Nancy Nickell

Physicians need to apply now for a national provider identifier number in order to start using it in May 2007, according to the Centers for Medicare and Medicaid Services.

The national provider identifier (NPI) is a 10-digit number that does not expire or change; it is used to speed claims processing. The Health Insurance Portability and Accountability Act mandates that the NPI be used for all standard health care transactions involving both public and private payers starting on May 23, 2007. Small health plans, defined as having annual receipts of $5 million or less, are given an additional year to comply.

A physician needs only one NPI, regardless of the number of specialties, licenses, or practice locations he or she may have. Once assigned to the physician, that number will stay with him or her through job changes and relocations.

Physicians will need to have several numbers on hand before applying, such as their health care license number or certificate number and any “legacy identifiers,” such as a unique physician identification number (UPIN).

Apply online for an NPI at https://NPPES.cms.hhs.gov

Physicians need to apply now for a national provider identifier number in order to start using it in May 2007, according to the Centers for Medicare and Medicaid Services.

The national provider identifier (NPI) is a 10-digit number that does not expire or change; it is used to speed claims processing. The Health Insurance Portability and Accountability Act mandates that the NPI be used for all standard health care transactions involving both public and private payers starting on May 23, 2007. Small health plans, defined as having annual receipts of $5 million or less, are given an additional year to comply.

A physician needs only one NPI, regardless of the number of specialties, licenses, or practice locations he or she may have. Once assigned to the physician, that number will stay with him or her through job changes and relocations.

Physicians will need to have several numbers on hand before applying, such as their health care license number or certificate number and any “legacy identifiers,” such as a unique physician identification number (UPIN).

Apply online for an NPI at https://NPPES.cms.hhs.gov

Physicians need to apply now for a national provider identifier number in order to start using it in May 2007, according to the Centers for Medicare and Medicaid Services.

The national provider identifier (NPI) is a 10-digit number that does not expire or change; it is used to speed claims processing. The Health Insurance Portability and Accountability Act mandates that the NPI be used for all standard health care transactions involving both public and private payers starting on May 23, 2007. Small health plans, defined as having annual receipts of $5 million or less, are given an additional year to comply.

A physician needs only one NPI, regardless of the number of specialties, licenses, or practice locations he or she may have. Once assigned to the physician, that number will stay with him or her through job changes and relocations.

Physicians will need to have several numbers on hand before applying, such as their health care license number or certificate number and any “legacy identifiers,” such as a unique physician identification number (UPIN).

Apply online for an NPI at https://NPPES.cms.hhs.gov

The rapid growth of the elderly population in the United States may create a shortage of critical care physicians in the United States—a shortage that could lead to tens of thousands of potentially preventable deaths in the country's intensive care units, a new federal report warns.

The report has prompted critical care societies to outline solutions and press lawmakers and federal health agencies for greater help in boosting the nation's supply of critical care intensivists.

Policy makers can attack the problem in three ways: by “increasing supply, increasing efficiency, or decreasing the need for intensive care,” said Dr. W. Michael Alberts, president of the American College of Chest Physicians.

With the nation's elderly population rising rapidly, “demand for intensivists will continue to exceed available supply through the year 2020 if current supply and demand trends continue,” according to the report, entitled “The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians.”

The federal Health Resources and Services Administration (HRSA) produced the report for Congress, which asked the agency in 2003 to examine the adequacy of the critical care workforce.

Almost 500,000 people die in ICUs each year, according to the report, and 360,000 of them are not managed by intensivists. If they were, an estimated 54,000 lives could be saved annually, according to a study cited by HRSA researchers (Eff. Clin. Pract. 2000;3:284–9).

Although intensivists currently direct the care of only one-third of critically ill patients, the proportion of patients receiving care under the direction of an intensivist has increased dramatically in recent years.

Increasing the proportion of ICU patients whose care is directed by an intensivist from one-third to a more optimal level of two-thirds would save lives—but it would also push the need for intensivists from 3,100 in 2000 to 4,300 by 2020.

The result: A shortage of about 1,200 intensivists in 2000 could grow to an estimated shortfall of 1,500 in 2020—or 129% above the projected supply.

As demand for critical care specialists grows, so does the burden on existing intensivists—prompting many of them to consider early retirement. More than half of intensivists expect to retire by age 60, and almost a third expect to retire by age 55, according to a report in 2000 by the Committee on Manpower for the Pulmonary and Critical Care Societies (COMPACCS).

Retirement isn't the only factor that may worsen the shortfall. Difficulty attracting physicians to the field, gender issues, and the proportion of international medical graduates (IMGs) could also leave the nation unable to meet its critical care needs. Currently, intensivist fellowship positions are not fully filled, said Dr. Alberts, who is a professor of oncology and medicine at the University of South Florida, Tampa. The number of newly trained critical care medicine fellows per year has actually dropped from 110 in 1998 to 86 in 2004, according to the HRSA report. In fact, less than 1% of U.S. medical school graduates are expected to choose to practice as intensivists.

Although 86% of pulmonologists and critical care physicians are men, a greater proportion of the younger generation of intensivists are women. Because female physicians tend to work fewer hours and retire sooner, the number of hours provided could fall, the report's authors cautioned.

The large proportion of critical care fellows who are international medical graduates may add to the uncertainty. Those IMGs may face visa restrictions that force them out of the United States.

Creation of more critical care specialists won't be easy, the HRSA report acknowledged. “Simple solutions to the critical care workforce problem are not likely to be found in the near future,” the report's authors said.

The rise of intensivist-managed ICUs could help meet some of the unmet demand. Encouraging intensivists and pulmonologists trained in critical care to spend more of their work hours in the ICU might increase supply as well. But the report's authors cautioned that such strategies may require significant financial incentives.

Better management of demand could come as more hospitals use in-house, full-time intensivists to ensure appropriate utilization of critical care services and reduce unnecessary ICU admissions. Improved education regarding end-of-life issues might help physicians and patients make better treatment decisions and potentially reduce the number of days of ICU care.

Organizational changes could improve patient access in a different way, especially in rural areas. “One example is the increased use of electronic ICUs, where specialist physicians and nurses monitor and help treat critically ill patients in widely scattered hospitals,” the authors stated.

To help close the projected shortfall, four critical care societies have outlined their own proposals to increase the efficient use of current critical care resources and boost the supply of intensivists in the future.

The Critical Care Workforce Partnership—composed of the American College of Chest Physicians, the American Association of Critical-Care Nurses, the American Thoracic Society, and the Society of Critical Care Medicine—also announced plans to work with Sen. Richard J. Durbin (D-Ill.) on legislative and regulatory steps.

“The looming critical care workforce shortage is an issue that affects every one of us and needs to be addressed now,” said Dr. Mark J. Rosen, chief of the division of pulmonary and critical care medicine at Beth Israel Medical Center, New York, and president-elect of the ACCP.

For a copy of the HRSA report, visit www.chestnet.org/practice/gr/hrsa.php

The rapid growth of the elderly population in the United States may create a shortage of critical care physicians in the United States—a shortage that could lead to tens of thousands of potentially preventable deaths in the country's intensive care units, a new federal report warns.

The report has prompted critical care societies to outline solutions and press lawmakers and federal health agencies for greater help in boosting the nation's supply of critical care intensivists.

Policy makers can attack the problem in three ways: by “increasing supply, increasing efficiency, or decreasing the need for intensive care,” said Dr. W. Michael Alberts, president of the American College of Chest Physicians.

With the nation's elderly population rising rapidly, “demand for intensivists will continue to exceed available supply through the year 2020 if current supply and demand trends continue,” according to the report, entitled “The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians.”

The federal Health Resources and Services Administration (HRSA) produced the report for Congress, which asked the agency in 2003 to examine the adequacy of the critical care workforce.

Almost 500,000 people die in ICUs each year, according to the report, and 360,000 of them are not managed by intensivists. If they were, an estimated 54,000 lives could be saved annually, according to a study cited by HRSA researchers (Eff. Clin. Pract. 2000;3:284–9).

Although intensivists currently direct the care of only one-third of critically ill patients, the proportion of patients receiving care under the direction of an intensivist has increased dramatically in recent years.

Increasing the proportion of ICU patients whose care is directed by an intensivist from one-third to a more optimal level of two-thirds would save lives—but it would also push the need for intensivists from 3,100 in 2000 to 4,300 by 2020.

The result: A shortage of about 1,200 intensivists in 2000 could grow to an estimated shortfall of 1,500 in 2020—or 129% above the projected supply.

As demand for critical care specialists grows, so does the burden on existing intensivists—prompting many of them to consider early retirement. More than half of intensivists expect to retire by age 60, and almost a third expect to retire by age 55, according to a report in 2000 by the Committee on Manpower for the Pulmonary and Critical Care Societies (COMPACCS).

Retirement isn't the only factor that may worsen the shortfall. Difficulty attracting physicians to the field, gender issues, and the proportion of international medical graduates (IMGs) could also leave the nation unable to meet its critical care needs. Currently, intensivist fellowship positions are not fully filled, said Dr. Alberts, who is a professor of oncology and medicine at the University of South Florida, Tampa. The number of newly trained critical care medicine fellows per year has actually dropped from 110 in 1998 to 86 in 2004, according to the HRSA report. In fact, less than 1% of U.S. medical school graduates are expected to choose to practice as intensivists.

Although 86% of pulmonologists and critical care physicians are men, a greater proportion of the younger generation of intensivists are women. Because female physicians tend to work fewer hours and retire sooner, the number of hours provided could fall, the report's authors cautioned.

The large proportion of critical care fellows who are international medical graduates may add to the uncertainty. Those IMGs may face visa restrictions that force them out of the United States.

Creation of more critical care specialists won't be easy, the HRSA report acknowledged. “Simple solutions to the critical care workforce problem are not likely to be found in the near future,” the report's authors said.

The rise of intensivist-managed ICUs could help meet some of the unmet demand. Encouraging intensivists and pulmonologists trained in critical care to spend more of their work hours in the ICU might increase supply as well. But the report's authors cautioned that such strategies may require significant financial incentives.

Better management of demand could come as more hospitals use in-house, full-time intensivists to ensure appropriate utilization of critical care services and reduce unnecessary ICU admissions. Improved education regarding end-of-life issues might help physicians and patients make better treatment decisions and potentially reduce the number of days of ICU care.

Organizational changes could improve patient access in a different way, especially in rural areas. “One example is the increased use of electronic ICUs, where specialist physicians and nurses monitor and help treat critically ill patients in widely scattered hospitals,” the authors stated.

To help close the projected shortfall, four critical care societies have outlined their own proposals to increase the efficient use of current critical care resources and boost the supply of intensivists in the future.

The Critical Care Workforce Partnership—composed of the American College of Chest Physicians, the American Association of Critical-Care Nurses, the American Thoracic Society, and the Society of Critical Care Medicine—also announced plans to work with Sen. Richard J. Durbin (D-Ill.) on legislative and regulatory steps.

“The looming critical care workforce shortage is an issue that affects every one of us and needs to be addressed now,” said Dr. Mark J. Rosen, chief of the division of pulmonary and critical care medicine at Beth Israel Medical Center, New York, and president-elect of the ACCP.

