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). If physicians have numbers issued by Medicaid and other health plans, they also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govhttp://www.cms.hhs.gov/apps/npi/01_overview.asp

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). If physicians have numbers issued by Medicaid and other health plans, they also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govhttp://www.cms.hhs.gov/apps/npi/01_overview.asp

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). If physicians have numbers issued by Medicaid and other health plans, they also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govhttp://www.cms.hhs.gov/apps/npi/01_overview.asp

Changes made possible by last year's Deficit Reduction Act are raising concerns in some sectors about reductions in care and conflicts of interest in West Virginia's Medicaid program.

The act also has allowed Kentucky to change its Medicaid program, although those changes are generating less controversy, and have less pediatric impact. “Kentucky's [plan] is more of a carrot; West Virginia's is more of a stick,” Robin Rudowitz, principal policy analyst at the Kaiser Family Foundation, said during a June 19 teleconference.

The new West Virginia Medicaid program was approved in early May by the Centers for Medicare and Medicaid Services (CMS) under a Deficit Reduction Act waiver. It started in July in three counties, and officials anticipate a statewide rollout over 4 years.

Parents and children affected by the West Virginia plan will receive a “Medicaid Member Agreement” to be signed at the physician's office or clinic. The agreement entitles them to an enhanced benefit package in exchange for a promise to “do my best to stay healthy,” to “go to health improvement programs as directed by my medical home [doctor] and go to my medical home when I am sick,” according to the plan that the state submitted to the CMS.

During the program's first year, physicians and health plans that contract with the Medicaid program will be asked to monitor whether beneficiaries comply with the agreement. “If the member has fulfilled the responsibilities agreed to, he or she will remain in the Enhanced Benefit Plan,” the plan notes. “If the member does not fulfill the responsibilities, he or she will be moved to the Basic Benefit Plan subject to good cause.” Members will receive advanced notification if their benefits are reduced, and will have the right to appeal the decision.

An attachment to the West Virginia Medicaid plan shows differences between enhanced and basic coverage. Diabetes care is included in the enhanced plan, but not the basic plan. “Chemical dependency/mental health services” also are included in the enhanced plan, but excluded from the basic plan. The basic plan limits patients to four prescriptions per month.

No matter which plan they're in, “Children will get the services they need,” John Law, assistant secretary for West Virginia's Department of Health and Human Resources, said in response to a question about diabetes and mental health care. Regarding prescriptions, “in our study of this population, we found that members use less then one prescription each month,” Mr. Law added.

Families also will not be penalized for going to the emergency department “when ER use is needed,” Mr. Law said. He emphasized that no groups were eliminated from coverage under the new Medicaid program.

In addition, children continue to be covered under the state Medicaid program's early periodic screening, diagnosis, and treatment (EPSDT) program, Mr. Law said. “Emergent medical problems, such as an emergency room diagnosis of diabetes, will be immediately treated, and the child will be referred to his or her health care provider for follow-up care.”

But the Center for Budget and Policy Priorities (CBPP), a progressive Washington think tank, expressed concern about coverage under the basic package compared with what the state currently provides. Under the EPSDT program, “children who need them are supposed to be entitled to the very services that are contained in West Virginia's current benefit package but are being eliminated or scaled back under the state's new plan,” the CBPP said in a statement.

Also, the requirement that physicians monitor their patients' compliance with the member agreement may create problems for doctors, according to the Center for Children and Families (CCF) at Georgetown University, Washington.

Requiring physicians to report compliance “may create many ethical and legal dilemmas for doctors … who are asked to evaluate and report on their patients' confidential behaviors,” the center noted.

Kentucky's plan, also approved in May, is aimed more at adults. For example, the “Get Healthy” benefits program provides incentives for members with certain targeted diseases to access additional benefits if they participate in certain “healthy practices.” Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation. Another difference: Patients also don't have to sign a contract.

Changes made possible by last year's Deficit Reduction Act are raising concerns in some sectors about reductions in care and conflicts of interest in West Virginia's Medicaid program.

The act also has allowed Kentucky to change its Medicaid program, although those changes are generating less controversy, and have less pediatric impact. “Kentucky's [plan] is more of a carrot; West Virginia's is more of a stick,” Robin Rudowitz, principal policy analyst at the Kaiser Family Foundation, said during a June 19 teleconference.

The new West Virginia Medicaid program was approved in early May by the Centers for Medicare and Medicaid Services (CMS) under a Deficit Reduction Act waiver. It started in July in three counties, and officials anticipate a statewide rollout over 4 years.

Parents and children affected by the West Virginia plan will receive a “Medicaid Member Agreement” to be signed at the physician's office or clinic. The agreement entitles them to an enhanced benefit package in exchange for a promise to “do my best to stay healthy,” to “go to health improvement programs as directed by my medical home [doctor] and go to my medical home when I am sick,” according to the plan that the state submitted to the CMS.

During the program's first year, physicians and health plans that contract with the Medicaid program will be asked to monitor whether beneficiaries comply with the agreement. “If the member has fulfilled the responsibilities agreed to, he or she will remain in the Enhanced Benefit Plan,” the plan notes. “If the member does not fulfill the responsibilities, he or she will be moved to the Basic Benefit Plan subject to good cause.” Members will receive advanced notification if their benefits are reduced, and will have the right to appeal the decision.

An attachment to the West Virginia Medicaid plan shows differences between enhanced and basic coverage. Diabetes care is included in the enhanced plan, but not the basic plan. “Chemical dependency/mental health services” also are included in the enhanced plan, but excluded from the basic plan. The basic plan limits patients to four prescriptions per month.

No matter which plan they're in, “Children will get the services they need,” John Law, assistant secretary for West Virginia's Department of Health and Human Resources, said in response to a question about diabetes and mental health care. Regarding prescriptions, “in our study of this population, we found that members use less then one prescription each month,” Mr. Law added.

Families also will not be penalized for going to the emergency department “when ER use is needed,” Mr. Law said. He emphasized that no groups were eliminated from coverage under the new Medicaid program.

In addition, children continue to be covered under the state Medicaid program's early periodic screening, diagnosis, and treatment (EPSDT) program, Mr. Law said. “Emergent medical problems, such as an emergency room diagnosis of diabetes, will be immediately treated, and the child will be referred to his or her health care provider for follow-up care.”

