Jane Anderson

WASHINGTON — The American College of Physicians, saying it is time for patients, physicians, and policy makers to consider the economic impact of health care choices along with their clinical impact, has issued a call for the creation of a new, independent entity that would conduct and disseminate such research.

Acknowledging fears that "this could be one of the first steps down the road to the rationing of care," Neil Kirschner, Ph.D., senior associate of regulatory and insurer affairs at the ACP, said that "the college believes this type of information should be used as a tool.

"Cost is already playing a major role in health care decisions," and patients and physicians deserve solid clinical and cost-effectiveness information to back up treatment decisions, Dr. Kirschner said at a press briefing about the ACP's new position paper outlining the need for better clinical and cost-effectiveness research.

The call comes at a time when lawmakers have shown some enthusiasm for research into comparative effectiveness. Last fall, about $375 million in proposed funding for such research—through the Agency for Healthcare Research and Quality (AHRQ)—was included in the Children's Health and Medicare Protection Act, but that bill failed to pass the Senate.

The position paper, released at the ACP's annual meeting and published simultaneously online in the Annals of Internal Medicine (www.annals.org/cgi/reprint/0000605-200806170-00222v1.pdf

The proposed new entity would develop and disseminate evidence on comparative clinical effectiveness and cost-effectiveness in health care, according to the ACP. It also would educate the public about what the ACP said is the urgency of modifying "an American cultural bias toward downplaying the cost of health care—especially when payment seemingly comes from a health insurer or other third-party payer rather than from patients' own pockets."

"Cost is not going away," ACP Regent Stephen Pauker said at the briefing, held during the ACP's annual meeting. "We are a country and a society of finite resources, and if we have limited resources we need to use those resources wisely."

Traditionally, researchers have compared treatments with placebo, but treatments must be compared with each other to gather information that would be useful in comparing cost and clinical effectiveness, Dr. Pauker noted. "Cost should be considered, but should never be considered without the simultaneous consideration of outcomes."

The ACP's position paper notes that many insurers already use information about cost because they must manage finite budgets.

"Of note, the strongest opposition seems to come from such constituencies as elderly persons and patients with certain chronic illnesses, for whom the incremental benefits of expensive interventions are typically small," the paper reads.

The ACP is lobbying to add funding to that Medicare legislation for creation of a new entity that would study both cost and clinical effectiveness, said ACP President David Dale.

"Who wouldn't want the most they can get for their money?" Dr. Dale said at the briefing. "On the other hand, this aspect of medicine has many complexities."

There is a research gap when it comes to studies comparing cost and clinical effectiveness of different treatments, according to the ACP's paper. "The college reviewed the national and international literature on comparative effectiveness information and came to the conclusion it is in incredibly short supply," Dr. Kirschner said.

For example, when comparing two cancer drug therapies, "A" could be substantially more expensive but could hold the potential for an additional 5 years of life, which could give it a cost-effectiveness advantage over less expensive therapy "B," Dr. Kirschner said. However, if the two therapies are similar in effectiveness but "A" is more expensive, then "B" would be preferred, he said.

"This type of relative economic value information is very little produced and very little used," Dr. Kirschner said. The National Institute for Health and Clinical Excellence in the United Kingdom produces this type of information for use in the U.K.'s National Health Service, he noted, but U.S. funding for such research at the AHRQ amounts to only $15 million a year.

There are concerns that development of this type of information could lead to limited access to more expensive therapies, and trigger a backlash from patient groups and other health system stakeholders, Dr. Kirschner said. For example, he said, "Medicare, on two different instances, tried to implement cost information in coverage, and both times has had to back off."

That's why the ACP is advocating that an independent, mostly federally funded entity conduct such research, Dr. Dale said. "The public and clinicians will only trust such information if it comes from an independent research source that does not itself have an economic conflict of interest in the results of its analyses."

The ACP would support adding such research funding to the AHRQ's budget if the studies could be adequately protected from the influence of special interests, Dr. Kirschner said.

However, the ACP believes that AHRQ may not be the best place for such a research effort, he said. As an agency within the executive branch of government, AHRQ "may not be protected enough from influence" from various stakeholders, he said.

Instead, the ACP in its position paper recommends establishment of a completely independent national entity that is "protected from undue government and private sector influence." The entity should be completely transparent, should include extensive stakeholder involvement, and should implement processes to ensure the general dissemination of its findings, according to the position paper.

WASHINGTON — The American College of Physicians, saying it is time for patients, physicians, and policy makers to consider the economic impact of health care choices along with their clinical impact, has issued a call for the creation of a new, independent entity that would conduct and disseminate such research.

Acknowledging fears that "this could be one of the first steps down the road to the rationing of care," Neil Kirschner, Ph.D., senior associate of regulatory and insurer affairs at the ACP, said that "the college believes this type of information should be used as a tool.

"Cost is already playing a major role in health care decisions," and patients and physicians deserve solid clinical and cost-effectiveness information to back up treatment decisions, Dr. Kirschner said at a press briefing about the ACP's new position paper outlining the need for better clinical and cost-effectiveness research.

The call comes at a time when lawmakers have shown some enthusiasm for research into comparative effectiveness. Last fall, about $375 million in proposed funding for such research—through the Agency for Healthcare Research and Quality (AHRQ)—was included in the Children's Health and Medicare Protection Act, but that bill failed to pass the Senate.

The position paper, released at the ACP's annual meeting and published simultaneously online in the Annals of Internal Medicine (www.annals.org/cgi/reprint/0000605-200806170-00222v1.pdf

The proposed new entity would develop and disseminate evidence on comparative clinical effectiveness and cost-effectiveness in health care, according to the ACP. It also would educate the public about what the ACP said is the urgency of modifying "an American cultural bias toward downplaying the cost of health care—especially when payment seemingly comes from a health insurer or other third-party payer rather than from patients' own pockets."

"Cost is not going away," ACP Regent Stephen Pauker said at the briefing, held during the ACP's annual meeting. "We are a country and a society of finite resources, and if we have limited resources we need to use those resources wisely."

Traditionally, researchers have compared treatments with placebo, but treatments must be compared with each other to gather information that would be useful in comparing cost and clinical effectiveness, Dr. Pauker noted. "Cost should be considered, but should never be considered without the simultaneous consideration of outcomes."

The ACP's position paper notes that many insurers already use information about cost because they must manage finite budgets.

"Of note, the strongest opposition seems to come from such constituencies as elderly persons and patients with certain chronic illnesses, for whom the incremental benefits of expensive interventions are typically small," the paper reads.

The ACP is lobbying to add funding to that Medicare legislation for creation of a new entity that would study both cost and clinical effectiveness, said ACP President David Dale.

"Who wouldn't want the most they can get for their money?" Dr. Dale said at the briefing. "On the other hand, this aspect of medicine has many complexities."

There is a research gap when it comes to studies comparing cost and clinical effectiveness of different treatments, according to the ACP's paper. "The college reviewed the national and international literature on comparative effectiveness information and came to the conclusion it is in incredibly short supply," Dr. Kirschner said.

For example, when comparing two cancer drug therapies, "A" could be substantially more expensive but could hold the potential for an additional 5 years of life, which could give it a cost-effectiveness advantage over less expensive therapy "B," Dr. Kirschner said. However, if the two therapies are similar in effectiveness but "A" is more expensive, then "B" would be preferred, he said.

"This type of relative economic value information is very little produced and very little used," Dr. Kirschner said. The National Institute for Health and Clinical Excellence in the United Kingdom produces this type of information for use in the U.K.'s National Health Service, he noted, but U.S. funding for such research at the AHRQ amounts to only $15 million a year.

There are concerns that development of this type of information could lead to limited access to more expensive therapies, and trigger a backlash from patient groups and other health system stakeholders, Dr. Kirschner said. For example, he said, "Medicare, on two different instances, tried to implement cost information in coverage, and both times has had to back off."

That's why the ACP is advocating that an independent, mostly federally funded entity conduct such research, Dr. Dale said. "The public and clinicians will only trust such information if it comes from an independent research source that does not itself have an economic conflict of interest in the results of its analyses."

The ACP would support adding such research funding to the AHRQ's budget if the studies could be adequately protected from the influence of special interests, Dr. Kirschner said.

However, the ACP believes that AHRQ may not be the best place for such a research effort, he said. As an agency within the executive branch of government, AHRQ "may not be protected enough from influence" from various stakeholders, he said.

Instead, the ACP in its position paper recommends establishment of a completely independent national entity that is "protected from undue government and private sector influence." The entity should be completely transparent, should include extensive stakeholder involvement, and should implement processes to ensure the general dissemination of its findings, according to the position paper.

WASHINGTON — The American College of Physicians, saying it is time for patients, physicians, and policy makers to consider the economic impact of health care choices along with their clinical impact, has issued a call for the creation of a new, independent entity that would conduct and disseminate such research.

Acknowledging fears that "this could be one of the first steps down the road to the rationing of care," Neil Kirschner, Ph.D., senior associate of regulatory and insurer affairs at the ACP, said that "the college believes this type of information should be used as a tool.

"Cost is already playing a major role in health care decisions," and patients and physicians deserve solid clinical and cost-effectiveness information to back up treatment decisions, Dr. Kirschner said at a press briefing about the ACP's new position paper outlining the need for better clinical and cost-effectiveness research.

