under a cloud.

“Some surgeons have become inextricably beholden to suppliers,” testified Said Hilal, president of Applied Medical Resources Corp., a small device company in Orange County, Calif.

“We hear of large suppliers approaching hundreds of surgeons with invitations to become consultants. However, these physicians appear to be no more than an extension of the sales and marketing efforts,” he said.

Device makers invited to testify said that they were working to rectify past lapses.

“In this industry, the same physicians we rely on as consultants to develop or train on the safe and effective use of our products may also select products for patients. … In hindsight, it now appears that as industry expanded to meet patients' needs, the use of physician consultants may have been excessive. Such excesses fostered a degree of mistrust of the industry and physicians, and invited the understandable scrutiny of the government and other stakeholders,” testified Chad Phipps, senior vice president and general counsel for Zimmer Holdings Inc.

The company was one of five device makers that recently settled with the Department of Justice over alleged violations of antikickback laws. While none of the companies admitted wrongdoing, collectively they agreed to pay fines totaling $311 million. Each of the companies also agreed to be monitored by an independent auditing firm.

The fines are unlikely to deter the companies from continuing to foster inappropriate financial arrangements with physicians, Mr. Hilal said. “A multibillion-dollar medical supplier does not consider $40 million or $400 million in penalties, after years of violations, as painful or prohibitive,” he said.

According to testimony from the Inspector General's office at Health and Human Services, the Department of Justice is also investigating whether to pursue charges against surgeons who might have solicited kickbacks from companies. However, witnesses said that the vast majority of surgeons eschew such conflicts of interest.

Industry critics said there is a need to ensure that the information provided by companies is communicated to the public in a consumer-friendly way, while industry representatives argued that small companies should also be included in the legislation. Currently, the bill applies only to drug and device makers with annual revenues in excess of $100 million.

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

"African Americans and Latinos suffer disproportionately from the HIV/AIDS epidemic in this country," said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

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

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

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

It's a "dream test," yet it's not being used, he said at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

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

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said. In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing.

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

Latino patients face the same barriers and more, given the inherent stigma created by the immigration debate, said Britt Rios-Ellis, Ph.D., director of the Center for Latino Community Health, Evaluation, and Leadership Training, a partnership between the National Council of La Raza and California State University, Long Beach.

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

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

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

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

"African Americans and Latinos suffer disproportionately from the HIV/AIDS epidemic in this country," said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

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

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

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

It's a "dream test," yet it's not being used, he said at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

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

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said. In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing.

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

Latino patients face the same barriers and more, given the inherent stigma created by the immigration debate, said Britt Rios-Ellis, Ph.D., director of the Center for Latino Community Health, Evaluation, and Leadership Training, a partnership between the National Council of La Raza and California State University, Long Beach.

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

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

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

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

"African Americans and Latinos suffer disproportionately from the HIV/AIDS epidemic in this country," said Dr. Madeline Sutton, who helps lead the Heightened National Response to the HIV/AIDS Crisis Among African Americans, a program of the Centers for Disease Control and Prevention.

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

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

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

It's a "dream test," yet it's not being used, he said at a meeting sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the Department of Health and Human Services.

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

Minorities face obstacles that researchers are still struggling to identify. For African Americans, it's not clearly genetics or behavior that is leading to the explosion in the infection rate, Dr. Sutton said. In part, the CDC's effort is based on forming a better understanding of what the barriers are to testing.

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

Latino patients face the same barriers and more, given the inherent stigma created by the immigration debate, said Britt Rios-Ellis, Ph.D., director of the Center for Latino Community Health, Evaluation, and Leadership Training, a partnership between the National Council of La Raza and California State University, Long Beach.

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

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

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

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

“What would be best for me, for everybody in this room, and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and have until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years.

By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.”

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

That fact underscores the need for physicians to get involved in advocating for themselves, Rep. Berkley said.