But the Center for Budget and Policy Priorities (CBPP), a progressive Washington think tank, expressed concern about coverage under the basic package compared with what the state currently provides. Under the EPSDT program, “children who need them are supposed to be entitled to the very services that are contained in West Virginia's current benefit package but are being eliminated or scaled back under the state's new plan,” the CBPP said in a statement.

Also, the requirement that physicians monitor their patients' compliance with the member agreement may create problems for doctors, according to the Center for Children and Families (CCF) at Georgetown University, Washington.

Requiring physicians to report compliance “may create many ethical and legal dilemmas for doctors … who are asked to evaluate and report on their patients' confidential behaviors,” the center noted.

Kentucky's plan, also approved in May, is aimed more at adults. For example, the “Get Healthy” benefits program provides incentives for members with certain targeted diseases to access additional benefits if they participate in certain “healthy practices.” Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation. Another difference: Patients also don't have to sign a contract.

Changes made possible by last year's Deficit Reduction Act are raising concerns in some sectors about reductions in care and conflicts of interest in West Virginia's Medicaid program.

The act also has allowed Kentucky to change its Medicaid program, although those changes are generating less controversy, and have less pediatric impact. “Kentucky's [plan] is more of a carrot; West Virginia's is more of a stick,” Robin Rudowitz, principal policy analyst at the Kaiser Family Foundation, said during a June 19 teleconference.

The new West Virginia Medicaid program was approved in early May by the Centers for Medicare and Medicaid Services (CMS) under a Deficit Reduction Act waiver. It started in July in three counties, and officials anticipate a statewide rollout over 4 years.

Parents and children affected by the West Virginia plan will receive a “Medicaid Member Agreement” to be signed at the physician's office or clinic. The agreement entitles them to an enhanced benefit package in exchange for a promise to “do my best to stay healthy,” to “go to health improvement programs as directed by my medical home [doctor] and go to my medical home when I am sick,” according to the plan that the state submitted to the CMS.

During the program's first year, physicians and health plans that contract with the Medicaid program will be asked to monitor whether beneficiaries comply with the agreement. “If the member has fulfilled the responsibilities agreed to, he or she will remain in the Enhanced Benefit Plan,” the plan notes. “If the member does not fulfill the responsibilities, he or she will be moved to the Basic Benefit Plan subject to good cause.” Members will receive advanced notification if their benefits are reduced, and will have the right to appeal the decision.

An attachment to the West Virginia Medicaid plan shows differences between enhanced and basic coverage. Diabetes care is included in the enhanced plan, but not the basic plan. “Chemical dependency/mental health services” also are included in the enhanced plan, but excluded from the basic plan. The basic plan limits patients to four prescriptions per month.

No matter which plan they're in, “Children will get the services they need,” John Law, assistant secretary for West Virginia's Department of Health and Human Resources, said in response to a question about diabetes and mental health care. Regarding prescriptions, “in our study of this population, we found that members use less then one prescription each month,” Mr. Law added.

Families also will not be penalized for going to the emergency department “when ER use is needed,” Mr. Law said. He emphasized that no groups were eliminated from coverage under the new Medicaid program.

In addition, children continue to be covered under the state Medicaid program's early periodic screening, diagnosis, and treatment (EPSDT) program, Mr. Law said. “Emergent medical problems, such as an emergency room diagnosis of diabetes, will be immediately treated, and the child will be referred to his or her health care provider for follow-up care.”

But the Center for Budget and Policy Priorities (CBPP), a progressive Washington think tank, expressed concern about coverage under the basic package compared with what the state currently provides. Under the EPSDT program, “children who need them are supposed to be entitled to the very services that are contained in West Virginia's current benefit package but are being eliminated or scaled back under the state's new plan,” the CBPP said in a statement.

Also, the requirement that physicians monitor their patients' compliance with the member agreement may create problems for doctors, according to the Center for Children and Families (CCF) at Georgetown University, Washington.

Requiring physicians to report compliance “may create many ethical and legal dilemmas for doctors … who are asked to evaluate and report on their patients' confidential behaviors,” the center noted.

Kentucky's plan, also approved in May, is aimed more at adults. For example, the “Get Healthy” benefits program provides incentives for members with certain targeted diseases to access additional benefits if they participate in certain “healthy practices.” Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation. Another difference: Patients also don't have to sign a contract.

In-Office AIDS Test, Please

Americans would much prefer to be tested for AIDS in a physician 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 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.

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 v. 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.

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.

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, rasing 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 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 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 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.

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 v. 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.

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.

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, rasing 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 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 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 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.

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 v. 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.

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.

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, rasing 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 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.

Physicians need to apply now for a national provider identifier number in order to start using them 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). If physicians have numbers issued by Medicaid and other health plans, they also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govhttp://www.cms.hhs.gov/apps/npi/01_overview.asp

Physicians need to apply now for a national provider identifier number in order to start using them 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). If physicians have numbers issued by Medicaid and other health plans, they also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govhttp://www.cms.hhs.gov/apps/npi/01_overview.asp

Physicians need to apply now for a national provider identifier number in order to start using them 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). If physicians have numbers issued by Medicaid and other health plans, they also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govhttp://www.cms.hhs.gov/apps/npi/01_overview.asp

Changes made possible by last year's Deficit Reduction Act are raising concerns in some sectors about reductions in care and conflicts of interest in West Virginia's Medicaid program.

The act also has allowed Kentucky to change its Medicaid program, although those changes are generating less controversy, and have less pediatric impact.

“Kentucky's [plan] is more of a carrot; West Virginia's is more of a stick,” Robin Rudowitz, a principal policy analyst at the Kaiser Family Foundation, said during a June 19 teleconference.

The new West Virginia Medicaid program was approved in early May by the Centers for Medicare and Medicaid Services (CMS) under a Deficit Reduction Act waiver. It starts in July in three counties, and officials anticipate a statewide rollout over 4 years.

Parents and children affected by the West Virginia plan will receive a “Medicaid Member Agreement” to be signed at the physician's office or clinic.

The agreement entitles them to an enhanced benefit package in exchange for a promise to “do my best to stay healthy,” to “go to health improvement programs as directed by my medical home [doctor] and go to my medical home when I am sick,” according to the plan that the state submitted to the CMS.