The call comes at a time when lawmakers have shown some enthusiasm for research into comparative effectiveness. Last fall, about $375 million in proposed funding for such research—through the Agency for Healthcare Research and Quality (AHRQ)—was included in the Children's Health and Medicare Protection Act, but that bill failed to pass the Senate.

The position paper, released at the ACP's annual meeting and published simultaneously online in the Annals of Internal Medicine (www.annals.org/cgi/reprint/0000605-200806170-00222v1.pdf

The proposed new entity would develop and disseminate evidence on comparative clinical effectiveness and cost-effectiveness in health care, according to the ACP. It also would educate the public about what the ACP said is the urgency of modifying "an American cultural bias toward downplaying the cost of health care—especially when payment seemingly comes from a health insurer or other third-party payer rather than from patients' own pockets."

"Cost is not going away," ACP Regent Stephen Pauker said at the briefing, held during the ACP's annual meeting. "We are a country and a society of finite resources, and if we have limited resources we need to use those resources wisely."

Traditionally, researchers have compared treatments with placebo, but treatments must be compared with each other to gather information that would be useful in comparing cost and clinical effectiveness, Dr. Pauker noted. "Cost should be considered, but should never be considered without the simultaneous consideration of outcomes."

The ACP's position paper notes that many insurers already use information about cost because they must manage finite budgets.

"Of note, the strongest opposition seems to come from such constituencies as elderly persons and patients with certain chronic illnesses, for whom the incremental benefits of expensive interventions are typically small," the paper reads.

The ACP is lobbying to add funding to that Medicare legislation for creation of a new entity that would study both cost and clinical effectiveness, said ACP President David Dale.

"Who wouldn't want the most they can get for their money?" Dr. Dale said at the briefing. "On the other hand, this aspect of medicine has many complexities."

There is a research gap when it comes to studies comparing cost and clinical effectiveness of different treatments, according to the ACP's paper. "The college reviewed the national and international literature on comparative effectiveness information and came to the conclusion it is in incredibly short supply," Dr. Kirschner said.

For example, when comparing two cancer drug therapies, "A" could be substantially more expensive but could hold the potential for an additional 5 years of life, which could give it a cost-effectiveness advantage over less expensive therapy "B," Dr. Kirschner said. However, if the two therapies are similar in effectiveness but "A" is more expensive, then "B" would be preferred, he said.

"This type of relative economic value information is very little produced and very little used," Dr. Kirschner said. The National Institute for Health and Clinical Excellence in the United Kingdom produces this type of information for use in the U.K.'s National Health Service, he noted, but U.S. funding for such research at the AHRQ amounts to only $15 million a year.

There are concerns that development of this type of information could lead to limited access to more expensive therapies, and trigger a backlash from patient groups and other health system stakeholders, Dr. Kirschner said. For example, he said, "Medicare, on two different instances, tried to implement cost information in coverage, and both times has had to back off."

That's why the ACP is advocating that an independent, mostly federally funded entity conduct such research, Dr. Dale said. "The public and clinicians will only trust such information if it comes from an independent research source that does not itself have an economic conflict of interest in the results of its analyses."

The ACP would support adding such research funding to the AHRQ's budget if the studies could be adequately protected from the influence of special interests, Dr. Kirschner said.

However, the ACP believes that AHRQ may not be the best place for such a research effort, he said. As an agency within the executive branch of government, AHRQ "may not be protected enough from influence" from various stakeholders, he said.

Instead, the ACP in its position paper recommends establishment of a completely independent national entity that is "protected from undue government and private sector influence." The entity should be completely transparent, should include extensive stakeholder involvement, and should implement processes to ensure the general dissemination of its findings, according to the position paper.

CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered services furnished to Medicare beneficiaries. Through the new measures, The CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test several melanoma- and radiology-related measures, in addition to measures dealing with cataracts and age-related macular degeneration. The CMS said that it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008. Providers will not receive financial incentive for reporting these test measures, CMS said.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records to improve the quality of patient care. The 5-year project has been designed to demonstrate the benefits of EHRs and help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, the CMS said. The areas selected to participate include: Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/ Washington; Oklahoma; Pittsburgh, Pa.; South Dakota; Virginia; and Madison, Wis. Over the course of the project, financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by their performance on specific clinical quality measures. Total payments under the demonstration for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

“Smart” IDs Given the Nod in Colo.

Colorado has become one of the first states to approve legislation mandating that all insurers in the state issue “smart” identification cards with standard, legible information about the patient, insurance product, and insurer. The cards, which must be issued by July 1, 2010, also must include machine-readable information encoded on a magnetic strip. The legislation, signed last month by Gov. Bill Ritter (D), helps reduce the potential for human errors and the data-entry burden posed by nonstandardized cards, according to the Medical Group Management Association, which is headquartered in Colorado. Dr. William Jessee, MGMA president, said in a statement that most insurance-claim rejections stem from incorrectly entered information about the patient or the insurance product, and the practice of photocopying patient ID cards and then typing the information into a database invites errors. A card with a magnetic strip on it costs about 50 cents to make, MGMA stated. Similar laws have been approved in Kansas, North Carolina, and Texas, the group said, and other states are considering legislation on the issue.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had yet another banner year for spending on lobbying in 2007, according to a new report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying members of Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations—the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association—accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and on free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered services furnished to Medicare beneficiaries. Through the new measures, The CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test several melanoma- and radiology-related measures, in addition to measures dealing with cataracts and age-related macular degeneration. The CMS said that it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008. Providers will not receive financial incentive for reporting these test measures, CMS said.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records to improve the quality of patient care. The 5-year project has been designed to demonstrate the benefits of EHRs and help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, the CMS said. The areas selected to participate include: Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/ Washington; Oklahoma; Pittsburgh, Pa.; South Dakota; Virginia; and Madison, Wis. Over the course of the project, financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by their performance on specific clinical quality measures. Total payments under the demonstration for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

“Smart” IDs Given the Nod in Colo.

Colorado has become one of the first states to approve legislation mandating that all insurers in the state issue “smart” identification cards with standard, legible information about the patient, insurance product, and insurer. The cards, which must be issued by July 1, 2010, also must include machine-readable information encoded on a magnetic strip. The legislation, signed last month by Gov. Bill Ritter (D), helps reduce the potential for human errors and the data-entry burden posed by nonstandardized cards, according to the Medical Group Management Association, which is headquartered in Colorado. Dr. William Jessee, MGMA president, said in a statement that most insurance-claim rejections stem from incorrectly entered information about the patient or the insurance product, and the practice of photocopying patient ID cards and then typing the information into a database invites errors. A card with a magnetic strip on it costs about 50 cents to make, MGMA stated. Similar laws have been approved in Kansas, North Carolina, and Texas, the group said, and other states are considering legislation on the issue.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had yet another banner year for spending on lobbying in 2007, according to a new report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying members of Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations—the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association—accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and on free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered services furnished to Medicare beneficiaries. Through the new measures, The CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test several melanoma- and radiology-related measures, in addition to measures dealing with cataracts and age-related macular degeneration. The CMS said that it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008. Providers will not receive financial incentive for reporting these test measures, CMS said.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a national Medicare demonstration project that provides incentive payments to physicians for using certified electronic health records to improve the quality of patient care. The 5-year project has been designed to demonstrate the benefits of EHRs and help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, the CMS said. The areas selected to participate include: Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/ Washington; Oklahoma; Pittsburgh, Pa.; South Dakota; Virginia; and Madison, Wis. Over the course of the project, financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by their performance on specific clinical quality measures. Total payments under the demonstration for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

“Smart” IDs Given the Nod in Colo.

Colorado has become one of the first states to approve legislation mandating that all insurers in the state issue “smart” identification cards with standard, legible information about the patient, insurance product, and insurer. The cards, which must be issued by July 1, 2010, also must include machine-readable information encoded on a magnetic strip. The legislation, signed last month by Gov. Bill Ritter (D), helps reduce the potential for human errors and the data-entry burden posed by nonstandardized cards, according to the Medical Group Management Association, which is headquartered in Colorado. Dr. William Jessee, MGMA president, said in a statement that most insurance-claim rejections stem from incorrectly entered information about the patient or the insurance product, and the practice of photocopying patient ID cards and then typing the information into a database invites errors. A card with a magnetic strip on it costs about 50 cents to make, MGMA stated. Similar laws have been approved in Kansas, North Carolina, and Texas, the group said, and other states are considering legislation on the issue.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had yet another banner year for spending on lobbying in 2007, according to a new report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying members of Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations—the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association—accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and on free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

WASHINGTON — The American College of Physicians, building on a successful 3-year initiative to improve diabetes care among medical practices, will extend the initiative by 2 years and expand it to 1,000 physician practices, the group said.

The new phase of the initiative, funded by a $4.2 million grant from Novo Nordisk Inc. and run jointly by the ACP and the ACP Foundation (ACPF), will create a Web-based version of the “Closing the Gap” diabetes program.

Closing the Gap aims to increase physician awareness of high-quality diabetes care and the gap between current practice and acceptable standards, to provide proven educational interventions for improving care to the entire diabetes team, and to recognize physicians and physician practices that improve the care of patients with diabetes.

In the first phase, the program provided in-person training sessions for 19 practice teams with 60 office members caring for a total of 1,300 patients. The hope is that the new, Web-based version of the training program will be able to reach more practices and still be as effective as the expensive, labor-intensive live training, said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

“We, for the first time, designed an initiative aimed at teaching practice teams,” Dr. Snow said at a briefing held at the ACP's annual meeting. “The main point of the initiative was to change practice behavior,” especially in the areas of patient self-management, diet, and behavior change, she said.