For a copy of the HRSA report, visit www.chestnet.org/practice/gr/hrsa.php

The rapid growth of the elderly population in the United States may create a shortage of critical care physicians in the United States—a shortage that could lead to tens of thousands of potentially preventable deaths in the country's intensive care units, a new federal report warns.

The report has prompted critical care societies to outline solutions and press lawmakers and federal health agencies for greater help in boosting the nation's supply of critical care intensivists.

Policy makers can attack the problem in three ways: by “increasing supply, increasing efficiency, or decreasing the need for intensive care,” said Dr. W. Michael Alberts, president of the American College of Chest Physicians.

With the nation's elderly population rising rapidly, “demand for intensivists will continue to exceed available supply through the year 2020 if current supply and demand trends continue,” according to the report, entitled “The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians.”

The federal Health Resources and Services Administration (HRSA) produced the report for Congress, which asked the agency in 2003 to examine the adequacy of the critical care workforce.

Almost 500,000 people die in ICUs each year, according to the report, and 360,000 of them are not managed by intensivists. If they were, an estimated 54,000 lives could be saved annually, according to a study cited by HRSA researchers (Eff. Clin. Pract. 2000;3:284–9).

Although intensivists currently direct the care of only one-third of critically ill patients, the proportion of patients receiving care under the direction of an intensivist has increased dramatically in recent years.

Increasing the proportion of ICU patients whose care is directed by an intensivist from one-third to a more optimal level of two-thirds would save lives—but it would also push the need for intensivists from 3,100 in 2000 to 4,300 by 2020.

The result: A shortage of about 1,200 intensivists in 2000 could grow to an estimated shortfall of 1,500 in 2020—or 129% above the projected supply.

As demand for critical care specialists grows, so does the burden on existing intensivists—prompting many of them to consider early retirement. More than half of intensivists expect to retire by age 60, and almost a third expect to retire by age 55, according to a report in 2000 by the Committee on Manpower for the Pulmonary and Critical Care Societies (COMPACCS).

Retirement isn't the only factor that may worsen the shortfall. Difficulty attracting physicians to the field, gender issues, and the proportion of international medical graduates (IMGs) could also leave the nation unable to meet its critical care needs. Currently, intensivist fellowship positions are not fully filled, said Dr. Alberts, who is a professor of oncology and medicine at the University of South Florida, Tampa. The number of newly trained critical care medicine fellows per year has actually dropped from 110 in 1998 to 86 in 2004, according to the HRSA report. In fact, less than 1% of U.S. medical school graduates are expected to choose to practice as intensivists.

Although 86% of pulmonologists and critical care physicians are men, a greater proportion of the younger generation of intensivists are women. Because female physicians tend to work fewer hours and retire sooner, the number of hours provided could fall, the report's authors cautioned.

The large proportion of critical care fellows who are international medical graduates may add to the uncertainty. Those IMGs may face visa restrictions that force them out of the United States.

Creation of more critical care specialists won't be easy, the HRSA report acknowledged. “Simple solutions to the critical care workforce problem are not likely to be found in the near future,” the report's authors said.

The rise of intensivist-managed ICUs could help meet some of the unmet demand. Encouraging intensivists and pulmonologists trained in critical care to spend more of their work hours in the ICU might increase supply as well. But the report's authors cautioned that such strategies may require significant financial incentives.

Better management of demand could come as more hospitals use in-house, full-time intensivists to ensure appropriate utilization of critical care services and reduce unnecessary ICU admissions. Improved education regarding end-of-life issues might help physicians and patients make better treatment decisions and potentially reduce the number of days of ICU care.

Organizational changes could improve patient access in a different way, especially in rural areas. “One example is the increased use of electronic ICUs, where specialist physicians and nurses monitor and help treat critically ill patients in widely scattered hospitals,” the authors stated.

To help close the projected shortfall, four critical care societies have outlined their own proposals to increase the efficient use of current critical care resources and boost the supply of intensivists in the future.

The Critical Care Workforce Partnership—composed of the American College of Chest Physicians, the American Association of Critical-Care Nurses, the American Thoracic Society, and the Society of Critical Care Medicine—also announced plans to work with Sen. Richard J. Durbin (D-Ill.) on legislative and regulatory steps.

“The looming critical care workforce shortage is an issue that affects every one of us and needs to be addressed now,” said Dr. Mark J. Rosen, chief of the division of pulmonary and critical care medicine at Beth Israel Medical Center, New York, and president-elect of the ACCP.

For a copy of the HRSA report, visit www.chestnet.org/practice/gr/hrsa.php

P4P Raises Pay in UK

A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester, England, and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.

Bill Aims to Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.

PAs Eye Specialty Recognition

Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.

Paying Community Pharmacies

Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.

Poll: Live Unhealthy, Pay the Price

More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent have affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.

P4P Raises Pay in UK

A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester, England, and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.

Bill Aims to Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.

PAs Eye Specialty Recognition

Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.

Paying Community Pharmacies

Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.

Poll: Live Unhealthy, Pay the Price

More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent have affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.

P4P Raises Pay in UK

A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester, England, and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.

Bill Aims to Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.

PAs Eye Specialty Recognition

Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.

Paying Community Pharmacies

Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.

Poll: Live Unhealthy, Pay the Price

More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent have affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.

Bill Aims to Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.

PAs Eye Specialty Recognition

Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.

P4P Raises Pay in U.K.

A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester (England) and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.

Paying Community Pharmacies

Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.

Poll: Live Unhealthy, Pay the Price

More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent had affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.

Bill Aims to Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.

PAs Eye Specialty Recognition

Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.

P4P Raises Pay in U.K.

A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester (England) and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.

Paying Community Pharmacies

Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.

Poll: Live Unhealthy, Pay the Price

More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent had affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.

Bill Aims to Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation to improve physician reimbursement under Medicare and delay cuts in payments for imaging services. The bill also would establish a system of quality measures to give patients more information about Medicare providers. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” The legislation would change formulas to end the “negative feedback loop that constantly creates a deficit in healthcare funding,” Rep. Burgess said in a statement. It also includes a 1-year delay for planned cuts in Medicare payments for imaging services and requires the Institute of Medicine to perform a study on the question of whether imaging saves money. The quality measures would help beneficiaries decide whether a particular physician was worth paying a higher copayment to see. “If a patient sees that short waiting times equate to perhaps a $10 increase in their bill, they may decide that the money is worth it,” the congressman added.

PAs Eye Specialty Recognition

Physician assistants are considering voluntary recognition for those practicing in specialties to denote their advanced knowledge. A task force organized by the National Commission on Certification of Physician Assistants is studying options after receiving comments on the issue during a forum it held on the topic earlier this summer. PAs find their supervising doctors often lack time to train them, forum participants said. The task force does not have a deadline, and it is only considering recognition—not certification—for specialties, Tiffany Flick, communications manager for NCCPA, said in an interview.

P4P Raises Pay in U.K.

A 3-year experiment in pay for performance boosted gross income for family physicians in the United Kingdom but may have made it too easy for the physicians to earn that extra money, according to a study by Tim Doran of the National Primary Care Research and Development Centre, University of Manchester (England) and colleagues. The $3 billion program was designed to boost family physicians' pay an average of 25% depending on how well they performed on certain quality indicators for 10 chronic diseases, including asthma, coronary heart disease, diabetes, and epilepsy. The physicians attained a median of 97% of the available points for clinical indicators—greatly exceeding predictions of 75%—and boosted their gross income by an average of $40,000. However, “the high levels of achievement might suggest that the targets were too easy to achieve,” the authors said, adding that the monetary gains may have been offset by the money physicians spent getting ready for the program, including expenses such as hiring extra staff and installing electronic health records. The article appeared in the July 27, 2006, issue of the New England Journal of Medicine. An accompanying editorial agreed that the targets may have been set too low and raised the possibility that some physicians may have “gamed the system” by excluding patients whose care did not meet the performance criteria.

Paying Community Pharmacies

Independent pharmacies are seeking legislative help as they struggle with the increased workload from Medicare Part D. Many are racking up debt under the strain—an average of just under $70,000 per pharmacy, according to a survey of 5,000 members of the National Community Pharmacists Association. The Fair and Speedy Treatment of Claims Act of 2006 would require pharmacy claims submitted electronically to be paid within 14 days. The measure aims “to ensure that pharmacists are not forced out of business by inadequate, slow reimbursement and unclear claims processing,” according to its sponsors, Rep. Marion Berry (D-Ark.), and Rep. Walter Jones (R-N.C.). Mark Merritt, president of the Pharmaceutical Care Management Association, responded in a teleconference by noting that pharmacy benefit management companies pay most claims from pharmacies within 30 days—standard in American business. The legislation also includes a $14 payment for filling a generic prescription and sets guidelines for medication therapy management programs offered by drug plans. Such programs aim to promote proper medication use in high-risk seniors. PCMA's analysis found that overall, the bill would cost the Medicare program at least $55 billion over 10 years and beneficiaries $30 billion. The measure had 144 cosponsors as of mid-July.

Poll: Live Unhealthy, Pay the Price

More than half of respondents to a Wall Street Journal/Harris Interactive poll say that people who smoke or choose not to wear seat belts should pay a higher health insurance premium than people who don't engage in those behaviors, but most people did not feel the same way about people who were overweight or didn't exercise enough. Only 27% of the poll's 2,200 respondents thought that overweight people should pay more for insurance than slimmer people; the same percentage favored having people who did not exercise regularly pay more. The amount of education the respondent had affected the responses he or she gave: Those with some college education were more likely to agree that those with unhealthy lifestyles should pay higher premiums, compared with respondents with a high school education or less. The poll had a 3.3% margin of error.

Voters to Feds: Let's Insure Children

In a poll of 800 likely voters, 65% said the federal government should take financial responsibility to cover uninsured children; of those, 80% said they would be willing to pay more in taxes to help cover the cost. Conversely, 28% of respondents said the federal government already provides enough assistance to children. The poll—conducted for the Catholic Health Association of the United States by Public Opinion Strategies of Alexandria, Va.—was unveiled at a news conference called to announce the Campaign for Children's Health Care. The campaign seeks to impact next year's reauthorization of the State Children's Health Insurance Program (SCHIP), according to Geraldine Henrich, a spokeswoman for the advocacy group and for coalition member Families USA. Retaining the children who currently are enrolled in SCHIP would cost $10 billion to $12 billion in additional funds over the next 5 years, said Ron Pollack, executive director of Families USA. Expanding it to cover 9 million uninsured children would require additional funds, he said. States have also been good laboratories for child coverage, and some, such as Illinois and Massachusetts, have been particularly creative, Mr. Pollack said. To raise public awareness of the need to cover children, the campaign plans activities over the next year, including town hall meetings and a national online petition.

Back to Sleep in Child Care

State regulations for care of infants outside the home have improved since 2003, according to a study by Dr. Rachel Moon of the Goldberg Center for Community Pediatric Health, Washington, and her colleagues. More than half of the regulations written since then mandate a nonprone sleep position, and include restrictions on soft bedding in the crib.

Contradictions exist: For example, bumper pads are prohibited in 11 states, but Nebraska requires them in all cribs.