During the program's first year, physicians and health plans that contract with the Medicaid program will be asked to monitor whether beneficiaries comply with the agreement.

“If the member has fulfilled the responsibilities agreed to, he or she will remain in the Enhanced Benefit Plan,” the plan notes. “If the member does not fulfill the responsibilities, he or she will be moved to the Basic Benefit Plan subject to good cause.” Members will receive advanced notification if their benefits are reduced, and will have the right to appeal the decision.

An attachment to the West Virginia Medicaid plan shows differences between enhanced and basic coverage.

Diabetes care is included in the enhanced plan, but not the basic plan. “Chemical dependency/mental health services” also are included in the enhanced plan, but excluded from the basic plan. The basic plan limits patients to four prescriptions per month.

No matter which plan they are in, “Children will get the services they need,” John Law, assistant secretary for West Virginia's Department of Health and Human Resources, said in response to a question about diabetes and mental health care.

Regarding prescriptions, “in our study of this population, we found that members use less then one prescription each month,” Mr. Law added.

Families also will not be penalized for going to the emergency department “when ER use is needed,” Mr. Law said. He emphasized that no groups were eliminated from coverage under the new Medicaid program.

In addition, children will continue to be covered under the state Medicaid program's early periodic screening, diagnosis, and treatment (EPSDT) program, Mr. Law said.

“Emergent medical problems, such as an emergency room diagnosis of diabetes, will be immediately treated, and the child will be referred to his or her health care provider for follow-up care.”

But the Center for Budget and Policy Priorities (CBPP), a progressive Washington think tank, expressed concern about coverage under the basic package compared with what the state currently provides.

Under the EPSDT program, “children who need them are supposed to be entitled to the very services that are contained in West Virginia's current benefit package but are being eliminated or scaled back under the state's new plan,” the CBPP said in a statement.

Furthermore, the requirement that physicians monitor their patients' compliance with the member agreement may create problems for doctors, according to the Center for Children and Families (CCF) at Georgetown University, Washington.

Requiring physicians to report compliance “may create many ethical and legal dilemmas for doctors … who are asked to evaluate and report on their patients' confidential behaviors,” the center noted in a statement.

“For example, pediatricians will be asked to make a decision regarding a parent's 'compliance' that could result in needed treatment not being available to a child.”

Dr. Joan Phillips, president of the West Virginia chapter of the American Academy of Pediatrics, pointed out that electronic health records or case managers would be needed to track patient compliance, and that few private pediatric practices in the state have either. She spoke in a May teleconference hosted by the CBPP.

Kentucky's plan, also approved in May, has generated less controversy in the pediatric community, in part because its changes are aimed more at adults. For example, the “Get Healthy” benefits program provides incentives for members with certain targeted diseases to access additional benefits if they participate in certain “healthy practices.”

Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation.

Also, unlike the West Virginia program, Kentucky Medicaid patients are not required to sign a contract, said Judith Solomon, a senior fellow at the CBPP. Kentucky officials say they are trying to control Medicaid costs while boosting healthier behavior. For example, Kentucky's plan requires patients to share in the cost of many services, but patients also receive full coverage of preventive services such as vaccines.

Kentucky is using its newfound federal flexibility to create a “tiered” approach, sorting enrollees into different groups with benefits targeted to their needs. A May 2 document from the state's Department of Medicaid Services (DMS) stated that packages “may contain service-specific coverage limits … None of the visit or dollar cost limits are 'hard' limits but rather are 'soft' limits,” which can be bypassed “if medical necessity is demonstrated by [a physician] through a prior authorization process.”

A better integrated system is the goal—for example, mental and physical health services will be better coordinated, according to the DMS.

The state also plans to transform the Kentucky Children's Health Insurance Program “from a Medicaid-administered program to a program potentially operated by a managed care organization,” according to the DMS.

This move will increase access to pediatricians and pediatric specialists, the DMS stated.

Changes made possible by last year's Deficit Reduction Act are raising concerns in some sectors about reductions in care and conflicts of interest in West Virginia's Medicaid program.

The act also has allowed Kentucky to change its Medicaid program, although those changes are generating less controversy, and have less pediatric impact.

“Kentucky's [plan] is more of a carrot; West Virginia's is more of a stick,” Robin Rudowitz, a principal policy analyst at the Kaiser Family Foundation, said during a June 19 teleconference.

The new West Virginia Medicaid program was approved in early May by the Centers for Medicare and Medicaid Services (CMS) under a Deficit Reduction Act waiver. It starts in July in three counties, and officials anticipate a statewide rollout over 4 years.

Parents and children affected by the West Virginia plan will receive a “Medicaid Member Agreement” to be signed at the physician's office or clinic.

The agreement entitles them to an enhanced benefit package in exchange for a promise to “do my best to stay healthy,” to “go to health improvement programs as directed by my medical home [doctor] and go to my medical home when I am sick,” according to the plan that the state submitted to the CMS.

During the program's first year, physicians and health plans that contract with the Medicaid program will be asked to monitor whether beneficiaries comply with the agreement.

“If the member has fulfilled the responsibilities agreed to, he or she will remain in the Enhanced Benefit Plan,” the plan notes. “If the member does not fulfill the responsibilities, he or she will be moved to the Basic Benefit Plan subject to good cause.” Members will receive advanced notification if their benefits are reduced, and will have the right to appeal the decision.

An attachment to the West Virginia Medicaid plan shows differences between enhanced and basic coverage.

Diabetes care is included in the enhanced plan, but not the basic plan. “Chemical dependency/mental health services” also are included in the enhanced plan, but excluded from the basic plan. The basic plan limits patients to four prescriptions per month.

No matter which plan they are in, “Children will get the services they need,” John Law, assistant secretary for West Virginia's Department of Health and Human Resources, said in response to a question about diabetes and mental health care.

Regarding prescriptions, “in our study of this population, we found that members use less then one prescription each month,” Mr. Law added.

Families also will not be penalized for going to the emergency department “when ER use is needed,” Mr. Law said. He emphasized that no groups were eliminated from coverage under the new Medicaid program.

In addition, children will continue to be covered under the state Medicaid program's early periodic screening, diagnosis, and treatment (EPSDT) program, Mr. Law said.