In its first 3 years, the ACP and ACPF diabetes initiative offered educational tools and practice-based, team-oriented training for physicians, patients, and health care teams. According to the ACP, the initiative resulted in statistically significant improvements on many clinical measures, such as a nearly 50% decrease in the average number of days between patient office visits for diabetes (from 115 days to 58), a 40% increase in the number of patients who received annual urine albumin testing, a 62% increase in the number who underwent annual dilated eye exams (from 29% to 47%), and a 100% increase in patients who had influenza vaccinations (from 26% to 52%).

To date, the ACP and ACPF have distributed more than 500,000 patient guides and more than 80,000 clinical care guides, both of which emphasize a team-based approach to diabetes care.

In addition, since the launch of the project's diabetes portal in June 2007 (diabetes.acponline.org

Denmark-based Novo Nordisk, the pharmaceutical company that first offered insulin commercially, funded the initial 3-year educational effort with an unrestricted educational grant of $9.27 million.

The new phase of the initiative will broaden the project to other primary care providers. Dr. Snow said that the initiative's Diabetes Advisory Board has been expanded to include members from the American Academy of Family Physicians, the American Academy of Nurse Practitioners, and others. Family physicians are welcome to participate in the new, Web-based version of the practice-based training, she added.

The Web portal for the Closing the Gap program will be able to reach more practices, said Dr. Vincenza Snow (with Dr. Nathaniel G. Clark of Novo Nordisk). Calvin Pierce/Elsevier Global Medical News Group

WASHINGTON — The American College of Physicians, building on a successful 3-year initiative to improve diabetes care among medical practices, will extend the initiative by 2 years and expand it to 1,000 physician practices, the group said.

The new phase of the initiative, funded by a $4.2 million grant from Novo Nordisk Inc. and run jointly by the ACP and the ACP Foundation (ACPF), will create a Web-based version of the “Closing the Gap” diabetes program.

Closing the Gap aims to increase physician awareness of high-quality diabetes care and the gap between current practice and acceptable standards, to provide proven educational interventions for improving care to the entire diabetes team, and to recognize physicians and physician practices that improve the care of patients with diabetes.

In the first phase, the program provided in-person training sessions for 19 practice teams with 60 office members caring for a total of 1,300 patients. The hope is that the new, Web-based version of the training program will be able to reach more practices and still be as effective as the expensive, labor-intensive live training, said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

“We, for the first time, designed an initiative aimed at teaching practice teams,” Dr. Snow said at a briefing held at the ACP's annual meeting. “The main point of the initiative was to change practice behavior,” especially in the areas of patient self-management, diet, and behavior change, she said.

In its first 3 years, the ACP and ACPF diabetes initiative offered educational tools and practice-based, team-oriented training for physicians, patients, and health care teams. According to the ACP, the initiative resulted in statistically significant improvements on many clinical measures, such as a nearly 50% decrease in the average number of days between patient office visits for diabetes (from 115 days to 58), a 40% increase in the number of patients who received annual urine albumin testing, a 62% increase in the number who underwent annual dilated eye exams (from 29% to 47%), and a 100% increase in patients who had influenza vaccinations (from 26% to 52%).

To date, the ACP and ACPF have distributed more than 500,000 patient guides and more than 80,000 clinical care guides, both of which emphasize a team-based approach to diabetes care.

In addition, since the launch of the project's diabetes portal in June 2007 (diabetes.acponline.org

Denmark-based Novo Nordisk, the pharmaceutical company that first offered insulin commercially, funded the initial 3-year educational effort with an unrestricted educational grant of $9.27 million.

The new phase of the initiative will broaden the project to other primary care providers. Dr. Snow said that the initiative's Diabetes Advisory Board has been expanded to include members from the American Academy of Family Physicians, the American Academy of Nurse Practitioners, and others. Family physicians are welcome to participate in the new, Web-based version of the practice-based training, she added.

The Web portal for the Closing the Gap program will be able to reach more practices, said Dr. Vincenza Snow (with Dr. Nathaniel G. Clark of Novo Nordisk). Calvin Pierce/Elsevier Global Medical News Group

WASHINGTON — The American College of Physicians, building on a successful 3-year initiative to improve diabetes care among medical practices, will extend the initiative by 2 years and expand it to 1,000 physician practices, the group said.

The new phase of the initiative, funded by a $4.2 million grant from Novo Nordisk Inc. and run jointly by the ACP and the ACP Foundation (ACPF), will create a Web-based version of the “Closing the Gap” diabetes program.

Closing the Gap aims to increase physician awareness of high-quality diabetes care and the gap between current practice and acceptable standards, to provide proven educational interventions for improving care to the entire diabetes team, and to recognize physicians and physician practices that improve the care of patients with diabetes.

In the first phase, the program provided in-person training sessions for 19 practice teams with 60 office members caring for a total of 1,300 patients. The hope is that the new, Web-based version of the training program will be able to reach more practices and still be as effective as the expensive, labor-intensive live training, said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

“We, for the first time, designed an initiative aimed at teaching practice teams,” Dr. Snow said at a briefing held at the ACP's annual meeting. “The main point of the initiative was to change practice behavior,” especially in the areas of patient self-management, diet, and behavior change, she said.

In its first 3 years, the ACP and ACPF diabetes initiative offered educational tools and practice-based, team-oriented training for physicians, patients, and health care teams. According to the ACP, the initiative resulted in statistically significant improvements on many clinical measures, such as a nearly 50% decrease in the average number of days between patient office visits for diabetes (from 115 days to 58), a 40% increase in the number of patients who received annual urine albumin testing, a 62% increase in the number who underwent annual dilated eye exams (from 29% to 47%), and a 100% increase in patients who had influenza vaccinations (from 26% to 52%).

To date, the ACP and ACPF have distributed more than 500,000 patient guides and more than 80,000 clinical care guides, both of which emphasize a team-based approach to diabetes care.

In addition, since the launch of the project's diabetes portal in June 2007 (diabetes.acponline.org

Denmark-based Novo Nordisk, the pharmaceutical company that first offered insulin commercially, funded the initial 3-year educational effort with an unrestricted educational grant of $9.27 million.

The new phase of the initiative will broaden the project to other primary care providers. Dr. Snow said that the initiative's Diabetes Advisory Board has been expanded to include members from the American Academy of Family Physicians, the American Academy of Nurse Practitioners, and others. Family physicians are welcome to participate in the new, Web-based version of the practice-based training, she added.

The Web portal for the Closing the Gap program will be able to reach more practices, said Dr. Vincenza Snow (with Dr. Nathaniel G. Clark of Novo Nordisk). Calvin Pierce/Elsevier Global Medical News Group

CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered Medicare services. CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test melanoma- and radiology-related measures, as well as measures dealing with cataracts and age-related macular degeneration. CMS said it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008, but providers will not receive financial incentives for reporting the measures.

AMA Launches Insurer Report Card

The American Medical Association has launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. Analysis of a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers showed that insurers reported to physicians the correct contracted payment rate only 62%-87% of the time. Also, payers varied widely as to how often they applied computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

ACP Helps Members Choose EHRs

The American College of Physicians has launched a program designed to help members purchase and install electronic health record systems that match the needs of their practices. The EHR Partners Program is a collaboration between the college and participating EHR companies that have achieved 2006 and/or 2007 certification by the Certification Commission for Healthcare Information Technology (CCHIT). The ACP said it strongly recommends that physicians entering the EHR arena for the first time, or who are seeking to upgrade older systems, consider certified EHRs.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a Medicare demonstration project that provides incentive payments to physicians for using certified EHRs to improve quality of care. The 5-year project is designed to help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, CMS said. The areas selected to participate include Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/Washington; Oklahoma; Pittsburgh; South Dakota; Virginia; and Madison, Wis. Financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by performance on clinical quality measures. Total payments for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had another banner year for spending on lobbying in 2007, according to a report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations (the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association) accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and supporting free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans has endorsed the concept of a medical home. The board voted to approve the principles for achieving coordinated, comprehensive care at the organization's Institute 2008 meeting. “The patient-centered medical home is a promising concept that would replace episodic care with a sustained relationship between patient and physician,” the board said in a statement. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all should follow eight broad principles: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be used; clinicians should commit to being accountable for quality and to report on outcomes and cost-effectiveness; and payments should reflect the level of management involved and help support the cost of developing a medical home infrastructure.

CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered Medicare services. CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test melanoma- and radiology-related measures, as well as measures dealing with cataracts and age-related macular degeneration. CMS said it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008, but providers will not receive financial incentives for reporting the measures.

