Nellie Bristol

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations. Benefits would be defined by an independent, nonpartisan, public-private group and encompass physical, mental, and dental health services.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster debate on health services availability and financing. The final recommendations, expected early next year, will be sent to Congress and the White House for further debate and consideration.

The 14-member panel held public meetings throughout the country, conducted polls, and read nearly 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, “sin taxes,” payroll taxes, and value-added taxes.

“The opinion polls we examined, the community meetings we held, and the Web-based survey and comments we receive all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care,” the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal coverage would require new revenues. “That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing.” Although Congress and the administration are not in the mood for another major health care expansion, the recommendations could act as a “motivational paper” to alert lawmakers to the public's values, he said.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the working group's report said. The report also suggested that end-of-life services financing and provisions should be restructured “so that people living with advanced incurable conditions have increased access to these services in the environment they choose.”

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations. Benefits would be defined by an independent, nonpartisan, public-private group and encompass physical, mental, and dental health services.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster debate on health services availability and financing. The final recommendations, expected early next year, will be sent to Congress and the White House for further debate and consideration.

The 14-member panel held public meetings throughout the country, conducted polls, and read nearly 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, “sin taxes,” payroll taxes, and value-added taxes.

“The opinion polls we examined, the community meetings we held, and the Web-based survey and comments we receive all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care,” the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal coverage would require new revenues. “That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing.” Although Congress and the administration are not in the mood for another major health care expansion, the recommendations could act as a “motivational paper” to alert lawmakers to the public's values, he said.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the working group's report said. The report also suggested that end-of-life services financing and provisions should be restructured “so that people living with advanced incurable conditions have increased access to these services in the environment they choose.”

Affordable health care coverage should be public policy established in law with a set of core benefits available to all Americans by 2012, the Citizens' Health Care Working Group said in its interim recommendations. Benefits would be defined by an independent, nonpartisan, public-private group and encompass physical, mental, and dental health services.

The working group was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to foster debate on health services availability and financing. The final recommendations, expected early next year, will be sent to Congress and the White House for further debate and consideration.

The 14-member panel held public meetings throughout the country, conducted polls, and read nearly 5,000 individual commentaries.

New revenues would be required for the coverage, with the group suggesting use of dedicated revenue streams including enrollee contributions, income taxes or surcharges, “sin taxes,” payroll taxes, and value-added taxes.

“The opinion polls we examined, the community meetings we held, and the Web-based survey and comments we receive all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care,” the working group said in its report.

Paul B. Ginsburg, president of the Center for Studying Health System Change, praised the panel for pointing out that universal coverage would require new revenues. “That's a reality check that almost no public leader is willing to admit because they always tells us you can do it for nothing.” Although Congress and the administration are not in the mood for another major health care expansion, the recommendations could act as a “motivational paper” to alert lawmakers to the public's values, he said.

The working group also recommended greater federal support of integrated community health networks through establishment of a specific unit with responsibility for coordinating all federal efforts regarding the health care safety net.

Efforts to improve quality and efficiency of care should be strengthened by the federal government through use of existing health care programs and promotion of health information technology and electronic medical records, especially in underserved areas, the working group's report said. The report also suggested that end-of-life services financing and provisions should be restructured “so that people living with advanced incurable conditions have increased access to these services in the environment they choose.”

WASHINGTON — The Centers for Medicare and Medicaid Services should clarify its position on shared on-call services to assure hospitals that the arrangements are allowed under the Emergency Medical Treatment and Active Labor Act, a federal advisory panel has recommended.

“This is a huge issue around the country,” said Dr. David Siegel, chair of the EMTALA technical advisory group and senior physician consultant/clinical coordinator for Florida Medical Quality Assurance Inc. (FMQAI). “We're being told that, essentially, under current policy … there's nothing wrong with [shared call], but the perception out there is that you can't do these things.”

CMS staff explained to the advisory group that sharing call is allowed, but hospitals are still required to perform screening exams for patients before they are transferred to the on-duty hospital.

“Our policy is that if two hospitals sharing call coverage divide it up month one, month two, that's fine,” said Molly Smith of the agency's Center for Medicare Management. “What hospitals do need to be aware of is that if a hospital this month doesn't have that call coverage but a patient does come to that emergency room asking for an examination … they still have an obligation under EMTALA to do the medical screening exam—they cannot just automatically transfer that patient out.”

The panel agreed to the recommendation to publicize CMS's stance on shared call and will continue to discuss the issue at future meetings.

While shared call may be permitted by CMS, hospitals should ensure that their arrangements do not violate antitrust laws, cautioned panel member Julie Mathis Nelson, an attorney with Coppersmith Gordon Schermer Owens & Nelson, Phoenix.

Exemptions in Emergencies

The panel also agreed to explore expansion of EMTALA exemptions during emergency situations. Current law allows exemptions only during national emergencies, is limited to a 72-hour period, and applies only to transfer requirements.

The panel is considering allowing exemptions from EMTALA during state, local, and hospital-specific emergencies, as well as lengthening the exemption time period. “As we have learned from Hurricane Katrina and other types of disasters, a hospital's or physician's ability to comply with EMTALA may extend beyond the EMTALA transfer requirements and exceed 72 hours,” according to technical advisory group documents.

EMTALA provisions being considered by the panel for waiver eligibility include medical screening examination, requirements defining qualified medical personnel, patient stabilization, documentation, and duty to accept transfers. Exemptions would be decided retrospectively, with some being decided on a case-by-case basis.

Panel member Warren Jones of the University of Mississippi, Jackson, argued that the technical advisory group did not need to address the issue, because efforts are underway at the national and state levels to reconfigure emergency procedures. “I don't think we need to regulate down to that level,” he argued. “The one defense against an EMTALA allegation is that you employed good clinical judgment in providing access and making the decision in the best interest of the patient.”

The panel will look into details of the exemptions and discuss recommendations at future meetings.

Consulting Personal Physicians

The group also approved recommendations specifically allowing communications between a treating physician and a patient's personal physician during the initial screening examination. EMTALA could be construed to prohibit those communications, panel members said, and the regulations should be clarified.

The EMTALA technical advisory group recommended that, while the contacted physician may give advice and provide information, the treating physician or qualified medical personnel should be responsible for the patient's care. The contact is not required and should not delay treatment.

After contact is made, the treating physician or qualified medical personnel would proceed with the patient's medical screening and stabilizing treatment as indicated, the recommendation says. If there is a difference of opinion between the physicians, the medical judgment of the treating clinician shall prevail, the panel agreed.

WASHINGTON — The Centers for Medicare and Medicaid Services should clarify its position on shared on-call services to assure hospitals that the arrangements are allowed under the Emergency Medical Treatment and Active Labor Act, a federal advisory panel has recommended.

“This is a huge issue around the country,” said Dr. David Siegel, chair of the EMTALA technical advisory group and senior physician consultant/clinical coordinator for Florida Medical Quality Assurance Inc. (FMQAI). “We're being told that, essentially, under current policy … there's nothing wrong with [shared call], but the perception out there is that you can't do these things.”

CMS staff explained to the advisory group that sharing call is allowed, but hospitals are still required to perform screening exams for patients before they are transferred to the on-duty hospital.

“Our policy is that if two hospitals sharing call coverage divide it up month one, month two, that's fine,” said Molly Smith of the agency's Center for Medicare Management. “What hospitals do need to be aware of is that if a hospital this month doesn't have that call coverage but a patient does come to that emergency room asking for an examination … they still have an obligation under EMTALA to do the medical screening exam—they cannot just automatically transfer that patient out.”

The panel agreed to the recommendation to publicize CMS's stance on shared call and will continue to discuss the issue at future meetings.

While shared call may be permitted by CMS, hospitals should ensure that their arrangements do not violate antitrust laws, cautioned panel member Julie Mathis Nelson, an attorney with Coppersmith Gordon Schermer Owens & Nelson, Phoenix.

Exemptions in Emergencies

The panel also agreed to explore expansion of EMTALA exemptions during emergency situations. Current law allows exemptions only during national emergencies, is limited to a 72-hour period, and applies only to transfer requirements.