“The doctors were asleep when things were taking place here in Washington and now you have to be ever vigilant to help us turn back the clock,” she said. “Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it.”

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

“What would be best for me, for everybody in this room, and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and have until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years.

By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.”

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

That fact underscores the need for physicians to get involved in advocating for themselves, Rep. Berkley said.

“The doctors were asleep when things were taking place here in Washington and now you have to be ever vigilant to help us turn back the clock,” she said. “Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it.”

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

“What would be best for me, for everybody in this room, and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and have until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years.

By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.”

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

That fact underscores the need for physicians to get involved in advocating for themselves, Rep. Berkley said.

“The doctors were asleep when things were taking place here in Washington and now you have to be ever vigilant to help us turn back the clock,” she said. “Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it.”

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

“What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

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

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

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

“What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

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

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

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

“What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

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

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

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

“What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.” He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

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

“What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.” He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

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

“What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix,” said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and has until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Sen. Kyl said. “It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented.” He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to an American College of Physicians' report.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by AcademyHealth.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, according to Dr. Dale.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs. “Health care will become so expensive that the country will no longer be able to support it,” he said.

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research.

The group also sent a “candidates pledge” outlining these goals to each of the presidential hopefuls as well as to the group's membership, who can in turn hand them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” according to Mr. Doherty.

The American Medical Association launched a national ad campaign that has been designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said. “Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country.

“But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to an American College of Physicians' report.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by AcademyHealth.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, according to Dr. Dale.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs. “Health care will become so expensive that the country will no longer be able to support it,” he said.

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research.

The group also sent a “candidates pledge” outlining these goals to each of the presidential hopefuls as well as to the group's membership, who can in turn hand them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” according to Mr. Doherty.

The American Medical Association launched a national ad campaign that has been designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said. “Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country.

“But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to an American College of Physicians' report.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by AcademyHealth.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, according to Dr. Dale.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs. “Health care will become so expensive that the country will no longer be able to support it,” he said.

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research.

The group also sent a “candidates pledge” outlining these goals to each of the presidential hopefuls as well as to the group's membership, who can in turn hand them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” according to Mr. Doherty.

The American Medical Association launched a national ad campaign that has been designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said. “Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country.

“But I don't think there is a real disagreement within the profession on the goal,” he said.

WASHINGTON – A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.

At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups–including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics–signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.

“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.

In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.

“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”

It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.

“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”

There was no apparent consensus on what is needed to make the idea of a medical home into a reality.

Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. Nor does it imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step. “Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.

Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.

Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.

Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.

“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.

Many of those at the meeting appeared undaunted.

After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations–both his and those of his patients.

“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”

WASHINGTON – A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.

At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups–including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics–signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.

“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.

In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.

“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”

It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.

“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”

There was no apparent consensus on what is needed to make the idea of a medical home into a reality.

Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. Nor does it imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step. “Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.

Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.

Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.

Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.

“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.

Many of those at the meeting appeared undaunted.

After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations–both his and those of his patients.

“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”

WASHINGTON – A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.

At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups–including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics–signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.

“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.

In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.

“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”

It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.

“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”

There was no apparent consensus on what is needed to make the idea of a medical home into a reality.

Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. Nor does it imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step. “Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.

Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.

Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.

Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.

“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.

Many of those at the meeting appeared undaunted.

After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations–both his and those of his patients.

“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”

WASHINGTON — A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.

At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups—including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics—signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.

“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.

In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.

“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Dr. Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”

It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.

“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”

There was no apparent consensus on what is needed to make the idea of a medical home into a reality.

Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. It also doesn't imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step.

“Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.

Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.

Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.

Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.

“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.

Many of those at the meeting appeared undaunted.

After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations—both his and those of his patients.

“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”

Joint Principles for a Medical Home

▸ Personal physician. Each patient has an ongoing relationship with a physician who provides continuous and comprehensive care.

▸ Physician direction. A physician-led team collectively takes responsibility for the ongoing care of patients.