“Emergent medical problems, such as an emergency room diagnosis of diabetes, will be immediately treated, and the child will be referred to his or her health care provider for follow-up care.”

But the Center for Budget and Policy Priorities (CBPP), a progressive Washington think tank, expressed concern about coverage under the basic package compared with what the state currently provides.

Under the EPSDT program, “children who need them are supposed to be entitled to the very services that are contained in West Virginia's current benefit package but are being eliminated or scaled back under the state's new plan,” the CBPP said in a statement.

Furthermore, the requirement that physicians monitor their patients' compliance with the member agreement may create problems for doctors, according to the Center for Children and Families (CCF) at Georgetown University, Washington.

Requiring physicians to report compliance “may create many ethical and legal dilemmas for doctors … who are asked to evaluate and report on their patients' confidential behaviors,” the center noted in a statement.

“For example, pediatricians will be asked to make a decision regarding a parent's 'compliance' that could result in needed treatment not being available to a child.”

Dr. Joan Phillips, president of the West Virginia chapter of the American Academy of Pediatrics, pointed out that electronic health records or case managers would be needed to track patient compliance, and that few private pediatric practices in the state have either. She spoke in a May teleconference hosted by the CBPP.

Kentucky's plan, also approved in May, has generated less controversy in the pediatric community, in part because its changes are aimed more at adults. For example, the “Get Healthy” benefits program provides incentives for members with certain targeted diseases to access additional benefits if they participate in certain “healthy practices.”

Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation.

Also, unlike the West Virginia program, Kentucky Medicaid patients are not required to sign a contract, said Judith Solomon, a senior fellow at the CBPP. Kentucky officials say they are trying to control Medicaid costs while boosting healthier behavior. For example, Kentucky's plan requires patients to share in the cost of many services, but patients also receive full coverage of preventive services such as vaccines.

Kentucky is using its newfound federal flexibility to create a “tiered” approach, sorting enrollees into different groups with benefits targeted to their needs. A May 2 document from the state's Department of Medicaid Services (DMS) stated that packages “may contain service-specific coverage limits … None of the visit or dollar cost limits are 'hard' limits but rather are 'soft' limits,” which can be bypassed “if medical necessity is demonstrated by [a physician] through a prior authorization process.”

A better integrated system is the goal—for example, mental and physical health services will be better coordinated, according to the DMS.

The state also plans to transform the Kentucky Children's Health Insurance Program “from a Medicaid-administered program to a program potentially operated by a managed care organization,” according to the DMS.

This move will increase access to pediatricians and pediatric specialists, the DMS stated.

Changes made possible by last year's Deficit Reduction Act are raising concerns in some sectors about reductions in care and conflicts of interest in West Virginia's Medicaid program.

The act also has allowed Kentucky to change its Medicaid program, although those changes are generating less controversy, and have less pediatric impact.

“Kentucky's [plan] is more of a carrot; West Virginia's is more of a stick,” Robin Rudowitz, a principal policy analyst at the Kaiser Family Foundation, said during a June 19 teleconference.

The new West Virginia Medicaid program was approved in early May by the Centers for Medicare and Medicaid Services (CMS) under a Deficit Reduction Act waiver. It starts in July in three counties, and officials anticipate a statewide rollout over 4 years.

Parents and children affected by the West Virginia plan will receive a “Medicaid Member Agreement” to be signed at the physician's office or clinic.

The agreement entitles them to an enhanced benefit package in exchange for a promise to “do my best to stay healthy,” to “go to health improvement programs as directed by my medical home [doctor] and go to my medical home when I am sick,” according to the plan that the state submitted to the CMS.

During the program's first year, physicians and health plans that contract with the Medicaid program will be asked to monitor whether beneficiaries comply with the agreement.

“If the member has fulfilled the responsibilities agreed to, he or she will remain in the Enhanced Benefit Plan,” the plan notes. “If the member does not fulfill the responsibilities, he or she will be moved to the Basic Benefit Plan subject to good cause.” Members will receive advanced notification if their benefits are reduced, and will have the right to appeal the decision.

An attachment to the West Virginia Medicaid plan shows differences between enhanced and basic coverage.

Diabetes care is included in the enhanced plan, but not the basic plan. “Chemical dependency/mental health services” also are included in the enhanced plan, but excluded from the basic plan. The basic plan limits patients to four prescriptions per month.

No matter which plan they are in, “Children will get the services they need,” John Law, assistant secretary for West Virginia's Department of Health and Human Resources, said in response to a question about diabetes and mental health care.

Regarding prescriptions, “in our study of this population, we found that members use less then one prescription each month,” Mr. Law added.

Families also will not be penalized for going to the emergency department “when ER use is needed,” Mr. Law said. He emphasized that no groups were eliminated from coverage under the new Medicaid program.

In addition, children will continue to be covered under the state Medicaid program's early periodic screening, diagnosis, and treatment (EPSDT) program, Mr. Law said.

“Emergent medical problems, such as an emergency room diagnosis of diabetes, will be immediately treated, and the child will be referred to his or her health care provider for follow-up care.”

But the Center for Budget and Policy Priorities (CBPP), a progressive Washington think tank, expressed concern about coverage under the basic package compared with what the state currently provides.

Under the EPSDT program, “children who need them are supposed to be entitled to the very services that are contained in West Virginia's current benefit package but are being eliminated or scaled back under the state's new plan,” the CBPP said in a statement.

Furthermore, the requirement that physicians monitor their patients' compliance with the member agreement may create problems for doctors, according to the Center for Children and Families (CCF) at Georgetown University, Washington.

Requiring physicians to report compliance “may create many ethical and legal dilemmas for doctors … who are asked to evaluate and report on their patients' confidential behaviors,” the center noted in a statement.

“For example, pediatricians will be asked to make a decision regarding a parent's 'compliance' that could result in needed treatment not being available to a child.”

Dr. Joan Phillips, president of the West Virginia chapter of the American Academy of Pediatrics, pointed out that electronic health records or case managers would be needed to track patient compliance, and that few private pediatric practices in the state have either. She spoke in a May teleconference hosted by the CBPP.

Kentucky's plan, also approved in May, has generated less controversy in the pediatric community, in part because its changes are aimed more at adults. For example, the “Get Healthy” benefits program provides incentives for members with certain targeted diseases to access additional benefits if they participate in certain “healthy practices.”

