Joel B. Finkelstein

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made. “What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

The federal government currently spends $5 billion a year on SCHIP. To keep the program running at current levels of enrollment, Congress will need to add $13 billion to $15 billion in funding to the program over the next 5 years, according to an estimate by the Congressional Budget Office.

It will cost more if lawmakers want to enable states to expand coverage to those children who are not currently enrolled and a lot more for those not currently eligible.

That money could be even harder to justify now since Democrats have invoked a pay-as-you-go rule, which requires any new spending to be offset by cuts somewhere else in the budget.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement.

SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible.

“It has helped a lot of families. But like any program now, we have the opportunity to take a look at it, see what's working, what's not, what needs to be improved,” a Republican congressional staffer said at the meeting.

SGR Fix

Both Democrats and Republicans have expressed interest in finding a solution to decreasing physician pay under the sustainable growth rate formula.

However, no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true now this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made. “What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

The federal government currently spends $5 billion a year on SCHIP. To keep the program running at current levels of enrollment, Congress will need to add $13 billion to $15 billion in funding to the program over the next 5 years, according to an estimate by the Congressional Budget Office.

It will cost more if lawmakers want to enable states to expand coverage to those children who are not currently enrolled and a lot more for those not currently eligible.

That money could be even harder to justify now since Democrats have invoked a pay-as-you-go rule, which requires any new spending to be offset by cuts somewhere else in the budget.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement.

SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible.

“It has helped a lot of families. But like any program now, we have the opportunity to take a look at it, see what's working, what's not, what needs to be improved,” a Republican congressional staffer said at the meeting.

SGR Fix

Both Democrats and Republicans have expressed interest in finding a solution to decreasing physician pay under the sustainable growth rate formula.

However, no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true now this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made. “What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

The federal government currently spends $5 billion a year on SCHIP. To keep the program running at current levels of enrollment, Congress will need to add $13 billion to $15 billion in funding to the program over the next 5 years, according to an estimate by the Congressional Budget Office.

It will cost more if lawmakers want to enable states to expand coverage to those children who are not currently enrolled and a lot more for those not currently eligible.

That money could be even harder to justify now since Democrats have invoked a pay-as-you-go rule, which requires any new spending to be offset by cuts somewhere else in the budget.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement.

SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible.

“It has helped a lot of families. But like any program now, we have the opportunity to take a look at it, see what's working, what's not, what needs to be improved,” a Republican congressional staffer said at the meeting.

SGR Fix

Both Democrats and Republicans have expressed interest in finding a solution to decreasing physician pay under the sustainable growth rate formula.

However, no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true now this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON -- Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, as is currently done by the Veterans Affairs system. Over in the Senate, Sen. Edward Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” she said. “This is going to be much more of a morass than people think.”

Medicare already sets prices for many services and procedures, but setting prices for prescription drugs is far more complicated, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals--most of it is in R&D for that drug and for the drugs that didn't make it--that's a much more challenging job to do well,” he said. However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, said a statement from Sen. Kennedy's office.

“My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, Dr. Moon said.

WASHINGTON -- Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, as is currently done by the Veterans Affairs system. Over in the Senate, Sen. Edward Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” she said. “This is going to be much more of a morass than people think.”

Medicare already sets prices for many services and procedures, but setting prices for prescription drugs is far more complicated, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals--most of it is in R&D for that drug and for the drugs that didn't make it--that's a much more challenging job to do well,” he said. However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, said a statement from Sen. Kennedy's office.

“My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, Dr. Moon said.

WASHINGTON -- Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, as is currently done by the Veterans Affairs system. Over in the Senate, Sen. Edward Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” she said. “This is going to be much more of a morass than people think.”

Medicare already sets prices for many services and procedures, but setting prices for prescription drugs is far more complicated, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals--most of it is in R&D for that drug and for the drugs that didn't make it--that's a much more challenging job to do well,” he said. However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, said a statement from Sen. Kennedy's office.

“My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, Dr. Moon said.

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

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

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

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

It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

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

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

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

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

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

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

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment.

Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

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

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures.

“The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka commented.

The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

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

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

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

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

It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

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

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

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

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

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

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

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment.

Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

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

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures.

“The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka commented.

The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

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

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

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

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

It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

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

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

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

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

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

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

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment.

Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

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

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures.

“The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka commented.

The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the launch the initiative.

NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Dr. Dickey said time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software for the past year. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey guessed.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors.

“This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” Dr. Pace said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards.

Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services (CMS)is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

“It all fits together in supporting the movement toward electronic prescribing to get to better quality care at a lower cost.”

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort.

“Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing.

