Mary Ellen Schneider

The U.S. House of Representatives has passed health reform legislation, clearing the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years.

Late in the evening on March 21, the House voted 219-212 to approve the health reform bill passed by the Senate last December. The bill (H.R. 3590) creates a health insurance exchange where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions. President Obama was expected to sign the bill into law as early as March 23.

Later the same night, the House voted 220-211 to approve a package of changes to the original Senate-passed bill. This legislative package would cover 32 million additional Americans, or about 94% of the population, according to the Congressional Budget Office (CBO). The CBO estimated the cost of the legislation at $940 billion over 10 years and said it would reduce the deficit by $143 billion from 2010 to 2019.

The second piece of legislation, known as the reconciliation bill (H.R. 4872), removes some of the controversial elements of the Senate-passed bill. For example, it stripped out the so-called "Cornhusker kickback," a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.

The reconciliation bill, which now moves to the Senate for a vote, includes increased federal subsidies for Americans who can't afford to purchase health insurance and also lowers financial penalties for individuals who choose not to purchase insurance.

Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians. The bill requires that Medicaid payments be increased up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014. It also increases funding for community health centers.

The bill also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.

The reconciliation bill also beefs up the insurance reform provisions of the Senate-passed bill. Under this new bill, the federal government would require health plans to provide coverage for nondependent children up to age 26 years within 6 months. It also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans would be barred from pre-existing conditions exclusions 6 months after enactment.

Although Democrats in the House were able to get the needed votes to pass the two measures, neither received a single Republican vote. In the hours of debate that preceded the bill, Republicans railed against the package as bloated and unaffordable, despite assurance from the CBO that the legislation would reduce the deficit. They also said that the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.

But the bills were backed by the American Medical Association. On March 19, the organization announced its "qualified" support for the amended version of health reform. AMA President Dr. J. James Rohack said that the bill would do many good things, such as improve health by expanding coverage to millions of uninsured Americans, eliminate denials based on pre-existing conditions, provide bonus payments to primary care physicians and general surgeons, and fund pilot projects on ways to resolve medical liability claims.

Congress, however, still has work to do on provisions such as the one establishing the Independent Payment Advisory Board, the AMA said, adding that this board needs to be overseen by Congress and have input from physicians. "The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery," according to a statement from Dr. Rohack.

He pledged that the AMA will continue to push Congress to pass a permanent repeal of the Medicare payment formula, known as the Sustainable Growth Rate or SGR: "We will hold Congress's feet to the fire on getting that done before this Congress adjourns."

The U.S. House of Representatives has passed health reform legislation, clearing the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years.

Late in the evening on March 21, the House voted 219-212 to approve the health reform bill passed by the Senate last December. The bill (H.R. 3590) creates a health insurance exchange where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions. President Obama was expected to sign the bill into law as early as March 23.

Later the same night, the House voted 220-211 to approve a package of changes to the original Senate-passed bill. This legislative package would cover 32 million additional Americans, or about 94% of the population, according to the Congressional Budget Office (CBO). The CBO estimated the cost of the legislation at $940 billion over 10 years and said it would reduce the deficit by $143 billion from 2010 to 2019.

The second piece of legislation, known as the reconciliation bill (H.R. 4872), removes some of the controversial elements of the Senate-passed bill. For example, it stripped out the so-called "Cornhusker kickback," a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.

The reconciliation bill, which now moves to the Senate for a vote, includes increased federal subsidies for Americans who can't afford to purchase health insurance and also lowers financial penalties for individuals who choose not to purchase insurance.

Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians. The bill requires that Medicaid payments be increased up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014. It also increases funding for community health centers.

The bill also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.

The reconciliation bill also beefs up the insurance reform provisions of the Senate-passed bill. Under this new bill, the federal government would require health plans to provide coverage for nondependent children up to age 26 years within 6 months. It also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans would be barred from pre-existing conditions exclusions 6 months after enactment.

Although Democrats in the House were able to get the needed votes to pass the two measures, neither received a single Republican vote. In the hours of debate that preceded the bill, Republicans railed against the package as bloated and unaffordable, despite assurance from the CBO that the legislation would reduce the deficit. They also said that the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.

But the bills were backed by the American Medical Association. On March 19, the organization announced its "qualified" support for the amended version of health reform. AMA President Dr. J. James Rohack said that the bill would do many good things, such as improve health by expanding coverage to millions of uninsured Americans, eliminate denials based on pre-existing conditions, provide bonus payments to primary care physicians and general surgeons, and fund pilot projects on ways to resolve medical liability claims.

Congress, however, still has work to do on provisions such as the one establishing the Independent Payment Advisory Board, the AMA said, adding that this board needs to be overseen by Congress and have input from physicians. "The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery," according to a statement from Dr. Rohack.

He pledged that the AMA will continue to push Congress to pass a permanent repeal of the Medicare payment formula, known as the Sustainable Growth Rate or SGR: "We will hold Congress's feet to the fire on getting that done before this Congress adjourns."