Initially, that program will be limited to those with pulmonary disease, diabetes, and cardiac conditions, but may be expanded. Those benefits will include additional dental and vision services, or counseling for nutrition or smoking cessation.

Also, unlike the West Virginia program, Kentucky Medicaid patients are not required to sign a contract, said Judith Solomon, a senior fellow at the CBPP. Kentucky officials say they are trying to control Medicaid costs while boosting healthier behavior. For example, Kentucky's plan requires patients to share in the cost of many services, but patients also receive full coverage of preventive services such as vaccines.

Kentucky is using its newfound federal flexibility to create a “tiered” approach, sorting enrollees into different groups with benefits targeted to their needs. A May 2 document from the state's Department of Medicaid Services (DMS) stated that packages “may contain service-specific coverage limits … None of the visit or dollar cost limits are 'hard' limits but rather are 'soft' limits,” which can be bypassed “if medical necessity is demonstrated by [a physician] through a prior authorization process.”

A better integrated system is the goal—for example, mental and physical health services will be better coordinated, according to the DMS.

The state also plans to transform the Kentucky Children's Health Insurance Program “from a Medicaid-administered program to a program potentially operated by a managed care organization,” according to the DMS.

This move will increase access to pediatricians and pediatric specialists, the DMS stated.

Can one type of electronic health record fit all types of practices, or do specialists need their own?

That's a question record developers and standard setters are asking.

Pediatricians argue that electronic health records (EHRs) should be tailored to their unique needs, with components such as growth charts and family-friendly links that are balanced by adolescent privacy assurances. However, the main body certifying EHRs, the Certification Commission for Healthcare Information Technology (CCHIT), has removed a requirement for growth charts from the main record.

During a May “town hall meeting” at a meeting sponsored by the Medical Records Institute, CCHIT chairman Dr. Mark K. Leavitt said the growth chart requirement had recently been removed. Dr. Leavitt was responding to an EHR developer in the audience who noted that many specialist physicians are unlikely to need a growth chart. CCHIT wants to know if specialists need their own EHRs, Dr. Leavitt said.

At least one pediatrician involved in EHRs is concerned that such segmentation would make the products hard to use, and would reinforce cultural biases regarding age. Dr. Joseph Schneider, chief medical information officer of the Children's Medical Center in Dallas and professor of pediatrics at the University of Texas Southwestern Medical Center, is concerned about “calling pediatrics a specialty” for EHR purposes, he said in an interview. Pediatricians are not the only ones caring for children and adolescents—family physicians do as well, and there is a “reasonable chance” that they would need to use growth charts, Dr. Schneider said.

Similar concerns exist at the opposite end of the age spectrum; the ability to dose by weight is important for geriatric patients, Dr. Schneider added. A 90-pound woman in advanced years has different medication needs than does the standard 140-pound woman.

So far, CCHIT's basic set of requirements is on the right track, Dr. Schneider said. It includes an attempt at weight-based dosing; it can also accommodate name changes and covers immunizations. “They even ask you to graph the height and weight— just not on a growth chart.”

In addition to the growth chart being missing, Dr. Schneider said, so is protection of adolescent privacy. For example, the current CCHIT scenario lacks the ability to hide contraceptive information when a record is sent to a camp or college. It also lacks the ability to handle family member links “and a host of other child-friendly and geriatric-friendly” features.

“I would anticipate that CCHIT will slowly incorporate these things into its requirements, as people begin to recognize that these sorts of things aren't 'pediatric-specific,'” Dr. Schneider said.

Meeting a broad range of physician requirements in the first year could seem daunting to developers, Dr. Schneider noted. It might seem easier to start the physician's office out with a simple EHR that could link to more advanced or specialized features via the Internet, he added.

CCHIT is spurring developers to keep improving their products. For 2006, 122 “functionality” items are listed. For example, a variety of identifiers can be used for patient lookup, such as phone number or date of birth. The road map for 2007 lists an additional 78 criteria, plus 7 that are provisional now and likely to be added in 2007, Dr. Leavitt said. He also predicted a “considerable number” of new criteria for interoperability and security will be required in 2007.

CCHIT has been holding testing sessions online for developers seeking certification in 2006; it plans to approve the first batch in July. EHR developers run through scripts, demonstrating product functions, while a jury containing at least one practicing physician watches via the Internet.

The Department of Health and Human Services awarded CCHIT a contract to develop standards for EHRs and to test products. CCHIT's efforts seem to be paying off; the Medical Group Management Association is urging its members to buy only EHRs bearing the CCHIT seal, according to Robert Tennant, the association's senior policy advisor for government affairs.

Can one type of electronic health record fit all types of practices, or do specialists need their own?

That's a question record developers and standard setters are asking.

Pediatricians argue that electronic health records (EHRs) should be tailored to their unique needs, with components such as growth charts and family-friendly links that are balanced by adolescent privacy assurances. However, the main body certifying EHRs, the Certification Commission for Healthcare Information Technology (CCHIT), has removed a requirement for growth charts from the main record.

During a May “town hall meeting” at a meeting sponsored by the Medical Records Institute, CCHIT chairman Dr. Mark K. Leavitt said the growth chart requirement had recently been removed. Dr. Leavitt was responding to an EHR developer in the audience who noted that many specialist physicians are unlikely to need a growth chart. CCHIT wants to know if specialists need their own EHRs, Dr. Leavitt said.

At least one pediatrician involved in EHRs is concerned that such segmentation would make the products hard to use, and would reinforce cultural biases regarding age. Dr. Joseph Schneider, chief medical information officer of the Children's Medical Center in Dallas and professor of pediatrics at the University of Texas Southwestern Medical Center, is concerned about “calling pediatrics a specialty” for EHR purposes, he said in an interview. Pediatricians are not the only ones caring for children and adolescents—family physicians do as well, and there is a “reasonable chance” that they would need to use growth charts, Dr. Schneider said.

Similar concerns exist at the opposite end of the age spectrum; the ability to dose by weight is important for geriatric patients, Dr. Schneider added. A 90-pound woman in advanced years has different medication needs than does the standard 140-pound woman.

So far, CCHIT's basic set of requirements is on the right track, Dr. Schneider said. It includes an attempt at weight-based dosing; it can also accommodate name changes and covers immunizations. “They even ask you to graph the height and weight— just not on a growth chart.”