▸ Whole-person orientation. A physician is responsible for providing for all of a patient's health care needs or arranging care with other qualified professionals.

▸ Coordinated care. A patient's care is integrated across all elements of the health care system and the community.

▸ Quality and safety. Practices adopt a comprehensive plan of ongoing self-assessment protocols that incorporate accountability, information technology, performance measures, and patient feedback.

▸ Enhanced access. Practices use systems such as open scheduling, expanded hours, and new options for communication among physician, staff, and patients.

▸ Appropriate payment. Payers recognize the added value provided by a medical home, such as care management, care coordination, quality improvement, and savings from reduced hospital visits.

Source: Patient-Centered Primary Care Collaborative

WASHINGTON — A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.

At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups—including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics—signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.

“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.

In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.

“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Dr. Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”

It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.

“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”

There was no apparent consensus on what is needed to make the idea of a medical home into a reality.

Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. It also doesn't imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step.

“Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.

Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.

Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.

Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.

“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.

Many of those at the meeting appeared undaunted.

After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations—both his and those of his patients.

“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”

Joint Principles for a Medical Home

▸ Personal physician. Each patient has an ongoing relationship with a physician who provides continuous and comprehensive care.

▸ Physician direction. A physician-led team collectively takes responsibility for the ongoing care of patients.

▸ Whole-person orientation. A physician is responsible for providing for all of a patient's health care needs or arranging care with other qualified professionals.

▸ Coordinated care. A patient's care is integrated across all elements of the health care system and the community.

▸ Quality and safety. Practices adopt a comprehensive plan of ongoing self-assessment protocols that incorporate accountability, information technology, performance measures, and patient feedback.

▸ Enhanced access. Practices use systems such as open scheduling, expanded hours, and new options for communication among physician, staff, and patients.

▸ Appropriate payment. Payers recognize the added value provided by a medical home, such as care management, care coordination, quality improvement, and savings from reduced hospital visits.

Source: Patient-Centered Primary Care Collaborative

WASHINGTON — A who's who list of physician organizations, advocacy groups, pharmaceutical manufacturers, and employers is throwing its weight behind the idea that the medical home model can cure much of what ails the health care system.

At a recent meeting of the Patient-Centered Primary Care Collaborative, 13 physician specialty groups—including the American College of Physicians, the American Academy of Family Physicians, and the American Academy of Pediatrics—signed on to the joint principles for a comprehensive, primary care, evidence-based, and physician-directed medical home. The principles also are supported by a variety of other organizations, including many large corporations.

“I have been a family physician for 31 years … and I have never been more excited about the future of health care,” said Dr. Doug Henley, executive vice president of the American Academy of Family Physicians.

In March, the Association of American Medical Colleges adopted the position that everyone should have access to a medical home.

“Many Americans, even among those with comprehensive health insurance, feel 'medically homeless' and lost in a system that is difficult to navigate when they require care,” AAMC president Dr. Darrell Kirch said in a statement. “The medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional.”

It's not just national groups that are buying into the concept. At least 41 states are preparing or considering pilot projects to implement the medical home model. Medicare is scheduled to launch a demonstration project next year, and Wal-Mart has begun to explore the model.

“We listen to our customers,” Dr. John Agwunobi, president of Wal-Mart's professional services division, said at the meeting. “We hear them saying that health care is too costly, too complicated, and too controlled.”

There was no apparent consensus on what is needed to make the idea of a medical home into a reality.

Although all of the groups have signed on to the joint principles, that endorsement doesn't imply specific responsibilities. It also doesn't imply that everyone agrees on what defines a medical home. A wide variety of measurement tools now being developed can be used to gauge and document the success of a medical home, and that is just the first step.

“Measurement is an extremely powerful tool. But it is only that. It is not an end in itself. … It gives us a compass so that we can see where we want to go and whether we are going in the right direction,” said Dr. David Meyers of the Agency for Healthcare Research and Quality. As director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, Dr. Meyers has helped develop a survey tool for measuring care coordination.