The U.S. House of Representatives has passed health reform legislation, clearing the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years.

Late in the evening on March 21, the House voted 219-212 to approve the health reform bill passed by the Senate last December. The bill (H.R. 3590) creates a health insurance exchange where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions. President Obama was expected to sign the bill into law as early as March 23.

Later the same night, the House voted 220-211 to approve a package of changes to the original Senate-passed bill. This legislative package would cover 32 million additional Americans, or about 94% of the population, according to the Congressional Budget Office (CBO). The CBO estimated the cost of the legislation at $940 billion over 10 years and said it would reduce the deficit by $143 billion from 2010 to 2019.

The second piece of legislation, known as the reconciliation bill (H.R. 4872), removes some of the controversial elements of the Senate-passed bill. For example, it stripped out the so-called "Cornhusker kickback," a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.

The reconciliation bill, which now moves to the Senate for a vote, includes increased federal subsidies for Americans who can't afford to purchase health insurance and also lowers financial penalties for individuals who choose not to purchase insurance.

Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians. The bill requires that Medicaid payments be increased up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014. It also increases funding for community health centers.

The bill also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.

The reconciliation bill also beefs up the insurance reform provisions of the Senate-passed bill. Under this new bill, the federal government would require health plans to provide coverage for nondependent children up to age 26 years within 6 months. It also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans would be barred from pre-existing conditions exclusions 6 months after enactment.

Although Democrats in the House were able to get the needed votes to pass the two measures, neither received a single Republican vote. In the hours of debate that preceded the bill, Republicans railed against the package as bloated and unaffordable, despite assurance from the CBO that the legislation would reduce the deficit. They also said that the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.

But the bills were backed by the American Medical Association. On March 19, the organization announced its "qualified" support for the amended version of health reform. AMA President Dr. J. James Rohack said that the bill would do many good things, such as improve health by expanding coverage to millions of uninsured Americans, eliminate denials based on pre-existing conditions, provide bonus payments to primary care physicians and general surgeons, and fund pilot projects on ways to resolve medical liability claims.

Congress, however, still has work to do on provisions such as the one establishing the Independent Payment Advisory Board, the AMA said, adding that this board needs to be overseen by Congress and have input from physicians. "The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery," according to a statement from Dr. Rohack.

He pledged that the AMA will continue to push Congress to pass a permanent repeal of the Medicare payment formula, known as the Sustainable Growth Rate or SGR: "We will hold Congress's feet to the fire on getting that done before this Congress adjourns."

The federal government has awarded $162 million in grants to states to aid in the secure exchange of health information across different proprietary systems.

The grants, which were announced on March 15, will go to 16 states and qualified state-designated entities. The money was set aside for states under the American Recovery and Reinvestment Act of 2009. This is the final round of grants, and follows the release of $385 million to 40 states and qualified state-designed entities in February.

“What these awards will do is strengthen our health care system and speed our economic recovery,” Kathleen Sebelius, Health and Human Services Secretary, said during a press conference to announce the grants. “They help to unleash the power of health information technology to cut costs, eliminate paperwork, and best of all help doctors deliver higher quality, coordinated care.”

Despite the benefits of adopting electronic health records (EHRs), only about 20% of physicians and 10% of hospitals have implemented even a basic EHR system, Ms. Sebelius said. The goal in awarding these grants is that the states will be able to develop policies and frameworks based on nationally-approved technical standards, which will allow physicians and hospitals to securely share information regardless of what type of EHR system they have implemented.

States will need to begin by bringing all the parties to the table—from physicians and hospitals to health insurers and lawyers, said Dr. David Blumenthal, the national coordinator for health information technology. These groups will need to agree on the strategic and operational plans for creating health-information exchange in each state, he said.

Health IT officials at the federal level will be working closely with the states on their plans for exchanging health data. But the states are in the best position to identify and credential physicians and hospitals that should be receiving and sending private and secure health information transmissions, Dr. Blumenthal said.

The states are currently at different points in their implementation timeline based on their past work on health information exchange, Dr. Blumenthal added. But he said he expects that many states will have the technology and governance structures in place by 2013 to allow physicians and hospitals to meet the information exchange requirements established under the federal incentive program for EHR implementation. That incentive program, created under the Recovery Act, calls for physicians and hospitals to demonstrate the ability to exchange information by 2011, but more robust exchange requirements do not phase in until 2013.

The federal government has awarded $162 million in grants to states to aid in the secure exchange of health information across different proprietary systems.

The grants, which were announced on March 15, will go to 16 states and qualified state-designated entities. The money was set aside for states under the American Recovery and Reinvestment Act of 2009. This is the final round of grants, and follows the release of $385 million to 40 states and qualified state-designed entities in February.

“What these awards will do is strengthen our health care system and speed our economic recovery,” Kathleen Sebelius, Health and Human Services Secretary, said during a press conference to announce the grants. “They help to unleash the power of health information technology to cut costs, eliminate paperwork, and best of all help doctors deliver higher quality, coordinated care.”