In addition to the growth chart being missing, Dr. Schneider said, so is protection of adolescent privacy. For example, the current CCHIT scenario lacks the ability to hide contraceptive information when a record is sent to a camp or college. It also lacks the ability to handle family member links “and a host of other child-friendly and geriatric-friendly” features.

“I would anticipate that CCHIT will slowly incorporate these things into its requirements, as people begin to recognize that these sorts of things aren't 'pediatric-specific,'” Dr. Schneider said.

Meeting a broad range of physician requirements in the first year could seem daunting to developers, Dr. Schneider noted. It might seem easier to start the physician's office out with a simple EHR that could link to more advanced or specialized features via the Internet, he added.

CCHIT is spurring developers to keep improving their products. For 2006, 122 “functionality” items are listed. For example, a variety of identifiers can be used for patient lookup, such as phone number or date of birth. The road map for 2007 lists an additional 78 criteria, plus 7 that are provisional now and likely to be added in 2007, Dr. Leavitt said. He also predicted a “considerable number” of new criteria for interoperability and security will be required in 2007.

CCHIT has been holding testing sessions online for developers seeking certification in 2006; it plans to approve the first batch in July. EHR developers run through scripts, demonstrating product functions, while a jury containing at least one practicing physician watches via the Internet.

The Department of Health and Human Services awarded CCHIT a contract to develop standards for EHRs and to test products. CCHIT's efforts seem to be paying off; the Medical Group Management Association is urging its members to buy only EHRs bearing the CCHIT seal, according to Robert Tennant, the association's senior policy advisor for government affairs.

Can one type of electronic health record fit all types of practices, or do specialists need their own?

That's a question record developers and standard setters are asking.

Pediatricians argue that electronic health records (EHRs) should be tailored to their unique needs, with components such as growth charts and family-friendly links that are balanced by adolescent privacy assurances. However, the main body certifying EHRs, the Certification Commission for Healthcare Information Technology (CCHIT), has removed a requirement for growth charts from the main record.

During a May “town hall meeting” at a meeting sponsored by the Medical Records Institute, CCHIT chairman Dr. Mark K. Leavitt said the growth chart requirement had recently been removed. Dr. Leavitt was responding to an EHR developer in the audience who noted that many specialist physicians are unlikely to need a growth chart. CCHIT wants to know if specialists need their own EHRs, Dr. Leavitt said.

At least one pediatrician involved in EHRs is concerned that such segmentation would make the products hard to use, and would reinforce cultural biases regarding age. Dr. Joseph Schneider, chief medical information officer of the Children's Medical Center in Dallas and professor of pediatrics at the University of Texas Southwestern Medical Center, is concerned about “calling pediatrics a specialty” for EHR purposes, he said in an interview. Pediatricians are not the only ones caring for children and adolescents—family physicians do as well, and there is a “reasonable chance” that they would need to use growth charts, Dr. Schneider said.

Similar concerns exist at the opposite end of the age spectrum; the ability to dose by weight is important for geriatric patients, Dr. Schneider added. A 90-pound woman in advanced years has different medication needs than does the standard 140-pound woman.

So far, CCHIT's basic set of requirements is on the right track, Dr. Schneider said. It includes an attempt at weight-based dosing; it can also accommodate name changes and covers immunizations. “They even ask you to graph the height and weight— just not on a growth chart.”

In addition to the growth chart being missing, Dr. Schneider said, so is protection of adolescent privacy. For example, the current CCHIT scenario lacks the ability to hide contraceptive information when a record is sent to a camp or college. It also lacks the ability to handle family member links “and a host of other child-friendly and geriatric-friendly” features.

“I would anticipate that CCHIT will slowly incorporate these things into its requirements, as people begin to recognize that these sorts of things aren't 'pediatric-specific,'” Dr. Schneider said.

Meeting a broad range of physician requirements in the first year could seem daunting to developers, Dr. Schneider noted. It might seem easier to start the physician's office out with a simple EHR that could link to more advanced or specialized features via the Internet, he added.

CCHIT is spurring developers to keep improving their products. For 2006, 122 “functionality” items are listed. For example, a variety of identifiers can be used for patient lookup, such as phone number or date of birth. The road map for 2007 lists an additional 78 criteria, plus 7 that are provisional now and likely to be added in 2007, Dr. Leavitt said. He also predicted a “considerable number” of new criteria for interoperability and security will be required in 2007.

CCHIT has been holding testing sessions online for developers seeking certification in 2006; it plans to approve the first batch in July. EHR developers run through scripts, demonstrating product functions, while a jury containing at least one practicing physician watches via the Internet.

The Department of Health and Human Services awarded CCHIT a contract to develop standards for EHRs and to test products. CCHIT's efforts seem to be paying off; the Medical Group Management Association is urging its members to buy only EHRs bearing the CCHIT seal, according to Robert Tennant, the association's senior policy advisor for government affairs.

Physicians need to apply now for a national provider identifier number in order to start using them 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).

Numbers issued by Medicaid and other health plans also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govwww.cms.hhs.gov/apps/npi/01_overview.asp

Physicians need to apply now for a national provider identifier number in order to start using them 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).

Numbers issued by Medicaid and other health plans also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govwww.cms.hhs.gov/apps/npi/01_overview.asp

Physicians need to apply now for a national provider identifier number in order to start using them 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).

Numbers issued by Medicaid and other health plans also need to be included in the application.

Apply online for an NPI at https://NPPES.cms.hhs.govwww.cms.hhs.gov/apps/npi/01_overview.asp

New VP at AAP Eyes Disparity Issues

The new vice president of the American Academy of Pediatrics intends to work with its leadership on a comprehensive national agenda for “optimal child health and development,” which includes addressing ethnic and minority child health disparities, she said in an interview. Dr. Renee Jenkins chairs the department of pediatrics and child health at Howard University and is professor of pediatrics at George Washington University, both in Washington. Dr. Jenkins defeated Dr. O. Marion Burton of the University of South Carolina, Columbia. The number of votes per candidate was not given, but the total number cast was 13,335, Dr. Jenkins said. Dr. Jenkins, who also has a special interest in adolescent health and underserved children, will become the president-elect in October and will serve as the 2007–2008 AAP president.