AMA Launches Insurer Report Card

The American Medical Association has launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. Analysis of a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers showed that insurers reported to physicians the correct contracted payment rate only 62%-87% of the time. Also, payers varied widely as to how often they applied computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

ACP Helps Members Choose EHRs

The American College of Physicians has launched a program designed to help members purchase and install electronic health record systems that match the needs of their practices. The EHR Partners Program is a collaboration between the college and participating EHR companies that have achieved 2006 and/or 2007 certification by the Certification Commission for Healthcare Information Technology (CCHIT). The ACP said it strongly recommends that physicians entering the EHR arena for the first time, or who are seeking to upgrade older systems, consider certified EHRs.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a Medicare demonstration project that provides incentive payments to physicians for using certified EHRs to improve quality of care. The 5-year project is designed to help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, CMS said. The areas selected to participate include Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/Washington; Oklahoma; Pittsburgh; South Dakota; Virginia; and Madison, Wis. Financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by performance on clinical quality measures. Total payments for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had another banner year for spending on lobbying in 2007, according to a report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations (the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association) accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and supporting free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans has endorsed the concept of a medical home. The board voted to approve the principles for achieving coordinated, comprehensive care at the organization's Institute 2008 meeting. “The patient-centered medical home is a promising concept that would replace episodic care with a sustained relationship between patient and physician,” the board said in a statement. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all should follow eight broad principles: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be used; clinicians should commit to being accountable for quality and to report on outcomes and cost-effectiveness; and payments should reflect the level of management involved and help support the cost of developing a medical home infrastructure.

CMS Tests PQRI Measures

The Centers for Medicare and Medicaid Services said it will begin testing 11 new quality measures for future adoption into the Physician Quality Reporting Initiative. PQRI provides incentive payments to providers who satisfactorily report data on covered Medicare services. CMS said it intends to track quality of care in influenza immunization in chronic kidney disease, assessment for use of anti-inflammatory or analgesic over-the-counter medications in osteoarthritis, and care plans for pain in medical and radiation oncology. CMS also will test melanoma- and radiology-related measures, as well as measures dealing with cataracts and age-related macular degeneration. CMS said it encourages providers to submit data for these test measures on Part B claims from July 1 through Sept. 30, 2008, but providers will not receive financial incentives for reporting the measures.

AMA Launches Insurer Report Card

The American Medical Association has launched a campaign to cut waste from the insurance claims process with a new health insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. Analysis of a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers showed that insurers reported to physicians the correct contracted payment rate only 62%-87% of the time. Also, payers varied widely as to how often they applied computer-generated edits to reduce payments—from a low of less than 0.5% to a high of more than 9%. Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

ACP Helps Members Choose EHRs

The American College of Physicians has launched a program designed to help members purchase and install electronic health record systems that match the needs of their practices. The EHR Partners Program is a collaboration between the college and participating EHR companies that have achieved 2006 and/or 2007 certification by the Certification Commission for Healthcare Information Technology (CCHIT). The ACP said it strongly recommends that physicians entering the EHR arena for the first time, or who are seeking to upgrade older systems, consider certified EHRs.

Areas Chosen for EHR Demo

Twelve areas across the country, ranging from entire states to smaller cities, will participate in a Medicare demonstration project that provides incentive payments to physicians for using certified EHRs to improve quality of care. The 5-year project is designed to help increase use of the technology in practices where adoption has been the slowest—at the individual physician and small practice level, CMS said. The areas selected to participate include Alabama; Delaware; Jacksonville, Fla.; Georgia; Maine; Louisiana; Maryland/Washington; Oklahoma; Pittsburgh; South Dakota; Virginia; and Madison, Wis. Financial incentives and bonus payments will be provided to as many as 1,200 primary care practices that use EHRs to improve quality, as measured by performance on clinical quality measures. Total payments for all 5 years may be up to $58,000 per physician or $290,000 per practice, CMS said.

Drug Lobby Spending Up 32%

The pharmaceutical and medical device industries had another banner year for spending on lobbying in 2007, according to a report by the Washington-based Center for Public Integrity. Last year, the pharmaceutical industry alone spent at least $168 million on lobbying Congress, a 32% increase from 2006, according to the report. Forty companies and three trade organizations (the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, and the Advanced Medical Technology Association) accounted for 90% of the spending. PhRMA led the way, spending $23 million in 2007. Amgen Inc. and Pfizer Inc. were the two biggest individual spenders, at $16 million and $13 million, respectively. Most efforts went into blocking drug reimportation, protecting patents, and supporting free-trade agreements. The industry also went to bat for reauthorization of the State Children's Health Insurance Program and extensions of the Prescription Drug User Fee and Best Pharmaceuticals for Children acts, according to the center's analysis of lobbying records submitted to the Senate Office of Public Records.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans has endorsed the concept of a medical home. The board voted to approve the principles for achieving coordinated, comprehensive care at the organization's Institute 2008 meeting. “The patient-centered medical home is a promising concept that would replace episodic care with a sustained relationship between patient and physician,” the board said in a statement. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all should follow eight broad principles: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be used; clinicians should commit to being accountable for quality and to report on outcomes and cost-effectiveness; and payments should reflect the level of management involved and help support the cost of developing a medical home infrastructure.

Policy & Practice

Court Overturns Gun Ban

The U.S. Supreme Court last month struck down the District of Columbia's ban on handgun ownership in a landmark 5-4 decision holding that the District's law violated the Second Amendment. The D.C. ban, one of the strictest in the nation, made it illegal to own handguns in the District and also required shotgun and rifle owners to unload and disassemble them, or use a trigger lock. A lower court had overturned the ban in March 2007, prompting the Supreme Court challenge. “The Supreme Court's decision undermines our efforts to protect children and adolescents from preventable injuries and deaths,” Dr. Robert Sege, director of the division of ambulatory pediatrics at Boston Medical Center and a member of the American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, said in an interview.

Head Start to Cut Enrollment

Faced with an effective $1 billion cut in funding since 2002, costly new administrative requirements, and a lack of congressional action on supplemental funding, Head Start programs across the United States will be forced to cut enrollment by up to 14,000 slots in fiscal year 2009, according to the National Head Start Association. “Unfortunately, the Bush administration and some in the current Congress have decided to leave Head Start twisting in the breeze, forcing us to scrimp, cut corners, and now eliminate slots for thousands of America's most at-risk youths,” said the group's board chairman, Ron Herndon. “As a result, the next president and Congress literally will be faced with the question of whether or not they are prepared to do what it will take to ensure we have a Head Start program moving forward.”

States Miss Breast-Feeding Measure

Only four states–Alaska, Montana, Oregon, and Washington–have met all five Healthy People 2010 federal targets for breast-feeding, according to the Centers for Disease Control and Prevention, which bases its results on a 2007 survey of hospitals and birth centers. The survey found that a substantial proportion of facilities used maternity practices that are not evidence based and are known to interfere with breast-feeding. The CDC said that southern states–including states previously determined to have the lowest 6-month breast-feeding rates–tended to have lower scores on the survey. Western states and those in New England generally had higher scores; Vermont and New Hampshire tied for the highest overall maternity practice scores. Healthy People 2010 objectives call for 75% of new mothers to initiate breast-feeding, 50% to continue for 6 months, and 25% to continue for 1 year.

Feds: THC Levels Are at a New High

The federal government says that levels of tetrahydrocannabinol (THC) in marijuana are at the highest-ever recorded amounts, and that the potency may be contributing to increasing numbers of teenagers seeking treatment for dependence. The University of Mississippi Potency Monitoring Project tests marijuana primarily taken during law enforcement seizures. The project is funded by the National Institute on Drug Abuse. A normal THC level is 1%-5%, but the average potency from the latest quarterly report was 9.6% for marijuana and 24% for hashish. The report is based on 1,248 marijuana samples and 33 hashish samples. The highest recorded potency was 37% for marijuana and 66% for hashish. “The increases in marijuana potency are of concern since they increase the likelihood of acute toxicity, including mental impairment,” Dr. Nora Volkow, NIDA director, said in a statement. The federal Office of National Drug Control Policy said that increasing potency may be linked to the increase in treatment admissions for marijuana abuse from 6% in 1992 to 16% in 2006.

Performance-Enhancing Drug Bill

Rep. Elton Gallegly (R-Calif.) has introduced a bill to help eliminate the use of performance-enhancing drugs by high school athletes. The High School Sports Anti-Drug Act would require the Secretary of Education to award grants to states to pilot random drug-testing programs. It would require a parent's written consent before a student could be tested for drugs, and grantees would have to provide recovery, counseling, and treatment programs for students who test positive. The bill also requires grantees to spend at least 10% of their grant funds on prevention. Rep. Gallegly proposes funding for the act of $10 million in 2009 and $20 million in 2010 and in 2011. “The recent Major League Baseball steroids scandal and Marion Jones's being stripped of her Olympic medals show how prevalent the use of performance-enhancing drugs is in amateur and professional sports,” he said, adding that it is important to give high-school athletes the opportunity to resist the pressure to use steroids and other dangerous performance-enhancing drugs.

Policy & Practice

Court Overturns Gun Ban

The U.S. Supreme Court last month struck down the District of Columbia's ban on handgun ownership in a landmark 5-4 decision holding that the District's law violated the Second Amendment. The D.C. ban, one of the strictest in the nation, made it illegal to own handguns in the District and also required shotgun and rifle owners to unload and disassemble them, or use a trigger lock. A lower court had overturned the ban in March 2007, prompting the Supreme Court challenge. “The Supreme Court's decision undermines our efforts to protect children and adolescents from preventable injuries and deaths,” Dr. Robert Sege, director of the division of ambulatory pediatrics at Boston Medical Center and a member of the American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, said in an interview.

Head Start to Cut Enrollment

Faced with an effective $1 billion cut in funding since 2002, costly new administrative requirements, and a lack of congressional action on supplemental funding, Head Start programs across the United States will be forced to cut enrollment by up to 14,000 slots in fiscal year 2009, according to the National Head Start Association. “Unfortunately, the Bush administration and some in the current Congress have decided to leave Head Start twisting in the breeze, forcing us to scrimp, cut corners, and now eliminate slots for thousands of America's most at-risk youths,” said the group's board chairman, Ron Herndon. “As a result, the next president and Congress literally will be faced with the question of whether or not they are prepared to do what it will take to ensure we have a Head Start program moving forward.”