Comprehensiveness is the linchpin. The principles of a medical home include providing all services each patient may need or, if necessary, making sure the patient has access to care outside the practice. In other words, the physician providing a medical home is responsible for ensuring that patients get appropriate care, while avoiding the trap of the gatekeeper era in which doctors found themselves in the position of denying care, Dr. Meyers said.

Using measurement tools to show progress and prove the value of the medical home concept quantitatively will be just one challenge, speakers emphasized.

Physicians, especially those in small or solo practices, will need to be shown that it is worth their time and trouble to adopt quality improvement measures, with only the promise of additional compensation. Patients will have to be educated on what a medical home is, why it benefits them, and how they can get one. And payers will have to be convinced that they are getting more for their money.

“Timing is everything,” said Helen Darling, president of the National Business Group on Health. The country is in a recession. Companies are going bankrupt or, at the least, cutting costs. “This is not a good time to talk about spending more money.” She encouraged the group to make sure that adoption of the medical home model is budget neutral.

Many of those at the meeting appeared undaunted.

After 29 years of practicing medicine, Dr. William Jagiello said that he found himself frustrated by a system that fell short of expectations—both his and those of his patients.

“I thought about all the things that I should have done for my patients and did not do,” said Dr. Jagiello, an Iowa family physician. “It began to dawn on me that the medical home concept would give me the process and the vehicle through which I could be doing all those things for my patients on a daily basis. And perhaps I could come home a lot more satisfied and less exhausted knowing that I have delivered the best care possible.”

Joint Principles for a Medical Home

▸ Personal physician. Each patient has an ongoing relationship with a physician who provides continuous and comprehensive care.

▸ Physician direction. A physician-led team collectively takes responsibility for the ongoing care of patients.

▸ Whole-person orientation. A physician is responsible for providing for all of a patient's health care needs or arranging care with other qualified professionals.

▸ Coordinated care. A patient's care is integrated across all elements of the health care system and the community.

▸ Quality and safety. Practices adopt a comprehensive plan of ongoing self-assessment protocols that incorporate accountability, information technology, performance measures, and patient feedback.

▸ Enhanced access. Practices use systems such as open scheduling, expanded hours, and new options for communication among physician, staff, and patients.

▸ Appropriate payment. Payers recognize the added value provided by a medical home, such as care management, care coordination, quality improvement, and savings from reduced hospital visits.

Source: Patient-Centered Primary Care Collaborative

WASHINGTON — The medical care provided to soldiers and veterans is under the microscope because of recent events, according to experts who have suggested that better coordination of care may be the answer to well-publicized lapses.

A single-payer system does not guarantee that there is not fragmentation, said Donna Shalala, Ph.D., president of the University of Miami, speaking at a health policy conference sponsored by Academy Health.

Along with former Sen. Bob Dole (R-Kan.), Dr. Shalala, who was Health and Human Services secretary under President Clinton, recently served on a federal commission to review care provided to injured soldiers at Walter Reed Army Medical Center and other military hospitals.

One of their main conclusions was that better coordination of care across the system would improve the experience of soldiers and their families. Soldiers interviewed by the panel described a complex system in which they had little help understanding what services were available to them or how to obtain them.

"A young man who had been wounded in Iraq said he had so many care coordinators he couldn't remember their names. More importantly, they all kept getting deployed after a number of months," said Dr. Shalala, also noting that in several cases family members ended up leaving their jobs to help the soldiers navigate their way through the system.

The Dole-Shalala commission advised the military to adopt a patient-centered recovery plan based on the experience with case management models in the private sector. However, the group also recognized that the infrastructure of the military health care system creates some unique barriers. While soldiers have access to any and all treatments they may need, each service is offered in select centers that are spread across the country, requiring the soldiers, and often their families, to move during the course of rehabilitation.

"It requires a different level of care coordination that involved coordinating family services as well as individual care, and taking a very complex health care system and making it work seamlessly," she said.