States were far more likely to have sleep positions written into their regulations if they were enacted in 2003 or later, according to the study. The findings suggest that the Healthy Child Care America Back to Sleep Campaign launched that year by the American Academy of Pediatrics, building on the initial campaign launched by the National Institute of Child Health and Human Development, was somewhat successful.

However, despite the decline in the incidence of sudden infant death syndrome (SIDS) and prone sleeping overall, the proportion of SIDS deaths occurring in child care settings has remained constant at about 20%, the authors said. The study was published in the July 2006 issue of Pediatrics.

Newborn Screening Rate Up

The newborn screening rate for 20 life-threatening disorders has nearly doubled since last year, a survey for the March of Dimes has found.

Nearly two-thirds of all babies born in the United States in 2006 are expected to be screened for certain metabolic disorders and hearing deficiency, according to the survey.

“However, disparities in state newborn screening programs mean some babies will die or develop brain damage or other severe complications from these disorders because they are not identified in time for effective treatment,” the group said in a statement.

Only five states—Iowa, Maryland, Mississippi, New Jersey, and Virginia, as well as the District of Columbia—have comprehensive programs encompassing all 29 disorders recommended for scrutiny by the March of Dimes and the American Academy of Pediatrics. The states improving most in 2006 were California, Florida, Kentucky, and Utah, as well as the District of Columbia.

Medicaid-Funded School Programs

Legislation to preserve access to Medicaid-funded school programs for low-income children, including those with disabilities, was introduced in Congress in mid-July. Sen. Edward Kennedy (D-Mass.) and Rep. John Dingell (D-Mich.), Rep. George Miller (D-Calif.), and Rep. Ed Whitfield (R-Ky.) wrote the bills to shield the programs from proposed cuts in the president's fiscal year 2007 budget, which seeks to reduce reimbursement to school districts by $3.6 billion over the next 5 years.

The House Committee on Education and the Workforce provided examples of fund use: A small district in Kentucky hired school nurses who could refer children to physicians; an Illinois district bought a special computer for a blind student. Districts have also used the funds to transport children to medical appointments, and to identify children who need special medical and learning services. The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, among others, support the bill.

Voters to Feds: Let's Insure Children

In a poll of 800 likely voters, 65% said the federal government should take financial responsibility to cover uninsured children; of those, 80% said they would be willing to pay more in taxes to help cover the cost. Conversely, 28% of respondents said the federal government already provides enough assistance to children. The poll—conducted for the Catholic Health Association of the United States by Public Opinion Strategies of Alexandria, Va.—was unveiled at a news conference called to announce the Campaign for Children's Health Care. The campaign seeks to impact next year's reauthorization of the State Children's Health Insurance Program (SCHIP), according to Geraldine Henrich, a spokeswoman for the advocacy group and for coalition member Families USA. Retaining the children who currently are enrolled in SCHIP would cost $10 billion to $12 billion in additional funds over the next 5 years, said Ron Pollack, executive director of Families USA. Expanding it to cover 9 million uninsured children would require additional funds, he said. States have also been good laboratories for child coverage, and some, such as Illinois and Massachusetts, have been particularly creative, Mr. Pollack said. To raise public awareness of the need to cover children, the campaign plans activities over the next year, including town hall meetings and a national online petition.

Back to Sleep in Child Care

State regulations for care of infants outside the home have improved since 2003, according to a study by Dr. Rachel Moon of the Goldberg Center for Community Pediatric Health, Washington, and her colleagues. More than half of the regulations written since then mandate a nonprone sleep position, and include restrictions on soft bedding in the crib.

Contradictions exist: For example, bumper pads are prohibited in 11 states, but Nebraska requires them in all cribs.

States were far more likely to have sleep positions written into their regulations if they were enacted in 2003 or later, according to the study. The findings suggest that the Healthy Child Care America Back to Sleep Campaign launched that year by the American Academy of Pediatrics, building on the initial campaign launched by the National Institute of Child Health and Human Development, was somewhat successful.

However, despite the decline in the incidence of sudden infant death syndrome (SIDS) and prone sleeping overall, the proportion of SIDS deaths occurring in child care settings has remained constant at about 20%, the authors said. The study was published in the July 2006 issue of Pediatrics.

Newborn Screening Rate Up

The newborn screening rate for 20 life-threatening disorders has nearly doubled since last year, a survey for the March of Dimes has found.

Nearly two-thirds of all babies born in the United States in 2006 are expected to be screened for certain metabolic disorders and hearing deficiency, according to the survey.

“However, disparities in state newborn screening programs mean some babies will die or develop brain damage or other severe complications from these disorders because they are not identified in time for effective treatment,” the group said in a statement.

Only five states—Iowa, Maryland, Mississippi, New Jersey, and Virginia, as well as the District of Columbia—have comprehensive programs encompassing all 29 disorders recommended for scrutiny by the March of Dimes and the American Academy of Pediatrics. The states improving most in 2006 were California, Florida, Kentucky, and Utah, as well as the District of Columbia.

Medicaid-Funded School Programs

Legislation to preserve access to Medicaid-funded school programs for low-income children, including those with disabilities, was introduced in Congress in mid-July. Sen. Edward Kennedy (D-Mass.) and Rep. John Dingell (D-Mich.), Rep. George Miller (D-Calif.), and Rep. Ed Whitfield (R-Ky.) wrote the bills to shield the programs from proposed cuts in the president's fiscal year 2007 budget, which seeks to reduce reimbursement to school districts by $3.6 billion over the next 5 years.

The House Committee on Education and the Workforce provided examples of fund use: A small district in Kentucky hired school nurses who could refer children to physicians; an Illinois district bought a special computer for a blind student. Districts have also used the funds to transport children to medical appointments, and to identify children who need special medical and learning services. The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, among others, support the bill.

Voters to Feds: Let's Insure Children

In a poll of 800 likely voters, 65% said the federal government should take financial responsibility to cover uninsured children; of those, 80% said they would be willing to pay more in taxes to help cover the cost. Conversely, 28% of respondents said the federal government already provides enough assistance to children. The poll—conducted for the Catholic Health Association of the United States by Public Opinion Strategies of Alexandria, Va.—was unveiled at a news conference called to announce the Campaign for Children's Health Care. The campaign seeks to impact next year's reauthorization of the State Children's Health Insurance Program (SCHIP), according to Geraldine Henrich, a spokeswoman for the advocacy group and for coalition member Families USA. Retaining the children who currently are enrolled in SCHIP would cost $10 billion to $12 billion in additional funds over the next 5 years, said Ron Pollack, executive director of Families USA. Expanding it to cover 9 million uninsured children would require additional funds, he said. States have also been good laboratories for child coverage, and some, such as Illinois and Massachusetts, have been particularly creative, Mr. Pollack said. To raise public awareness of the need to cover children, the campaign plans activities over the next year, including town hall meetings and a national online petition.

Back to Sleep in Child Care

State regulations for care of infants outside the home have improved since 2003, according to a study by Dr. Rachel Moon of the Goldberg Center for Community Pediatric Health, Washington, and her colleagues. More than half of the regulations written since then mandate a nonprone sleep position, and include restrictions on soft bedding in the crib.

Contradictions exist: For example, bumper pads are prohibited in 11 states, but Nebraska requires them in all cribs.

States were far more likely to have sleep positions written into their regulations if they were enacted in 2003 or later, according to the study. The findings suggest that the Healthy Child Care America Back to Sleep Campaign launched that year by the American Academy of Pediatrics, building on the initial campaign launched by the National Institute of Child Health and Human Development, was somewhat successful.

However, despite the decline in the incidence of sudden infant death syndrome (SIDS) and prone sleeping overall, the proportion of SIDS deaths occurring in child care settings has remained constant at about 20%, the authors said. The study was published in the July 2006 issue of Pediatrics.

Newborn Screening Rate Up

The newborn screening rate for 20 life-threatening disorders has nearly doubled since last year, a survey for the March of Dimes has found.

Nearly two-thirds of all babies born in the United States in 2006 are expected to be screened for certain metabolic disorders and hearing deficiency, according to the survey.

“However, disparities in state newborn screening programs mean some babies will die or develop brain damage or other severe complications from these disorders because they are not identified in time for effective treatment,” the group said in a statement.

Only five states—Iowa, Maryland, Mississippi, New Jersey, and Virginia, as well as the District of Columbia—have comprehensive programs encompassing all 29 disorders recommended for scrutiny by the March of Dimes and the American Academy of Pediatrics. The states improving most in 2006 were California, Florida, Kentucky, and Utah, as well as the District of Columbia.

Medicaid-Funded School Programs

Legislation to preserve access to Medicaid-funded school programs for low-income children, including those with disabilities, was introduced in Congress in mid-July. Sen. Edward Kennedy (D-Mass.) and Rep. John Dingell (D-Mich.), Rep. George Miller (D-Calif.), and Rep. Ed Whitfield (R-Ky.) wrote the bills to shield the programs from proposed cuts in the president's fiscal year 2007 budget, which seeks to reduce reimbursement to school districts by $3.6 billion over the next 5 years.

The House Committee on Education and the Workforce provided examples of fund use: A small district in Kentucky hired school nurses who could refer children to physicians; an Illinois district bought a special computer for a blind student. Districts have also used the funds to transport children to medical appointments, and to identify children who need special medical and learning services. The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, among others, support the bill.

IM/FP Demand Up Again

Internists and family physicians top hospital and medical groups' list of most-requested doctors, according to a new report from physician search firm Merritt, Hawkins & Associates. The company tracked close to 3,000 of its permanent, full-time physician search assignments from March 31, 2005, to April 1, 2006. In that period, the company fielded more requests for internists and family physicians than for any other type of physician; requests for family physicians were up 55% over the previous year, and requests for internists were up 46%. Requests for primary care physicians decreased in the 1990s and early 2000s, but began to move back up last year, reaching the top this year, according to Merritt, Hawkins.

New Drugs: Confidence Drops

Physicians, pharmacists, and consumers are losing confidence in the safety of new drugs and are developing a preference for older ones, a study conducted by Forrester Research on behalf of Medco, a pharmacy benefit management company, has found. Of physician respondents, 70% expressed increased concern about the safety of the drugs they prescribe “due to recent issues affecting several prescription drugs on the market.” One in three physicians said that new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more, as did 29% of consumers and 26% of pharmacists, Medco said in a statement. Because direct-to-consumer marketing features new drugs, it is not surprising that consumer concerns about prescription drugs would focus on newer ones, Duane Kirking, Ph.D., director of medication use, policy, and economics at the University of Michigan College of Pharmacy, Ann Arbor, said in an interview. Dr. Kirking added that Medco is the only PBM that strongly promotes generic drugs; PBMs usually make more revenue from handling newer drugs. The Medco survey involved 3,200 respondents in the U.S., including 2,000 consumers, 300 practicing physicians, 450 retail pharmacists, and 450 health benefit administrators, and was taken in the first quarter of 2006.