The panel is considering allowing exemptions from EMTALA during state, local, and hospital-specific emergencies, as well as lengthening the exemption time period. “As we have learned from Hurricane Katrina and other types of disasters, a hospital's or physician's ability to comply with EMTALA may extend beyond the EMTALA transfer requirements and exceed 72 hours,” according to technical advisory group documents.

EMTALA provisions being considered by the panel for waiver eligibility include medical screening examination, requirements defining qualified medical personnel, patient stabilization, documentation, and duty to accept transfers. Exemptions would be decided retrospectively, with some being decided on a case-by-case basis.

Panel member Warren Jones of the University of Mississippi, Jackson, argued that the technical advisory group did not need to address the issue, because efforts are underway at the national and state levels to reconfigure emergency procedures. “I don't think we need to regulate down to that level,” he argued. “The one defense against an EMTALA allegation is that you employed good clinical judgment in providing access and making the decision in the best interest of the patient.”

The panel will look into details of the exemptions and discuss recommendations at future meetings.

Consulting Personal Physicians

The group also approved recommendations specifically allowing communications between a treating physician and a patient's personal physician during the initial screening examination. EMTALA could be construed to prohibit those communications, panel members said, and the regulations should be clarified.

The EMTALA technical advisory group recommended that, while the contacted physician may give advice and provide information, the treating physician or qualified medical personnel should be responsible for the patient's care. The contact is not required and should not delay treatment.

After contact is made, the treating physician or qualified medical personnel would proceed with the patient's medical screening and stabilizing treatment as indicated, the recommendation says. If there is a difference of opinion between the physicians, the medical judgment of the treating clinician shall prevail, the panel agreed.

WASHINGTON — The Centers for Medicare and Medicaid Services should clarify its position on shared on-call services to assure hospitals that the arrangements are allowed under the Emergency Medical Treatment and Active Labor Act, a federal advisory panel has recommended.

“This is a huge issue around the country,” said Dr. David Siegel, chair of the EMTALA technical advisory group and senior physician consultant/clinical coordinator for Florida Medical Quality Assurance Inc. (FMQAI). “We're being told that, essentially, under current policy … there's nothing wrong with [shared call], but the perception out there is that you can't do these things.”

CMS staff explained to the advisory group that sharing call is allowed, but hospitals are still required to perform screening exams for patients before they are transferred to the on-duty hospital.

“Our policy is that if two hospitals sharing call coverage divide it up month one, month two, that's fine,” said Molly Smith of the agency's Center for Medicare Management. “What hospitals do need to be aware of is that if a hospital this month doesn't have that call coverage but a patient does come to that emergency room asking for an examination … they still have an obligation under EMTALA to do the medical screening exam—they cannot just automatically transfer that patient out.”

The panel agreed to the recommendation to publicize CMS's stance on shared call and will continue to discuss the issue at future meetings.

While shared call may be permitted by CMS, hospitals should ensure that their arrangements do not violate antitrust laws, cautioned panel member Julie Mathis Nelson, an attorney with Coppersmith Gordon Schermer Owens & Nelson, Phoenix.

Exemptions in Emergencies

The panel also agreed to explore expansion of EMTALA exemptions during emergency situations. Current law allows exemptions only during national emergencies, is limited to a 72-hour period, and applies only to transfer requirements.

The panel is considering allowing exemptions from EMTALA during state, local, and hospital-specific emergencies, as well as lengthening the exemption time period. “As we have learned from Hurricane Katrina and other types of disasters, a hospital's or physician's ability to comply with EMTALA may extend beyond the EMTALA transfer requirements and exceed 72 hours,” according to technical advisory group documents.

EMTALA provisions being considered by the panel for waiver eligibility include medical screening examination, requirements defining qualified medical personnel, patient stabilization, documentation, and duty to accept transfers. Exemptions would be decided retrospectively, with some being decided on a case-by-case basis.

Panel member Warren Jones of the University of Mississippi, Jackson, argued that the technical advisory group did not need to address the issue, because efforts are underway at the national and state levels to reconfigure emergency procedures. “I don't think we need to regulate down to that level,” he argued. “The one defense against an EMTALA allegation is that you employed good clinical judgment in providing access and making the decision in the best interest of the patient.”

The panel will look into details of the exemptions and discuss recommendations at future meetings.

Consulting Personal Physicians

The group also approved recommendations specifically allowing communications between a treating physician and a patient's personal physician during the initial screening examination. EMTALA could be construed to prohibit those communications, panel members said, and the regulations should be clarified.

The EMTALA technical advisory group recommended that, while the contacted physician may give advice and provide information, the treating physician or qualified medical personnel should be responsible for the patient's care. The contact is not required and should not delay treatment.

After contact is made, the treating physician or qualified medical personnel would proceed with the patient's medical screening and stabilizing treatment as indicated, the recommendation says. If there is a difference of opinion between the physicians, the medical judgment of the treating clinician shall prevail, the panel agreed.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union testified at a hearing of the House Energy and Commerce subcommittee on health.

"When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient," Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. "We need to be cautious of large regulatory proposals," he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems.

One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health and by Rep. Deal. The legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician "shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals," according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings.

The antikickback preemption is supported by the American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

"We recognize physicians, hospitals and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT," Mr. Mertz said.

He added, however, that the preemptions should be "crafted carefully" to make sure "providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor."

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination "because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community."

Several witnesses promoted the use of pay for performance to spur dissemination of electronic health records. "Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system," said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. "Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide," he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union testified at a hearing of the House Energy and Commerce subcommittee on health.

"When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient," Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. "We need to be cautious of large regulatory proposals," he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems.

One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health and by Rep. Deal. The legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician "shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals," according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings.

The antikickback preemption is supported by the American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

"We recognize physicians, hospitals and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT," Mr. Mertz said.

He added, however, that the preemptions should be "crafted carefully" to make sure "providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor."

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination "because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community."

Several witnesses promoted the use of pay for performance to spur dissemination of electronic health records. "Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system," said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. "Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide," he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union testified at a hearing of the House Energy and Commerce subcommittee on health.

"When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient," Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. "We need to be cautious of large regulatory proposals," he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems.

One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health and by Rep. Deal. The legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician "shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals," according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings.

The antikickback preemption is supported by the American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

"We recognize physicians, hospitals and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT," Mr. Mertz said.

He added, however, that the preemptions should be "crafted carefully" to make sure "providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor."

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination "because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community."

Several witnesses promoted the use of pay for performance to spur dissemination of electronic health records. "Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system," said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. "Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide," he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union, testified at a hearing of the House Energy and Commerce subcommittee on health.

“When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient,” Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. “We need to be cautious of large regulatory proposals,” he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems. One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health, and by Rep. Deal. The proposed legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician “shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals,” according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings. The antikickback preemption is supported by The American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

“We recognize that physicians, hospitals, and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT,” Mr. Mertz said.

He added, however, that the preemptions should be “crafted carefully” to make sure “providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor.”

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination “because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community.”

Several witnesses promoted the use of pay for performance under federal health programs to spur the dissemination of electronic health records. “Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system,” said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. “Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide,” he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union, testified at a hearing of the House Energy and Commerce subcommittee on health.

“When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient,” Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. “We need to be cautious of large regulatory proposals,” he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems. One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health, and by Rep. Deal. The proposed legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician “shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals,” according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings. The antikickback preemption is supported by The American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

“We recognize that physicians, hospitals, and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT,” Mr. Mertz said.

He added, however, that the preemptions should be “crafted carefully” to make sure “providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor.”

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination “because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community.”

Several witnesses promoted the use of pay for performance under federal health programs to spur the dissemination of electronic health records. “Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system,” said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. “Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide,” he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union, testified at a hearing of the House Energy and Commerce subcommittee on health.

“When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient,” Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. “We need to be cautious of large regulatory proposals,” he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems. One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health, and by Rep. Deal. The proposed legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician “shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals,” according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings. The antikickback preemption is supported by The American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

“We recognize that physicians, hospitals, and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT,” Mr. Mertz said.

He added, however, that the preemptions should be “crafted carefully” to make sure “providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor.”

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination “because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community.”