Despite the benefits of adopting electronic health records (EHRs), only about 20% of physicians and 10% of hospitals have implemented even a basic EHR system, Ms. Sebelius said. The goal in awarding these grants is that the states will be able to develop policies and frameworks based on nationally-approved technical standards, which will allow physicians and hospitals to securely share information regardless of what type of EHR system they have implemented.

States will need to begin by bringing all the parties to the table—from physicians and hospitals to health insurers and lawyers, said Dr. David Blumenthal, the national coordinator for health information technology. These groups will need to agree on the strategic and operational plans for creating health-information exchange in each state, he said.

Health IT officials at the federal level will be working closely with the states on their plans for exchanging health data. But the states are in the best position to identify and credential physicians and hospitals that should be receiving and sending private and secure health information transmissions, Dr. Blumenthal said.

The states are currently at different points in their implementation timeline based on their past work on health information exchange, Dr. Blumenthal added. But he said he expects that many states will have the technology and governance structures in place by 2013 to allow physicians and hospitals to meet the information exchange requirements established under the federal incentive program for EHR implementation. That incentive program, created under the Recovery Act, calls for physicians and hospitals to demonstrate the ability to exchange information by 2011, but more robust exchange requirements do not phase in until 2013.

The federal government has awarded $162 million in grants to states to aid in the secure exchange of health information across different proprietary systems.

The grants, which were announced on March 15, will go to 16 states and qualified state-designated entities. The money was set aside for states under the American Recovery and Reinvestment Act of 2009. This is the final round of grants, and follows the release of $385 million to 40 states and qualified state-designed entities in February.

“What these awards will do is strengthen our health care system and speed our economic recovery,” Kathleen Sebelius, Health and Human Services Secretary, said during a press conference to announce the grants. “They help to unleash the power of health information technology to cut costs, eliminate paperwork, and best of all help doctors deliver higher quality, coordinated care.”

Despite the benefits of adopting electronic health records (EHRs), only about 20% of physicians and 10% of hospitals have implemented even a basic EHR system, Ms. Sebelius said. The goal in awarding these grants is that the states will be able to develop policies and frameworks based on nationally-approved technical standards, which will allow physicians and hospitals to securely share information regardless of what type of EHR system they have implemented.

States will need to begin by bringing all the parties to the table—from physicians and hospitals to health insurers and lawyers, said Dr. David Blumenthal, the national coordinator for health information technology. These groups will need to agree on the strategic and operational plans for creating health-information exchange in each state, he said.

Health IT officials at the federal level will be working closely with the states on their plans for exchanging health data. But the states are in the best position to identify and credential physicians and hospitals that should be receiving and sending private and secure health information transmissions, Dr. Blumenthal said.

The states are currently at different points in their implementation timeline based on their past work on health information exchange, Dr. Blumenthal added. But he said he expects that many states will have the technology and governance structures in place by 2013 to allow physicians and hospitals to meet the information exchange requirements established under the federal incentive program for EHR implementation. That incentive program, created under the Recovery Act, calls for physicians and hospitals to demonstrate the ability to exchange information by 2011, but more robust exchange requirements do not phase in until 2013.

Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.

The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.

The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.

Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.

ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.

The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.

The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.

But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.

The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.

"This may be just a Mohs fellowship by another name," Dr. Portnoff said.

Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.

The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.

The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.

Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.

ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.

The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.

The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.

But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.

The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.

"This may be just a Mohs fellowship by another name," Dr. Portnoff said.

Procedural dermatology fellows will soon have new requirements, including specifics about how many surgical cases they must perform.

The requirement is one of the changes put forward by the Accreditation Council for Graduate Medical Education as part of a regular review of the graduate medical education program requirements for procedural dermatology. This is the first revision to the program requirements since the subspecialty was first accredited in 2003.

The new requirements are scheduled to go into effect in July, but there may be some additional revisions before then as the group receives last-minute comments on the document, according to ACGME. The current requirements and revisions are posted online at www.acgme.org/acWebsite/RRC_080/080_prIndex.asp.

Under the revised document, ACGME is keeping the requirement that fellowship programs provide a sufficient volume and variety of surgical cases for fellows, specifically that at least 1,000 dermatologic surgical procedures per fellow are available and that at least 500 of that total must be Mohs micrographic surgery procedures. ACGME, however, is now also specifying case requirements for individual fellows. Fellows must perform, not simply observe, at least 400 surgical cases, of which at least 200 have to be Mohs surgery procedures.

ACGME is also adding requirements that frozen section slides for Mohs surgery must be reviewed and approved as part of an ongoing quality assurance program by an appropriate peer-reviewed organization. Facilities also will be required to have their frozen section laboratory and examination areas accredited by appropriate oversight bodies.

The biggest change in the document is the way it is organized, but much of the content is the same, said Dr. Randall K. Roenigk, professor of dermatology at the Mayo Clinic in Rochester, Minn., and chair of ACGME's Residency Review Committee for Dermatology. For example, the three major components of procedural dermatology fellowship training--Mohs micrographic surgery, reconstruction, and cosmetic surgery--remain the same, he said.