Pick a Card

Medical practice administrators are seeking more uniformity in the information, appearance, and technology of patient identification cards, in an effort to eliminate errors and reduce claim rejections. A machine-readable card is the goal, and the Working Group on Electronic Data Interchange (WEDI) has been refining guidelines that have been previously developed by the American National Standards Institute. WEDI, a broad-based healthcare industry coalition with information technology projects, recently received support for its efforts from the Healthcare Administrative Simplification Coalition, a public/private partnership aimed at reducing the administrative costs and complexity of health care, composed of the Medical Group Management Association, the American Academy of Family Physicians, and others. Meanwhile, the Kansas City-based Mid-American Coalition on Health Care developed voluntary guidelines for standardizing patient ID cards. For example, the card must not have logos or other nonmember information obscuring text.

Clinical Trial Participation

Physicians who participate in a pharmaceutical company-sponsored trial are more likely to prescribe the sponsor's drug than are physicians who did not participate, according to a study conducted by researchers from the University of Southern Denmark and the University of Aarhus, Denmark. However, participation in drug trials did not affect adherence to international treatment guidelines, the researchers said in the study published in the Journal of the American Medical Association. The investigators performed a retrospective study comparing the behavior of physicians in 10 general practices who had participated in an AstraZeneca trial of the asthma drug Symbicort (budesonide/formoterol) with the conduct of physicians in 165 practices that were not part of the trial. After 2 years, researchers found that Symbicort's share of the total prescribed volume of asthma drugs was about 6.7% higher in practices that had participated in the trial than it was in the control practices. Adherence to treatment guidelines, measured by the use of inhaled steroids in asthma patients, improved in both groups by about the same amount.

CVS Buying MinuteClinic

MinuteClinic, a company that provides certain primary care services to customers at pharmacies and other retail outlets, has been acquired by CVS Corp., parent company of CVS/pharmacy. Currently in 83 locations nationwide (66 of which are in CVS pharmacies), MinuteClinics provide diagnosis and treatment of common conditions such as strep throat and conjunctivitis and are staffed by nurse practitioners and physician assistants. MinuteClinics are “intended to be a supplement, but not a replacement, for a patient's ongoing relationship with a primary care provider,” and provide lists of physicians to patients who lack a primary care provider, CVS said in a statement. “The MinuteClinic team has proven they can work collaboratively with physicians and deliver quality care in a convenient, timely, and cost-effective manner,” Thomas Ryan, chairman, president, and chief executive officer of CVS, said in the statement. According to the company, MinuteClinic plans to continue operating in CVS pharmacies and other retail locations—including competing pharmacies—and looks to expand to corporate and government offices.

IM/FP Demand Up Again

Internists and family physicians top hospital and medical groups' list of most-requested doctors, according to a new report from physician search firm Merritt, Hawkins & Associates. The company tracked close to 3,000 of its permanent, full-time physician search assignments from March 31, 2005, to April 1, 2006. In that period, the company fielded more requests for internists and family physicians than for any other type of physician; requests for family physicians were up 55% over the previous year, and requests for internists were up 46%. Requests for primary care physicians decreased in the 1990s and early 2000s, but began to move back up last year, reaching the top this year, according to Merritt, Hawkins.

New Drugs: Confidence Drops

Physicians, pharmacists, and consumers are losing confidence in the safety of new drugs and are developing a preference for older ones, a study conducted by Forrester Research on behalf of Medco, a pharmacy benefit management company, has found. Of physician respondents, 70% expressed increased concern about the safety of the drugs they prescribe “due to recent issues affecting several prescription drugs on the market.” One in three physicians said that new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more, as did 29% of consumers and 26% of pharmacists, Medco said in a statement. Because direct-to-consumer marketing features new drugs, it is not surprising that consumer concerns about prescription drugs would focus on newer ones, Duane Kirking, Ph.D., director of medication use, policy, and economics at the University of Michigan College of Pharmacy, Ann Arbor, said in an interview. Dr. Kirking added that Medco is the only PBM that strongly promotes generic drugs; PBMs usually make more revenue from handling newer drugs. The Medco survey involved 3,200 respondents in the U.S., including 2,000 consumers, 300 practicing physicians, 450 retail pharmacists, and 450 health benefit administrators, and was taken in the first quarter of 2006.

Pick a Card

Medical practice administrators are seeking more uniformity in the information, appearance, and technology of patient identification cards, in an effort to eliminate errors and reduce claim rejections. A machine-readable card is the goal, and the Working Group on Electronic Data Interchange (WEDI) has been refining guidelines that have been previously developed by the American National Standards Institute. WEDI, a broad-based healthcare industry coalition with information technology projects, recently received support for its efforts from the Healthcare Administrative Simplification Coalition, a public/private partnership aimed at reducing the administrative costs and complexity of health care, composed of the Medical Group Management Association, the American Academy of Family Physicians, and others. Meanwhile, the Kansas City-based Mid-American Coalition on Health Care developed voluntary guidelines for standardizing patient ID cards. For example, the card must not have logos or other nonmember information obscuring text.

Clinical Trial Participation

Physicians who participate in a pharmaceutical company-sponsored trial are more likely to prescribe the sponsor's drug than are physicians who did not participate, according to a study conducted by researchers from the University of Southern Denmark and the University of Aarhus, Denmark. However, participation in drug trials did not affect adherence to international treatment guidelines, the researchers said in the study published in the Journal of the American Medical Association. The investigators performed a retrospective study comparing the behavior of physicians in 10 general practices who had participated in an AstraZeneca trial of the asthma drug Symbicort (budesonide/formoterol) with the conduct of physicians in 165 practices that were not part of the trial. After 2 years, researchers found that Symbicort's share of the total prescribed volume of asthma drugs was about 6.7% higher in practices that had participated in the trial than it was in the control practices. Adherence to treatment guidelines, measured by the use of inhaled steroids in asthma patients, improved in both groups by about the same amount.

CVS Buying MinuteClinic

MinuteClinic, a company that provides certain primary care services to customers at pharmacies and other retail outlets, has been acquired by CVS Corp., parent company of CVS/pharmacy. Currently in 83 locations nationwide (66 of which are in CVS pharmacies), MinuteClinics provide diagnosis and treatment of common conditions such as strep throat and conjunctivitis and are staffed by nurse practitioners and physician assistants. MinuteClinics are “intended to be a supplement, but not a replacement, for a patient's ongoing relationship with a primary care provider,” and provide lists of physicians to patients who lack a primary care provider, CVS said in a statement. “The MinuteClinic team has proven they can work collaboratively with physicians and deliver quality care in a convenient, timely, and cost-effective manner,” Thomas Ryan, chairman, president, and chief executive officer of CVS, said in the statement. According to the company, MinuteClinic plans to continue operating in CVS pharmacies and other retail locations—including competing pharmacies—and looks to expand to corporate and government offices.

IM/FP Demand Up Again

Internists and family physicians top hospital and medical groups' list of most-requested doctors, according to a new report from physician search firm Merritt, Hawkins & Associates. The company tracked close to 3,000 of its permanent, full-time physician search assignments from March 31, 2005, to April 1, 2006. In that period, the company fielded more requests for internists and family physicians than for any other type of physician; requests for family physicians were up 55% over the previous year, and requests for internists were up 46%. Requests for primary care physicians decreased in the 1990s and early 2000s, but began to move back up last year, reaching the top this year, according to Merritt, Hawkins.

New Drugs: Confidence Drops

Physicians, pharmacists, and consumers are losing confidence in the safety of new drugs and are developing a preference for older ones, a study conducted by Forrester Research on behalf of Medco, a pharmacy benefit management company, has found. Of physician respondents, 70% expressed increased concern about the safety of the drugs they prescribe “due to recent issues affecting several prescription drugs on the market.” One in three physicians said that new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more, as did 29% of consumers and 26% of pharmacists, Medco said in a statement. Because direct-to-consumer marketing features new drugs, it is not surprising that consumer concerns about prescription drugs would focus on newer ones, Duane Kirking, Ph.D., director of medication use, policy, and economics at the University of Michigan College of Pharmacy, Ann Arbor, said in an interview. Dr. Kirking added that Medco is the only PBM that strongly promotes generic drugs; PBMs usually make more revenue from handling newer drugs. The Medco survey involved 3,200 respondents in the U.S., including 2,000 consumers, 300 practicing physicians, 450 retail pharmacists, and 450 health benefit administrators, and was taken in the first quarter of 2006.

Pick a Card

Medical practice administrators are seeking more uniformity in the information, appearance, and technology of patient identification cards, in an effort to eliminate errors and reduce claim rejections. A machine-readable card is the goal, and the Working Group on Electronic Data Interchange (WEDI) has been refining guidelines that have been previously developed by the American National Standards Institute. WEDI, a broad-based healthcare industry coalition with information technology projects, recently received support for its efforts from the Healthcare Administrative Simplification Coalition, a public/private partnership aimed at reducing the administrative costs and complexity of health care, composed of the Medical Group Management Association, the American Academy of Family Physicians, and others. Meanwhile, the Kansas City-based Mid-American Coalition on Health Care developed voluntary guidelines for standardizing patient ID cards. For example, the card must not have logos or other nonmember information obscuring text.

Clinical Trial Participation

Physicians who participate in a pharmaceutical company-sponsored trial are more likely to prescribe the sponsor's drug than are physicians who did not participate, according to a study conducted by researchers from the University of Southern Denmark and the University of Aarhus, Denmark. However, participation in drug trials did not affect adherence to international treatment guidelines, the researchers said in the study published in the Journal of the American Medical Association. The investigators performed a retrospective study comparing the behavior of physicians in 10 general practices who had participated in an AstraZeneca trial of the asthma drug Symbicort (budesonide/formoterol) with the conduct of physicians in 165 practices that were not part of the trial. After 2 years, researchers found that Symbicort's share of the total prescribed volume of asthma drugs was about 6.7% higher in practices that had participated in the trial than it was in the control practices. Adherence to treatment guidelines, measured by the use of inhaled steroids in asthma patients, improved in both groups by about the same amount.

CVS Buying MinuteClinic

MinuteClinic, a company that provides certain primary care services to customers at pharmacies and other retail outlets, has been acquired by CVS Corp., parent company of CVS/pharmacy. Currently in 83 locations nationwide (66 of which are in CVS pharmacies), MinuteClinics provide diagnosis and treatment of common conditions such as strep throat and conjunctivitis and are staffed by nurse practitioners and physician assistants. MinuteClinics are “intended to be a supplement, but not a replacement, for a patient's ongoing relationship with a primary care provider,” and provide lists of physicians to patients who lack a primary care provider, CVS said in a statement. “The MinuteClinic team has proven they can work collaboratively with physicians and deliver quality care in a convenient, timely, and cost-effective manner,” Thomas Ryan, chairman, president, and chief executive officer of CVS, said in the statement. According to the company, MinuteClinic plans to continue operating in CVS pharmacies and other retail locations—including competing pharmacies—and looks to expand to corporate and government offices.

IM/FP Demand Up Again

Internists and family physicians top hospital and medical groups' list of most-requested doctors, according to a report from physician search firm Merritt, Hawkins & Associates. The company tracked close to 3,000 of its permanent, full-time physician search assignments from March 31, 2005, to April 1, 2006. In that period, the company fielded more requests for internists and family physicians than for any other type of physician; compared with the previous year, requests were up 46% for internists and 55% for family physicians. Requests for primary care physicians fell in the 1990s and early 2000s, but began to move back up last year, reaching the top this year, according to Merritt, Hawkins. Demand stems from an aging population along with a shortage of internal medicine subspecialists, the company said.