Several witnesses promoted the use of pay for performance under federal health programs to spur the dissemination of electronic health records. “Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system,” said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. “Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide,” he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union, testified at a hearing of the House Energy and Commerce subcommittee on health.

“When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient,” Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. “We need to be cautious of large regulatory proposals,” he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems. One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health and by Rep. Deal. The proposed legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician “shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals,” according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings. The antikickback preemption is supported by The American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

“We recognize that physicians, hospitals, and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT,” Mr. Mertz said.

He added, however, that the preemptions should be “crafted carefully” to make sure “providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor.”

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination “because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community.”

Several witnesses promoted the use of pay for performance under federal health programs to spur the dissemination of electronic health records. “Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system,” said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. “Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide,” he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union, testified at a hearing of the House Energy and Commerce subcommittee on health.

“When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient,” Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. “We need to be cautious of large regulatory proposals,” he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems. One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health and by Rep. Deal. The proposed legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician “shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals,” according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings. The antikickback preemption is supported by The American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

“We recognize that physicians, hospitals, and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT,” Mr. Mertz said.

He added, however, that the preemptions should be “crafted carefully” to make sure “providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor.”

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination “because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community.”

Several witnesses promoted the use of pay for performance under federal health programs to spur the dissemination of electronic health records. “Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system,” said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. “Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide,” he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

WASHINGTON — Suspension of antikickback laws to encourage adoption of health information technology could compromise physicians' referral patterns, William Vaughan, senior policy analyst for the Consumers Union, testified at a hearing of the House Energy and Commerce subcommittee on health.

“When a hospital system offers an IT package to a nonaffiliated physician group, it hopes the ease of communication between them (and the goodwill generated by the gift) will encourage referrals to its facilities, regardless of whether the facility is the best quality or best value facility for the patient,” Mr. Vaughan testified.

The hearing focused on legislation to promote electronic health records (EHRs) and other health IT topics. In his opening statement, panel Chairman Nathan Deal (R-Ga.) said the subcommittee is working to ensure continuation of the innovation and investment being made in EHRs by the private sector. “We need to be cautious of large regulatory proposals,” he said.

Rep. Deal said he is committed to moving health information promotion legislation forward this year. He added that it likely would be in the form of a combination of proposals and not any specific measure already introduced.

Several pending bills would create safe harbors in antikickback laws for health information technology. The move is intended to help physicians with the enormous cost of the systems. One bill, H.R. 4157, is sponsored by Rep. Nancy Johnson (R-Conn.), chairman of the House Ways and Means subcommittee on health and by Rep. Deal. The proposed legislation would clarify conditions under which provision of health information technology and related training by a hospital to a physician “shall not be considered a prohibited payment … made as an inducement to reduce or limit services to certain individuals,” according to a summary of the bill.

As an alternative to constraining the laws, Mr. Vaughan proposed reforms in the physician payment system that would allow physicians to elect a temporary increase in Medicare practice expense payments to be repaid out of improved office productivity savings. The antikickback preemption is supported by The American Clinical Laboratory Association (ACLA). In testimony before the panel, ACLA President Alan Mertz said the action is needed to standardize requirements found in different states and to reassure health care providers.

“We recognize that physicians, hospitals, and other providers routinely cite the fear of legal action/debarment from Medicare as one of the biggest deterrents toward adoption of health IT,” Mr. Mertz said.

He added, however, that the preemptions should be “crafted carefully” to make sure “providers will continue to compete on the services they are providing and not, for instance, on the size of a monitor.”

He advocated that clinical labs be among providers exempt from the statutes for health IT dissemination “because of the critical role laboratories have and continue to play in facilitation of health IT adoption in the health care community.”

Several witnesses promoted the use of pay for performance under federal health programs to spur the dissemination of electronic health records. “Actually, pay-for-performance programs represent a clear argument for payers to provide some of the financing for health IT—because in order to pay for performance you have to be able to rank performance and quality in the delivery of care, and to do that efficiently you need sophisticated information capabilities embedded in the health care system,” said Don Detmer, president and CEO of the American Medical Informatics Association.

But even blanket availability of health IT doesn't guarantee dissemination of EHRs, Mr. Detmer argued. “Ultimately, IT comes down to health care workers and patients being sufficiently skilled to take advantage of the opportunities for improved care and efficiency and access that health information technology and an interconnected national health information infrastructure can provide,” he said.

Another key to the successful dissemination of the EHRs is the assurance of patient privacy, witnesses said. James Pyles, counsel for the American Psychoanalytic Association, said health information technology should include meaningful informed patient consent, a private right of action, and an opt out for some or all personal information.

Hospitals in only two states have adequate plans to encourage health professionals to report to work during a major infectious disease outbreak, according to a report from the Trust for America's Health.

Hospitals in Rhode Island and South Dakota provide incentives such as health care workforce priority for vaccines and medicines and extra compensation for workers during emergencies, Shelley Hearne, Dr.PH., executive director of the Trust for America's Health (TFAH), said at a press briefing to release the organization's 2005 report card of all-hazard preparedness in the U.S. public health system.

TFAH gave the federal government a D+ overall for levels of preparedness. The grade includes preparations for the Strategic National Stockpile (C+); federal initiatives including cities readiness, biosurveillance, pandemic flu planning, and oversight and management of federal funds and programs (C−); and coordination among agencies (D).

“While considerable progress has been achieved in improving America's post-September 11 health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face,” the report said. It added that the response to Hurricane Katrina provided many valuable lessons in preparedness.

“Hurricane Katrina provided a sharp indictment of America's emergency response capabilities as the gaps between 'plans' and 'realities' became strikingly evident,” the report said.

“Parts of the public health system did not work, and while many did work as intended, those functions were often too limited and divorced from other response activities to match the real needs in a timely way.”

The group calls for full funding of public health and bioterrorism preparedness legislation and for congressional passage of the $7.1 billion pandemic influenza preparedness request made earlier this year by President Bush.

The federal government also should provide $1 billion annually in medical/hospital surge capacity grants to states, TFAH said. In addition, Congress should fund $950 million annually in public health bioterrorism preparedness grants to states, $230 million annually to bolster workforce capacity, $70 million annually to improve stockpile distribution capabilities, and $200 million for modernizing laboratory capabilities.

The federal government also should provide $100 million to improve disease tracking capabilities.

TFAH noted that experts have widely recognized that the nation's public health system is “chronically underfunded” and that sustained effort is needed for improvements. “This all costs money,” said Lowell Weicker Jr., TFAH board president.

Such funds should be new money, not funds appropriated from other health programs, Dr. Hearne added.

The group called for increased leadership and oversight of bioterrorism and public health preparedness. It also recommended performance standards and increased measures to ensure state and local planning efforts, as well as public involvement with planning and heightened efforts to include the needs of vulnerable populations in emergency plans. Dr. Hearne also cited the need for increased transparency in preparedness efforts.

On the state level, the group scored Delaware, South Carolina, and Virginia as the most prepared states, meeting 8 out of 10 preparedness indicators. Sixteen states met 5 of 10 indicators. Worst prepared were Alabama, Alaska, Iowa, and New Hampshire, which met only two indicators.

States were measured on indicators representing capabilities of state and local health departments and reflecting the use of bioterrorism and public health grants received through the Centers for Disease Control and Prevention.

Indicators measured laboratory response capabilities, numbers of lab scientists, chemical response capabilities, and standards to track disease outbreak information.

The Trust for America's Health is a nonprofit, nonpartisan health advocacy organization.

“Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism 2005” is available at www.healthyamericans.org

Hospitals in only two states have adequate plans to encourage health professionals to report to work during a major infectious disease outbreak, according to a report from the Trust for America's Health.

Hospitals in Rhode Island and South Dakota provide incentives such as health care workforce priority for vaccines and medicines and extra compensation for workers during emergencies, Shelley Hearne, Dr.PH., executive director of the Trust for America's Health (TFAH), said at a press briefing to release the organization's 2005 report card of all-hazard preparedness in the U.S. public health system.

TFAH gave the federal government a D+ overall for levels of preparedness. The grade includes preparations for the Strategic National Stockpile (C+); federal initiatives including cities readiness, biosurveillance, pandemic flu planning, and oversight and management of federal funds and programs (C−); and coordination among agencies (D).

