Nellie Bristol

WASHINGTON — A coalition of national mental health organizations—including the American Psychiatric Association and the National Alliance for the Mentally Ill—has launched a campaign aimed at implementing some of the goals set 2 years ago by the New Freedom Commission on Mental Health.

A top priority of the effort, called the Campaign for Mental Health Reform, is the enactment of mental health-parity legislation. Other priorities include using Medicaid funds for home- and community-based care instead of institutional services and allowing states to fund comprehensive treatment plans. The campaign also will work for legislation aimed at allowing families to buy into Medicaid services for children with disabilities.

Ending discrimination in the treatment of mental illness is “the next frontier,” according to Sen. Edward M. Kennedy (D-Mass.), who attended the press event in late July outlining the campaign's agenda.

“It is something that this country has to come to grips with. [We] should and will be the better country, be a fairer, more just country, when we deal with this in the way that we have with physical illness,” said Sen. Kennedy, who was joined by several other members of Congress, including Sen. Mike DeWine (R-Ohio), Rep. Patrick Kennedy (D-R.I.), Rep. Sue Myrick (R-N.C.), and Rep. Jim Ramstad (R-Minn).

The coalition's steering committee members are from the Bazelon Center for Mental Health Law, the National Association of State Mental Health Program Directors, the National Mental Health Association, and NAMI. The group developed “Emergency Response: A Roadmap for Federal Action on America's Mental Health Crisis,” which lists 28 “action steps” aimed at improving provision of mental health services in the United States.

In 2003, President Bush's New Freedom Commission on Mental Health report called for “fundamental transformation of the nation's approach to mental health care.” However, the Campaign for Mental Health Reform noted in its executive summary that “there has been little progress in realizing the commission's goals or implementing its recommendations.”

In fact, since the commission released its report, the campaign noted, 63,000 Americans have died from suicide; more than 200,000 Americans with mental illness have been incarcerated; more than 25,000 families have given up custody of their children to get them mental health services; and juvenile detention centers have spent $200 million “'warehousing' youth instead of providing treatment.”

The campaign estimates that the U.S. economy has lost more than $150 billion in productivity because of unaddressed mental health needs. Other priorities for the group include reforming copayments for mental health treatment under Medicare and providing early identification and effective treatment both for returning veterans at risk of posttraumatic stress disorder and to mothers and children who receive health care at federally funded maternal- and child-health clinics.

The coalition also advocates presumptive eligibility for Social Security benefits and Medicaid for mentally ill homeless people and diverting mentally ill individuals who have committed nonviolent crimes into treatment instead of jail or prison.

Some of the group's priority proposals are included in legislation pending in the House or Senate, campaign director Charles Konigsberg said. For example, mental health parity is outlined in the Paul Wellstone Mental Health Equitable Treatment Act of 2005, sponsored in the House by Rep. Kennedy. Attempts to pass mental health-parity legislation have failed for the last several years.

Legislation to encourage states to let parents keep custody of their mentally ill children and still receive services is sponsored in the House by Rep. Ramstad and in the Senate by Sen. Susan Collins (R-Maine).

Mr. Konigsberg said the campaign considers its effort complementary to that of a federal agency agenda for mental health services improvement announced a few days earlier by six federal departments. The “multiyear effort to alter the form and function of the mental health system,” includes a federal executive steering committee that would oversee the “mental health system transformation,” according to press materials.

The 70-item Mental Health Action Agenda includes reinforcing the message that mental illness and emotional disturbances are treatable and that “recovery is the expectation,” through a national public education program sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The agenda also proposes working to reduce the number of suicides through implementation of the National Strategy for Suicide Prevention and helping states formulate and implement comprehensive state mental health plans that would be able to create individualized plans of care.

WASHINGTON — A coalition of national mental health organizations—including the American Psychiatric Association and the National Alliance for the Mentally Ill—has launched a campaign aimed at implementing some of the goals set 2 years ago by the New Freedom Commission on Mental Health.

A top priority of the effort, called the Campaign for Mental Health Reform, is the enactment of mental health-parity legislation. Other priorities include using Medicaid funds for home- and community-based care instead of institutional services and allowing states to fund comprehensive treatment plans. The campaign also will work for legislation aimed at allowing families to buy into Medicaid services for children with disabilities.

Ending discrimination in the treatment of mental illness is “the next frontier,” according to Sen. Edward M. Kennedy (D-Mass.), who attended the press event in late July outlining the campaign's agenda.