New Drugs: Confidence Drops

Physicians, pharmacists, and consumers are losing confidence in the safety of new drugs and are developing a preference for older ones, a study conducted by Forrester Research on behalf of Medco, a pharmacy benefit management company, suggests. Of physician respondents, 70% expressed increased concern about the safety of the drugs they prescribe “due to recent issues affecting several prescription drugs on the market.” One in three physicians said new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more, as did 29% of consumers and 26% of pharmacists, Medco said in a statement. Direct-to-consumer marketing features new drugs, so it is not surprising that consumer concerns about prescription drugs would focus on newer ones, said Duane Kirking, Ph.D., director of medication use, policy, and economics at the University of Michigan College of Pharmacy, Ann Arbor. In an interview, Dr. Kirking said Medco is the only PBM that strongly promotes generic drugs; PBMs usually make more revenue from handling newer drugs. The Medco survey, conducted in the first quarter of 2006, involved 3,200 U.S. respondents, including 2,000 consumers, 300 practicing physicians, 450 retail pharmacists, and 450 health benefit administrators.

Pick a Card, a Uniform Card

Medical practice administrators are seeking more uniformity in the information, appearance, and technology of patient identification cards, in an effort to eliminate errors and reduce claim rejections. A machine-readable card is the goal, and the Working Group on Electronic Data Interchange (WEDI) has been refining guidelines previously developed by the American National Standards Institute. WEDI, a broad-based healthcare industry coalition with information technology projects, recently received support for its efforts from the Healthcare Administrative Simplification Coalition, a public/private partnership aimed at reducing the administrative costs and complexity of health care. The coalition is composed of the Medical Group Management Association, the American Academy of Family Physicians, and others. Meanwhile, the Kansas City-based Mid-American Coalition on Health Care developed voluntary guidelines for standardizing patient ID cards. For example, the card must not have logos or other nonmember information obscuring text, must be printed on a durable material such as plastic, and should be easy to photocopy.

Clinical Trial Participation

Physicians who participate in a pharmaceutical company-sponsored trial are more likely to prescribe the sponsor's drug than are physicians who did not participate, according to a study by researchers from the University of Southern Denmark and the University of Aarhus, Denmark. But participation in drug trials did not affect adherence to international treatment guidelines, the researchers said in the study published in the Journal of the American Medical Association. The researchers performed a retrospective study comparing the behavior of physicians in 10 general practices who had participated in an AstraZeneca trial of the asthma drug Symbicort (budesonide/formoterol) with the conduct of physicians in 165 practices that were not part of the trial. After 2 years, Symbicort's share of the total prescribed volume of asthma drugs was about 6.7% higher in practices that had participated in the trial than it was in the control practices. Adherence to treatment guidelines, measured by the use of inhaled steroids in asthma patients, improved in both groups by about the same amount.

CVS Buying MinuteClinic

MinuteClinic, a company that provides certain primary care services to customers at pharmacies and other retail outlets, has been acquired by CVS Corp., parent company of CVS/pharmacy. Currently in 83 locations nationwide (66 of which are in CVS pharmacies), MinuteClinics provide diagnosis and treatment of common conditions such as strep throat and conjunctivitis. Staffed by nurse practitioners and physician assistants, MinuteClinics are “intended to be a supplement, but not a replacement, for a patient's ongoing relationship with a primary care provider,” and provide lists of physicians to patients who lack a primary care provider, CVS said in a statement. “The MinuteClinic team has proven they can work collaboratively with physicians and deliver quality care in a convenient, timely, and cost-effective manner,” Thomas Ryan, chairman, president, and chief executive officer of CVS, said in the statement. According to the company, MinuteClinic plans to continue operating in CVS pharmacies and other retail locations—including competing pharmacies—and looks to expand to corporate and government offices.

IM/FP Demand Up Again

Internists and family physicians top hospital and medical groups' list of most-requested doctors, according to a report from physician search firm Merritt, Hawkins & Associates. The company tracked close to 3,000 of its permanent, full-time physician search assignments from March 31, 2005, to April 1, 2006. In that period, the company fielded more requests for internists and family physicians than for any other type of physician; compared with the previous year, requests were up 46% for internists and 55% for family physicians. Requests for primary care physicians fell in the 1990s and early 2000s, but began to move back up last year, reaching the top this year, according to Merritt, Hawkins. Demand stems from an aging population along with a shortage of internal medicine subspecialists, the company said.

New Drugs: Confidence Drops

Physicians, pharmacists, and consumers are losing confidence in the safety of new drugs and are developing a preference for older ones, a study conducted by Forrester Research on behalf of Medco, a pharmacy benefit management company, suggests. Of physician respondents, 70% expressed increased concern about the safety of the drugs they prescribe “due to recent issues affecting several prescription drugs on the market.” One in three physicians said new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more, as did 29% of consumers and 26% of pharmacists, Medco said in a statement. Direct-to-consumer marketing features new drugs, so it is not surprising that consumer concerns about prescription drugs would focus on newer ones, said Duane Kirking, Ph.D., director of medication use, policy, and economics at the University of Michigan College of Pharmacy, Ann Arbor. In an interview, Dr. Kirking said Medco is the only PBM that strongly promotes generic drugs; PBMs usually make more revenue from handling newer drugs. The Medco survey, conducted in the first quarter of 2006, involved 3,200 U.S. respondents, including 2,000 consumers, 300 practicing physicians, 450 retail pharmacists, and 450 health benefit administrators.

Pick a Card, a Uniform Card

Medical practice administrators are seeking more uniformity in the information, appearance, and technology of patient identification cards, in an effort to eliminate errors and reduce claim rejections. A machine-readable card is the goal, and the Working Group on Electronic Data Interchange (WEDI) has been refining guidelines previously developed by the American National Standards Institute. WEDI, a broad-based healthcare industry coalition with information technology projects, recently received support for its efforts from the Healthcare Administrative Simplification Coalition, a public/private partnership aimed at reducing the administrative costs and complexity of health care. The coalition is composed of the Medical Group Management Association, the American Academy of Family Physicians, and others. Meanwhile, the Kansas City-based Mid-American Coalition on Health Care developed voluntary guidelines for standardizing patient ID cards. For example, the card must not have logos or other nonmember information obscuring text, must be printed on a durable material such as plastic, and should be easy to photocopy.

Clinical Trial Participation

Physicians who participate in a pharmaceutical company-sponsored trial are more likely to prescribe the sponsor's drug than are physicians who did not participate, according to a study by researchers from the University of Southern Denmark and the University of Aarhus, Denmark. But participation in drug trials did not affect adherence to international treatment guidelines, the researchers said in the study published in the Journal of the American Medical Association. The researchers performed a retrospective study comparing the behavior of physicians in 10 general practices who had participated in an AstraZeneca trial of the asthma drug Symbicort (budesonide/formoterol) with the conduct of physicians in 165 practices that were not part of the trial. After 2 years, Symbicort's share of the total prescribed volume of asthma drugs was about 6.7% higher in practices that had participated in the trial than it was in the control practices. Adherence to treatment guidelines, measured by the use of inhaled steroids in asthma patients, improved in both groups by about the same amount.

CVS Buying MinuteClinic

MinuteClinic, a company that provides certain primary care services to customers at pharmacies and other retail outlets, has been acquired by CVS Corp., parent company of CVS/pharmacy. Currently in 83 locations nationwide (66 of which are in CVS pharmacies), MinuteClinics provide diagnosis and treatment of common conditions such as strep throat and conjunctivitis. Staffed by nurse practitioners and physician assistants, MinuteClinics are “intended to be a supplement, but not a replacement, for a patient's ongoing relationship with a primary care provider,” and provide lists of physicians to patients who lack a primary care provider, CVS said in a statement. “The MinuteClinic team has proven they can work collaboratively with physicians and deliver quality care in a convenient, timely, and cost-effective manner,” Thomas Ryan, chairman, president, and chief executive officer of CVS, said in the statement. According to the company, MinuteClinic plans to continue operating in CVS pharmacies and other retail locations—including competing pharmacies—and looks to expand to corporate and government offices.

IM/FP Demand Up Again

Internists and family physicians top hospital and medical groups' list of most-requested doctors, according to a report from physician search firm Merritt, Hawkins & Associates. The company tracked close to 3,000 of its permanent, full-time physician search assignments from March 31, 2005, to April 1, 2006. In that period, the company fielded more requests for internists and family physicians than for any other type of physician; compared with the previous year, requests were up 46% for internists and 55% for family physicians. Requests for primary care physicians fell in the 1990s and early 2000s, but began to move back up last year, reaching the top this year, according to Merritt, Hawkins. Demand stems from an aging population along with a shortage of internal medicine subspecialists, the company said.

New Drugs: Confidence Drops

Physicians, pharmacists, and consumers are losing confidence in the safety of new drugs and are developing a preference for older ones, a study conducted by Forrester Research on behalf of Medco, a pharmacy benefit management company, suggests. Of physician respondents, 70% expressed increased concern about the safety of the drugs they prescribe “due to recent issues affecting several prescription drugs on the market.” One in three physicians said new or recently approved prescription drugs are less safe than drugs that have been on the market for 10 years or more, as did 29% of consumers and 26% of pharmacists, Medco said in a statement. Direct-to-consumer marketing features new drugs, so it is not surprising that consumer concerns about prescription drugs would focus on newer ones, said Duane Kirking, Ph.D., director of medication use, policy, and economics at the University of Michigan College of Pharmacy, Ann Arbor. In an interview, Dr. Kirking said Medco is the only PBM that strongly promotes generic drugs; PBMs usually make more revenue from handling newer drugs. The Medco survey, conducted in the first quarter of 2006, involved 3,200 U.S. respondents, including 2,000 consumers, 300 practicing physicians, 450 retail pharmacists, and 450 health benefit administrators.

Pick a Card, a Uniform Card

Medical practice administrators are seeking more uniformity in the information, appearance, and technology of patient identification cards, in an effort to eliminate errors and reduce claim rejections. A machine-readable card is the goal, and the Working Group on Electronic Data Interchange (WEDI) has been refining guidelines previously developed by the American National Standards Institute. WEDI, a broad-based healthcare industry coalition with information technology projects, recently received support for its efforts from the Healthcare Administrative Simplification Coalition, a public/private partnership aimed at reducing the administrative costs and complexity of health care. The coalition is composed of the Medical Group Management Association, the American Academy of Family Physicians, and others. Meanwhile, the Kansas City-based Mid-American Coalition on Health Care developed voluntary guidelines for standardizing patient ID cards. For example, the card must not have logos or other nonmember information obscuring text, must be printed on a durable material such as plastic, and should be easy to photocopy.

Clinical Trial Participation

Physicians who participate in a pharmaceutical company-sponsored trial are more likely to prescribe the sponsor's drug than are physicians who did not participate, according to a study by researchers from the University of Southern Denmark and the University of Aarhus, Denmark. But participation in drug trials did not affect adherence to international treatment guidelines, the researchers said in the study published in the Journal of the American Medical Association. The researchers performed a retrospective study comparing the behavior of physicians in 10 general practices who had participated in an AstraZeneca trial of the asthma drug Symbicort (budesonide/formoterol) with the conduct of physicians in 165 practices that were not part of the trial. After 2 years, Symbicort's share of the total prescribed volume of asthma drugs was about 6.7% higher in practices that had participated in the trial than it was in the control practices. Adherence to treatment guidelines, measured by the use of inhaled steroids in asthma patients, improved in both groups by about the same amount.