“While considerable progress has been achieved in improving America's post-September 11 health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face,” the report said. It added that the response to Hurricane Katrina provided many valuable lessons in preparedness.

“Hurricane Katrina provided a sharp indictment of America's emergency response capabilities as the gaps between 'plans' and 'realities' became strikingly evident,” the report said.

“Parts of the public health system did not work, and while many did work as intended, those functions were often too limited and divorced from other response activities to match the real needs in a timely way.”

The group calls for full funding of public health and bioterrorism preparedness legislation and for congressional passage of the $7.1 billion pandemic influenza preparedness request made earlier this year by President Bush.

The federal government also should provide $1 billion annually in medical/hospital surge capacity grants to states, TFAH said. In addition, Congress should fund $950 million annually in public health bioterrorism preparedness grants to states, $230 million annually to bolster workforce capacity, $70 million annually to improve stockpile distribution capabilities, and $200 million for modernizing laboratory capabilities.

The federal government also should provide $100 million to improve disease tracking capabilities.

TFAH noted that experts have widely recognized that the nation's public health system is “chronically underfunded” and that sustained effort is needed for improvements. “This all costs money,” said Lowell Weicker Jr., TFAH board president.

Such funds should be new money, not funds appropriated from other health programs, Dr. Hearne added.

The group called for increased leadership and oversight of bioterrorism and public health preparedness. It also recommended performance standards and increased measures to ensure state and local planning efforts, as well as public involvement with planning and heightened efforts to include the needs of vulnerable populations in emergency plans. Dr. Hearne also cited the need for increased transparency in preparedness efforts.

On the state level, the group scored Delaware, South Carolina, and Virginia as the most prepared states, meeting 8 out of 10 preparedness indicators. Sixteen states met 5 of 10 indicators. Worst prepared were Alabama, Alaska, Iowa, and New Hampshire, which met only two indicators.

States were measured on indicators representing capabilities of state and local health departments and reflecting the use of bioterrorism and public health grants received through the Centers for Disease Control and Prevention.

Indicators measured laboratory response capabilities, numbers of lab scientists, chemical response capabilities, and standards to track disease outbreak information.

The Trust for America's Health is a nonprofit, nonpartisan health advocacy organization.

“Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism 2005” is available at www.healthyamericans.org

Hospitals in only two states have adequate plans to encourage health professionals to report to work during a major infectious disease outbreak, according to a report from the Trust for America's Health.

Hospitals in Rhode Island and South Dakota provide incentives such as health care workforce priority for vaccines and medicines and extra compensation for workers during emergencies, Shelley Hearne, Dr.PH., executive director of the Trust for America's Health (TFAH), said at a press briefing to release the organization's 2005 report card of all-hazard preparedness in the U.S. public health system.

TFAH gave the federal government a D+ overall for levels of preparedness. The grade includes preparations for the Strategic National Stockpile (C+); federal initiatives including cities readiness, biosurveillance, pandemic flu planning, and oversight and management of federal funds and programs (C−); and coordination among agencies (D).

“While considerable progress has been achieved in improving America's post-September 11 health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face,” the report said. It added that the response to Hurricane Katrina provided many valuable lessons in preparedness.

“Hurricane Katrina provided a sharp indictment of America's emergency response capabilities as the gaps between 'plans' and 'realities' became strikingly evident,” the report said.

“Parts of the public health system did not work, and while many did work as intended, those functions were often too limited and divorced from other response activities to match the real needs in a timely way.”

The group calls for full funding of public health and bioterrorism preparedness legislation and for congressional passage of the $7.1 billion pandemic influenza preparedness request made earlier this year by President Bush.

The federal government also should provide $1 billion annually in medical/hospital surge capacity grants to states, TFAH said. In addition, Congress should fund $950 million annually in public health bioterrorism preparedness grants to states, $230 million annually to bolster workforce capacity, $70 million annually to improve stockpile distribution capabilities, and $200 million for modernizing laboratory capabilities.

The federal government also should provide $100 million to improve disease tracking capabilities.

TFAH noted that experts have widely recognized that the nation's public health system is “chronically underfunded” and that sustained effort is needed for improvements. “This all costs money,” said Lowell Weicker Jr., TFAH board president.

Such funds should be new money, not funds appropriated from other health programs, Dr. Hearne added.

The group called for increased leadership and oversight of bioterrorism and public health preparedness. It also recommended performance standards and increased measures to ensure state and local planning efforts, as well as public involvement with planning and heightened efforts to include the needs of vulnerable populations in emergency plans. Dr. Hearne also cited the need for increased transparency in preparedness efforts.

On the state level, the group scored Delaware, South Carolina, and Virginia as the most prepared states, meeting 8 out of 10 preparedness indicators. Sixteen states met 5 of 10 indicators. Worst prepared were Alabama, Alaska, Iowa, and New Hampshire, which met only two indicators.

States were measured on indicators representing capabilities of state and local health departments and reflecting the use of bioterrorism and public health grants received through the Centers for Disease Control and Prevention.

Indicators measured laboratory response capabilities, numbers of lab scientists, chemical response capabilities, and standards to track disease outbreak information.

The Trust for America's Health is a nonprofit, nonpartisan health advocacy organization.

“Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism 2005” is available at www.healthyamericans.org

WASHINGTON — Eight of 10 patients reported that they took steps to protect their health care privacy, including asking a physician not to record a health problem, the California Healthcare Foundation announced at a press briefing to release results of its survey.

Patients also reported seeing another doctor to avoid telling their regular physician about a health condition; paying for a test, procedure, or counseling out-of-pocket rather than submitting a claim; and rejecting a test to avoid discovery of the results by others. The survey of 2,100 people was conducted for the foundation by Forrester Research.

Cancer patients were most likely to pay for a service out of pocket rather than submit a claim, followed by those with arthritis, weight problems, diabetes, or depression or anxiety. Of those diagnosed with cancer, 11% said they had engaged in privacy protective behavior while 9% of those diagnosed with the other diseases reported the same.

Such privacy fears could adversely affect health and slow the adoption of electronic health records, according to a panel of health care, information technology, and privacy experts at the briefing.

Convincing Americans that their information can be protected in an electronic health record system is key to the systems' survival, argued Sam Karp, chief program officer of California Healthcare Foundation, a nonprofit health care organization in Oakland. “Without better education about their rights, strong privacy safeguards, and vigorous enforcement, the public's support for health IT may be in jeopardy.”

The survey found that 67% of respondents are concerned about privacy of personal health information, including 73% of ethnic minorities and 67% of those who have a chronic disease.

Further, survey results indicated that consumers still are largely unaware of their rights under the Health Insurance Portability and Accountability Act. HIPAA spells out how personal health information may be used by health care providers and insurers and creates civil and criminal penalties for violating the statute.

In this first privacy-related study conducted by the group since HIPAA provisions were implemented in 2003, the foundation found that concerns about employer use of medical claims information has increased over time. In 2005, 52% of respondents said they were concerned that claims information could be seen by an employer and used to limit job opportunities. Only 36% of respondents had similar concerns in 1999.

Racial and ethnic minorities and those with chronic disease were more concerned about employer misuse of personal health information: 61% of racial and ethnic minorities were concerned, as were 55% of those who have been diagnosed with a disease. Those over 45 years old were more likely to be concerned than those under 45 (51% vs. 48%).

The survey also found that 59% of respondents are willing to share their personal information when it is beneficial to their care or could result in better coordination of medical treatment.

A vast majority of respondents were willing to share their information with their doctor (98%) or other doctors involved in their care (92%), but a much smaller fractions were willing to share it with drug companies (27%) or government agencies (20%).

Dr. Louis Sullivan, former secretary of Health and Human Services said the survey showed some “very troubling realities” especially relating to minority trust of the health care system. He called for better enforcement of HIPAA-related complaints. “Having the law there is one thing—having confidence that it will be enforced is another,” he said.

But Dr. Sullivan also called on health care providers to calm consumer fears about privacy. Patient privacy protection, he said, should be built into the medical profession's code of conduct and presented to patients that way. “I don't think [privacy fears are] going to be solved by passing more legislation,” he said.