States Miss Breast-Feeding Measure

Only four states–Alaska, Montana, Oregon, and Washington–have met all five Healthy People 2010 federal targets for breast-feeding, according to the Centers for Disease Control and Prevention, which bases its results on a 2007 survey of hospitals and birth centers. The survey found that a substantial proportion of facilities used maternity practices that are not evidence based and are known to interfere with breast-feeding. The CDC said that southern states–including states previously determined to have the lowest 6-month breast-feeding rates–tended to have lower scores on the survey. Western states and those in New England generally had higher scores; Vermont and New Hampshire tied for the highest overall maternity practice scores. Healthy People 2010 objectives call for 75% of new mothers to initiate breast-feeding, 50% to continue for 6 months, and 25% to continue for 1 year.

Feds: THC Levels Are at a New High

The federal government says that levels of tetrahydrocannabinol (THC) in marijuana are at the highest-ever recorded amounts, and that the potency may be contributing to increasing numbers of teenagers seeking treatment for dependence. The University of Mississippi Potency Monitoring Project tests marijuana primarily taken during law enforcement seizures. The project is funded by the National Institute on Drug Abuse. A normal THC level is 1%-5%, but the average potency from the latest quarterly report was 9.6% for marijuana and 24% for hashish. The report is based on 1,248 marijuana samples and 33 hashish samples. The highest recorded potency was 37% for marijuana and 66% for hashish. “The increases in marijuana potency are of concern since they increase the likelihood of acute toxicity, including mental impairment,” Dr. Nora Volkow, NIDA director, said in a statement. The federal Office of National Drug Control Policy said that increasing potency may be linked to the increase in treatment admissions for marijuana abuse from 6% in 1992 to 16% in 2006.

Performance-Enhancing Drug Bill

Rep. Elton Gallegly (R-Calif.) has introduced a bill to help eliminate the use of performance-enhancing drugs by high school athletes. The High School Sports Anti-Drug Act would require the Secretary of Education to award grants to states to pilot random drug-testing programs. It would require a parent's written consent before a student could be tested for drugs, and grantees would have to provide recovery, counseling, and treatment programs for students who test positive. The bill also requires grantees to spend at least 10% of their grant funds on prevention. Rep. Gallegly proposes funding for the act of $10 million in 2009 and $20 million in 2010 and in 2011. “The recent Major League Baseball steroids scandal and Marion Jones's being stripped of her Olympic medals show how prevalent the use of performance-enhancing drugs is in amateur and professional sports,” he said, adding that it is important to give high-school athletes the opportunity to resist the pressure to use steroids and other dangerous performance-enhancing drugs.

Policy & Practice

Court Overturns Gun Ban

The U.S. Supreme Court last month struck down the District of Columbia's ban on handgun ownership in a landmark 5-4 decision holding that the District's law violated the Second Amendment. The D.C. ban, one of the strictest in the nation, made it illegal to own handguns in the District and also required shotgun and rifle owners to unload and disassemble them, or use a trigger lock. A lower court had overturned the ban in March 2007, prompting the Supreme Court challenge. “The Supreme Court's decision undermines our efforts to protect children and adolescents from preventable injuries and deaths,” Dr. Robert Sege, director of the division of ambulatory pediatrics at Boston Medical Center and a member of the American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, said in an interview.

Head Start to Cut Enrollment

Faced with an effective $1 billion cut in funding since 2002, costly new administrative requirements, and a lack of congressional action on supplemental funding, Head Start programs across the United States will be forced to cut enrollment by up to 14,000 slots in fiscal year 2009, according to the National Head Start Association. “Unfortunately, the Bush administration and some in the current Congress have decided to leave Head Start twisting in the breeze, forcing us to scrimp, cut corners, and now eliminate slots for thousands of America's most at-risk youths,” said the group's board chairman, Ron Herndon. “As a result, the next president and Congress literally will be faced with the question of whether or not they are prepared to do what it will take to ensure we have a Head Start program moving forward.”

States Miss Breast-Feeding Measure

Only four states–Alaska, Montana, Oregon, and Washington–have met all five Healthy People 2010 federal targets for breast-feeding, according to the Centers for Disease Control and Prevention, which bases its results on a 2007 survey of hospitals and birth centers. The survey found that a substantial proportion of facilities used maternity practices that are not evidence based and are known to interfere with breast-feeding. The CDC said that southern states–including states previously determined to have the lowest 6-month breast-feeding rates–tended to have lower scores on the survey. Western states and those in New England generally had higher scores; Vermont and New Hampshire tied for the highest overall maternity practice scores. Healthy People 2010 objectives call for 75% of new mothers to initiate breast-feeding, 50% to continue for 6 months, and 25% to continue for 1 year.

Feds: THC Levels Are at a New High

The federal government says that levels of tetrahydrocannabinol (THC) in marijuana are at the highest-ever recorded amounts, and that the potency may be contributing to increasing numbers of teenagers seeking treatment for dependence. The University of Mississippi Potency Monitoring Project tests marijuana primarily taken during law enforcement seizures. The project is funded by the National Institute on Drug Abuse. A normal THC level is 1%-5%, but the average potency from the latest quarterly report was 9.6% for marijuana and 24% for hashish. The report is based on 1,248 marijuana samples and 33 hashish samples. The highest recorded potency was 37% for marijuana and 66% for hashish. “The increases in marijuana potency are of concern since they increase the likelihood of acute toxicity, including mental impairment,” Dr. Nora Volkow, NIDA director, said in a statement. The federal Office of National Drug Control Policy said that increasing potency may be linked to the increase in treatment admissions for marijuana abuse from 6% in 1992 to 16% in 2006.

Performance-Enhancing Drug Bill

Rep. Elton Gallegly (R-Calif.) has introduced a bill to help eliminate the use of performance-enhancing drugs by high school athletes. The High School Sports Anti-Drug Act would require the Secretary of Education to award grants to states to pilot random drug-testing programs. It would require a parent's written consent before a student could be tested for drugs, and grantees would have to provide recovery, counseling, and treatment programs for students who test positive. The bill also requires grantees to spend at least 10% of their grant funds on prevention. Rep. Gallegly proposes funding for the act of $10 million in 2009 and $20 million in 2010 and in 2011. “The recent Major League Baseball steroids scandal and Marion Jones's being stripped of her Olympic medals show how prevalent the use of performance-enhancing drugs is in amateur and professional sports,” he said, adding that it is important to give high-school athletes the opportunity to resist the pressure to use steroids and other dangerous performance-enhancing drugs.

AHIP Proposes Reform Plan

The United States could reduce total health care spending by $145 billion in the next 7 years while improving the quality of patient care by implementing five proposals, according to a plan from industry group America's Health Insurance Plans. The plan endorsed a combination of measures, including better disease management and care coordination, prevention, a move to electronic transactions, a transition to a value-based payment system, and new technology. The group also called for replacing the current medical liability system with a dispute resolution process consisting of an independent administrative process to provide quick and fair resolution to disputes. AHIP president and CEO Karen Ignagni said most aspects of the proposal are already used by health insurance companies. “The nation needs a coordinated approach across the public and private sectors to maximize the impact of these strategies,” she said in a statement.

ACP Provides Framework

The American College of Physicians has reiterated its 2002 message that all Americans should have access to affordable health insurance coverage. In an update to its position paper, ACP reviewed its key reform recommendations and said they remain, with some revisions, a viable approach to making coverage available universally. The paper said reforms to expand coverage should be done in concert with changes in health care financing and delivery to improve outcomes and efficiency of care. “Expanding health insurance coverage to all Americans is a moral imperative,” said Dr. Jeffrey Harris, president of ACP. The paper advised expanding Medicaid coverage, creating tax credits, adding options for small employers, and measures to ensure all participate. It also asked for federal government support for states to redesign health care delivery programs to expand coverage and organize care around patient-centered medical homes.

Mass. Uninsured Rate Cut

In the first year after Massachusetts implemented its health insurance coverage expansion and reforms, the uninsured rate in the state's adults dropped by almost half, from 13% to just over 7%, according to an Urban Institute study published online in Health Affairs. The study also showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. In addition, it found no evidence that the expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage. The reforms, enacted in April 2006, included an expansion of Medicaid, state subsidies for low-income residents to purchase health insurance, and a new purchasing arrangement for private health insurance. Under the reforms, most uninsured individuals must purchase insurance or pay a penalty to the state.

Consumer Reports Eyes Hospitals

Consumer Reports has begun grading hospitals and plans to add ratings for other health care providers. The ratings, which include nearly 3,000 hospitals, are at

www.consumerreportshealth.org

CMS Outlines Hospice Rights

The Centers for Medicare and Medicaid Services has finalized regulations that give Medicare beneficiaries with terminal illnesses the right to determine how they receive end-of-life care. The provisions, contained in an overhaul of regulations governing the hospice industry, include explicit language on patient rights that had not existed under the previous regulations, CMS said. With the new rule, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan, the right to effective pain management, the right to refuse treatment, and the right to choose their own physician. CMS noted that although many hospice patients already are active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights. “It is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” said CMS Acting Director Kerry Weems in a statement.