CVS Buying MinuteClinic

MinuteClinic, a company that provides certain primary care services to customers at pharmacies and other retail outlets, has been acquired by CVS Corp., parent company of CVS/pharmacy. Currently in 83 locations nationwide (66 of which are in CVS pharmacies), MinuteClinics provide diagnosis and treatment of common conditions such as strep throat and conjunctivitis. Staffed by nurse practitioners and physician assistants, MinuteClinics are “intended to be a supplement, but not a replacement, for a patient's ongoing relationship with a primary care provider,” and provide lists of physicians to patients who lack a primary care provider, CVS said in a statement. “The MinuteClinic team has proven they can work collaboratively with physicians and deliver quality care in a convenient, timely, and cost-effective manner,” Thomas Ryan, chairman, president, and chief executive officer of CVS, said in the statement. According to the company, MinuteClinic plans to continue operating in CVS pharmacies and other retail locations—including competing pharmacies—and looks to expand to corporate and government offices.

The Department of Health and Human Services is buying 5 million additional doses of Anthrax Vaccine Adsorbed from the BioPort Corp., Lansing, Mich.

The purchase modifies an existing HHS contract with BioPort awarded in May 2005, also for 5 million doses, the agency said in a statement. The vaccine will be placed in the Strategic National Stockpile and will be available for use in the event of a bioterror anthrax incident. “Together with an already substantial supply of antibiotics, which is the nation's first line of defense against an anthrax attack, the additional [anthrax] vaccine will further diversify the stockpile's medical countermeasures,” according to the statement.

The HHS Office of Public Health Emergency Preparedness will manage the vaccine contract through Project BioShield. The 10 million doses will act as a bridge while another type of anthrax vaccine is developed, said HHS spokesman Bill Hall. If a physician suspects a case of anthrax, local and state public health departments should be contacted immediately, he said.

The Department of Health and Human Services is buying 5 million additional doses of Anthrax Vaccine Adsorbed from the BioPort Corp., Lansing, Mich.

The purchase modifies an existing HHS contract with BioPort awarded in May 2005, also for 5 million doses, the agency said in a statement. The vaccine will be placed in the Strategic National Stockpile and will be available for use in the event of a bioterror anthrax incident. “Together with an already substantial supply of antibiotics, which is the nation's first line of defense against an anthrax attack, the additional [anthrax] vaccine will further diversify the stockpile's medical countermeasures,” according to the statement.

The HHS Office of Public Health Emergency Preparedness will manage the vaccine contract through Project BioShield. The 10 million doses will act as a bridge while another type of anthrax vaccine is developed, said HHS spokesman Bill Hall. If a physician suspects a case of anthrax, local and state public health departments should be contacted immediately, he said.

The Department of Health and Human Services is buying 5 million additional doses of Anthrax Vaccine Adsorbed from the BioPort Corp., Lansing, Mich.

The purchase modifies an existing HHS contract with BioPort awarded in May 2005, also for 5 million doses, the agency said in a statement. The vaccine will be placed in the Strategic National Stockpile and will be available for use in the event of a bioterror anthrax incident. “Together with an already substantial supply of antibiotics, which is the nation's first line of defense against an anthrax attack, the additional [anthrax] vaccine will further diversify the stockpile's medical countermeasures,” according to the statement.

The HHS Office of Public Health Emergency Preparedness will manage the vaccine contract through Project BioShield. The 10 million doses will act as a bridge while another type of anthrax vaccine is developed, said HHS spokesman Bill Hall. If a physician suspects a case of anthrax, local and state public health departments should be contacted immediately, he said.

The science is now anything but hazy: Secondhand tobacco smoke causes premature death and disease in children and adults who don't smoke—and there is no safe exposure level, the U.S. surgeon general warned in a comprehensive new report.

In a return to a public health issue last addressed in a 1986 surgeon general's report, the nation's top physician found significant progress in the campaign to reduce Americans' exposure to secondhand smoke. But new scientific evidence in the intervening 20 years strengthens the links between involuntary smoking and a host of harmful cardiovascular, respiratory, and reproductive effects.

In particular, the surgeon general's report cautioned that exposure to secondhand smoke increases nonsmokers' risk of developing heart disease by 25%–30% and their risk of developing lung cancer by 20%–30%.

In addition, the home is surpassing work as the primary source of secondhand smoke exposure—a trend that poses special danger for children, who are at increased risk for sudden infant death syndrome, ear problems, asthma, and acute respiratory infections.

As a result, physicians “should routinely ask about secondhand smoke exposure, particularly in susceptible groups or when a child has an illness caused by secondhand smoke, such as pneumonia,” U.S. Surgeon General Dr. Richard H. Carmona stated in his 709-page review, “The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.”

Clearing the Air

The new report acknowledges that the secondhand smoke picture has cleared significantly since the last look at the topic 20 years ago.

Thanks to the spread of smoke-free environments at work sites and other public places, levels of cotinine, a biologic marker for secondhand smoke exposure, have fallen in nonsmokers by 70% since the late 1980s. The proportion of nonsmokers with detectable cotinine levels has been halved from 88% in 1988–1991 to 43% in 2001–2002.

Nonetheless, nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke, and children's median cotinine levels were more than twice those of adult nonsmokers.

The California Environmental Protection Agency highlighted secondhand smoke's human toll in a 2005 study cited by the U.S. surgeon general. Exposure resulted in an estimated 3,400 deaths annually from lung cancer, 46,000 deaths from cardiac-related causes, and 430 deaths attributed to sudden infant death syndrome.

More than 50 carcinogens have been identified in sidestream and secondhand smoke, and there is sufficient evidence that exposure in nonsmokers causes a “significant increase” in urinary levels of metabolites of the tobacco-specific lung carcinogen NNK, or 4-(methylnitrosamino)-1- (3-pyridyl)-1-butanone.

The Cardiorespiratory Costs

Two decades of new data further cement the causal links connecting secondhand smoke to cardiovascular and respiratory disease.

Sufficient evidence now exists to infer a causal relationship between secondhand smoke exposure and lung cancer in lifetime nonsmokers—a conclusion that extended to all secondhand smoke exposure, regardless of location.

In contrast, the study data supporting a causal link between secondhand smoke exposure and breast cancer are suggestive but not sufficient.

The evidence is sufficient to back a causal link between secondhand smoke and increased risk of coronary heart disease, although the report deemed the evidence of increased risk of stroke or atherosclerosis as “suggestive but not sufficient.”

Among people with asthma, the evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms such as cough, wheeze, chest tightness, and difficulty breathing.

The evidence was also suggestive but not sufficient to draw a causal link between exposure and an acute decline in lung function and short-term secondhand smoke in people with asthma.

The data supporting a causal link between secondhand smoke and risk for chronic obstructive pulmonary disease were deemed suggestive but not sufficient, while the report said that the evidence was “inadequate” to infer the presence or absence of a causal relationship between exposure and morbidity in patients with chronic obstructive pulmonary disease.

Pediatric Impact

Because of young children's high levels of exposure, secondhand smoke should be considered a significant pediatric issue, according to the report. The pediatric findings were especially stark regarding mothers who smoke.

In its 2005 report, Cal/EPA estimated that, nationwide, secondhand smoke exposure resulted annually in between 24,300 and 71,900 low-birth-weight or preterm deliveries, about 202,300 episodes of childhood asthma (new cases and exacerbations), between 150,000 and 300,000 cases of lower respiratory illness in children, and about 789,700 cases of middle ear infections.

According to the U.S. surgeon general's report, the evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and sudden infant death syndrome, as well as lower respiratory illnesses in infants and children.

Sufficient evidence also exists to infer a causal relationship between parental smoking and middle ear disease in children, including acute and recurring otitis media and chronic middle ear effusion.

For childhood asthma, a causal relationship was found between secondhand smoke exposure from parental smoking and the onset of wheeze illnesses in early childhood. However, the evidence was only suggestive of a causal relationship between secondhand smoke exposure from parental smoking and the onset of childhood asthma.

The latest data on lung growth and pulmonary function showed a causal relationship between maternal smoking during pregnancy and persistent adverse effects on lung function during childhood. Exposure to secondhand smoke after birth was also linked to a lower level of lung function during childhood.

Seeking Solutions

To prevent these risks, the surgeon general said, the smoke must be stopped—everywhere. Creating separately ventilated rooms is not an answer to preventing exposure, and the use of typical air cleaning strategies is also not sufficient.

“The only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors,” according to the report.

Arguments that such no-smoking policies would cripple the hospitality industry carry no weight in the surgeon general's report. Assessing the evidence demonstrates that “smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry,” the report stated.

The report “clearly supports” a pattern that oncologists have long observed, said Dr. Shirish Gadgeel, an oncologist at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit.

The surgeon general's report “absolutely” gives him more clout with patients, he said, adding that some lung cancer patients continue to smoke during treatment.

Now, Dr. Gadgeel said, he can point to the report and say that smokers are putting the health of their “near and dear ones” at risk by continuing to smoke.

The science is now anything but hazy: Secondhand tobacco smoke causes premature death and disease in children and adults who don't smoke—and there is no safe exposure level, the U.S. surgeon general warned in a comprehensive new report.

In a return to a public health issue last addressed in a 1986 surgeon general's report, the nation's top physician found significant progress in the campaign to reduce Americans' exposure to secondhand smoke. But new scientific evidence in the intervening 20 years strengthens the links between involuntary smoking and a host of harmful cardiovascular, respiratory, and reproductive effects.

In particular, the surgeon general's report cautioned that exposure to secondhand smoke increases nonsmokers' risk of developing heart disease by 25%–30% and their risk of developing lung cancer by 20%–30%.

In addition, the home is surpassing work as the primary source of secondhand smoke exposure—a trend that poses special danger for children, who are at increased risk for sudden infant death syndrome, ear problems, asthma, and acute respiratory infections.

As a result, physicians “should routinely ask about secondhand smoke exposure, particularly in susceptible groups or when a child has an illness caused by secondhand smoke, such as pneumonia,” U.S. Surgeon General Dr. Richard H. Carmona stated in his 709-page review, “The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.”

Clearing the Air

The new report acknowledges that the secondhand smoke picture has cleared significantly since the last look at the topic 20 years ago.

Thanks to the spread of smoke-free environments at work sites and other public places, levels of cotinine, a biologic marker for secondhand smoke exposure, have fallen in nonsmokers by 70% since the late 1980s. The proportion of nonsmokers with detectable cotinine levels has been halved from 88% in 1988–1991 to 43% in 2001–2002.

Nonetheless, nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke, and children's median cotinine levels were more than twice those of adult nonsmokers.

The California Environmental Protection Agency highlighted secondhand smoke's human toll in a 2005 study cited by the U.S. surgeon general. Exposure resulted in an estimated 3,400 deaths annually from lung cancer, 46,000 deaths from cardiac-related causes, and 430 deaths attributed to sudden infant death syndrome.