Janlori Goldman, director of the Health Privacy Project, also called for better HIPAA enforcement. It is especially troubling, she said, that people worry about employment-related consequences connected with health care information and that they are not aware of their rights under HIPAA.

Part of the blame lies with the way HIPAA forms found at health care providers' offices are worded, she said. They start with what providers can do with personal health information, not what individual rights are. “They are not written with consumers in mind,” she said.

Ms. Goldman said HIPAA needs to be expanded to include employers and that privacy constraints should be built into both electronic health records technology and in disaster preparedness plans.

WASHINGTON — Eight of 10 patients reported that they took steps to protect their health care privacy, including asking a physician not to record a health problem, the California Healthcare Foundation announced at a press briefing to release results of its survey.

Patients also reported seeing another doctor to avoid telling their regular physician about a health condition; paying for a test, procedure, or counseling out-of-pocket rather than submitting a claim; and rejecting a test to avoid discovery of the results by others. The survey of 2,100 people was conducted for the foundation by Forrester Research.

Cancer patients were most likely to pay for a service out of pocket rather than submit a claim, followed by those with arthritis, weight problems, diabetes, or depression or anxiety. Of those diagnosed with cancer, 11% said they had engaged in privacy protective behavior while 9% of those diagnosed with the other diseases reported the same.

Such privacy fears could adversely affect health and slow the adoption of electronic health records, according to a panel of health care, information technology, and privacy experts at the briefing.

Convincing Americans that their information can be protected in an electronic health record system is key to the systems' survival, argued Sam Karp, chief program officer of California Healthcare Foundation, a nonprofit health care organization in Oakland. “Without better education about their rights, strong privacy safeguards, and vigorous enforcement, the public's support for health IT may be in jeopardy.”

The survey found that 67% of respondents are concerned about privacy of personal health information, including 73% of ethnic minorities and 67% of those who have a chronic disease.

Further, survey results indicated that consumers still are largely unaware of their rights under the Health Insurance Portability and Accountability Act. HIPAA spells out how personal health information may be used by health care providers and insurers and creates civil and criminal penalties for violating the statute.

In this first privacy-related study conducted by the group since HIPAA provisions were implemented in 2003, the foundation found that concerns about employer use of medical claims information has increased over time. In 2005, 52% of respondents said they were concerned that claims information could be seen by an employer and used to limit job opportunities. Only 36% of respondents had similar concerns in 1999.

Racial and ethnic minorities and those with chronic disease were more concerned about employer misuse of personal health information: 61% of racial and ethnic minorities were concerned, as were 55% of those who have been diagnosed with a disease. Those over 45 years old were more likely to be concerned than those under 45 (51% vs. 48%).

The survey also found that 59% of respondents are willing to share their personal information when it is beneficial to their care or could result in better coordination of medical treatment.

A vast majority of respondents were willing to share their information with their doctor (98%) or other doctors involved in their care (92%), but a much smaller fractions were willing to share it with drug companies (27%) or government agencies (20%).

Dr. Louis Sullivan, former secretary of Health and Human Services said the survey showed some “very troubling realities” especially relating to minority trust of the health care system. He called for better enforcement of HIPAA-related complaints. “Having the law there is one thing—having confidence that it will be enforced is another,” he said.

But Dr. Sullivan also called on health care providers to calm consumer fears about privacy. Patient privacy protection, he said, should be built into the medical profession's code of conduct and presented to patients that way. “I don't think [privacy fears are] going to be solved by passing more legislation,” he said.

Janlori Goldman, director of the Health Privacy Project, also called for better HIPAA enforcement. It is especially troubling, she said, that people worry about employment-related consequences connected with health care information and that they are not aware of their rights under HIPAA.

Part of the blame lies with the way HIPAA forms found at health care providers' offices are worded, she said. They start with what providers can do with personal health information, not what individual rights are. “They are not written with consumers in mind,” she said.

Ms. Goldman said HIPAA needs to be expanded to include employers and that privacy constraints should be built into both electronic health records technology and in disaster preparedness plans.

WASHINGTON — Eight of 10 patients reported that they took steps to protect their health care privacy, including asking a physician not to record a health problem, the California Healthcare Foundation announced at a press briefing to release results of its survey.

Patients also reported seeing another doctor to avoid telling their regular physician about a health condition; paying for a test, procedure, or counseling out-of-pocket rather than submitting a claim; and rejecting a test to avoid discovery of the results by others. The survey of 2,100 people was conducted for the foundation by Forrester Research.

Cancer patients were most likely to pay for a service out of pocket rather than submit a claim, followed by those with arthritis, weight problems, diabetes, or depression or anxiety. Of those diagnosed with cancer, 11% said they had engaged in privacy protective behavior while 9% of those diagnosed with the other diseases reported the same.

Such privacy fears could adversely affect health and slow the adoption of electronic health records, according to a panel of health care, information technology, and privacy experts at the briefing.

Convincing Americans that their information can be protected in an electronic health record system is key to the systems' survival, argued Sam Karp, chief program officer of California Healthcare Foundation, a nonprofit health care organization in Oakland. “Without better education about their rights, strong privacy safeguards, and vigorous enforcement, the public's support for health IT may be in jeopardy.”

The survey found that 67% of respondents are concerned about privacy of personal health information, including 73% of ethnic minorities and 67% of those who have a chronic disease.

Further, survey results indicated that consumers still are largely unaware of their rights under the Health Insurance Portability and Accountability Act. HIPAA spells out how personal health information may be used by health care providers and insurers and creates civil and criminal penalties for violating the statute.

In this first privacy-related study conducted by the group since HIPAA provisions were implemented in 2003, the foundation found that concerns about employer use of medical claims information has increased over time. In 2005, 52% of respondents said they were concerned that claims information could be seen by an employer and used to limit job opportunities. Only 36% of respondents had similar concerns in 1999.

Racial and ethnic minorities and those with chronic disease were more concerned about employer misuse of personal health information: 61% of racial and ethnic minorities were concerned, as were 55% of those who have been diagnosed with a disease. Those over 45 years old were more likely to be concerned than those under 45 (51% vs. 48%).

The survey also found that 59% of respondents are willing to share their personal information when it is beneficial to their care or could result in better coordination of medical treatment.

A vast majority of respondents were willing to share their information with their doctor (98%) or other doctors involved in their care (92%), but a much smaller fractions were willing to share it with drug companies (27%) or government agencies (20%).

Dr. Louis Sullivan, former secretary of Health and Human Services said the survey showed some “very troubling realities” especially relating to minority trust of the health care system. He called for better enforcement of HIPAA-related complaints. “Having the law there is one thing—having confidence that it will be enforced is another,” he said.

But Dr. Sullivan also called on health care providers to calm consumer fears about privacy. Patient privacy protection, he said, should be built into the medical profession's code of conduct and presented to patients that way. “I don't think [privacy fears are] going to be solved by passing more legislation,” he said.

Janlori Goldman, director of the Health Privacy Project, also called for better HIPAA enforcement. It is especially troubling, she said, that people worry about employment-related consequences connected with health care information and that they are not aware of their rights under HIPAA.

Part of the blame lies with the way HIPAA forms found at health care providers' offices are worded, she said. They start with what providers can do with personal health information, not what individual rights are. “They are not written with consumers in mind,” she said.

Ms. Goldman said HIPAA needs to be expanded to include employers and that privacy constraints should be built into both electronic health records technology and in disaster preparedness plans.

WASHINGTON — Eight of 10 patients reported that they took steps to protect their health care privacy, including asking a physician not to record a health problem, the California Healthcare Foundation announced at a press briefing to release results of its survey.

Patients also reported seeing another doctor to avoid telling their regular physician about a health condition; paying for a test, procedure, or counseling out-of-pocket rather than submitting a claim; and rejecting a test to avoid discovery of the results by others. The survey of 2,100 people was conducted for the foundation by Forrester Research.

Cancer patients were most likely to pay for a service out of pocket rather than submit a claim, followed by those with arthritis, weight problems, diabetes, or depression or anxiety. Of those diagnosed with cancer, 11% said they had engaged in privacy protective behavior while 9% of those diagnosed with the other diseases reported the same.