AMA: Ensure Flu Vaccine Supply

Physicians at the annual meeting of the American Medical Association's House of Delegates voiced their frustration with the uneven supply and distribution of influenza vaccine that have become commonplace in recent years. AMA delegates approved a resolution instructing the AMA leadership to “vigorously” work to ensure that an adequate supply of every manufacturer's vaccine is sold directly to health care providers who are immunizing high-priority patients, as defined by the Advisory Committee on Immunization Practices. The resolution also calls on manufacturers and distributors of influenza vaccine to provide a dedicated ordering system for small- and medium-sized practices to preorder vaccine up to a certain amount. The delegates also instructed the AMA to prepare a report educating physicians about the influenza vaccine supply and distribution process. “We must develop a more streamlined process for getting influenza vaccine into the hands of physicians to help patients become vaccinated,” Dr. Ronald M. Davis, AMA president-elect, said in a statement.

AAP Urges Ban on ATV Use by Kids

The American Academy of Pediatrics has criticized the Consumer Product Safety Commission for failing to propose a ban on all-terrain vehicle (ATV) use by children under 16 years of age. CPSC commissioners were briefed by agency staff in June; staff members outlined regulatory options such as keeping children away from adult ATVs and directing them instead to smaller youth ATVs with speeds that can be restricted to as low as 10 mph. In a statement, the AAP called CPSC's staff report “another ineffective effort by the agency to reduce the risk of child injury and death associated with ATVs,” adding that other steps, such as a driver's license, should be required. “ATV crashes killed 130 children and sent 44,700 more to emergency departments in 2004,” the statement said. The CPSC has not yet decided whether to take the more definite step of proposing a rule.

Genome Project for Common Diseases

A major children's hospital is launching a genome project to develop treatments for asthma, obesity, diabetes, attention-deficit hyperactivity disorder, and other common childhood diseases, as well as pediatric cancer. The Children's Hospital of Philadelphia (CHOP) will start with patients in its own hospital network, said Dr. Hakon Hakonarson, who is leading the new Center for Applied Genomics. Multiple layers of encryption will be used on patient Social Security numbers to protect confidentiality. Dr. Hakonarson added that pediatricians outside of CHOP with a “keen interest” in the work would also be eligible to participate. “The goal is to network this [project] worldwide,” he said in an interview. CHOP plans to have the center up and running by September, with the initial work on neuroblastoma, Dr. Hakonarson said. The center plans to analyze blood samples from more than 100,000 children during the next 3 years.

E-Records Enhance Asthma Care

Electronic medical records can enable physicians to keep in touch with asthmatic patients and may help reduce hospitalizations, according to Dr. Elmer Martin, formerly of Cincinnati Group Health Associates. Pediatricians at CGHA, a multispecialty group of more than 100 physicians in the Cincinnati area, each developed their own electronic patient rosters for moderate to severe asthmatics and updated them annually. CGHA providers and staff used letters and phone calls to contact patients periodically and check medicine compliance; they also encouraged influenza vaccination. The vaccination rate in this patient group increased from 8.7% in 2001 to 42.7% in 2003. In addition, the CGHA yearly pediatric hospital admissions for asthma declined by 50% from 2001 to 2003. The study appeared in the April issue of Clinical Pediatrics.

New VP at AAP Eyes Disparity Issues

The new vice president of the American Academy of Pediatrics intends to work with its leadership on a comprehensive national agenda for “optimal child health and development,” which includes addressing ethnic and minority child health disparities, she said in an interview. Dr. Renee Jenkins chairs the department of pediatrics and child health at Howard University and is professor of pediatrics at George Washington University, both in Washington. Dr. Jenkins defeated Dr. O. Marion Burton of the University of South Carolina, Columbia. The number of votes per candidate was not given, but the total number cast was 13,335, Dr. Jenkins said. Dr. Jenkins, who also has a special interest in adolescent health and underserved children, will become the president-elect in October and will serve as the 2007–2008 AAP president.

AMA: Ensure Flu Vaccine Supply

Physicians at the annual meeting of the American Medical Association's House of Delegates voiced their frustration with the uneven supply and distribution of influenza vaccine that have become commonplace in recent years. AMA delegates approved a resolution instructing the AMA leadership to “vigorously” work to ensure that an adequate supply of every manufacturer's vaccine is sold directly to health care providers who are immunizing high-priority patients, as defined by the Advisory Committee on Immunization Practices. The resolution also calls on manufacturers and distributors of influenza vaccine to provide a dedicated ordering system for small- and medium-sized practices to preorder vaccine up to a certain amount. The delegates also instructed the AMA to prepare a report educating physicians about the influenza vaccine supply and distribution process. “We must develop a more streamlined process for getting influenza vaccine into the hands of physicians to help patients become vaccinated,” Dr. Ronald M. Davis, AMA president-elect, said in a statement.

AAP Urges Ban on ATV Use by Kids

The American Academy of Pediatrics has criticized the Consumer Product Safety Commission for failing to propose a ban on all-terrain vehicle (ATV) use by children under 16 years of age. CPSC commissioners were briefed by agency staff in June; staff members outlined regulatory options such as keeping children away from adult ATVs and directing them instead to smaller youth ATVs with speeds that can be restricted to as low as 10 mph. In a statement, the AAP called CPSC's staff report “another ineffective effort by the agency to reduce the risk of child injury and death associated with ATVs,” adding that other steps, such as a driver's license, should be required. “ATV crashes killed 130 children and sent 44,700 more to emergency departments in 2004,” the statement said. The CPSC has not yet decided whether to take the more definite step of proposing a rule.

Genome Project for Common Diseases

A major children's hospital is launching a genome project to develop treatments for asthma, obesity, diabetes, attention-deficit hyperactivity disorder, and other common childhood diseases, as well as pediatric cancer. The Children's Hospital of Philadelphia (CHOP) will start with patients in its own hospital network, said Dr. Hakon Hakonarson, who is leading the new Center for Applied Genomics. Multiple layers of encryption will be used on patient Social Security numbers to protect confidentiality. Dr. Hakonarson added that pediatricians outside of CHOP with a “keen interest” in the work would also be eligible to participate. “The goal is to network this [project] worldwide,” he said in an interview. CHOP plans to have the center up and running by September, with the initial work on neuroblastoma, Dr. Hakonarson said. The center plans to analyze blood samples from more than 100,000 children during the next 3 years.