More than 50 carcinogens have been identified in sidestream and secondhand smoke, and there is sufficient evidence that exposure in nonsmokers causes a “significant increase” in urinary levels of metabolites of the tobacco-specific lung carcinogen NNK, or 4-(methylnitrosamino)-1- (3-pyridyl)-1-butanone.

The Cardiorespiratory Costs

Two decades of new data further cement the causal links connecting secondhand smoke to cardiovascular and respiratory disease.

Sufficient evidence now exists to infer a causal relationship between secondhand smoke exposure and lung cancer in lifetime nonsmokers—a conclusion that extended to all secondhand smoke exposure, regardless of location.

In contrast, the study data supporting a causal link between secondhand smoke exposure and breast cancer are suggestive but not sufficient.

The evidence is sufficient to back a causal link between secondhand smoke and increased risk of coronary heart disease, although the report deemed the evidence of increased risk of stroke or atherosclerosis as “suggestive but not sufficient.”

Among people with asthma, the evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms such as cough, wheeze, chest tightness, and difficulty breathing.

The evidence was also suggestive but not sufficient to draw a causal link between exposure and an acute decline in lung function and short-term secondhand smoke in people with asthma.

The data supporting a causal link between secondhand smoke and risk for chronic obstructive pulmonary disease were deemed suggestive but not sufficient, while the report said that the evidence was “inadequate” to infer the presence or absence of a causal relationship between exposure and morbidity in patients with chronic obstructive pulmonary disease.

Pediatric Impact

Because of young children's high levels of exposure, secondhand smoke should be considered a significant pediatric issue, according to the report. The pediatric findings were especially stark regarding mothers who smoke.

In its 2005 report, Cal/EPA estimated that, nationwide, secondhand smoke exposure resulted annually in between 24,300 and 71,900 low-birth-weight or preterm deliveries, about 202,300 episodes of childhood asthma (new cases and exacerbations), between 150,000 and 300,000 cases of lower respiratory illness in children, and about 789,700 cases of middle ear infections.

According to the U.S. surgeon general's report, the evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and sudden infant death syndrome, as well as lower respiratory illnesses in infants and children.

Sufficient evidence also exists to infer a causal relationship between parental smoking and middle ear disease in children, including acute and recurring otitis media and chronic middle ear effusion.

For childhood asthma, a causal relationship was found between secondhand smoke exposure from parental smoking and the onset of wheeze illnesses in early childhood. However, the evidence was only suggestive of a causal relationship between secondhand smoke exposure from parental smoking and the onset of childhood asthma.

The latest data on lung growth and pulmonary function showed a causal relationship between maternal smoking during pregnancy and persistent adverse effects on lung function during childhood. Exposure to secondhand smoke after birth was also linked to a lower level of lung function during childhood.

Seeking Solutions

To prevent these risks, the surgeon general said, the smoke must be stopped—everywhere. Creating separately ventilated rooms is not an answer to preventing exposure, and the use of typical air cleaning strategies is also not sufficient.

“The only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors,” according to the report.

Arguments that such no-smoking policies would cripple the hospitality industry carry no weight in the surgeon general's report. Assessing the evidence demonstrates that “smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry,” the report stated.

The report “clearly supports” a pattern that oncologists have long observed, said Dr. Shirish Gadgeel, an oncologist at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit.

The surgeon general's report “absolutely” gives him more clout with patients, he said, adding that some lung cancer patients continue to smoke during treatment.

Now, Dr. Gadgeel said, he can point to the report and say that smokers are putting the health of their “near and dear ones” at risk by continuing to smoke.

The science is now anything but hazy: Secondhand tobacco smoke causes premature death and disease in children and adults who don't smoke—and there is no safe exposure level, the U.S. surgeon general warned in a comprehensive new report.

In a return to a public health issue last addressed in a 1986 surgeon general's report, the nation's top physician found significant progress in the campaign to reduce Americans' exposure to secondhand smoke. But new scientific evidence in the intervening 20 years strengthens the links between involuntary smoking and a host of harmful cardiovascular, respiratory, and reproductive effects.

In particular, the surgeon general's report cautioned that exposure to secondhand smoke increases nonsmokers' risk of developing heart disease by 25%–30% and their risk of developing lung cancer by 20%–30%.

In addition, the home is surpassing work as the primary source of secondhand smoke exposure—a trend that poses special danger for children, who are at increased risk for sudden infant death syndrome, ear problems, asthma, and acute respiratory infections.

As a result, physicians “should routinely ask about secondhand smoke exposure, particularly in susceptible groups or when a child has an illness caused by secondhand smoke, such as pneumonia,” U.S. Surgeon General Dr. Richard H. Carmona stated in his 709-page review, “The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.”

Clearing the Air

The new report acknowledges that the secondhand smoke picture has cleared significantly since the last look at the topic 20 years ago.

Thanks to the spread of smoke-free environments at work sites and other public places, levels of cotinine, a biologic marker for secondhand smoke exposure, have fallen in nonsmokers by 70% since the late 1980s. The proportion of nonsmokers with detectable cotinine levels has been halved from 88% in 1988–1991 to 43% in 2001–2002.

Nonetheless, nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke, and children's median cotinine levels were more than twice those of adult nonsmokers.

The California Environmental Protection Agency highlighted secondhand smoke's human toll in a 2005 study cited by the U.S. surgeon general. Exposure resulted in an estimated 3,400 deaths annually from lung cancer, 46,000 deaths from cardiac-related causes, and 430 deaths attributed to sudden infant death syndrome.

More than 50 carcinogens have been identified in sidestream and secondhand smoke, and there is sufficient evidence that exposure in nonsmokers causes a “significant increase” in urinary levels of metabolites of the tobacco-specific lung carcinogen NNK, or 4-(methylnitrosamino)-1- (3-pyridyl)-1-butanone.

The Cardiorespiratory Costs

Two decades of new data further cement the causal links connecting secondhand smoke to cardiovascular and respiratory disease.

Sufficient evidence now exists to infer a causal relationship between secondhand smoke exposure and lung cancer in lifetime nonsmokers—a conclusion that extended to all secondhand smoke exposure, regardless of location.

In contrast, the study data supporting a causal link between secondhand smoke exposure and breast cancer are suggestive but not sufficient.

The evidence is sufficient to back a causal link between secondhand smoke and increased risk of coronary heart disease, although the report deemed the evidence of increased risk of stroke or atherosclerosis as “suggestive but not sufficient.”

Among people with asthma, the evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms such as cough, wheeze, chest tightness, and difficulty breathing.

The evidence was also suggestive but not sufficient to draw a causal link between exposure and an acute decline in lung function and short-term secondhand smoke in people with asthma.

The data supporting a causal link between secondhand smoke and risk for chronic obstructive pulmonary disease were deemed suggestive but not sufficient, while the report said that the evidence was “inadequate” to infer the presence or absence of a causal relationship between exposure and morbidity in patients with chronic obstructive pulmonary disease.

Pediatric Impact

Because of young children's high levels of exposure, secondhand smoke should be considered a significant pediatric issue, according to the report. The pediatric findings were especially stark regarding mothers who smoke.

In its 2005 report, Cal/EPA estimated that, nationwide, secondhand smoke exposure resulted annually in between 24,300 and 71,900 low-birth-weight or preterm deliveries, about 202,300 episodes of childhood asthma (new cases and exacerbations), between 150,000 and 300,000 cases of lower respiratory illness in children, and about 789,700 cases of middle ear infections.

According to the U.S. surgeon general's report, the evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and sudden infant death syndrome, as well as lower respiratory illnesses in infants and children.

Sufficient evidence also exists to infer a causal relationship between parental smoking and middle ear disease in children, including acute and recurring otitis media and chronic middle ear effusion.

For childhood asthma, a causal relationship was found between secondhand smoke exposure from parental smoking and the onset of wheeze illnesses in early childhood. However, the evidence was only suggestive of a causal relationship between secondhand smoke exposure from parental smoking and the onset of childhood asthma.

The latest data on lung growth and pulmonary function showed a causal relationship between maternal smoking during pregnancy and persistent adverse effects on lung function during childhood. Exposure to secondhand smoke after birth was also linked to a lower level of lung function during childhood.

Seeking Solutions

To prevent these risks, the surgeon general said, the smoke must be stopped—everywhere. Creating separately ventilated rooms is not an answer to preventing exposure, and the use of typical air cleaning strategies is also not sufficient.

“The only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors,” according to the report.

Arguments that such no-smoking policies would cripple the hospitality industry carry no weight in the surgeon general's report. Assessing the evidence demonstrates that “smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry,” the report stated.

The report “clearly supports” a pattern that oncologists have long observed, said Dr. Shirish Gadgeel, an oncologist at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit.

The surgeon general's report “absolutely” gives him more clout with patients, he said, adding that some lung cancer patients continue to smoke during treatment.

Now, Dr. Gadgeel said, he can point to the report and say that smokers are putting the health of their “near and dear ones” at risk by continuing to smoke.

In-Office AIDS Test, Please

Americans would much prefer to be tested for AIDS in a physician's office or clinic, instead of performing a home test, according to a survey of 2,500 adults by the Kaiser Family Foundation. Overall, 62% of respondents preferred a doctor's office or clinic, compared with 26% who preferred home testing; only 10% said the location did not matter. However, respondents did think home tests should be an option; 65% said home tests help people who otherwise would not learn their HIV status. On the other hand, 27% agreed with the statement that home tests are “a bad idea” because people need counseling that is available only in a physician's office or clinic. HIV testing should be treated like any routine screening and included as part of regular check-ups and exams, according to 65% of respondents. Slightly more than one-fourth (27%) of respondents disagreed; instead, they agreed with the statement that HIV testing is different and requires special procedures such as written permission from the patient.

MinuteClinic: Quality Council

MinuteClinic, the nation's largest provider of retail-based health care, has created a National Clinical Quality Advisory Council. The eight-member council has five physicians, including a representative of the American Academy of Family Physicians. To develop its own standards, MinuteClinic uses quality guidance from AAFP and the American Academy of Pediatrics Red Book as well as the Midwestern Institute for Clinical Systems Improvement, Dr. James Woodburn, chief medical officer, said in an interview. Dr. Ari Brown, a spokesperson for the Texas Pediatrics Society, said that she was surprised that MinuteClinic was creating a quality council after the company was already up and running. Dr. Brown questioned the retail clinic's role in providing a quality “medical home” to patients. Dr. Woodburn said patients should have a medical home, but about 30% of the time, MinuteClinic patients either have no regular doctor or else do not want to reveal the name. If the patient does have a regular physician, the MinuteClinic mails a record of the visit to that office, Dr. Woodburn said.

Maine PBM Law Stands

The U.S. Supreme Court rejected a challenge to Maine's pharmacy benefit management company law. The Maine statute requires PBMs to disclose “all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefits manager and any prescription drug manufacturer or labeler, including … formulary management and drug-switch programs, educational support, claims processing and pharmacy network fees that are charged from retail pharmacies, and data sales fees.” The PBM trade group Pharmaceutical Care Management Association (PCMA) sued Maine when it enacted the law in 2003, claiming that it overstepped federal, state, and contract boundaries. But an independent pharmacy group hailed the high court's decision. “The decision to affirm the state's right to regulate PBMs is a major victory for consumers in Maine and many other states” the National Community Pharmacists Association said in a June statement. PBMs were disappointed. The state pushed into the “contractual relationship” between PBMs and their customers, Stephanie Kanwit, special counsel to PCMA, said in an interview. She noted that physicians might have fewer choices when writing prescriptions, because weaker PBMs could lead to higher drug prices.