“It is something that this country has to come to grips with. [We] should and will be the better country, be a fairer, more just country, when we deal with this in the way that we have with physical illness,” said Sen. Kennedy, who was joined by several other members of Congress, including Sen. Mike DeWine (R-Ohio), Rep. Patrick Kennedy (D-R.I.), Rep. Sue Myrick (R-N.C.), and Rep. Jim Ramstad (R-Minn).

The coalition's steering committee members are from the Bazelon Center for Mental Health Law, the National Association of State Mental Health Program Directors, the National Mental Health Association, and NAMI. The group developed “Emergency Response: A Roadmap for Federal Action on America's Mental Health Crisis,” which lists 28 “action steps” aimed at improving provision of mental health services in the United States.

In 2003, President Bush's New Freedom Commission on Mental Health report called for “fundamental transformation of the nation's approach to mental health care.” However, the Campaign for Mental Health Reform noted in its executive summary that “there has been little progress in realizing the commission's goals or implementing its recommendations.”

In fact, since the commission released its report, the campaign noted, 63,000 Americans have died from suicide; more than 200,000 Americans with mental illness have been incarcerated; more than 25,000 families have given up custody of their children to get them mental health services; and juvenile detention centers have spent $200 million “'warehousing' youth instead of providing treatment.”

The campaign estimates that the U.S. economy has lost more than $150 billion in productivity because of unaddressed mental health needs. Other priorities for the group include reforming copayments for mental health treatment under Medicare and providing early identification and effective treatment both for returning veterans at risk of posttraumatic stress disorder and to mothers and children who receive health care at federally funded maternal- and child-health clinics.

The coalition also advocates presumptive eligibility for Social Security benefits and Medicaid for mentally ill homeless people and diverting mentally ill individuals who have committed nonviolent crimes into treatment instead of jail or prison.

Some of the group's priority proposals are included in legislation pending in the House or Senate, campaign director Charles Konigsberg said. For example, mental health parity is outlined in the Paul Wellstone Mental Health Equitable Treatment Act of 2005, sponsored in the House by Rep. Kennedy. Attempts to pass mental health-parity legislation have failed for the last several years.

Legislation to encourage states to let parents keep custody of their mentally ill children and still receive services is sponsored in the House by Rep. Ramstad and in the Senate by Sen. Susan Collins (R-Maine).

Mr. Konigsberg said the campaign considers its effort complementary to that of a federal agency agenda for mental health services improvement announced a few days earlier by six federal departments. The “multiyear effort to alter the form and function of the mental health system,” includes a federal executive steering committee that would oversee the “mental health system transformation,” according to press materials.

The 70-item Mental Health Action Agenda includes reinforcing the message that mental illness and emotional disturbances are treatable and that “recovery is the expectation,” through a national public education program sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The agenda also proposes working to reduce the number of suicides through implementation of the National Strategy for Suicide Prevention and helping states formulate and implement comprehensive state mental health plans that would be able to create individualized plans of care.

WASHINGTON — A coalition of national mental health organizations—including the American Psychiatric Association and the National Alliance for the Mentally Ill—has launched a campaign aimed at implementing some of the goals set 2 years ago by the New Freedom Commission on Mental Health.

A top priority of the effort, called the Campaign for Mental Health Reform, is the enactment of mental health-parity legislation. Other priorities include using Medicaid funds for home- and community-based care instead of institutional services and allowing states to fund comprehensive treatment plans. The campaign also will work for legislation aimed at allowing families to buy into Medicaid services for children with disabilities.

Ending discrimination in the treatment of mental illness is “the next frontier,” according to Sen. Edward M. Kennedy (D-Mass.), who attended the press event in late July outlining the campaign's agenda.

“It is something that this country has to come to grips with. [We] should and will be the better country, be a fairer, more just country, when we deal with this in the way that we have with physical illness,” said Sen. Kennedy, who was joined by several other members of Congress, including Sen. Mike DeWine (R-Ohio), Rep. Patrick Kennedy (D-R.I.), Rep. Sue Myrick (R-N.C.), and Rep. Jim Ramstad (R-Minn).

The coalition's steering committee members are from the Bazelon Center for Mental Health Law, the National Association of State Mental Health Program Directors, the National Mental Health Association, and NAMI. The group developed “Emergency Response: A Roadmap for Federal Action on America's Mental Health Crisis,” which lists 28 “action steps” aimed at improving provision of mental health services in the United States.