“But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, Mr. Tullman added.

Such a large coalition of payers and vendors has the potential to put a real dent in the problem, said Dr. Pace.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said.

It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper,” said Dr. Pace.

Who's on Board The eRx Express?

Members of the National ePrescribing Patient Safety Initiative include:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the launch the initiative.

NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Dr. Dickey said time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software for the past year. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey guessed.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors.

“This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” Dr. Pace said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards.

Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services (CMS)is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

“It all fits together in supporting the movement toward electronic prescribing to get to better quality care at a lower cost.”

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort.

“Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing.

“But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, Mr. Tullman added.

Such a large coalition of payers and vendors has the potential to put a real dent in the problem, said Dr. Pace.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said.

It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper,” said Dr. Pace.

Who's on Board The eRx Express?

Members of the National ePrescribing Patient Safety Initiative include:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the launch the initiative.

NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Dr. Dickey said time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software for the past year. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey guessed.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors.

“This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” Dr. Pace said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards.

Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services (CMS)is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

“It all fits together in supporting the movement toward electronic prescribing to get to better quality care at a lower cost.”

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort.

“Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing.

“But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, Mr. Tullman added.

Such a large coalition of payers and vendors has the potential to put a real dent in the problem, said Dr. Pace.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said.

It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper,” said Dr. Pace.

Who's on Board The eRx Express?

Members of the National ePrescribing Patient Safety Initiative include:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The NEPSI initiative is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the initiative. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

According to the Institute of Medicine, “1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. Many errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses, the report found.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

Time and money have been major barriers to adoption of electronic prescribing, Dr. Dickey said, even though widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said. That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors. “This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” Dr. Pace said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing, and Medicare Advantage plans are moving toward similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

The initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. In contrast, other free electronic prescribing software requires physicians to market personal health records or other products to patients.

The companies that are paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort. “Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing.

But “our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, he added.

Who's on Board?

The National ePrescribing Patient Safety Initiative includes these members:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The NEPSI initiative is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the initiative. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

According to the Institute of Medicine, “1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. Many errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses, the report found.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

Time and money have been major barriers to adoption of electronic prescribing, Dr. Dickey said, even though widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said. That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors. “This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” Dr. Pace said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing, and Medicare Advantage plans are moving toward similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

The initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. In contrast, other free electronic prescribing software requires physicians to market personal health records or other products to patients.

The companies that are paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort. “Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing.

But “our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, he added.

Who's on Board?

The National ePrescribing Patient Safety Initiative includes these members:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The NEPSI initiative is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the initiative. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

According to the Institute of Medicine, “1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. Many errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses, the report found.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

Time and money have been major barriers to adoption of electronic prescribing, Dr. Dickey said, even though widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said. That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors. “This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” Dr. Pace said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing, and Medicare Advantage plans are moving toward similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

The initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. In contrast, other free electronic prescribing software requires physicians to market personal health records or other products to patients.

The companies that are paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort. “Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing.

But “our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, he added.

Who's on Board?

The National ePrescribing Patient Safety Initiative includes these members:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is currently done by the Veterans Affairs system. Over in the Senate, Sen. Edward Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, has placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” Dr. Moon stated at the forum.

“This is going to be much more of a morass than people think. I think it's a mistake on the part of a lot of the Democrats to have been promising that's what we're going to do,” she said.

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is far more complicated than setting prices for something like procedures, which can be based on hospital expenses, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals—most of it is in R&D for that drug and for the drugs that didn't make it—that's a much more challenging job to do well,” he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, according to a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said.

“My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, she said.

Setting prices for prescription drugs is far more complicated than setting prices for something like procedures. DR. GINSBURG

WASHINGTON — Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is currently done by the Veterans Affairs system. Over in the Senate, Sen. Edward Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, has placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” Dr. Moon stated at the forum.

“This is going to be much more of a morass than people think. I think it's a mistake on the part of a lot of the Democrats to have been promising that's what we're going to do,” she said.

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is far more complicated than setting prices for something like procedures, which can be based on hospital expenses, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals—most of it is in R&D for that drug and for the drugs that didn't make it—that's a much more challenging job to do well,” he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, according to a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said.

“My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, she said.

Setting prices for prescription drugs is far more complicated than setting prices for something like procedures. DR. GINSBURG

WASHINGTON — Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is currently done by the Veterans Affairs system. Over in the Senate, Sen. Edward Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, has placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” Dr. Moon stated at the forum.

“This is going to be much more of a morass than people think. I think it's a mistake on the part of a lot of the Democrats to have been promising that's what we're going to do,” she said.