E-Records Enhance Asthma Care

Electronic medical records can enable physicians to keep in touch with asthmatic patients and may help reduce hospitalizations, according to Dr. Elmer Martin, formerly of Cincinnati Group Health Associates. Pediatricians at CGHA, a multispecialty group of more than 100 physicians in the Cincinnati area, each developed their own electronic patient rosters for moderate to severe asthmatics and updated them annually. CGHA providers and staff used letters and phone calls to contact patients periodically and check medicine compliance; they also encouraged influenza vaccination. The vaccination rate in this patient group increased from 8.7% in 2001 to 42.7% in 2003. In addition, the CGHA yearly pediatric hospital admissions for asthma declined by 50% from 2001 to 2003. The study appeared in the April issue of Clinical Pediatrics.

New VP at AAP Eyes Disparity Issues

The new vice president of the American Academy of Pediatrics intends to work with its leadership on a comprehensive national agenda for “optimal child health and development,” which includes addressing ethnic and minority child health disparities, she said in an interview. Dr. Renee Jenkins chairs the department of pediatrics and child health at Howard University and is professor of pediatrics at George Washington University, both in Washington. Dr. Jenkins defeated Dr. O. Marion Burton of the University of South Carolina, Columbia. The number of votes per candidate was not given, but the total number cast was 13,335, Dr. Jenkins said. Dr. Jenkins, who also has a special interest in adolescent health and underserved children, will become the president-elect in October and will serve as the 2007–2008 AAP president.

AMA: Ensure Flu Vaccine Supply

Physicians at the annual meeting of the American Medical Association's House of Delegates voiced their frustration with the uneven supply and distribution of influenza vaccine that have become commonplace in recent years. AMA delegates approved a resolution instructing the AMA leadership to “vigorously” work to ensure that an adequate supply of every manufacturer's vaccine is sold directly to health care providers who are immunizing high-priority patients, as defined by the Advisory Committee on Immunization Practices. The resolution also calls on manufacturers and distributors of influenza vaccine to provide a dedicated ordering system for small- and medium-sized practices to preorder vaccine up to a certain amount. The delegates also instructed the AMA to prepare a report educating physicians about the influenza vaccine supply and distribution process. “We must develop a more streamlined process for getting influenza vaccine into the hands of physicians to help patients become vaccinated,” Dr. Ronald M. Davis, AMA president-elect, said in a statement.

AAP Urges Ban on ATV Use by Kids

The American Academy of Pediatrics has criticized the Consumer Product Safety Commission for failing to propose a ban on all-terrain vehicle (ATV) use by children under 16 years of age. CPSC commissioners were briefed by agency staff in June; staff members outlined regulatory options such as keeping children away from adult ATVs and directing them instead to smaller youth ATVs with speeds that can be restricted to as low as 10 mph. In a statement, the AAP called CPSC's staff report “another ineffective effort by the agency to reduce the risk of child injury and death associated with ATVs,” adding that other steps, such as a driver's license, should be required. “ATV crashes killed 130 children and sent 44,700 more to emergency departments in 2004,” the statement said. The CPSC has not yet decided whether to take the more definite step of proposing a rule.

Genome Project for Common Diseases

A major children's hospital is launching a genome project to develop treatments for asthma, obesity, diabetes, attention-deficit hyperactivity disorder, and other common childhood diseases, as well as pediatric cancer. The Children's Hospital of Philadelphia (CHOP) will start with patients in its own hospital network, said Dr. Hakon Hakonarson, who is leading the new Center for Applied Genomics. Multiple layers of encryption will be used on patient Social Security numbers to protect confidentiality. Dr. Hakonarson added that pediatricians outside of CHOP with a “keen interest” in the work would also be eligible to participate. “The goal is to network this [project] worldwide,” he said in an interview. CHOP plans to have the center up and running by September, with the initial work on neuroblastoma, Dr. Hakonarson said. The center plans to analyze blood samples from more than 100,000 children during the next 3 years.

E-Records Enhance Asthma Care

Electronic medical records can enable physicians to keep in touch with asthmatic patients and may help reduce hospitalizations, according to Dr. Elmer Martin, formerly of Cincinnati Group Health Associates. Pediatricians at CGHA, a multispecialty group of more than 100 physicians in the Cincinnati area, each developed their own electronic patient rosters for moderate to severe asthmatics and updated them annually. CGHA providers and staff used letters and phone calls to contact patients periodically and check medicine compliance; they also encouraged influenza vaccination. The vaccination rate in this patient group increased from 8.7% in 2001 to 42.7% in 2003. In addition, the CGHA yearly pediatric hospital admissions for asthma declined by 50% from 2001 to 2003. The study appeared in the April issue of Clinical Pediatrics.

Feds Seek Electronic Credentials

The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.

Too Many Screening Tests?

Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. About 37 million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on whether it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.

J-1 Visas for Underserved Areas

J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the U.S. Government Accountability Office. The GAO surveyed the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”

Feds Seek Electronic Credentials

The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.

Too Many Screening Tests?

Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. About 37 million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on whether it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.

J-1 Visas for Underserved Areas

J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the U.S. Government Accountability Office. The GAO surveyed the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”

Feds Seek Electronic Credentials

The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.

Too Many Screening Tests?

Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. About 37 million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on whether it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.

J-1 Visas for Underserved Areas

J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the U.S. Government Accountability Office. The GAO surveyed the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”

Feds Seek Electronic Credential

The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.

Too Many Screening Tests?

Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. Thirty-seven million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on if it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.

J-1 Visas for Underserved Areas

J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the Government Accountability Office. The GAO surveyed 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”

Feds Seek Electronic Credential

The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.

Too Many Screening Tests?

Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. Thirty-seven million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on if it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.

J-1 Visas for Underserved Areas

J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the Government Accountability Office. The GAO surveyed 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”

Feds Seek Electronic Credential

The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.

Survey: FDA Influenced by Politics

A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.

Too Many Screening Tests?

Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. Thirty-seven million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on if it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.

J-1 Visas for Underserved Areas

J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the Government Accountability Office. The GAO surveyed 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.

ICD-10 Fraud Concerns

The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”