In 2003, President Bush's New Freedom Commission on Mental Health report called for “fundamental transformation of the nation's approach to mental health care.” However, the Campaign for Mental Health Reform noted in its executive summary that “there has been little progress in realizing the commission's goals or implementing its recommendations.”

In fact, since the commission released its report, the campaign noted, 63,000 Americans have died from suicide; more than 200,000 Americans with mental illness have been incarcerated; more than 25,000 families have given up custody of their children to get them mental health services; and juvenile detention centers have spent $200 million “'warehousing' youth instead of providing treatment.”

The campaign estimates that the U.S. economy has lost more than $150 billion in productivity because of unaddressed mental health needs. Other priorities for the group include reforming copayments for mental health treatment under Medicare and providing early identification and effective treatment both for returning veterans at risk of posttraumatic stress disorder and to mothers and children who receive health care at federally funded maternal- and child-health clinics.

The coalition also advocates presumptive eligibility for Social Security benefits and Medicaid for mentally ill homeless people and diverting mentally ill individuals who have committed nonviolent crimes into treatment instead of jail or prison.

Some of the group's priority proposals are included in legislation pending in the House or Senate, campaign director Charles Konigsberg said. For example, mental health parity is outlined in the Paul Wellstone Mental Health Equitable Treatment Act of 2005, sponsored in the House by Rep. Kennedy. Attempts to pass mental health-parity legislation have failed for the last several years.

Legislation to encourage states to let parents keep custody of their mentally ill children and still receive services is sponsored in the House by Rep. Ramstad and in the Senate by Sen. Susan Collins (R-Maine).

Mr. Konigsberg said the campaign considers its effort complementary to that of a federal agency agenda for mental health services improvement announced a few days earlier by six federal departments. The “multiyear effort to alter the form and function of the mental health system,” includes a federal executive steering committee that would oversee the “mental health system transformation,” according to press materials.

The 70-item Mental Health Action Agenda includes reinforcing the message that mental illness and emotional disturbances are treatable and that “recovery is the expectation,” through a national public education program sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The agenda also proposes working to reduce the number of suicides through implementation of the National Strategy for Suicide Prevention and helping states formulate and implement comprehensive state mental health plans that would be able to create individualized plans of care.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement—and is likely to demand some adjustment in physician attitudes about error reporting.

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can be used in a criminal trial only after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

The law authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish “niche PSOs” to track specific areas, such as anesthesiology.

For physicians, who have operated so long in an environment of liability fear, it may take a while to trust the new system, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“Physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding that it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

Many patient safety organizations will likely be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers,” Dr. Fleming said. “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The PSOs will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

Federal PSOs will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal PSOs. The federal program will provide standardized reporting methods and more in-depth, comprehensive analysis and potentially will develop more solutions to common problems, she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement—and is likely to demand some adjustment in physician attitudes about error reporting.

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can be used in a criminal trial only after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

The law authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish “niche PSOs” to track specific areas, such as anesthesiology.

For physicians, who have operated so long in an environment of liability fear, it may take a while to trust the new system, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“Physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding that it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

Many patient safety organizations will likely be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers,” Dr. Fleming said. “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The PSOs will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

Federal PSOs will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal PSOs. The federal program will provide standardized reporting methods and more in-depth, comprehensive analysis and potentially will develop more solutions to common problems, she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement—and is likely to demand some adjustment in physician attitudes about error reporting.

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can be used in a criminal trial only after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

The law authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish “niche PSOs” to track specific areas, such as anesthesiology.

For physicians, who have operated so long in an environment of liability fear, it may take a while to trust the new system, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“Physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding that it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

Many patient safety organizations will likely be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers,” Dr. Fleming said. “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The PSOs will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

Federal PSOs will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal PSOs. The federal program will provide standardized reporting methods and more in-depth, comprehensive analysis and potentially will develop more solutions to common problems, she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush likely will take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding it may take physicians time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Under the law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the law could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat.”

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish “niche PSOs” to track specific areas, such as anesthesiology.

AAFP's Dr. Fleming said that while many such organizations likely would be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers.” He added, “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The PSOs will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

WASHINGTON — The patient safety system signed into law this summer by President Bush likely will take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding it may take physicians time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Under the law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the law could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat.”

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish “niche PSOs” to track specific areas, such as anesthesiology.

AAFP's Dr. Fleming said that while many such organizations likely would be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers.” He added, “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The PSOs will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

WASHINGTON — The patient safety system signed into law this summer by President Bush likely will take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding it may take physicians time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Under the law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the law could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat.”