The need to transition soldiers between the urgent care provided by the Department of Defense and the more sustained care provided by the Department of Veterans Affairs adds another layer of complexity on top of that, said Lt. Gen. James Roudebush, surgeon general of the U.S. Air Force.

"The mission of the DOD for our military health system is to provide a healthy, fit force," he explained. "The VA, on the other hand, is more focused on the rehabilitation and sustained care. … So we have rather different focuses with a very significant interface."

Dr. Roudebush, who served on the Dole-Shalala commission, said the group also looked to recent advances in case management for better ways to treat soldiers with complex medical problems.

"Frankly, right now we are not doing nearly as good a job as we need to," he said. Where the military has excelled and continues to do so is in the field of battle, with the lowest rate of both non-combat-related illnesses and the lowest rate of soldiers dying of their injuries seen in history, boasted Dr. Roudebush.

"Medicine is central to our ability to accomplish the military mission in whatever circumstance we find ourselves," he said.

WASHINGTON — The medical care provided to soldiers and veterans is under the microscope because of recent events, according to experts who have suggested that better coordination of care may be the answer to well-publicized lapses.

A single-payer system does not guarantee that there is not fragmentation, said Donna Shalala, Ph.D., president of the University of Miami, speaking at a health policy conference sponsored by Academy Health.

Along with former Sen. Bob Dole (R-Kan.), Dr. Shalala, who was Health and Human Services secretary under President Clinton, recently served on a federal commission to review care provided to injured soldiers at Walter Reed Army Medical Center and other military hospitals.

One of their main conclusions was that better coordination of care across the system would improve the experience of soldiers and their families. Soldiers interviewed by the panel described a complex system in which they had little help understanding what services were available to them or how to obtain them.

"A young man who had been wounded in Iraq said he had so many care coordinators he couldn't remember their names. More importantly, they all kept getting deployed after a number of months," said Dr. Shalala, also noting that in several cases family members ended up leaving their jobs to help the soldiers navigate their way through the system.

The Dole-Shalala commission advised the military to adopt a patient-centered recovery plan based on the experience with case management models in the private sector. However, the group also recognized that the infrastructure of the military health care system creates some unique barriers. While soldiers have access to any and all treatments they may need, each service is offered in select centers that are spread across the country, requiring the soldiers, and often their families, to move during the course of rehabilitation.

"It requires a different level of care coordination that involved coordinating family services as well as individual care, and taking a very complex health care system and making it work seamlessly," she said.

The need to transition soldiers between the urgent care provided by the Department of Defense and the more sustained care provided by the Department of Veterans Affairs adds another layer of complexity on top of that, said Lt. Gen. James Roudebush, surgeon general of the U.S. Air Force.

"The mission of the DOD for our military health system is to provide a healthy, fit force," he explained. "The VA, on the other hand, is more focused on the rehabilitation and sustained care. … So we have rather different focuses with a very significant interface."

Dr. Roudebush, who served on the Dole-Shalala commission, said the group also looked to recent advances in case management for better ways to treat soldiers with complex medical problems.

"Frankly, right now we are not doing nearly as good a job as we need to," he said. Where the military has excelled and continues to do so is in the field of battle, with the lowest rate of both non-combat-related illnesses and the lowest rate of soldiers dying of their injuries seen in history, boasted Dr. Roudebush.

"Medicine is central to our ability to accomplish the military mission in whatever circumstance we find ourselves," he said.

WASHINGTON — The medical care provided to soldiers and veterans is under the microscope because of recent events, according to experts who have suggested that better coordination of care may be the answer to well-publicized lapses.

A single-payer system does not guarantee that there is not fragmentation, said Donna Shalala, Ph.D., president of the University of Miami, speaking at a health policy conference sponsored by Academy Health.

Along with former Sen. Bob Dole (R-Kan.), Dr. Shalala, who was Health and Human Services secretary under President Clinton, recently served on a federal commission to review care provided to injured soldiers at Walter Reed Army Medical Center and other military hospitals.