The regular revisions to the program requirements by ACGME are really a way to assure the public. "It's really an attempt to demonstrate to the public that we're doing our best to train the best doctors," Dr. Roenigk said.

But Dr. Lee S. Portnoff, a full-time Mohs surgeon in St. Louis and president of the American Society for Mohs Surgery, said that he is concerned about some of the changes ACGME has made.

The requirement to perform at least 400 surgical cases, of which at least 200 are Mohs procedures, would allow some fellows to complete the requirements without getting sufficient experience in non-Mohs surgeries, he said. If fellows are allowed to count Mohs-related repairs toward their overall surgical requirement, they could easily meet the requirements without doing much in the way of other types of procedures.

"This may be just a Mohs fellowship by another name," Dr. Portnoff said.

LAS VEGAS — Medicare's Physician Quality Reporting Initiative could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.

And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.

“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems Inc., based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”

In 2010, physicians in PQRI are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010.

Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, he said.

Although the pending federal health care reform effort would include more moves in that direction, CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.

LAS VEGAS — Medicare's Physician Quality Reporting Initiative could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.

And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.

“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems Inc., based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”

In 2010, physicians in PQRI are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010.

Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, he said.

Although the pending federal health care reform effort would include more moves in that direction, CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.

LAS VEGAS — Medicare's Physician Quality Reporting Initiative could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.

And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.

“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems Inc., based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”

In 2010, physicians in PQRI are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010.

Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, he said.

Although the pending federal health care reform effort would include more moves in that direction, CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.

The federal government has put forward its plan to test and certify electronic health records in preparation for the Medicare and Medicaid incentive program that will reward physicians for their use of health information technology.

The proposed rule, which was released on March 2, establishes a temporary certification program in which the National Coordinator for Health Information Technology, Dr. David Blumenthal, will designate certain organizations to test and certify complete electronic health records (EHRs) and related modules.

Under the temporary program, Dr. Blumenthal's office would take on many of the functions, such as accreditation, that will later be performed by private groups. The idea behind the temporary program is to ensure that certified EHR products are available before the first incentives for use of certified systems begin in 2011.

The rule also proposes the creation of a permanent certification program that would eventually replace the temporary one. The permanent program would be more sophisticated, dividing the responsibility for testing and certification among different organizations. The permanent program also would include accreditation processes and set forth the requirement that certification bodies perform surveillance of certified EHR products. Certification bodies also may be able to assess additional health information technology products beyond EHRs and their modules. Both certification programs, however, would be voluntary.

Dr. Blumenthal called publication of the proposed rule an “important first step” to bringing structure to the evaluation of EHRs and EHR modules. “The programs will help support end users of certified products, and ultimately serve the interests of each patient by ensuring that their information is securely managed and available where and when it is needed,” he said in a statement.

Earlier this year, the federal government issued a proposed rule outlining the criteria for meaningful use of EHRs and an interim final rule that included an initial set of standards and specifications for certification of products.

Two separate regulations finalizing the temporary and permanent certification programs are expected to be published by the fall.

The federal government has put forward its plan to test and certify electronic health records in preparation for the Medicare and Medicaid incentive program that will reward physicians for their use of health information technology.

The proposed rule, which was released on March 2, establishes a temporary certification program in which the National Coordinator for Health Information Technology, Dr. David Blumenthal, will designate certain organizations to test and certify complete electronic health records (EHRs) and related modules.

Under the temporary program, Dr. Blumenthal's office would take on many of the functions, such as accreditation, that will later be performed by private groups. The idea behind the temporary program is to ensure that certified EHR products are available before the first incentives for use of certified systems begin in 2011.

The rule also proposes the creation of a permanent certification program that would eventually replace the temporary one. The permanent program would be more sophisticated, dividing the responsibility for testing and certification among different organizations. The permanent program also would include accreditation processes and set forth the requirement that certification bodies perform surveillance of certified EHR products. Certification bodies also may be able to assess additional health information technology products beyond EHRs and their modules. Both certification programs, however, would be voluntary.

Dr. Blumenthal called publication of the proposed rule an “important first step” to bringing structure to the evaluation of EHRs and EHR modules. “The programs will help support end users of certified products, and ultimately serve the interests of each patient by ensuring that their information is securely managed and available where and when it is needed,” he said in a statement.

Earlier this year, the federal government issued a proposed rule outlining the criteria for meaningful use of EHRs and an interim final rule that included an initial set of standards and specifications for certification of products.

Two separate regulations finalizing the temporary and permanent certification programs are expected to be published by the fall.

The federal government has put forward its plan to test and certify electronic health records in preparation for the Medicare and Medicaid incentive program that will reward physicians for their use of health information technology.

The proposed rule, which was released on March 2, establishes a temporary certification program in which the National Coordinator for Health Information Technology, Dr. David Blumenthal, will designate certain organizations to test and certify complete electronic health records (EHRs) and related modules.