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish “niche PSOs” to track specific areas, such as anesthesiology.

AAFP's Dr. Fleming said that while many such organizations likely would be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers.” He added, “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The PSOs will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

WASHINGTON – Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act.

According to recommendations developed by Andy Schneider, an attorney and Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billon in reduced federal spending over 5 years.

Mr. Dorn offered other cost savings alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies. The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Limits on spending and benefits are not part of any current federal budget plans, but lawmakers are looking broadly at Medicaid reform proposals this year. Caps could be considered as part of those proposals, Mr. Dorn pointed out at the forum, which was cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, Mr. Dorn said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” he said, meaning it expands as the economy contracts. Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows. With national and state unemployment rates as triggers, automatic adjustment would not require waiting for new federal legislation each time a recession begins and the increase would end promptly when economic conditions improved. “It would be better timed and come into effect immediately,” Dorn noted. Congress passed a 2.95% increase in the federal matching rate for the 15 months ending on June 30, 2004.

Studies show the boost allowed states to continue Medicaid benefits even though state revenues shrank.

WASHINGTON – Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act.

According to recommendations developed by Andy Schneider, an attorney and Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billon in reduced federal spending over 5 years.

Mr. Dorn offered other cost savings alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies. The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Limits on spending and benefits are not part of any current federal budget plans, but lawmakers are looking broadly at Medicaid reform proposals this year. Caps could be considered as part of those proposals, Mr. Dorn pointed out at the forum, which was cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, Mr. Dorn said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” he said, meaning it expands as the economy contracts. Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows. With national and state unemployment rates as triggers, automatic adjustment would not require waiting for new federal legislation each time a recession begins and the increase would end promptly when economic conditions improved. “It would be better timed and come into effect immediately,” Dorn noted. Congress passed a 2.95% increase in the federal matching rate for the 15 months ending on June 30, 2004.

Studies show the boost allowed states to continue Medicaid benefits even though state revenues shrank.

WASHINGTON – Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act.

According to recommendations developed by Andy Schneider, an attorney and Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billon in reduced federal spending over 5 years.

Mr. Dorn offered other cost savings alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies. The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Limits on spending and benefits are not part of any current federal budget plans, but lawmakers are looking broadly at Medicaid reform proposals this year. Caps could be considered as part of those proposals, Mr. Dorn pointed out at the forum, which was cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, Mr. Dorn said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” he said, meaning it expands as the economy contracts. Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows. With national and state unemployment rates as triggers, automatic adjustment would not require waiting for new federal legislation each time a recession begins and the increase would end promptly when economic conditions improved. “It would be better timed and come into effect immediately,” Dorn noted. Congress passed a 2.95% increase in the federal matching rate for the 15 months ending on June 30, 2004.

Studies show the boost allowed states to continue Medicaid benefits even though state revenues shrank.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement—and is likely to demand some adjustment in physician attitudes about error reporting.

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can be used in a criminal trial only after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

This structure will allow providers to voluntarily submit information to patient safety organizations that have been certified by the Department of Health and Human Services. Patient confidentiality must be maintained.

The purpose of the patient safety system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would help prevent similar errors in the future.

The law authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish 'niche patient safety organizations' to track specific areas, such as anesthesiology.

For physicians, who have operated so long in an environment characterized by liability fear, it may take a while to trust the new system, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“Physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding that it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

Many patient safety organizations will most likely be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers,” Dr. Fleming said. “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The patient safety organizations (PSOs) will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

Federal patient safety organizations will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal patient safety organizations.

The federal program will provide standardized reporting methods and more in-depth, comprehensive analysis. In addition, the federal system has the potential to develop more solutions to common problems, Ms. VanAmringe said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement—and is likely to demand some adjustment in physician attitudes about error reporting.

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can be used in a criminal trial only after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

This structure will allow providers to voluntarily submit information to patient safety organizations that have been certified by the Department of Health and Human Services. Patient confidentiality must be maintained.

The purpose of the patient safety system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would help prevent similar errors in the future.

The law authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish 'niche patient safety organizations' to track specific areas, such as anesthesiology.

For physicians, who have operated so long in an environment characterized by liability fear, it may take a while to trust the new system, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“Physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding that it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

Many patient safety organizations will most likely be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers,” Dr. Fleming said. “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The patient safety organizations (PSOs) will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

Federal patient safety organizations will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal patient safety organizations.