Florida Expands Coverage Options

Florida Gov. Charlie Crist, a Republican, has signed legislation that will allow the state to negotiate with health insurers to develop affordable health coverage for the 3.8 million uninsured Floridians aged 19–64 years. The legislation focuses on primary and preventive care to discourage unnecessary emergency room visits. Private insurers have said the plan will allow them to create benefits packages for about $150 a month or less. All benefit plans will include, at the very least, coverage for preventive services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies, according to the governor's office. Approved insurance companies also would have to offer consumers a plan that includes catastrophic and hospital coverage. The law includes provisions for all families to buy into the Florida Kid Care program and creates a clearinghouse where small businesses can choose from a variety of health care plans and services for their employees.

AHIP Proposes Reform Plan

The United States could reduce total health care spending by $145 billion in the next 7 years while improving the quality of patient care by implementing five proposals, according to a plan from industry group America's Health Insurance Plans. The plan endorsed a combination of measures, including better disease management and care coordination, prevention, a move to electronic transactions, a transition to a value-based payment system, and new technology. The group also called for replacing the current medical liability system with a dispute resolution process consisting of an independent administrative process to provide quick and fair resolution to disputes. AHIP president and CEO Karen Ignagni said most aspects of the proposal are already used by health insurance companies. “The nation needs a coordinated approach across the public and private sectors to maximize the impact of these strategies,” she said in a statement.

ACP Provides Framework

The American College of Physicians has reiterated its 2002 message that all Americans should have access to affordable health insurance coverage. In an update to its position paper, ACP reviewed its key reform recommendations and said they remain, with some revisions, a viable approach to making coverage available universally. The paper said reforms to expand coverage should be done in concert with changes in health care financing and delivery to improve outcomes and efficiency of care. “Expanding health insurance coverage to all Americans is a moral imperative,” said Dr. Jeffrey Harris, president of ACP. The paper advised expanding Medicaid coverage, creating tax credits, adding options for small employers, and measures to ensure all participate. It also asked for federal government support for states to redesign health care delivery programs to expand coverage and organize care around patient-centered medical homes.

Mass. Uninsured Rate Cut

In the first year after Massachusetts implemented its health insurance coverage expansion and reforms, the uninsured rate in the state's adults dropped by almost half, from 13% to just over 7%, according to an Urban Institute study published online in Health Affairs. The study also showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. In addition, it found no evidence that the expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage. The reforms, enacted in April 2006, included an expansion of Medicaid, state subsidies for low-income residents to purchase health insurance, and a new purchasing arrangement for private health insurance. Under the reforms, most uninsured individuals must purchase insurance or pay a penalty to the state.

Consumer Reports Eyes Hospitals

Consumer Reports has begun grading hospitals and plans to add ratings for other health care providers. The ratings, which include nearly 3,000 hospitals, are at

www.consumerreportshealth.org

CMS Outlines Hospice Rights

The Centers for Medicare and Medicaid Services has finalized regulations that give Medicare beneficiaries with terminal illnesses the right to determine how they receive end-of-life care. The provisions, contained in an overhaul of regulations governing the hospice industry, include explicit language on patient rights that had not existed under the previous regulations, CMS said. With the new rule, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan, the right to effective pain management, the right to refuse treatment, and the right to choose their own physician. CMS noted that although many hospice patients already are active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights. “It is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” said CMS Acting Director Kerry Weems in a statement.

Florida Expands Coverage Options

Florida Gov. Charlie Crist, a Republican, has signed legislation that will allow the state to negotiate with health insurers to develop affordable health coverage for the 3.8 million uninsured Floridians aged 19–64 years. The legislation focuses on primary and preventive care to discourage unnecessary emergency room visits. Private insurers have said the plan will allow them to create benefits packages for about $150 a month or less. All benefit plans will include, at the very least, coverage for preventive services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies, according to the governor's office. Approved insurance companies also would have to offer consumers a plan that includes catastrophic and hospital coverage. The law includes provisions for all families to buy into the Florida Kid Care program and creates a clearinghouse where small businesses can choose from a variety of health care plans and services for their employees.

AHIP Proposes Reform Plan

The United States could reduce total health care spending by $145 billion in the next 7 years while improving the quality of patient care by implementing five proposals, according to a plan from industry group America's Health Insurance Plans. The plan endorsed a combination of measures, including better disease management and care coordination, prevention, a move to electronic transactions, a transition to a value-based payment system, and new technology. The group also called for replacing the current medical liability system with a dispute resolution process consisting of an independent administrative process to provide quick and fair resolution to disputes. AHIP president and CEO Karen Ignagni said most aspects of the proposal are already used by health insurance companies. “The nation needs a coordinated approach across the public and private sectors to maximize the impact of these strategies,” she said in a statement.

ACP Provides Framework

The American College of Physicians has reiterated its 2002 message that all Americans should have access to affordable health insurance coverage. In an update to its position paper, ACP reviewed its key reform recommendations and said they remain, with some revisions, a viable approach to making coverage available universally. The paper said reforms to expand coverage should be done in concert with changes in health care financing and delivery to improve outcomes and efficiency of care. “Expanding health insurance coverage to all Americans is a moral imperative,” said Dr. Jeffrey Harris, president of ACP. The paper advised expanding Medicaid coverage, creating tax credits, adding options for small employers, and measures to ensure all participate. It also asked for federal government support for states to redesign health care delivery programs to expand coverage and organize care around patient-centered medical homes.

Mass. Uninsured Rate Cut

In the first year after Massachusetts implemented its health insurance coverage expansion and reforms, the uninsured rate in the state's adults dropped by almost half, from 13% to just over 7%, according to an Urban Institute study published online in Health Affairs. The study also showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. In addition, it found no evidence that the expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage. The reforms, enacted in April 2006, included an expansion of Medicaid, state subsidies for low-income residents to purchase health insurance, and a new purchasing arrangement for private health insurance. Under the reforms, most uninsured individuals must purchase insurance or pay a penalty to the state.

Consumer Reports Eyes Hospitals

Consumer Reports has begun grading hospitals and plans to add ratings for other health care providers. The ratings, which include nearly 3,000 hospitals, are at

www.consumerreportshealth.org

CMS Outlines Hospice Rights

The Centers for Medicare and Medicaid Services has finalized regulations that give Medicare beneficiaries with terminal illnesses the right to determine how they receive end-of-life care. The provisions, contained in an overhaul of regulations governing the hospice industry, include explicit language on patient rights that had not existed under the previous regulations, CMS said. With the new rule, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan, the right to effective pain management, the right to refuse treatment, and the right to choose their own physician. CMS noted that although many hospice patients already are active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights. “It is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” said CMS Acting Director Kerry Weems in a statement.

Florida Expands Coverage Options

Florida Gov. Charlie Crist, a Republican, has signed legislation that will allow the state to negotiate with health insurers to develop affordable health coverage for the 3.8 million uninsured Floridians aged 19–64 years. The legislation focuses on primary and preventive care to discourage unnecessary emergency room visits. Private insurers have said the plan will allow them to create benefits packages for about $150 a month or less. All benefit plans will include, at the very least, coverage for preventive services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies, according to the governor's office. Approved insurance companies also would have to offer consumers a plan that includes catastrophic and hospital coverage. The law includes provisions for all families to buy into the Florida Kid Care program and creates a clearinghouse where small businesses can choose from a variety of health care plans and services for their employees.

Each day in the United States, roughly one doctor dies by suicide. Studies over the past 4 decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

“Physicians have the means and the knowledge and access to ways to kill themselves,” Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention, said in an interview.

But the data on physicians dying by suicide are difficult to come by, and “we certainly don't have any data that [say] any particular specialty has any higher rates of suicide,” Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide. Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

“It wasn't as if the institution and the department weren't aware that they had some problems,” he said in an interview. “Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well.”

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and “we certainly did everything we could in terms of their family in both cases.” But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added. [Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it,” said Dr. Austen.

“There's this proudness about their ability to cope,” Dr. Clayton said. “They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem.”

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. “I worked with a physician who took lithium,” she said. “The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses.”

However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded the production of three films on physician suicide as part of an ongoing outreach campaign that seeks to educate physicians about depression. The goal is to help them better recognize the symptoms in themselves and their patients while also cultivating a more thorough understanding of mood disorders in the community at large.

Each day in the United States, roughly one doctor dies by suicide. Studies over the past 4 decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

“Physicians have the means and the knowledge and access to ways to kill themselves,” Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention, said in an interview.

But the data on physicians dying by suicide are difficult to come by, and “we certainly don't have any data that [say] any particular specialty has any higher rates of suicide,” Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide. Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

“It wasn't as if the institution and the department weren't aware that they had some problems,” he said in an interview. “Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well.”

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and “we certainly did everything we could in terms of their family in both cases.” But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added. [Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it,” said Dr. Austen.

“There's this proudness about their ability to cope,” Dr. Clayton said. “They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem.”

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. “I worked with a physician who took lithium,” she said. “The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses.”

However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded the production of three films on physician suicide as part of an ongoing outreach campaign that seeks to educate physicians about depression. The goal is to help them better recognize the symptoms in themselves and their patients while also cultivating a more thorough understanding of mood disorders in the community at large.

Each day in the United States, roughly one doctor dies by suicide. Studies over the past 4 decades have confirmed that physicians—especially women physicians—die by suicide more frequently than people in other professions or those in the general population.

“Physicians have the means and the knowledge and access to ways to kill themselves,” Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention, said in an interview.