Chiropractors Sue Insurers

Chiropractors, podiatrists, and others have petitioned the U.S. District Court in Miami to join Solomon vs. Anthem, a class-action suit by nonphysician providers against insurance companies, charging that the companies conspired to systematically underpay providers and deny medically necessary care to patients. The American Chiropractic Association (ACA) also asked that ACN Group Inc. and United Healthcare Services Inc. be named as additional defendants. The suit seeks unspecified monetary damages and changes in the companies' practices. A similar class-action suit by physicians—known as the consolidated Provider Track cases—has been in that same court. The next steps in the Solomon case may depend upon resolution of the Provider Track cases, Thomas Daly, counsel for ACA, said in an interview. On June 19, Judge Federico A. Moreno dismissed United Healthcare from the Provider Track cases. “There is simply insufficient evidence of the wrongdoing claimed, i.e. agreeing with their competitors to defraud the doctors,” Judge Moreno wrote. Two other insurers in the Provider Track cases, Aetna and Cigna, settled in 2003, agreeing to change their coding and claims procedures.

Marlboro Case at Supreme Court

The U.S. Supreme Court has agreed to hear Philip Morris USA's appeal of an $80 million punitive damage award involving the death of a Marlboro smoker, raising concerns about the future of punitive damages in tobacco and other public health matters. The estate of Oregon resident Jesse Williams was awarded the money in a fraud and negligence suit against the tobacco maker. Mr. Williams, who died of lung cancer, was a heavy smoker of Marlboros, and his estate argued that his smoking habit killed him. The estate urged the jury to award punitive damages based on the estimated number of Marlboro smokers in Oregon. The high court agreed to address due process of law and punitive damage amount questions. Now that the states have signed the master settlement agreement, individual suits are one of the remaining vital weapons against tobacco products, David Dobbins, deputy general counsel of the American Legacy Foundation said.

In-Office AIDS Test, Please

Americans would much prefer to be tested for AIDS in a physician's office or clinic, instead of performing a home test, according to a survey of 2,500 adults by the Kaiser Family Foundation. Overall, 62% of respondents preferred a doctor's office or clinic, compared with 26% who preferred home testing; only 10% said the location did not matter. However, respondents did think home tests should be an option; 65% said home tests help people who otherwise would not learn their HIV status. On the other hand, 27% agreed with the statement that home tests are “a bad idea” because people need counseling that is available only in a physician's office or clinic. HIV testing should be treated like any routine screening and included as part of regular check-ups and exams, according to 65% of respondents. Slightly more than one-fourth (27%) of respondents disagreed; instead, they agreed with the statement that HIV testing is different and requires special procedures such as written permission from the patient.

MinuteClinic: Quality Council

MinuteClinic, the nation's largest provider of retail-based health care, has created a National Clinical Quality Advisory Council. The eight-member council has five physicians, including a representative of the American Academy of Family Physicians. To develop its own standards, MinuteClinic uses quality guidance from AAFP and the American Academy of Pediatrics Red Book as well as the Midwestern Institute for Clinical Systems Improvement, Dr. James Woodburn, chief medical officer, said in an interview. Dr. Ari Brown, a spokesperson for the Texas Pediatrics Society, said that she was surprised that MinuteClinic was creating a quality council after the company was already up and running. Dr. Brown questioned the retail clinic's role in providing a quality “medical home” to patients. Dr. Woodburn said patients should have a medical home, but about 30% of the time, MinuteClinic patients either have no regular doctor or else do not want to reveal the name. If the patient does have a regular physician, the MinuteClinic mails a record of the visit to that office, Dr. Woodburn said.

Maine PBM Law Stands

The U.S. Supreme Court rejected a challenge to Maine's pharmacy benefit management company law. The Maine statute requires PBMs to disclose “all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefits manager and any prescription drug manufacturer or labeler, including … formulary management and drug-switch programs, educational support, claims processing and pharmacy network fees that are charged from retail pharmacies, and data sales fees.” The PBM trade group Pharmaceutical Care Management Association (PCMA) sued Maine when it enacted the law in 2003, claiming that it overstepped federal, state, and contract boundaries. But an independent pharmacy group hailed the high court's decision. “The decision to affirm the state's right to regulate PBMs is a major victory for consumers in Maine and many other states” the National Community Pharmacists Association said in a June statement. PBMs were disappointed. The state pushed into the “contractual relationship” between PBMs and their customers, Stephanie Kanwit, special counsel to PCMA, said in an interview. She noted that physicians might have fewer choices when writing prescriptions, because weaker PBMs could lead to higher drug prices.

Chiropractors Sue Insurers

Chiropractors, podiatrists, and others have petitioned the U.S. District Court in Miami to join Solomon vs. Anthem, a class-action suit by nonphysician providers against insurance companies, charging that the companies conspired to systematically underpay providers and deny medically necessary care to patients. The American Chiropractic Association (ACA) also asked that ACN Group Inc. and United Healthcare Services Inc. be named as additional defendants. The suit seeks unspecified monetary damages and changes in the companies' practices. A similar class-action suit by physicians—known as the consolidated Provider Track cases—has been in that same court. The next steps in the Solomon case may depend upon resolution of the Provider Track cases, Thomas Daly, counsel for ACA, said in an interview. On June 19, Judge Federico A. Moreno dismissed United Healthcare from the Provider Track cases. “There is simply insufficient evidence of the wrongdoing claimed, i.e. agreeing with their competitors to defraud the doctors,” Judge Moreno wrote. Two other insurers in the Provider Track cases, Aetna and Cigna, settled in 2003, agreeing to change their coding and claims procedures.

Marlboro Case at Supreme Court

The U.S. Supreme Court has agreed to hear Philip Morris USA's appeal of an $80 million punitive damage award involving the death of a Marlboro smoker, raising concerns about the future of punitive damages in tobacco and other public health matters. The estate of Oregon resident Jesse Williams was awarded the money in a fraud and negligence suit against the tobacco maker. Mr. Williams, who died of lung cancer, was a heavy smoker of Marlboros, and his estate argued that his smoking habit killed him. The estate urged the jury to award punitive damages based on the estimated number of Marlboro smokers in Oregon. The high court agreed to address due process of law and punitive damage amount questions. Now that the states have signed the master settlement agreement, individual suits are one of the remaining vital weapons against tobacco products, David Dobbins, deputy general counsel of the American Legacy Foundation said.

In-Office AIDS Test, Please

Americans would much prefer to be tested for AIDS in a physician's office or clinic, instead of performing a home test, according to a survey of 2,500 adults by the Kaiser Family Foundation. Overall, 62% of respondents preferred a doctor's office or clinic, compared with 26% who preferred home testing; only 10% said the location did not matter. However, respondents did think home tests should be an option; 65% said home tests help people who otherwise would not learn their HIV status. On the other hand, 27% agreed with the statement that home tests are “a bad idea” because people need counseling that is available only in a physician's office or clinic. HIV testing should be treated like any routine screening and included as part of regular check-ups and exams, according to 65% of respondents. Slightly more than one-fourth (27%) of respondents disagreed; instead, they agreed with the statement that HIV testing is different and requires special procedures such as written permission from the patient.

MinuteClinic: Quality Council

MinuteClinic, the nation's largest provider of retail-based health care, has created a National Clinical Quality Advisory Council. The eight-member council has five physicians, including a representative of the American Academy of Family Physicians. To develop its own standards, MinuteClinic uses quality guidance from AAFP and the American Academy of Pediatrics Red Book as well as the Midwestern Institute for Clinical Systems Improvement, Dr. James Woodburn, chief medical officer, said in an interview. Dr. Ari Brown, a spokesperson for the Texas Pediatrics Society, said that she was surprised that MinuteClinic was creating a quality council after the company was already up and running. Dr. Brown questioned the retail clinic's role in providing a quality “medical home” to patients. Dr. Woodburn said patients should have a medical home, but about 30% of the time, MinuteClinic patients either have no regular doctor or else do not want to reveal the name. If the patient does have a regular physician, the MinuteClinic mails a record of the visit to that office, Dr. Woodburn said.

Maine PBM Law Stands

The U.S. Supreme Court rejected a challenge to Maine's pharmacy benefit management company law. The Maine statute requires PBMs to disclose “all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefits manager and any prescription drug manufacturer or labeler, including … formulary management and drug-switch programs, educational support, claims processing and pharmacy network fees that are charged from retail pharmacies, and data sales fees.” The PBM trade group Pharmaceutical Care Management Association (PCMA) sued Maine when it enacted the law in 2003, claiming that it overstepped federal, state, and contract boundaries. But an independent pharmacy group hailed the high court's decision. “The decision to affirm the state's right to regulate PBMs is a major victory for consumers in Maine and many other states” the National Community Pharmacists Association said in a June statement. PBMs were disappointed. The state pushed into the “contractual relationship” between PBMs and their customers, Stephanie Kanwit, special counsel to PCMA, said in an interview. She noted that physicians might have fewer choices when writing prescriptions, because weaker PBMs could lead to higher drug prices.

Chiropractors Sue Insurers

Chiropractors, podiatrists, and others have petitioned the U.S. District Court in Miami to join Solomon vs. Anthem, a class-action suit by nonphysician providers against insurance companies, charging that the companies conspired to systematically underpay providers and deny medically necessary care to patients. The American Chiropractic Association (ACA) also asked that ACN Group Inc. and United Healthcare Services Inc. be named as additional defendants. The suit seeks unspecified monetary damages and changes in the companies' practices. A similar class-action suit by physicians—known as the consolidated Provider Track cases—has been in that same court. The next steps in the Solomon case may depend upon resolution of the Provider Track cases, Thomas Daly, counsel for ACA, said in an interview. On June 19, Judge Federico A. Moreno dismissed United Healthcare from the Provider Track cases. “There is simply insufficient evidence of the wrongdoing claimed, i.e. agreeing with their competitors to defraud the doctors,” Judge Moreno wrote. Two other insurers in the Provider Track cases, Aetna and Cigna, settled in 2003, agreeing to change their coding and claims procedures.

Marlboro Case at Supreme Court

The U.S. Supreme Court has agreed to hear Philip Morris USA's appeal of an $80 million punitive damage award involving the death of a Marlboro smoker, raising concerns about the future of punitive damages in tobacco and other public health matters. The estate of Oregon resident Jesse Williams was awarded the money in a fraud and negligence suit against the tobacco maker. Mr. Williams, who died of lung cancer, was a heavy smoker of Marlboros, and his estate argued that his smoking habit killed him. The estate urged the jury to award punitive damages based on the estimated number of Marlboro smokers in Oregon. The high court agreed to address due process of law and punitive damage amount questions. Now that the states have signed the master settlement agreement, individual suits are one of the remaining vital weapons against tobacco products, David Dobbins, deputy general counsel of the American Legacy Foundation said.