Under the temporary program, Dr. Blumenthal's office would take on many of the functions, such as accreditation, that will later be performed by private groups. The idea behind the temporary program is to ensure that certified EHR products are available before the first incentives for use of certified systems begin in 2011.

The rule also proposes the creation of a permanent certification program that would eventually replace the temporary one. The permanent program would be more sophisticated, dividing the responsibility for testing and certification among different organizations. The permanent program also would include accreditation processes and set forth the requirement that certification bodies perform surveillance of certified EHR products. Certification bodies also may be able to assess additional health information technology products beyond EHRs and their modules. Both certification programs, however, would be voluntary.

Dr. Blumenthal called publication of the proposed rule an “important first step” to bringing structure to the evaluation of EHRs and EHR modules. “The programs will help support end users of certified products, and ultimately serve the interests of each patient by ensuring that their information is securely managed and available where and when it is needed,” he said in a statement.

Earlier this year, the federal government issued a proposed rule outlining the criteria for meaningful use of EHRs and an interim final rule that included an initial set of standards and specifications for certification of products.

Two separate regulations finalizing the temporary and permanent certification programs are expected to be published by the fall.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.

The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.

The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.

The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.

The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.

The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.

The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Top scientists at the National Institutes of Health and the Food and Drug Administration will be working together more closely in an effort to improve the regulatory process and bring new treatments to market sooner.

With more new treatments based on emerging technologies, NIH and FDA scientists must communicate with each other earlier and more often, explained Kathleen Sebelius, secretary of the Department of Health and Human Services. From the beginning of a therapy's development, basic scientists at the NIH should share information with the FDA so that FDA regulators can develop appropriate safety and effectiveness standards early on.

At the same time, FDA scientists can help researchers identify possible safety or quality issues earlier in the process, Ms. Sebelius said during a news conference to announce the partnership.

“By communicating throughout the process, it will help researchers navigate the regulatory process and give regulators the scientific tools they need to quickly assess a treatment's risks and benefits,” Ms. Sebelius said. “For Americans, this is going to mean that new treatments are available sooner.”

The initiative calls for the creation of a joint FDA-NIH Leadership Council that will include FDA commissioner Dr. Margaret A. Hamburg and NIH director Dr. Francis S. Collins, as well as six senior scientists from each of the two agencies. In addition, the NIH and the FDA have pooled their resources to offer $6.75 million in grants during the next 3 years for research on regulatory science. For example, the agencies are looking for ideas on how the FDA would evaluate the safety and effectiveness of new stem cell therapies.

Government officials will be seeking public comment on how the two agencies can improve their collaboration. The NIH and the FDA will hold a public meeting jointly this spring to gather input from industry, patient advocates, and the public.

To bring safe, effective therapies into the market sooner, the science used to develop new therapeutic compounds must be closely connected to the science that the FDA uses to review those compounds, Dr. Collins said.

But that hasn't always been the case, he added. Researchers have not always shared information with the FDA early in the process, leaving the regulators to evaluate medicines without the data they need. Meanwhile, academics sometimes have expressed concern that the FDA lacks understanding about certain aspects of novel therapies, Dr. Collins noted.

Bridging that gap will be essential, he said, as the FDA is asked to evaluate more combination therapies and medicines developed under the umbrella of personalized medicine.

“The science that undergirds this kind of regulatory effort could certainly use some additional energy,” Dr. Collins said.

Top scientists at the National Institutes of Health and the Food and Drug Administration will be working together more closely in an effort to improve the regulatory process and bring new treatments to market sooner.

With more new treatments based on emerging technologies, NIH and FDA scientists must communicate with each other earlier and more often, explained Kathleen Sebelius, secretary of the Department of Health and Human Services. From the beginning of a therapy's development, basic scientists at the NIH should share information with the FDA so that FDA regulators can develop appropriate safety and effectiveness standards early on.

At the same time, FDA scientists can help researchers identify possible safety or quality issues earlier in the process, Ms. Sebelius said during a news conference to announce the partnership.

“By communicating throughout the process, it will help researchers navigate the regulatory process and give regulators the scientific tools they need to quickly assess a treatment's risks and benefits,” Ms. Sebelius said. “For Americans, this is going to mean that new treatments are available sooner.”

The initiative calls for the creation of a joint FDA-NIH Leadership Council that will include FDA commissioner Dr. Margaret A. Hamburg and NIH director Dr. Francis S. Collins, as well as six senior scientists from each of the two agencies. In addition, the NIH and the FDA have pooled their resources to offer $6.75 million in grants during the next 3 years for research on regulatory science. For example, the agencies are looking for ideas on how the FDA would evaluate the safety and effectiveness of new stem cell therapies.

Government officials will be seeking public comment on how the two agencies can improve their collaboration. The NIH and the FDA will hold a public meeting jointly this spring to gather input from industry, patient advocates, and the public.

To bring safe, effective therapies into the market sooner, the science used to develop new therapeutic compounds must be closely connected to the science that the FDA uses to review those compounds, Dr. Collins said.