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is far more complicated than setting prices for something like procedures, which can be based on hospital expenses, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals—most of it is in R&D for that drug and for the drugs that didn't make it—that's a much more challenging job to do well,” he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, according to a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said.

“My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, she said.

Setting prices for prescription drugs is far more complicated than setting prices for something like procedures. DR. GINSBURG

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians using the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at the Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Dr. Dickey said time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software for the past year. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey said.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors.

“This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” he said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

“It all fits together in supporting the movement toward electronic prescribing to get to better quality care at a lower cost.”

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort. “Down the road, we're very hopeful that this encourages adoption of full electronic health records and Allscripts is a leading provider of those health records,” he said at the briefing. “But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” Mr. Tullman added.

Such a large coalition of payers and vendors has the potential to put a real dent in the problem, said Dr. Pace.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said.

It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper,” said Dr. Pace.

Who's on Board?

Members of the National ePrescribing Patient Safety Initiative include:

Aetna

Allscripts Inc.

Cisco Systems

Dell Inc.

Fujitsu Computers of America

Google

Microsoft Corp.

Sprint Nextel

SureScripts

WellPoint

Wolters Kluwer Health

12 regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians using the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at the Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Dr. Dickey said time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software for the past year. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey said.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors.

“This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” he said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

“It all fits together in supporting the movement toward electronic prescribing to get to better quality care at a lower cost.”

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort. “Down the road, we're very hopeful that this encourages adoption of full electronic health records and Allscripts is a leading provider of those health records,” he said at the briefing. “But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” Mr. Tullman added.

Such a large coalition of payers and vendors has the potential to put a real dent in the problem, said Dr. Pace.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said.

It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper,” said Dr. Pace.

Who's on Board?

Members of the National ePrescribing Patient Safety Initiative include:

Aetna

Allscripts Inc.

Cisco Systems

Dell Inc.

Fujitsu Computers of America

Google

Microsoft Corp.

Sprint Nextel

SureScripts

WellPoint

Wolters Kluwer Health

12 regional health care organizations

WASHINGTON — Doctors who have yet to get on the health information technology bandwagon no longer have any excuses, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with the software in 99% of the nation's pharmacies, coalition members said at a press briefing. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians using the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at the Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Dr. Dickey said time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership.

“Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software for the past year. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey said.

NEPSI's efforts may be just the kick-start some physicians need, said Dr. Wilson Pace, director of the American Academy of Family Physicians' National Research Network and a member of the IOM committee that produced last year's report on medication errors.

“This appears to be a relatively safe way to try out something and get started for somebody who is not quite clear where they want to go,” he said in an interview.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

“It all fits together in supporting the movement toward electronic prescribing to get to better quality care at a lower cost.”

But this is not something that the government can achieve alone. Partners in the private sector are crucial, he said.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort. “Down the road, we're very hopeful that this encourages adoption of full electronic health records and Allscripts is a leading provider of those health records,” he said at the briefing. “But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” Mr. Tullman added.

Such a large coalition of payers and vendors has the potential to put a real dent in the problem, said Dr. Pace.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said.

It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper,” said Dr. Pace.

Who's on Board?

Members of the National ePrescribing Patient Safety Initiative include:

Aetna

Allscripts Inc.

Cisco Systems

Dell Inc.

Fujitsu Computers of America

Google

Microsoft Corp.

Sprint Nextel

SureScripts

WellPoint

Wolters Kluwer Health

12 regional health care organizations

WASHINGTON – Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is done by the Veterans Affairs system. In the Senate, Sen. Edward M. Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, has placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with one another based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” she said.

Dr. Moon agreed. “This is going to be much more of a morass than people think,” she said. “It's a mistake on the part of a lot of the Democrats to have been promising that's what we're going to do.”

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is a far more complicated proposition, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals–most of it is in R&D for that drug and for the drugs that didn't make it–that's a much more challenging job to do well,” he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, said a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said. “My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, she said.

WASHINGTON – Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is done by the Veterans Affairs system. In the Senate, Sen. Edward M. Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, has placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with one another based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” she said.

Dr. Moon agreed. “This is going to be much more of a morass than people think,” she said. “It's a mistake on the part of a lot of the Democrats to have been promising that's what we're going to do.”

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is a far more complicated proposition, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals–most of it is in R&D for that drug and for the drugs that didn't make it–that's a much more challenging job to do well,” he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, said a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said. “My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, she said.

WASHINGTON – Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

In January, the House of Representatives passed H.R. 4, which would require the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is done by the Veterans Affairs system. In the Senate, Sen. Edward M. Kennedy (D-Mass.), who chairs the powerful Health, Education, Labor, and Pension Committee, has placed this legislation near the top of the committee's agenda.