The federal program will provide standardized reporting methods and more in-depth, comprehensive analysis. In addition, the federal system has the potential to develop more solutions to common problems, Ms. VanAmringe said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement—and is likely to demand some adjustment in physician attitudes about error reporting.

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can be used in a criminal trial only after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

This structure will allow providers to voluntarily submit information to patient safety organizations that have been certified by the Department of Health and Human Services. Patient confidentiality must be maintained.

The purpose of the patient safety system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would help prevent similar errors in the future.

The law authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations. It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information.

HHS will also certify the organizations, which were described as “new animals,” by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Ms. VanAmringe also said groups like JCAHO could develop patient safety organizations, as could medical specialty organizations looking to establish 'niche patient safety organizations' to track specific areas, such as anesthesiology.

For physicians, who have operated so long in an environment characterized by liability fear, it may take a while to trust the new system, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“Physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming, adding that it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

Many patient safety organizations will most likely be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers,” Dr. Fleming said. “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said patient safety organizations will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” The patient safety organizations (PSOs) will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

Federal patient safety organizations will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal patient safety organizations.

The federal program will provide standardized reporting methods and more in-depth, comprehensive analysis. In addition, the federal system has the potential to develop more solutions to common problems, Ms. VanAmringe said.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in "another unfunded mandate" for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, "Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient."

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

"I really want a lot of information, very digestible," said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. "Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'"

"We are trying to make the information available as simple as possible," said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting "much more robust formularies" from drug plans than officials had anticipated. "They're looking like commercial formularies," he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but "preferably with a physician's help," he said. "All medically necessary drugs that are approved by the FDA with certain exceptions have to be available." However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary. Part D also will ensure drugs are available for chronic conditions by "favorably risk adjusting" those diseases, Dr. Kelman said. The plans also will "overadjust" for low-income individuals and nursing homes.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn. said she was relieved by Dr. Kelman's comments. "We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies."

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. Beneficiaries can enroll in the program from Nov. 15 through May 15.

In other issues, Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. Other drugs not covered include cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in "another unfunded mandate" for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, "Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient."

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

"I really want a lot of information, very digestible," said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. "Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'"

"We are trying to make the information available as simple as possible," said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting "much more robust formularies" from drug plans than officials had anticipated. "They're looking like commercial formularies," he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but "preferably with a physician's help," he said. "All medically necessary drugs that are approved by the FDA with certain exceptions have to be available." However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary. Part D also will ensure drugs are available for chronic conditions by "favorably risk adjusting" those diseases, Dr. Kelman said. The plans also will "overadjust" for low-income individuals and nursing homes.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn. said she was relieved by Dr. Kelman's comments. "We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies."

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. Beneficiaries can enroll in the program from Nov. 15 through May 15.

In other issues, Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. Other drugs not covered include cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in "another unfunded mandate" for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, "Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient."

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple as possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

"I really want a lot of information, very digestible," said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. "Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'"

"We are trying to make the information available as simple as possible," said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested that the agency develop a computer program that would allow physicians to type in the drugs a patient is using and come up with the plan that would cover all of them. She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting "much more robust formularies" from drug plans than officials had anticipated. "They're looking like commercial formularies," he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but "preferably with a physician's help," he said. "All medically necessary drugs that are approved by the FDA with certain exceptions have to be available." However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary. Part D also will ensure drugs are available for chronic conditions by "favorably risk adjusting" those diseases, Dr. Kelman said. The plans also will "overadjust" for low-income individuals and nursing homes.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn. said she was relieved by Dr. Kelman's comments. "We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies."

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. Beneficiaries can enroll in the program from Nov. 15 through May 15.

In other issues, Dr. Kelman pointed out that by law, barbiturates and benzodiazepines will not be covered by the plans. Other drugs not covered include cosmetic agents and weight-loss and weight-gain products.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

"I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously," said Dr. Fleming. But, he added, it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. "In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things."

Under the new law, a "patient safety work product" of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is "material to the proceeding" and "not reasonably available from another source," according to the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. "This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat," he noted.

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS "secretary's got a lot to do to set it up." HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations and must develop or adopt voluntary national standards to promote electronic exchange of health care information.

HHS will also certify the organizations, which were described as "new animals," by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Groups such as JCAHO could develop patient safety organizations, as could medical specialty organizations.

AAFP's Dr. Fleming said that while many such organizations likely would be run by systems analysts and industrial engineers, "I'm hoping there are also going to be peers. I think physicians are going to feel much more comfortable if we have peer evaluation."