But that hasn't always been the case, he added. Researchers have not always shared information with the FDA early in the process, leaving the regulators to evaluate medicines without the data they need. Meanwhile, academics sometimes have expressed concern that the FDA lacks understanding about certain aspects of novel therapies, Dr. Collins noted.

Bridging that gap will be essential, he said, as the FDA is asked to evaluate more combination therapies and medicines developed under the umbrella of personalized medicine.

“The science that undergirds this kind of regulatory effort could certainly use some additional energy,” Dr. Collins said.

Top scientists at the National Institutes of Health and the Food and Drug Administration will be working together more closely in an effort to improve the regulatory process and bring new treatments to market sooner.

With more new treatments based on emerging technologies, NIH and FDA scientists must communicate with each other earlier and more often, explained Kathleen Sebelius, secretary of the Department of Health and Human Services. From the beginning of a therapy's development, basic scientists at the NIH should share information with the FDA so that FDA regulators can develop appropriate safety and effectiveness standards early on.

At the same time, FDA scientists can help researchers identify possible safety or quality issues earlier in the process, Ms. Sebelius said during a news conference to announce the partnership.

“By communicating throughout the process, it will help researchers navigate the regulatory process and give regulators the scientific tools they need to quickly assess a treatment's risks and benefits,” Ms. Sebelius said. “For Americans, this is going to mean that new treatments are available sooner.”

The initiative calls for the creation of a joint FDA-NIH Leadership Council that will include FDA commissioner Dr. Margaret A. Hamburg and NIH director Dr. Francis S. Collins, as well as six senior scientists from each of the two agencies. In addition, the NIH and the FDA have pooled their resources to offer $6.75 million in grants during the next 3 years for research on regulatory science. For example, the agencies are looking for ideas on how the FDA would evaluate the safety and effectiveness of new stem cell therapies.

Government officials will be seeking public comment on how the two agencies can improve their collaboration. The NIH and the FDA will hold a public meeting jointly this spring to gather input from industry, patient advocates, and the public.

To bring safe, effective therapies into the market sooner, the science used to develop new therapeutic compounds must be closely connected to the science that the FDA uses to review those compounds, Dr. Collins said.

But that hasn't always been the case, he added. Researchers have not always shared information with the FDA early in the process, leaving the regulators to evaluate medicines without the data they need. Meanwhile, academics sometimes have expressed concern that the FDA lacks understanding about certain aspects of novel therapies, Dr. Collins noted.

Bridging that gap will be essential, he said, as the FDA is asked to evaluate more combination therapies and medicines developed under the umbrella of personalized medicine.

“The science that undergirds this kind of regulatory effort could certainly use some additional energy,” Dr. Collins said.

Top scientists at the National Institutes of Health and the Food and Drug Administration will be working together more closely in an effort to improve regulatory science and bring new treatments to market sooner.

With more new treatments based on emerging technologies, NIH and FDA scientists must communicate earlier and more often, explained Kathleen Sebelius, secretary of the Department of Health and Human Services. From the beginning of a therapy's development, basic scientists at the NIH should share information with the FDA so that FDA regulators can develop appropriate safety and effectiveness standards early on.

At the same time, FDA scientists can help researchers identify possible safety or quality issues earlier in the process, she said during a news conference to announce the partnership.

“By communicating throughout the process, it will help researchers navigate the regulatory process and give regulators the scientific tools they need to quickly assess a treatment's risks and benefits,” Ms. Sebelius said.

The initiative calls for the creation of a joint FDA–NIH Leadership Council that will include FDA Commissioner Dr. Margaret A. Hamburg and NIH Director Dr. Francis S. Collins, as well as six senior scientists from each of the two agencies. The NIH and the FDA have also pooled their resources to offer $6.75 million in grants over the next 3 years for research on regulatory science.

Government officials will be seeking public comment on how the two agencies can improve their collaboration. The NIH and the FDA will hold a public meeting jointly this spring to gather input from industry, patient advocates, and the public.

To bring safe, effective therapies into the market sooner, the science used to develop new therapeutic compounds must be closely connected to the science the FDA uses to review those compounds, said Dr. Collins of the NIH.

Top scientists at the National Institutes of Health and the Food and Drug Administration will be working together more closely in an effort to improve regulatory science and bring new treatments to market sooner.

With more new treatments based on emerging technologies, NIH and FDA scientists must communicate earlier and more often, explained Kathleen Sebelius, secretary of the Department of Health and Human Services. From the beginning of a therapy's development, basic scientists at the NIH should share information with the FDA so that FDA regulators can develop appropriate safety and effectiveness standards early on.

At the same time, FDA scientists can help researchers identify possible safety or quality issues earlier in the process, she said during a news conference to announce the partnership.

“By communicating throughout the process, it will help researchers navigate the regulatory process and give regulators the scientific tools they need to quickly assess a treatment's risks and benefits,” Ms. Sebelius said.