One of their main conclusions was that better coordination of care across the system would improve the experience of soldiers and their families. Soldiers interviewed by the panel described a complex system in which they had little help understanding what services were available to them or how to obtain them.

"A young man who had been wounded in Iraq said he had so many care coordinators he couldn't remember their names. More importantly, they all kept getting deployed after a number of months," said Dr. Shalala, also noting that in several cases family members ended up leaving their jobs to help the soldiers navigate their way through the system.

The Dole-Shalala commission advised the military to adopt a patient-centered recovery plan based on the experience with case management models in the private sector. However, the group also recognized that the infrastructure of the military health care system creates some unique barriers. While soldiers have access to any and all treatments they may need, each service is offered in select centers that are spread across the country, requiring the soldiers, and often their families, to move during the course of rehabilitation.

"It requires a different level of care coordination that involved coordinating family services as well as individual care, and taking a very complex health care system and making it work seamlessly," she said.

The need to transition soldiers between the urgent care provided by the Department of Defense and the more sustained care provided by the Department of Veterans Affairs adds another layer of complexity on top of that, said Lt. Gen. James Roudebush, surgeon general of the U.S. Air Force.

"The mission of the DOD for our military health system is to provide a healthy, fit force," he explained. "The VA, on the other hand, is more focused on the rehabilitation and sustained care. … So we have rather different focuses with a very significant interface."

Dr. Roudebush, who served on the Dole-Shalala commission, said the group also looked to recent advances in case management for better ways to treat soldiers with complex medical problems.

"Frankly, right now we are not doing nearly as good a job as we need to," he said. Where the military has excelled and continues to do so is in the field of battle, with the lowest rate of both non-combat-related illnesses and the lowest rate of soldiers dying of their injuries seen in history, boasted Dr. Roudebush.

"Medicine is central to our ability to accomplish the military mission in whatever circumstance we find ourselves," he said.

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

"What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix," said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and have until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Rep. Kyl said. "It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented." He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

That fact underscores the need for physicians to get involved in advocating for themselves, said Rep. Berkley.

"The doctors were asleep when things were taking place here in Washington and now you have to be ever vigilant to help us turn back the clock," she said. "Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it."

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

"What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix," said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and have until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Rep. Kyl said. "It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented." He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

That fact underscores the need for physicians to get involved in advocating for themselves, said Rep. Berkley.

"The doctors were asleep when things were taking place here in Washington and now you have to be ever vigilant to help us turn back the clock," she said. "Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it."

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

"What would be best for me, for everybody in this room and for the older Americans under the Medicare system is to do a permanent fix. What my gut is telling me is that, at best, we will do an 18-month fix," said Rep. Shelley Berkley (D-Nev.).

Congress passed a 6-month update to the Medicare physician payment rate late last year and have until July 1 to avert a 10.6% cut for the remainder of the year. However, under current federal spending rules, lawmakers will have to offset any increases to physician pay by cutting another program or raising taxes.

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

For example, the proposed 18-month fix that would keep physician pay steady through 2008 and raise it 1% in 2009 would cost $37.5 billion over 5 years. By comparison, a 6-month fix, like the one passed last year, would cost $8.4 billion, saving lawmakers nearly $30 billion in offsets.

That's the easier solution, Rep. Kyl said. "It's not an ideal situation. However, our priority has been and must continue to be averting scheduled cuts and securing a positive update. So we are very short-term oriented." He added that, while there is currently enough wiggle room in the budget to pay for the 18-month approach, some lawmakers had other priorities for the money.

That fact underscores the need for physicians to get involved in advocating for themselves, said Rep. Berkley.

"The doctors were asleep when things were taking place here in Washington and now you have to be ever vigilant to help us turn back the clock," she said. "Doctors are the lousiest politicians on the planet. You are not good at this, but I encourage you to get good at it."