Ms. VanAmringe said patient safety organizations will not only need to collect data but also aggregate and analyze those data to provide institutions with "feedback on common problems." The PSOs will develop solutions and best practices by collating data from different institutions and monitoring whether proposed interventions work. "PSOs will play a fairly robust role in using the data that are reported to them," she said.

Federal PSOs will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal PSOs. The federal program will provide standardized reporting methods, more in-depth analysis, and will potentially develop more solutions to common problems, she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

"I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously," said Dr. Fleming. But, he added, it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. "In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things."

Under the new law, a "patient safety work product" of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is "material to the proceeding" and "not reasonably available from another source," according to the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. "This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat," he noted.

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS "secretary's got a lot to do to set it up." HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations and must develop or adopt voluntary national standards to promote electronic exchange of health care information.

HHS will also certify the organizations, which were described as "new animals," by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Groups such as JCAHO could develop patient safety organizations, as could medical specialty organizations.

AAFP's Dr. Fleming said that while many such organizations likely would be run by systems analysts and industrial engineers, "I'm hoping there are also going to be peers. I think physicians are going to feel much more comfortable if we have peer evaluation."

Ms. VanAmringe said patient safety organizations will not only need to collect data but also aggregate and analyze those data to provide institutions with "feedback on common problems." The PSOs will develop solutions and best practices by collating data from different institutions and monitoring whether proposed interventions work. "PSOs will play a fairly robust role in using the data that are reported to them," she said.

Federal PSOs will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal PSOs. The federal program will provide standardized reporting methods, more in-depth analysis, and will potentially develop more solutions to common problems, she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

"I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously," said Dr. Fleming. But, he added, it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. "In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things."

Under the new law, a "patient safety work product" of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is "material to the proceeding" and "not reasonably available from another source," according to the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Department of Health and Human Services. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. "This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat," he noted.

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS "secretary's got a lot to do to set it up." HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations and must develop or adopt voluntary national standards to promote electronic exchange of health care information.

HHS will also certify the organizations, which were described as "new animals," by Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

There are several possible models for patient safety organizations, she said, including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors. Groups such as JCAHO could develop patient safety organizations, as could medical specialty organizations.

AAFP's Dr. Fleming said that while many such organizations likely would be run by systems analysts and industrial engineers, "I'm hoping there are also going to be peers. I think physicians are going to feel much more comfortable if we have peer evaluation."

Ms. VanAmringe said patient safety organizations will not only need to collect data but also aggregate and analyze those data to provide institutions with "feedback on common problems." The PSOs will develop solutions and best practices by collating data from different institutions and monitoring whether proposed interventions work. "PSOs will play a fairly robust role in using the data that are reported to them," she said.

Federal PSOs will not preempt state laws, even those with mandatory reporting systems, but VanAmringe said many state arrangements are more narrowly focused and do not provide the data analysis expected from federal PSOs. The federal program will provide standardized reporting methods, more in-depth analysis, and will potentially develop more solutions to common problems, she said.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested the agency to develop a computer program that would allow physicians to type in the drugs a patient is using and come up with a plan to cover all of them.

She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare-drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes.

“We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared to others in their region and to commercial plans.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn., said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from Nov. 15 through May 15.

Dr. Kelman also noted that by law, barbiturates and benzodiazepines will not be covered. Those medications are inexpensive and the program was hoping states would continue to pay for them for beneficiaries receiving both Medicaid and Medicare benefits. Cosmetic agents and weight-management products also will not be covered.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested the agency to develop a computer program that would allow physicians to type in the drugs a patient is using and come up with a plan to cover all of them.

She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare-drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes.

“We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared to others in their region and to commercial plans.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn., said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from Nov. 15 through May 15.

Dr. Kelman also noted that by law, barbiturates and benzodiazepines will not be covered. Those medications are inexpensive and the program was hoping states would continue to pay for them for beneficiaries receiving both Medicaid and Medicare benefits. Cosmetic agents and weight-management products also will not be covered.

WASHINGTON — Physician obligation to help patients negotiate the upcoming Medicare Part D outpatient drug benefit will result in “another unfunded mandate” for Medicare providers, Ronald Castellanos, M.D., chairman of the Practicing Physicians Advisory Council said at the group's recent meeting.

Noting that patients are most likely to rely on their physicians for aid in choosing among the new drug plans, Dr. Castellanos said, “Basically what you're doing is putting the burden on physicians in their offices to really educate the Medicare recipient.”