But the data on physicians dying by suicide are difficult to come by, and “we certainly don't have any data that [say] any particular specialty has any higher rates of suicide,” Dr. Clayton said.

Although no information is available on the risk of suicide by specialty, researchers do know that physician suicides are equally divided between men and women, whereas in the general population, four times as many men kill themselves as do women, according to Dr. Clayton.

Awareness of the problem remains low, and professional and cultural barriers deter or prevent physicians who are depressed from seeking treatment for their illness, Dr. Clayton said. For example, most physicians do not have a regular source of health care; only 35% of doctors have a personal physician, and even fewer interns and residents have a doctor themselves.

Dr. W. Gerald Austen, surgeon-in-chief emeritus at Massachusetts General Hospital, has first-hand experience with physician suicide. Twenty-eight years ago, when he was surgeon-in-chief, one of his younger staff committed suicide. And about 11 years ago, a surgical resident committed suicide. Those two deaths were the two saddest moments of his career, yet Dr. Austen said he doesn't know what the department and the hospital could have done to prevent these young physicians from taking their own lives.

“It wasn't as if the institution and the department weren't aware that they had some problems,” he said in an interview. “Both of these individuals were under psychiatric care. They were believed by both their doctors and their contemporaries and colleagues to be doing rather well.”

In each case, the surgery department reviewed the situation with the psychiatry department, Dr. Austen said, and “we certainly did everything we could in terms of their family in both cases.” But he said the department didn't find any procedures to change internally as a result of the deaths.

It's possible that increasing awareness of physician depression could help get physicians the help they need before it's too late, Dr. Austen said. “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

But it's difficult to know the difference between someone who is simply unhappy, and someone who is clinically depressed and potentially at risk for suicide, he added. [Physicians believe] their job is to help other people with problems. If they have a problem themselves, they would prefer to not have people know about it,” said Dr. Austen.

“There's this proudness about their ability to cope,” Dr. Clayton said. “They are reluctant to seek help because they fear the stigma will harm them—people won't refer them patients, the hospital might revoke their privileges, and licensing could become a problem.”

State medical licensing boards ask for information on whether the person applying for licensure has been treated for a mental illness, and that information can affect licensing, she said. “I worked with a physician who took lithium,” she said. “The state board made him get blood drawn periodically to prove he continued to take it. That's punitive—they don't do that for other illnesses.”

However, some progress has been made in reducing the stigma: A total of 19 states now focus specifically on whether an applicant is impaired because of psychiatric illness, she said.

Dr. Clayton's group recently funded the production of three films on physician suicide as part of an ongoing outreach campaign that seeks to educate physicians about depression. The goal is to help them better recognize the symptoms in themselves and their patients while also cultivating a more thorough understanding of mood disorders in the community at large.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems said that the proposals “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders. Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.”

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day.”

Specifically, the proposed standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well.

The rule also proposes new protections for those enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems said that the proposals “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders. Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.”

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day.”

Specifically, the proposed standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well.

The rule also proposes new protections for those enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices, at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems said that the proposals “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders. Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.”

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day.”

Specifically, the proposed standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well.

The rule also proposes new protections for those enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

AHIP Proposes Reform Plan

The United States could reduce total health care spending by $145 billion in the next 7 years while improving the quality of patient care by implementing five proposals, according to a plan from industry group America's Health Insurance Plans. The AHIP plan endorsed a combination of measures, including better disease management and care coordination, prevention, a move to electronic transactions, a transition to a value-based payment system, and new technology, to improve the U.S. health care system and save money. The group also called for replacing the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process. AHIP President and CEO Karen Ignagni said that most pieces of her group's proposal are in use now by health insurance companies. “Plans have made measurable progress, but the nation needs a coordinated approach across the public and private sectors to maximize the impact of these strategies,” Ms. Ignagni said in a statement.

ACP Provides Framework

The American College of Physicians has reiterated its 2002 message that all Americans should have access to affordable health insurance coverage. In an update to its 6-year-old position paper, ACP reviewed the key reforms recommended and said they remain, with some revisions, a viable approach to making coverage available universally. The paper emphasized ACP's belief that reforms to expand coverage should be done in concert with changes in health care financing and delivery to improve outcomes and efficiency of care. “Expanding health insurance coverage to all Americans is a moral imperative,” said Dr. Jeffrey Harris, ACP president. The paper recommended expanding Medicaid coverage, creating tax credits, and adding options for small employers. It also asked for federal government support for states to expand coverage and organize care around a patient-centered medical home.

Consumer Reports to Grade Hospitals

Consumer Reports has begun grading hospitals, and plans to eventually add ratings for other health care providers. The ratings, which include nearly 3,000 hospitals, are available at

www.consumerreportshealth.org

Florida Expands Coverage Options

Florida Gov. Charlie Crist, a Republican, has signed legislation that will allow the state to negotiate with health insurers to develop affordable health coverage for the 3.8 million uninsured Floridians aged 19–64 years. The legislation focuses on primary and preventive care to discourage unnecessary emergency department visits. Private insurers have indicated that the plan will allow them to create benefits packages for about $150 a month or less. All benefit plans will include, at the very least, coverage for preventive services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies, according to the governor's office. Approved insurance companies also would have to offer consumers a plan that includes catastrophic and hospital coverage. In addition, the new law creates a centralized clearinghouse where small businesses can choose from a variety of health care plans for their employees.

CMS Outlines Hospice Rights

The Centers for Medicare and Medicaid Services has finalized regulations that give Medicare beneficiaries with terminal illnesses the right to determine how they receive end-of-life care. The provisions, contained in an overhaul of regulations governing the hospice industry, include explicit language on patient rights that had not existed under the previous regulations, CMS said. According to the new rule, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan, the right to effective pain management, the right to refuse treatment, and the right to choose their own physician. CMS noted that although many hospice patients already are active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights. “End-of-life care has changed markedly in the past 25 years and it is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” said CMS Acting Administrator Kerry Weems in a statement.

Mass. Uninsured Rate Cut

In the first year after Massachusetts implemented its health insurance coverage expansion and reforms, the uninsured rate among adults in the state dropped by almost half, from 13% to just over 7%, according to an Urban Institute study published online in Health Affairs. The study also showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. In addition, the study's author found no evidence that the expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage. The reforms, enacted in April 2006, included an expansion of Medicaid, state subsidies for low-income residents to purchase health insurance, and a new purchasing arrangement for private health insurance. Under the reforms, most uninsured individuals must purchase insurance or pay a penalty to the state.

AHIP Proposes Reform Plan

The United States could reduce total health care spending by $145 billion in the next 7 years while improving the quality of patient care by implementing five proposals, according to a plan from industry group America's Health Insurance Plans. The AHIP plan endorsed a combination of measures, including better disease management and care coordination, prevention, a move to electronic transactions, a transition to a value-based payment system, and new technology, to improve the U.S. health care system and save money. The group also called for replacing the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process. AHIP President and CEO Karen Ignagni said that most pieces of her group's proposal are in use now by health insurance companies. “Plans have made measurable progress, but the nation needs a coordinated approach across the public and private sectors to maximize the impact of these strategies,” Ms. Ignagni said in a statement.

ACP Provides Framework

The American College of Physicians has reiterated its 2002 message that all Americans should have access to affordable health insurance coverage. In an update to its 6-year-old position paper, ACP reviewed the key reforms recommended and said they remain, with some revisions, a viable approach to making coverage available universally. The paper emphasized ACP's belief that reforms to expand coverage should be done in concert with changes in health care financing and delivery to improve outcomes and efficiency of care. “Expanding health insurance coverage to all Americans is a moral imperative,” said Dr. Jeffrey Harris, ACP president. The paper recommended expanding Medicaid coverage, creating tax credits, and adding options for small employers. It also asked for federal government support for states to expand coverage and organize care around a patient-centered medical home.

Consumer Reports to Grade Hospitals

Consumer Reports has begun grading hospitals, and plans to eventually add ratings for other health care providers. The ratings, which include nearly 3,000 hospitals, are available at

www.consumerreportshealth.org

Florida Expands Coverage Options

Florida Gov. Charlie Crist, a Republican, has signed legislation that will allow the state to negotiate with health insurers to develop affordable health coverage for the 3.8 million uninsured Floridians aged 19–64 years. The legislation focuses on primary and preventive care to discourage unnecessary emergency department visits. Private insurers have indicated that the plan will allow them to create benefits packages for about $150 a month or less. All benefit plans will include, at the very least, coverage for preventive services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies, according to the governor's office. Approved insurance companies also would have to offer consumers a plan that includes catastrophic and hospital coverage. In addition, the new law creates a centralized clearinghouse where small businesses can choose from a variety of health care plans for their employees.

CMS Outlines Hospice Rights

The Centers for Medicare and Medicaid Services has finalized regulations that give Medicare beneficiaries with terminal illnesses the right to determine how they receive end-of-life care. The provisions, contained in an overhaul of regulations governing the hospice industry, include explicit language on patient rights that had not existed under the previous regulations, CMS said. According to the new rule, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan, the right to effective pain management, the right to refuse treatment, and the right to choose their own physician. CMS noted that although many hospice patients already are active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights. “End-of-life care has changed markedly in the past 25 years and it is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” said CMS Acting Administrator Kerry Weems in a statement.