Such privacy fears could adversely affect health and slow the adoption of electronic health records, according to a panel of health care, information technology, and privacy experts at the briefing. Convincing Americans that their information can be protected in an electronic health record system is key to the systems' survival, argued Sam Karp, chief program officer of California Healthcare Foundation, a nonprofit health care organization in Oakland. “Without better education about their rights, strong privacy safe guards, and vigorous enforcement, the public's support for health IT may be in jeopardy.”

The survey found that 67% of respondents are concerned about privacy of personal health information, including 73% of ethnic minorities and 67% of those who have a chronic disease.

Further, survey results indicated that consumers still are largely unaware of their rights under the Health Insurance Portability and Accountability Act. HIPAA spells out how personal health information may be used by health care providers and insurers and creates civil and criminal penalties for violating the statute.

In this first privacy-related study conducted by the group since HIPAA provisions were implemented in 2003, the foundation found that concerns abut employer use of medical claims information has increased over time. In 2005, 52% of respondents said they were concerned that claims information could be seen by an employer and used to limit job opportunities. Only 36% of respondents had similar concerns in 1999.

Racial and ethnic minorities and those with chronic disease were more concerned about employer misuse of personal health information: 61% of racial and ethnic minorities were concerned, as were 55% of those who have been diagnosed with a disease. Those over 45 years old were more likely to be concerned than those under 45 (51% vs. 48%).

The survey also found that 59% of respondents are willing to share their personal information when it is beneficial to their care or could result in better coordination of medical treatment. A vast majority of respondents were willing to share their information with their doctor (98%) or other doctors involved in their care (92%). Fewer were willing to share it with drug companies (27%) or the government (20%).

Dr. Louis Sullivan, former secretary of Health and Human Services said the survey showed some “very troubling realities” especially relating to minority trust of the health care system. He called for better enforcement of HIPAA-related complaints. “Having the law there is one thing—having confidence that it will be enforced is another,” he said.

But Dr. Sullivan also called on health care providers to calm consumer fears about privacy. Patient privacy protection, he said, should be built into the medical profession's code of conduct and presented to patients that way. “I don't think [privacy fears are] going to be solved by passing more legislation,” he said.

Janlori Goldman, director of the Health Privacy Project, also called for better HIPAA enforcement. It is especially troubling, she said, that people worry about employment-related consequences connected with health care information and that they are not aware of their rights under HIPAA.

Part of the blame lies with the way HIPAA forms found at health care providers' offices are worded, she said. “They are not written with consumers in mind.”

Ms. Goldman said HIPAA needs to be expanded to include employers and that privacy constraints should be built into both electronic health records technology and in disaster preparedness plans.

WASHINGTON — Eight of 10 patients reported that they took steps to protect their health care privacy, including asking a physician not to record a health problem, the California Healthcare Foundation announced at a press briefing to release results of its survey.

Patients also reported seeing another doctor to avoid telling their regular physician about a health condition; paying for a test, procedure, or counseling out-of-pocket rather than submitting a claim; and rejecting a test to avoid discovery of the results by others. The survey of 2,100 people was conducted for the foundation by Forrester Research.

Cancer patients were most likely to pay for a service out of pocket rather than submit a claim, followed by those with arthritis, weight problems, diabetes, or depression or anxiety. Of those diagnosed with cancer, 11% said they had engaged in privacy protective behavior while 9% of those diagnosed with the other diseases reported the same.

Such privacy fears could adversely affect health and slow the adoption of electronic health records, according to a panel of health care, information technology, and privacy experts at the briefing. Convincing Americans that their information can be protected in an electronic health record system is key to the systems' survival, argued Sam Karp, chief program officer of California Healthcare Foundation, a nonprofit health care organization in Oakland. “Without better education about their rights, strong privacy safe guards, and vigorous enforcement, the public's support for health IT may be in jeopardy.”

The survey found that 67% of respondents are concerned about privacy of personal health information, including 73% of ethnic minorities and 67% of those who have a chronic disease.

Further, survey results indicated that consumers still are largely unaware of their rights under the Health Insurance Portability and Accountability Act. HIPAA spells out how personal health information may be used by health care providers and insurers and creates civil and criminal penalties for violating the statute.

In this first privacy-related study conducted by the group since HIPAA provisions were implemented in 2003, the foundation found that concerns abut employer use of medical claims information has increased over time. In 2005, 52% of respondents said they were concerned that claims information could be seen by an employer and used to limit job opportunities. Only 36% of respondents had similar concerns in 1999.

Racial and ethnic minorities and those with chronic disease were more concerned about employer misuse of personal health information: 61% of racial and ethnic minorities were concerned, as were 55% of those who have been diagnosed with a disease. Those over 45 years old were more likely to be concerned than those under 45 (51% vs. 48%).

The survey also found that 59% of respondents are willing to share their personal information when it is beneficial to their care or could result in better coordination of medical treatment. A vast majority of respondents were willing to share their information with their doctor (98%) or other doctors involved in their care (92%). Fewer were willing to share it with drug companies (27%) or the government (20%).

Dr. Louis Sullivan, former secretary of Health and Human Services said the survey showed some “very troubling realities” especially relating to minority trust of the health care system. He called for better enforcement of HIPAA-related complaints. “Having the law there is one thing—having confidence that it will be enforced is another,” he said.

But Dr. Sullivan also called on health care providers to calm consumer fears about privacy. Patient privacy protection, he said, should be built into the medical profession's code of conduct and presented to patients that way. “I don't think [privacy fears are] going to be solved by passing more legislation,” he said.

Janlori Goldman, director of the Health Privacy Project, also called for better HIPAA enforcement. It is especially troubling, she said, that people worry about employment-related consequences connected with health care information and that they are not aware of their rights under HIPAA.

Part of the blame lies with the way HIPAA forms found at health care providers' offices are worded, she said. “They are not written with consumers in mind.”

Ms. Goldman said HIPAA needs to be expanded to include employers and that privacy constraints should be built into both electronic health records technology and in disaster preparedness plans.

WASHINGTON — Eight of 10 patients reported that they took steps to protect their health care privacy, including asking a physician not to record a health problem, the California Healthcare Foundation announced at a press briefing to release results of its survey.

Patients also reported seeing another doctor to avoid telling their regular physician about a health condition; paying for a test, procedure, or counseling out-of-pocket rather than submitting a claim; and rejecting a test to avoid discovery of the results by others. The survey of 2,100 people was conducted for the foundation by Forrester Research.

Cancer patients were most likely to pay for a service out of pocket rather than submit a claim, followed by those with arthritis, weight problems, diabetes, or depression or anxiety. Of those diagnosed with cancer, 11% said they had engaged in privacy protective behavior while 9% of those diagnosed with the other diseases reported the same.

Such privacy fears could adversely affect health and slow the adoption of electronic health records, according to a panel of health care, information technology, and privacy experts at the briefing. Convincing Americans that their information can be protected in an electronic health record system is key to the systems' survival, argued Sam Karp, chief program officer of California Healthcare Foundation, a nonprofit health care organization in Oakland. “Without better education about their rights, strong privacy safe guards, and vigorous enforcement, the public's support for health IT may be in jeopardy.”

The survey found that 67% of respondents are concerned about privacy of personal health information, including 73% of ethnic minorities and 67% of those who have a chronic disease.

Further, survey results indicated that consumers still are largely unaware of their rights under the Health Insurance Portability and Accountability Act. HIPAA spells out how personal health information may be used by health care providers and insurers and creates civil and criminal penalties for violating the statute.

In this first privacy-related study conducted by the group since HIPAA provisions were implemented in 2003, the foundation found that concerns abut employer use of medical claims information has increased over time. In 2005, 52% of respondents said they were concerned that claims information could be seen by an employer and used to limit job opportunities. Only 36% of respondents had similar concerns in 1999.

Racial and ethnic minorities and those with chronic disease were more concerned about employer misuse of personal health information: 61% of racial and ethnic minorities were concerned, as were 55% of those who have been diagnosed with a disease. Those over 45 years old were more likely to be concerned than those under 45 (51% vs. 48%).

The survey also found that 59% of respondents are willing to share their personal information when it is beneficial to their care or could result in better coordination of medical treatment. A vast majority of respondents were willing to share their information with their doctor (98%) or other doctors involved in their care (92%). Fewer were willing to share it with drug companies (27%) or the government (20%).