The initiative calls for the creation of a joint FDA–NIH Leadership Council that will include FDA Commissioner Dr. Margaret A. Hamburg and NIH Director Dr. Francis S. Collins, as well as six senior scientists from each of the two agencies. The NIH and the FDA have also pooled their resources to offer $6.75 million in grants over the next 3 years for research on regulatory science.

Government officials will be seeking public comment on how the two agencies can improve their collaboration. The NIH and the FDA will hold a public meeting jointly this spring to gather input from industry, patient advocates, and the public.

To bring safe, effective therapies into the market sooner, the science used to develop new therapeutic compounds must be closely connected to the science the FDA uses to review those compounds, said Dr. Collins of the NIH.

Top scientists at the National Institutes of Health and the Food and Drug Administration will be working together more closely in an effort to improve regulatory science and bring new treatments to market sooner.

With more new treatments based on emerging technologies, NIH and FDA scientists must communicate earlier and more often, explained Kathleen Sebelius, secretary of the Department of Health and Human Services. From the beginning of a therapy's development, basic scientists at the NIH should share information with the FDA so that FDA regulators can develop appropriate safety and effectiveness standards early on.

At the same time, FDA scientists can help researchers identify possible safety or quality issues earlier in the process, she said during a news conference to announce the partnership.

“By communicating throughout the process, it will help researchers navigate the regulatory process and give regulators the scientific tools they need to quickly assess a treatment's risks and benefits,” Ms. Sebelius said.

The initiative calls for the creation of a joint FDA–NIH Leadership Council that will include FDA Commissioner Dr. Margaret A. Hamburg and NIH Director Dr. Francis S. Collins, as well as six senior scientists from each of the two agencies. The NIH and the FDA have also pooled their resources to offer $6.75 million in grants over the next 3 years for research on regulatory science.

Government officials will be seeking public comment on how the two agencies can improve their collaboration. The NIH and the FDA will hold a public meeting jointly this spring to gather input from industry, patient advocates, and the public.

To bring safe, effective therapies into the market sooner, the science used to develop new therapeutic compounds must be closely connected to the science the FDA uses to review those compounds, said Dr. Collins of the NIH.

The Obama administration wants to combat waste, fraud, and abuse in the Medicare and Medicaid programs and plans to spend more than $500 million to do it.

As part of the administration's budget proposal for fiscal year 2011, the Health and Human Services department is proposing to invest $561 million in discretionary funding to fight health care fraud, a $250 million increase over FY 2010. Specifically, the department plans to expand the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which brings together high-level officials at HHS and the U.S. Department of Justice to spot trends and develop new fraud prevention tools.

HHS said the new funding also will be used to minimize inappropriate payments, pinpoint potential weaknesses in program oversight, and target emerging fraud schemes. Department officials estimate that the efforts to fight fraud and abuse will save $9.9 billion over the next decade.

HHS also expects to squeeze more savings out of the Medicare and Medicaid programs by giving more scrutiny to the provider enrollment process, increasing oversight of claims, improving the data analysis within Medicare, and reducing the overutilization of prescription drugs in Medicaid.

“This budget sends a clear message to those who commit fraud: Stop stealing from seniors and tax payers or we'll put you behind bars,” Kathleen Sebelius, HHS Secretary, said during a press conference to release the HHS budget proposal.

The FY 2011 budget proposal focuses on fraud prevention, wellness, and building the public health infrastructure. While the budget documents note that the HHS proposal lays the “groundwork” for health reform, it is a stark contrast to last year's proposal, which included a $635 billion “reserve fund” dedicated to health reform over the next decade.

Ms. Sebelius said that while the current budget proposal tries to increase coverage and curb costs, it would do little to affect the overall trajectory of health care costs if it is not accompanied by health reform legislation. The FY 2011 budget aims to invest in wellness, health information technology, and comparative effectiveness research, but it won't significantly alter the rise in health care costs, fill the coverage gap, or provide security to those with coverage that they can remain insured, she said.

Overall, the Obama administration is seeking $911 billion in funding for HHS in FY 2011, an increase of $51 billion over the current fiscal year. Since the bulk of HHS's funding is tied up in mandatory obligations including Medicare and Medicaid, the budget includes $81 billion in discretionary program spending, an increase of $2.3 billion over last year.

The Obama administration's budget request assumes that Congress will step in to correct the Medicare physician payment formula, known as the Sustainable Growth Rate. At press time, physicians were scheduled to face a 21% across-the-board cut to their Medicare payments on March 1, unless Congress acted to avert the cut.

The budget request also calls for a $290 million investment in community health centers, bringing their funding to $2.5 billion. The increase should allow the health centers to continue to serve the new patients they began caring for when the centers got an infusion of funding under the American Recovery and Reinvestment Act (stimulus bill) last year. HHS estimates that community health centers will be able to serve more than 20 million patients in FY 2011.

The budget request also calls for nearly $1 billion, an increase of about $33 million, to help shore up the health care workforce. The money will help to expand loan repayment programs for physicians, nurses, and dentists who agree to practice medically underserved areas.