PPAC members asked the Centers for Medicare and Medicaid Services to make educational materials as simple possible, including information on whether beneficiaries are eligible for the low-income portion of the program.

“I really want a lot of information, very digestible,” said PPAC member Geraldine O'Shea, D.O., an internist from Jackson, Calif. “Something very easy for them to understand, because I do not want to take time out of my time to do medicine with my patient to say, 'Well, let me see your tax return.'”

“We are trying to make the information available as simple as possible,” said Jeffrey Kelman, M.D., medical officer for the CMS Center for Beneficiary Choices, noting that he would bring educational material to the council's next meeting.

Council member Barbara McAneny, M.D., an oncologist from Albuquerque, requested the agency to develop a computer program that would allow physicians to type in the drugs a patient is using and come up with a plan to cover all of them.

She also proposed a draft recommendation that would require CMS to develop a reimbursement code for physician time spent on drug plan education, but it was voted down by the panel, with members saying it wasn't practical.

Walking through the benefit, Dr. Kelman said CMS is getting “much more robust formularies” from drug plans than officials had anticipated. “They're looking like commercial formularies,” he said. He added that the formularies would be available on the Web site in October.

All drugs approved by the Food and Drug Administration must be on the formularies, Dr. Kelman said. If a drug is not included, a beneficiary can appeal, based on medical necessity, but “preferably with a physician's help,” he said. “All medically necessary drugs that are approved by the FDA with certain exceptions … have to be available.” However, off-label prescriptions will be covered, Dr. Kelman said.

In a move important to rare-drug organizations, Dr. Kelman said if there is only one drug to treat a disease, it must be included in the formulary.

Part D also will ensure drugs are available for chronic conditions by “favorably risk adjusting” those diseases, Dr. Kelman said. The plans also will “overadjust” for low-income individuals and nursing homes.

“We went to a lot to trouble to ensure nobody was discriminated against on the formulary or based on the Part D benefit,” Dr. Kelman said. He said formularies would be compared to others in their region and to commercial plans.

Council member Laura Powers, M.D., a neurologist from Knoxville, Tenn., said she was relieved by Dr. Kelman's comments. “We were so worried that our patients with very expensive drugs were going to be eliminated from all the formularies.”

Dr. Kelman urged physicians to begin moving patients to the new formularies before the benefit is effective Jan. 1, 2006. “The last thing we want is 40 million exceptions and appeals in the first week,” he said. Beneficiaries can enroll in the program from Nov. 15 through May 15.

Dr. Kelman also noted that by law, barbiturates and benzodiazepines will not be covered. Those medications are inexpensive and the program was hoping states would continue to pay for them for beneficiaries receiving both Medicaid and Medicare benefits. Cosmetic agents and weight-management products also will not be covered.

WASHINGTON — Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act.

According to recommendations developed by Andy Schneider, J.D., Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billion in reduced federal spending over 5 years.

Mr. Dorn offered other cost saving alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies.

The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Although limits on spending and benefits are not part of any current federal budget plans, lawmakers are looking broadly at Medicaid reform proposals this year; caps could be considered as part of those, Mr. Dorn pointed out at the forum, cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, he said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” Mr. Dorn said, meaning it expands as the economy contracts. Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows.

WASHINGTON — Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act.

According to recommendations developed by Andy Schneider, J.D., Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billion in reduced federal spending over 5 years.

Mr. Dorn offered other cost saving alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies.

The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Although limits on spending and benefits are not part of any current federal budget plans, lawmakers are looking broadly at Medicaid reform proposals this year; caps could be considered as part of those, Mr. Dorn pointed out at the forum, cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, he said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” Mr. Dorn said, meaning it expands as the economy contracts. Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows.

WASHINGTON — Private bounty hunters are one way to fight fraud in the Medicaid program, according to Stan Dorn, J.D., senior analyst at the Economic and Social Research Institute.

Successfully used by Medicare, the bounty hunter approach allows whistle-blowers to share in funds recovered through prosecutions under the False Claims Act.

According to recommendations developed by Andy Schneider, J.D., Medicaid policy expert for Taxpayers Against Fraud, Congress could bolster Medicaid whistle-blower opportunities by increasing federal payments to states that enact their own False Claims Act and by offering whistle-blowers a minimum of 20% of the federal share of any recovered funds.

At a policy forum sponsored by the American Public Health Association, Mr. Dorn included enhanced fraud reduction efforts among nine budget cutting options that would trim the cost of the program without capping spending or enrollment. Congress is expected to propose Medicaid program changes this year that will result in $10 billion in reduced federal spending over 5 years.