Mass. Uninsured Rate Cut

In the first year after Massachusetts implemented its health insurance coverage expansion and reforms, the uninsured rate among adults in the state dropped by almost half, from 13% to just over 7%, according to an Urban Institute study published online in Health Affairs. The study also showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. In addition, the study's author found no evidence that the expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage. The reforms, enacted in April 2006, included an expansion of Medicaid, state subsidies for low-income residents to purchase health insurance, and a new purchasing arrangement for private health insurance. Under the reforms, most uninsured individuals must purchase insurance or pay a penalty to the state.

AHIP Proposes Reform Plan

The United States could reduce total health care spending by $145 billion in the next 7 years while improving the quality of patient care by implementing five proposals, according to a plan from industry group America's Health Insurance Plans. The AHIP plan endorsed a combination of measures, including better disease management and care coordination, prevention, a move to electronic transactions, a transition to a value-based payment system, and new technology, to improve the U.S. health care system and save money. The group also called for replacing the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process. AHIP President and CEO Karen Ignagni said that most pieces of her group's proposal are in use now by health insurance companies. “Plans have made measurable progress, but the nation needs a coordinated approach across the public and private sectors to maximize the impact of these strategies,” Ms. Ignagni said in a statement.

ACP Provides Framework

The American College of Physicians has reiterated its 2002 message that all Americans should have access to affordable health insurance coverage. In an update to its 6-year-old position paper, ACP reviewed the key reforms recommended and said they remain, with some revisions, a viable approach to making coverage available universally. The paper emphasized ACP's belief that reforms to expand coverage should be done in concert with changes in health care financing and delivery to improve outcomes and efficiency of care. “Expanding health insurance coverage to all Americans is a moral imperative,” said Dr. Jeffrey Harris, ACP president. The paper recommended expanding Medicaid coverage, creating tax credits, and adding options for small employers. It also asked for federal government support for states to expand coverage and organize care around a patient-centered medical home.

Consumer Reports to Grade Hospitals

Consumer Reports has begun grading hospitals, and plans to eventually add ratings for other health care providers. The ratings, which include nearly 3,000 hospitals, are available at

www.consumerreportshealth.org

Florida Expands Coverage Options

Florida Gov. Charlie Crist, a Republican, has signed legislation that will allow the state to negotiate with health insurers to develop affordable health coverage for the 3.8 million uninsured Floridians aged 19–64 years. The legislation focuses on primary and preventive care to discourage unnecessary emergency department visits. Private insurers have indicated that the plan will allow them to create benefits packages for about $150 a month or less. All benefit plans will include, at the very least, coverage for preventive services, screenings, office visits, outpatient and inpatient surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies, according to the governor's office. Approved insurance companies also would have to offer consumers a plan that includes catastrophic and hospital coverage. In addition, the new law creates a centralized clearinghouse where small businesses can choose from a variety of health care plans for their employees.

CMS Outlines Hospice Rights

The Centers for Medicare and Medicaid Services has finalized regulations that give Medicare beneficiaries with terminal illnesses the right to determine how they receive end-of-life care. The provisions, contained in an overhaul of regulations governing the hospice industry, include explicit language on patient rights that had not existed under the previous regulations, CMS said. According to the new rule, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan, the right to effective pain management, the right to refuse treatment, and the right to choose their own physician. CMS noted that although many hospice patients already are active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights. “End-of-life care has changed markedly in the past 25 years and it is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” said CMS Acting Administrator Kerry Weems in a statement.

Mass. Uninsured Rate Cut

In the first year after Massachusetts implemented its health insurance coverage expansion and reforms, the uninsured rate among adults in the state dropped by almost half, from 13% to just over 7%, according to an Urban Institute study published online in Health Affairs. The study also showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. In addition, the study's author found no evidence that the expansion of publicly subsidized coverage has “crowded out” employer-sponsored coverage. The reforms, enacted in April 2006, included an expansion of Medicaid, state subsidies for low-income residents to purchase health insurance, and a new purchasing arrangement for private health insurance. Under the reforms, most uninsured individuals must purchase insurance or pay a penalty to the state.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices.

“There won't be the kinds of incentives there are in the market now for brokers and agents to try and convince beneficiaries to move from one plan to another,” Ms. Block said at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems noted that the proposed regulations “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program.” He added, “I want to emphasize that this is a large and comprehensive rule.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.” In March, AHIP advocated for stronger federal regulation and oversight of Medicare Advantage and Part D plan marketing activities.

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day. These regulations do nothing to prevent insurance companies from using high commissions and volume-based bonuses to encourage agents to enroll people with Medicare in substandard plans that provide inadequate financial protection, abysmal customer service, and poor access to providers.”

Specifically, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS.

In addition, Medicare Advantage organizations that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well. The requirements are designed to discourage “churning,” and would ensure that beneficiaries are receiving the information and counseling necessary to select the best plan based on their needs, according to CMS.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those who are eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, would more clearly establish and clarify delivery of care standards for SNPs, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

CMS is accepting comments on the proposal until July 15.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices.

“There won't be the kinds of incentives there are in the market now for brokers and agents to try and convince beneficiaries to move from one plan to another,” Ms. Block said at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems noted that the proposed regulations “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program.” He added, “I want to emphasize that this is a large and comprehensive rule.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.” In March, AHIP advocated for stronger federal regulation and oversight of Medicare Advantage and Part D plan marketing activities.

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day. These regulations do nothing to prevent insurance companies from using high commissions and volume-based bonuses to encourage agents to enroll people with Medicare in substandard plans that provide inadequate financial protection, abysmal customer service, and poor access to providers.”

Specifically, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS.

In addition, Medicare Advantage organizations that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well. The requirements are designed to discourage “churning,” and would ensure that beneficiaries are receiving the information and counseling necessary to select the best plan based on their needs, according to CMS.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those who are eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, would more clearly establish and clarify delivery of care standards for SNPs, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

CMS is accepting comments on the proposal until July 15.

The Centers for Medicare and Medicaid Services, seeking to curtail marketing abuses within Medicare Advantage and Medicare Part D prescription drug plans, has proposed new regulations that would prohibit such tactics as door-to-door marketing and cold-calling of beneficiaries.

The proposed rules, which would incorporate into regulation several requirements that CMS already has imposed administratively, would tighten marketing standards and require independent insurance agents who sell Medicare Advantage and Part D products to be licensed by the state, the agency said.

The rules, which are subject to public comment, also seek to eliminate incentives for agents to “churn” beneficiaries, or persuade people to change plans, in order to gain enhanced commissions, said Abby Block, director of the CMS Center for Beneficiary Choices.

“There won't be the kinds of incentives there are in the market now for brokers and agents to try and convince beneficiaries to move from one plan to another,” Ms. Block said at a press briefing.

CMS plans to roll out the final rule before the fall open enrollment season.

CMS Acting Administrator Kerry Weems noted that the proposed regulations “go beyond what the insurance industry recently endorsed as necessary regulatory changes to the program.” He added, “I want to emphasize that this is a large and comprehensive rule.”

However, the House Committee on Energy and Commerce, which has released a report on the Medicare Advantage program, said that the proposed changes in marketing requirements “will do little to address the fundamental problems with Medicare Advantage plans.”

According to Rep. Bart Stupak (D-Mich.), chairman of the committee's subcommittee on oversight and investigation, the committee's report “has verified countless stories of deceptive sales practices by insurance agents who prey on the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” He noted in a statement that the report “shows that steps taken by CMS will not be nearly enough to protect our most vulnerable citizens from deceptive sales practices.”

The committee report recommended better sales agent training, strengthened state oversight of plan sales operations, standardization of plan benefit packages, and comprehensive tracking of beneficiary complaints.

The CMS proposal received mixed reviews from Medicare Advantage stakeholders.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement that the proposed regulations are “an important step to ensure beneficiaries can rely on the information being provided to make the Medicare coverage decisions that are right for them.” In March, AHIP advocated for stronger federal regulation and oversight of Medicare Advantage and Part D plan marketing activities.

Robert Hayes, president of the consumer advocacy group the Medicare Rights Center, said in a statement that the proposed regulations “are inadequate to address the problems we see every day. These regulations do nothing to prevent insurance companies from using high commissions and volume-based bonuses to encourage agents to enroll people with Medicare in substandard plans that provide inadequate financial protection, abysmal customer service, and poor access to providers.”

Specifically, the proposed plan marketing standards would prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances, such as sales activities at educational events like health information fairs and community meetings, or in areas such as waiting rooms where patients primarily intend to receive health care-related services, according to CMS.

In addition, Medicare Advantage organizations that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.

The regulations also would require Medicare Advantage organizations to establish commission structures for sales agents and brokers that are level across all years and across all product types. Commission structures for prescription drug plans would have to be level across the sponsors' plans as well. The requirements are designed to discourage “churning,” and would ensure that beneficiaries are receiving the information and counseling necessary to select the best plan based on their needs, according to CMS.

The rule also proposes new protections for beneficiaries enrolled in special needs plans (SNPs), a type of Medicare Advantage plan that provides coordinated care to individuals in certain institutions, such as nursing homes; those who are eligible for both Medicare and Medicaid; and those who have certain severe or disabling chronic conditions.

The proposed rules would require that 90% of new enrollees in SNPs be special needs individuals, would more clearly establish and clarify delivery of care standards for SNPs, and would protect beneficiaries enrolled in both Medicare and Medicaid from being billed for cost sharing that is not their responsibility.

CMS is accepting comments on the proposal until July 15.