“I'm a little perplexed at how this issue is going to play out,” said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. “In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it.”

The Part D program is based on the concept that the different plans would compete with one another based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

“If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this,” she said.

Dr. Moon agreed. “This is going to be much more of a morass than people think,” she said. “It's a mistake on the part of a lot of the Democrats to have been promising that's what we're going to do.”

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is a far more complicated proposition, Dr. Ginsburg said.

“Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals–most of it is in R&D for that drug and for the drugs that didn't make it–that's a much more challenging job to do well,” he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, said a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said. “My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time” by keeping their health problems in check, she said.

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

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

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

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

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

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

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

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

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

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

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

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

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

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

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

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

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

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

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

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

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

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

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

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

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

Unlike hospitals and other large institutions, small medical practices have not had the resources to adopt electronic health records or other information technology, said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

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

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

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

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

WASHINGTON — Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

Democrats, poised to take over the majority in Congress in January, have announced intentions to push legislation that would enable the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is currently done by the Veterans Affairs system. Sen. Edward Kennedy (D-Mass.), who will chair the powerful Health, Education, Labor, and Pension Committee next year, has placed this legislation near the top of the committee's agenda.

"I'm a little perplexed at how this issue is going to play out," said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. "In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it."

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

"If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this," she said. "This is going to be much more of a morass than people think."

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is far more complicated than setting prices for something like procedures, which can be based on hospital expenses, Dr. Ginsburg said.

"Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals—most of it is in R&D for that drug and for the drugs that didn't make it—that's a much more challenging job to do well," he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, according to a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said.

"My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time" by keeping their health problems in check, she said.

WASHINGTON — Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

Democrats, poised to take over the majority in Congress in January, have announced intentions to push legislation that would enable the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is currently done by the Veterans Affairs system. Sen. Edward Kennedy (D-Mass.), who will chair the powerful Health, Education, Labor, and Pension Committee next year, has placed this legislation near the top of the committee's agenda.

"I'm a little perplexed at how this issue is going to play out," said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. "In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it."

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

"If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this," she said. "This is going to be much more of a morass than people think."

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is far more complicated than setting prices for something like procedures, which can be based on hospital expenses, Dr. Ginsburg said.

"Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals—most of it is in R&D for that drug and for the drugs that didn't make it—that's a much more challenging job to do well," he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, according to a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said.

"My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time" by keeping their health problems in check, she said.

WASHINGTON — Rhetoric aside, it's not clear whether lifting restrictions on the government's ability to negotiate pharmaceutical prices for the Part D benefit will have any real impact, experts said at a forum on the future of Medicare sponsored by the Association of Health Care Journalists.

Democrats, poised to take over the majority in Congress in January, have announced intentions to push legislation that would enable the Secretary of Health and Human Services to negotiate drug prices directly with manufacturers, similar to what is currently done by the Veterans Affairs system. Sen. Edward Kennedy (D-Mass.), who will chair the powerful Health, Education, Labor, and Pension Committee next year, has placed this legislation near the top of the committee's agenda.

"I'm a little perplexed at how this issue is going to play out," said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change. "In a sense, if you really want the government to negotiate with manufacturers, you might as well repeal, not the benefit, but the whole structure of delivering it."

The Part D program is based on the concept that the different plans would compete with each other based on price, said Marilyn Moon, Ph.D., vice president and director of the health program at the American Institutes for Research.

"If you hand them a price list, there's really no reason for them to be there. It's very difficult to imagine how you would do this," she said. "This is going to be much more of a morass than people think."

Medicare already sets prices for physician services and many medical procedures, but setting prices for prescription drugs is far more complicated than setting prices for something like procedures, which can be based on hospital expenses, Dr. Ginsburg said.

"Setting prices for pharmaceuticals, given the fact that the actual production costs of pharmaceuticals are a very small part of the total cost of pharmaceuticals—most of it is in R&D for that drug and for the drugs that didn't make it—that's a much more challenging job to do well," he said.

However, Democrats argue that negotiating drug prices will help solve other problems with Part D.

Giving the government the ability to negotiate discounted drug prices will lower expenses for seniors and yield savings for Medicare that can be used to fill the gap in coverage known as the doughnut hole, according to a statement from Sen. Kennedy's office.

But the new Congress could design a workaround to fill the doughnut hole without adding money to the program, Dr. Moon said.

"My concern about the doughnut hole is that who it really hits are the people who are taking maintenance drugs, who are also the main ones who can save costs over time" by keeping their health problems in check, she said.