Dr. Louis Sullivan, former secretary of Health and Human Services said the survey showed some “very troubling realities” especially relating to minority trust of the health care system. He called for better enforcement of HIPAA-related complaints. “Having the law there is one thing—having confidence that it will be enforced is another,” he said.

But Dr. Sullivan also called on health care providers to calm consumer fears about privacy. Patient privacy protection, he said, should be built into the medical profession's code of conduct and presented to patients that way. “I don't think [privacy fears are] going to be solved by passing more legislation,” he said.

Janlori Goldman, director of the Health Privacy Project, also called for better HIPAA enforcement. It is especially troubling, she said, that people worry about employment-related consequences connected with health care information and that they are not aware of their rights under HIPAA.

Part of the blame lies with the way HIPAA forms found at health care providers' offices are worded, she said. “They are not written with consumers in mind.”

Ms. Goldman said HIPAA needs to be expanded to include employers and that privacy constraints should be built into both electronic health records technology and in disaster preparedness plans.

Hospitals in only two states have adequate plans to encourage health professionals to report to work during a major infectious disease outbreak, according to a report from the Trust for America's Health.

Hospitals in Rhode Island and South Dakota provide incentives such as health care workforce priority for vaccines and medicines and extra compensation for workers during emergencies, Shelley Hearne, Dr.P.H., executive director of the Trust for America's Health (TFAH), said at a press briefing to release the organization's 2005 report card of all-hazard preparedness in the U.S. public health system.

Overall, TFAH gave the federal government an overall D+ for levels of preparedness. The grade includes preparations for the Strategic National Stockpile (C+); federal initiatives including cities readiness, biosurveillance, pandemic flu planning, and oversight and management of federal funds and programs (C-); and coordination among agencies (D).

"While considerable progress has been achieved in improving America's post-September 11 health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face," the report said. It added that the response to Hurricane Katrina provided many valuable lessons in preparedness.

"Hurricane Katrina provided a sharp indictment of America's emergency response capabilities as the gaps between 'plans' and 'realities' became strikingly evident," the report said. "Parts of the public health system did not work, and while many did work as intended, those functions were often too limited and divorced from other response activities to match the real needs in a timely way."

The group calls for full funding of public health and bioterrorism preparedness legislation and for congressional passage of the $7.1 billion pandemic influenza preparedness request made earlier this year by President Bush.

The federal government also should provide $1 billion annually in medical/hospital surge capacity grants to states, TFAH said. In addition, Congress should fund $950 million annually in public health bioterrorism preparedness grants to states, $230 million annually to bolster workforce capacity, $70 million annually to improve stockpile distribution capabilities, and $200 million for modernizing laboratory capabilities.

The federal government also should provide $100 million to improve disease tracking capabilities.

TFAH noted that experts have widely recognized that the nation's public health system is "chronically underfunded" and that sustained effort is needed for improvements. "This all costs money," said Lowell Weicker Jr., TFAH board president.

Such funds should be new money, not funds appropriated from other health programs, Dr. Hearne added.

The group called for increased leadership and oversight of bioterrorism and public health preparedness, including a "single accountable official below the Secretary of HHS with budget and policy authority for programs."

It also recommended performance standards and increased measures to ensure state and local planning efforts, as well as public involvement with planning and heightened efforts to include the needs of vulnerable populations in emergency plans.

On the state level, the group scored Delaware, South Carolina, and Virginia as the most prepared states, meeting 8 out of 10 preparedness indicators. Sixteen states met 5 of 10 indicators. Worst prepared were Alabama, Alaska, Iowa, and New Hampshire, which met only two indicators.

States were measured on indicators representing capabilities of state and local health departments and reflecting the use of bioterrorism and public health grants received through the Centers for Disease Control and Prevention.

Indicators measured laboratory response capabilities, numbers of lab scientists, chemical response capabilities, and standards to track disease outbreak information. Data to rate performance on these indicators came from CDC reports, surveys by the Association of Public Health Laboratories, public announcements from states, and interviews with government officials.

The Trust for America's Health is a nonprofit, nonpartisan advocacy organization.

Hospitals in only two states have adequate plans to encourage health professionals to report to work during a major infectious disease outbreak, according to a report from the Trust for America's Health.

Hospitals in Rhode Island and South Dakota provide incentives such as health care workforce priority for vaccines and medicines and extra compensation for workers during emergencies, Shelley Hearne, Dr.P.H., executive director of the Trust for America's Health (TFAH), said at a press briefing to release the organization's 2005 report card of all-hazard preparedness in the U.S. public health system.

Overall, TFAH gave the federal government an overall D+ for levels of preparedness. The grade includes preparations for the Strategic National Stockpile (C+); federal initiatives including cities readiness, biosurveillance, pandemic flu planning, and oversight and management of federal funds and programs (C-); and coordination among agencies (D).

"While considerable progress has been achieved in improving America's post-September 11 health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face," the report said. It added that the response to Hurricane Katrina provided many valuable lessons in preparedness.

"Hurricane Katrina provided a sharp indictment of America's emergency response capabilities as the gaps between 'plans' and 'realities' became strikingly evident," the report said. "Parts of the public health system did not work, and while many did work as intended, those functions were often too limited and divorced from other response activities to match the real needs in a timely way."

The group calls for full funding of public health and bioterrorism preparedness legislation and for congressional passage of the $7.1 billion pandemic influenza preparedness request made earlier this year by President Bush.

The federal government also should provide $1 billion annually in medical/hospital surge capacity grants to states, TFAH said. In addition, Congress should fund $950 million annually in public health bioterrorism preparedness grants to states, $230 million annually to bolster workforce capacity, $70 million annually to improve stockpile distribution capabilities, and $200 million for modernizing laboratory capabilities.

The federal government also should provide $100 million to improve disease tracking capabilities.

TFAH noted that experts have widely recognized that the nation's public health system is "chronically underfunded" and that sustained effort is needed for improvements. "This all costs money," said Lowell Weicker Jr., TFAH board president.

Such funds should be new money, not funds appropriated from other health programs, Dr. Hearne added.

The group called for increased leadership and oversight of bioterrorism and public health preparedness, including a "single accountable official below the Secretary of HHS with budget and policy authority for programs."

It also recommended performance standards and increased measures to ensure state and local planning efforts, as well as public involvement with planning and heightened efforts to include the needs of vulnerable populations in emergency plans.

On the state level, the group scored Delaware, South Carolina, and Virginia as the most prepared states, meeting 8 out of 10 preparedness indicators. Sixteen states met 5 of 10 indicators. Worst prepared were Alabama, Alaska, Iowa, and New Hampshire, which met only two indicators.

States were measured on indicators representing capabilities of state and local health departments and reflecting the use of bioterrorism and public health grants received through the Centers for Disease Control and Prevention.

Indicators measured laboratory response capabilities, numbers of lab scientists, chemical response capabilities, and standards to track disease outbreak information. Data to rate performance on these indicators came from CDC reports, surveys by the Association of Public Health Laboratories, public announcements from states, and interviews with government officials.

The Trust for America's Health is a nonprofit, nonpartisan advocacy organization.

Hospitals in only two states have adequate plans to encourage health professionals to report to work during a major infectious disease outbreak, according to a report from the Trust for America's Health.

Hospitals in Rhode Island and South Dakota provide incentives such as health care workforce priority for vaccines and medicines and extra compensation for workers during emergencies, Shelley Hearne, Dr.P.H., executive director of the Trust for America's Health (TFAH), said at a press briefing to release the organization's 2005 report card of all-hazard preparedness in the U.S. public health system.

Overall, TFAH gave the federal government an overall D+ for levels of preparedness. The grade includes preparations for the Strategic National Stockpile (C+); federal initiatives including cities readiness, biosurveillance, pandemic flu planning, and oversight and management of federal funds and programs (C-); and coordination among agencies (D).

"While considerable progress has been achieved in improving America's post-September 11 health emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face," the report said. It added that the response to Hurricane Katrina provided many valuable lessons in preparedness.

"Hurricane Katrina provided a sharp indictment of America's emergency response capabilities as the gaps between 'plans' and 'realities' became strikingly evident," the report said. "Parts of the public health system did not work, and while many did work as intended, those functions were often too limited and divorced from other response activities to match the real needs in a timely way."