Mr. Dorn offered other cost saving alternatives, such as improving case management for the chronically ill and implementing community-based obesity prevention strategies.

The Bush administration in its fiscal year 2006 budget proposed reducing Medicaid funding by reforming the program's drug purchasing system and limiting asset transfers that qualify seniors for long-term care.

Although limits on spending and benefits are not part of any current federal budget plans, lawmakers are looking broadly at Medicaid reform proposals this year; caps could be considered as part of those, Mr. Dorn pointed out at the forum, cosponsored by the Joint Center for Political and Economic Studies.

Not only would caps affect Medicaid recipients, but they also could prove detrimental to the economy, he said.

Since Medicaid must provide benefits to all of those eligible, the bulk of the program is economically “countercyclical,” Mr. Dorn said, meaning it expands as the economy contracts. Not only does this ensure health benefits are available to low income individuals, but it also contributes to the flow of funds to health care providers and, in turn, other sectors of the economy.

To capitalize on Medicaid's stabilizing effects, Mr. Dorn suggested that federal matching rates could automatically rise when the economy slows.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming. But, he added, it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Health and Human Services department. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations (PSOs). It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information. HHS will also certify the PSOs.

According to Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), there are several possible models for the PSOs including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors.

AAFP's Dr. Fleming said that while many PSOs likely would be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers.” He added, “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said PSOs will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” They will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming. But, he added, it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Health and Human Services department. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations (PSOs). It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information. HHS will also certify the PSOs.

According to Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), there are several possible models for the PSOs including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors.

AAFP's Dr. Fleming said that while many PSOs likely would be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers.” He added, “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said PSOs will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” They will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.

WASHINGTON — The patient safety system signed into law this summer by President Bush will likely take many months to implement; but, after operating so long in an environment of liability fear, doctors may take even longer to trust it, said Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians.

“I think physicians are going to have to get comfortable with this and realize that [documenting errors under the plan] is a thing that you can do now, and it's going to improve quality tremendously,” said Dr. Fleming. But, he added, it may take physicians some time to lose their reporting inhibitions.

Doctors are concerned about reporting something going wrong, because someone will be at fault and liable for that situation, he said. “In medicine, unfortunately, too many times everybody—from staff to nurses to doctors—has been afraid to report things.”

Under the new law, a “patient safety work product” of reported errors and near misses is privileged and cannot be used in legal or disciplinary actions. Data collected can only be used in a criminal trial after the court makes a determination that the evidence is “material to the proceeding” and “not reasonably available from another source,” according to text of the Patient Safety and Quality Improvement Act of 2005.

The structure will allow providers to voluntarily submit information to patient safety organizations certified by the Health and Human Services department. Patient confidentiality must be maintained. The purpose of the system is to create a searchable database of medical errors that can be analyzed and used to develop new care systems and best practices that would avoid similar errors in the future.

Dr. Fleming said the arrangement could help reveal weaknesses in medication dispensing and other systems. “This will give us an opportunity, when these errors occur, to report them without having to worry about the consequences of a liability threat,” he noted.

The law became effective when the president signed it and authorizes federal funding for fiscal years 2006–2010. Implementation could begin as early as next year, said Gordon Wheeler, associate executive director for public affairs for the American College of Emergency Physicians, noting that for that to happen, the HHS “secretary's got a lot to do to set it up.”

HHS must coordinate databases nationwide into a single aggregated interactive resource for providers and patient safety organizations (PSOs). It also must develop or adopt voluntary national standards to promote the electronic exchange of health care information. HHS will also certify the PSOs.

According to Margaret VanAmringe, vice president for public policy and government relations at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), there are several possible models for the PSOs including U.S. Pharmacopeia's MEDMARX system. For a subscription fee, hospitals and health care systems can access MEDMARX's database to track adverse drug reactions and medication errors.

AAFP's Dr. Fleming said that while many PSOs likely would be run by systems analysts and industrial engineers, “I'm hoping there are also going to be peers.” He added, “I think physicians are going to feel much more comfortable if we have peer evaluation.”

Ms. VanAmringe said PSOs will not only need to collect data but also have the ability to aggregate and analyze those data to provide institutions with “feedback on common problems.” They will develop solutions and best practices by collating data from different institutions and then monitoring whether proposed interventions work.

“PSOs will play a fairly robust role in using the data that are reported to them,” she said.