The group calls for full funding of public health and bioterrorism preparedness legislation and for congressional passage of the $7.1 billion pandemic influenza preparedness request made earlier this year by President Bush.

The federal government also should provide $1 billion annually in medical/hospital surge capacity grants to states, TFAH said. In addition, Congress should fund $950 million annually in public health bioterrorism preparedness grants to states, $230 million annually to bolster workforce capacity, $70 million annually to improve stockpile distribution capabilities, and $200 million for modernizing laboratory capabilities.

The federal government also should provide $100 million to improve disease tracking capabilities.

TFAH noted that experts have widely recognized that the nation's public health system is "chronically underfunded" and that sustained effort is needed for improvements. "This all costs money," said Lowell Weicker Jr., TFAH board president.

Such funds should be new money, not funds appropriated from other health programs, Dr. Hearne added.

The group called for increased leadership and oversight of bioterrorism and public health preparedness, including a "single accountable official below the Secretary of HHS with budget and policy authority for programs."

It also recommended performance standards and increased measures to ensure state and local planning efforts, as well as public involvement with planning and heightened efforts to include the needs of vulnerable populations in emergency plans.

On the state level, the group scored Delaware, South Carolina, and Virginia as the most prepared states, meeting 8 out of 10 preparedness indicators. Sixteen states met 5 of 10 indicators. Worst prepared were Alabama, Alaska, Iowa, and New Hampshire, which met only two indicators.

States were measured on indicators representing capabilities of state and local health departments and reflecting the use of bioterrorism and public health grants received through the Centers for Disease Control and Prevention.

Indicators measured laboratory response capabilities, numbers of lab scientists, chemical response capabilities, and standards to track disease outbreak information. Data to rate performance on these indicators came from CDC reports, surveys by the Association of Public Health Laboratories, public announcements from states, and interviews with government officials.

The Trust for America's Health is a nonprofit, nonpartisan advocacy organization.

WASHINGTON — American health care could be in for the world's largest customer satisfaction survey as the U.S. Citizens' Health Care Working Group seeks comments nationwide on how to reform the system.

“In order to make health care work for all Americans, we need to hear from all Americans,” said working group member Rosario Perez, a registered nurse and vice president of Mission Integration and Outreach Services for CHRISTUS Santa Rosa Health Care in San Antonio. “We want to hear from individuals across the country. That means your parents, your relatives, your coworkers, and people in your community.” Perez spoke at a briefing sponsored by the Citizen's Health Care Working Group.

Established by the 2003 Medicare Modernization Act, the 14-member panel will collect as many comments and suggestions as possible before April 15. Submissions will serve as the basis for panel recommendations for Congress and President Bush to consider next spring. The recommendations will address costs, care affordability, and quality improvement.

“Despite increases in medical care spending that are greater than the rate of inflation, population growth, and Gross Domestic Product growth, there has not been a commensurate improvement in our health status as a nation,” according to the law that established the working group.

Among areas of interest highlighted by the working group are consumer concerns about health care delivery, benefits that should be provided, how health care should be paid for, and acceptable trade-offs to ensure broad access to services.

The Health Care Working Group will collect comments via its Internet site (www.citizenshealthcare.gov

The press briefing was held in the same Senate room as the 1912 hearings on the sinking of the Titanic, and Sen. Wyden said the U.S. health care system could suffer a similar dire fate “if something dramatic isn't done to save it.”

Sen. Wyden suggested citizen input may engender systemic change that has stymied Congress for the last 6 decades. A “citizens' road map” for change could help “overcome the feeding frenzy by special interests,” he argued.

The panel is made up of health care professionals, economists, benefits experts, and advocates from across the country, and includes Health and Human Services Secretary Michael Leavitt. The group is chaired by Randall L. Johnson, head of corporate benefits for Motorola Inc.; vice chair is Catherine McLaughlin, Ph.D., a health economist at the University of Michigan. To jump start the national discussion, the group developed a 30-page “Health Report to the American People,” which summarizes the current state of U.S. health care.

WASHINGTON — American health care could be in for the world's largest customer satisfaction survey as the U.S. Citizens' Health Care Working Group seeks comments nationwide on how to reform the system.

“In order to make health care work for all Americans, we need to hear from all Americans,” said working group member Rosario Perez, a registered nurse and vice president of Mission Integration and Outreach Services for CHRISTUS Santa Rosa Health Care in San Antonio. “We want to hear from individuals across the country. That means your parents, your relatives, your coworkers, and people in your community.” Perez spoke at a briefing sponsored by the Citizen's Health Care Working Group.

Established by the 2003 Medicare Modernization Act, the 14-member panel will collect as many comments and suggestions as possible before April 15. Submissions will serve as the basis for panel recommendations for Congress and President Bush to consider next spring. The recommendations will address costs, care affordability, and quality improvement.

“Despite increases in medical care spending that are greater than the rate of inflation, population growth, and Gross Domestic Product growth, there has not been a commensurate improvement in our health status as a nation,” according to the law that established the working group.

Among areas of interest highlighted by the working group are consumer concerns about health care delivery, benefits that should be provided, how health care should be paid for, and acceptable trade-offs to ensure broad access to services.

The Health Care Working Group will collect comments via its Internet site (www.citizenshealthcare.gov

The press briefing was held in the same Senate room as the 1912 hearings on the sinking of the Titanic, and Sen. Wyden said the U.S. health care system could suffer a similar dire fate “if something dramatic isn't done to save it.”

Sen. Wyden suggested citizen input may engender systemic change that has stymied Congress for the last 6 decades. A “citizens' road map” for change could help “overcome the feeding frenzy by special interests,” he argued.

The panel is made up of health care professionals, economists, benefits experts, and advocates from across the country, and includes Health and Human Services Secretary Michael Leavitt. The group is chaired by Randall L. Johnson, head of corporate benefits for Motorola Inc.; vice chair is Catherine McLaughlin, Ph.D., a health economist at the University of Michigan. To jump start the national discussion, the group developed a 30-page “Health Report to the American People,” which summarizes the current state of U.S. health care.

WASHINGTON — American health care could be in for the world's largest customer satisfaction survey as the U.S. Citizens' Health Care Working Group seeks comments nationwide on how to reform the system.

“In order to make health care work for all Americans, we need to hear from all Americans,” said working group member Rosario Perez, a registered nurse and vice president of Mission Integration and Outreach Services for CHRISTUS Santa Rosa Health Care in San Antonio. “We want to hear from individuals across the country. That means your parents, your relatives, your coworkers, and people in your community.” Perez spoke at a briefing sponsored by the Citizen's Health Care Working Group.

Established by the 2003 Medicare Modernization Act, the 14-member panel will collect as many comments and suggestions as possible before April 15. Submissions will serve as the basis for panel recommendations for Congress and President Bush to consider next spring. The recommendations will address costs, care affordability, and quality improvement.

“Despite increases in medical care spending that are greater than the rate of inflation, population growth, and Gross Domestic Product growth, there has not been a commensurate improvement in our health status as a nation,” according to the law that established the working group.

Among areas of interest highlighted by the working group are consumer concerns about health care delivery, benefits that should be provided, how health care should be paid for, and acceptable trade-offs to ensure broad access to services.

The Health Care Working Group will collect comments via its Internet site (www.citizenshealthcare.gov

The press briefing was held in the same Senate room as the 1912 hearings on the sinking of the Titanic, and Sen. Wyden said the U.S. health care system could suffer a similar dire fate “if something dramatic isn't done to save it.”

Sen. Wyden suggested citizen input may engender systemic change that has stymied Congress for the last 6 decades. A “citizens' road map” for change could help “overcome the feeding frenzy by special interests,” he argued.

The panel is made up of health care professionals, economists, benefits experts, and advocates from across the country, and includes Health and Human Services Secretary Michael Leavitt. The group is chaired by Randall L. Johnson, head of corporate benefits for Motorola Inc.; vice chair is Catherine McLaughlin, Ph.D., a health economist at the University of Michigan. To jump start the national discussion, the group developed a 30-page “Health Report to the American People,” which summarizes the current state of U.S. health care.