The Obama administration also proposes to spend $4 billion to fund the Food and Drug Administration, with $1.4 billion going toward medical product safety, including drugs, devices, vaccines, and the blood supply. The funding represents an increase of $101 million in FY 2011. The new money would go toward import safety, high-risk products, and partnerships for patient safety. About $40 million of that new funding is slated to go toward the generic drugs program, including new investments in postmarket drug safety and the establishment of a medical device registry.

The Obama administration wants to combat waste, fraud, and abuse in the Medicare and Medicaid programs and plans to spend more than $500 million to do it.

As part of the administration's budget proposal for fiscal year 2011, the Health and Human Services department is proposing to invest $561 million in discretionary funding to fight health care fraud, a $250 million increase over FY 2010. Specifically, the department plans to expand the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which brings together high-level officials at HHS and the U.S. Department of Justice to spot trends and develop new fraud prevention tools.

HHS said the new funding also will be used to minimize inappropriate payments, pinpoint potential weaknesses in program oversight, and target emerging fraud schemes. Department officials estimate that the efforts to fight fraud and abuse will save $9.9 billion over the next decade.

HHS also expects to squeeze more savings out of the Medicare and Medicaid programs by giving more scrutiny to the provider enrollment process, increasing oversight of claims, improving the data analysis within Medicare, and reducing the overutilization of prescription drugs in Medicaid.

“This budget sends a clear message to those who commit fraud: Stop stealing from seniors and tax payers or we'll put you behind bars,” Kathleen Sebelius, HHS Secretary, said during a press conference to release the HHS budget proposal.

The FY 2011 budget proposal focuses on fraud prevention, wellness, and building the public health infrastructure. While the budget documents note that the HHS proposal lays the “groundwork” for health reform, it is a stark contrast to last year's proposal, which included a $635 billion “reserve fund” dedicated to health reform over the next decade.

Ms. Sebelius said that while the current budget proposal tries to increase coverage and curb costs, it would do little to affect the overall trajectory of health care costs if it is not accompanied by health reform legislation. The FY 2011 budget aims to invest in wellness, health information technology, and comparative effectiveness research, but it won't significantly alter the rise in health care costs, fill the coverage gap, or provide security to those with coverage that they can remain insured, she said.

Overall, the Obama administration is seeking $911 billion in funding for HHS in FY 2011, an increase of $51 billion over the current fiscal year. Since the bulk of HHS's funding is tied up in mandatory obligations including Medicare and Medicaid, the budget includes $81 billion in discretionary program spending, an increase of $2.3 billion over last year.

The Obama administration's budget request assumes that Congress will step in to correct the Medicare physician payment formula, known as the Sustainable Growth Rate. At press time, physicians were scheduled to face a 21% across-the-board cut to their Medicare payments on March 1, unless Congress acted to avert the cut.

The budget request also calls for a $290 million investment in community health centers, bringing their funding to $2.5 billion. The increase should allow the health centers to continue to serve the new patients they began caring for when the centers got an infusion of funding under the American Recovery and Reinvestment Act (stimulus bill) last year. HHS estimates that community health centers will be able to serve more than 20 million patients in FY 2011.

The budget request also calls for nearly $1 billion, an increase of about $33 million, to help shore up the health care workforce. The money will help to expand loan repayment programs for physicians, nurses, and dentists who agree to practice medically underserved areas.

The Obama administration also proposes to spend $4 billion to fund the Food and Drug Administration, with $1.4 billion going toward medical product safety, including drugs, devices, vaccines, and the blood supply. The funding represents an increase of $101 million in FY 2011. The new money would go toward import safety, high-risk products, and partnerships for patient safety. About $40 million of that new funding is slated to go toward the generic drugs program, including new investments in postmarket drug safety and the establishment of a medical device registry.

The Obama administration wants to combat waste, fraud, and abuse in the Medicare and Medicaid programs and plans to spend more than $500 million to do it.

As part of the administration's budget proposal for fiscal year 2011, the Health and Human Services department is proposing to invest $561 million in discretionary funding to fight health care fraud, a $250 million increase over FY 2010. Specifically, the department plans to expand the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which brings together high-level officials at HHS and the U.S. Department of Justice to spot trends and develop new fraud prevention tools.

HHS said the new funding also will be used to minimize inappropriate payments, pinpoint potential weaknesses in program oversight, and target emerging fraud schemes. Department officials estimate that the efforts to fight fraud and abuse will save $9.9 billion over the next decade.

HHS also expects to squeeze more savings out of the Medicare and Medicaid programs by giving more scrutiny to the provider enrollment process, increasing oversight of claims, improving the data analysis within Medicare, and reducing the overutilization of prescription drugs in Medicaid.

“This budget sends a clear message to those who commit fraud: Stop stealing from seniors and tax payers or we'll put you behind bars,” Kathleen Sebelius, HHS Secretary, said during a press conference to release the HHS budget proposal.

The FY 2011 budget proposal focuses on fraud prevention, wellness, and building the public health infrastructure. While the budget documents note that the HHS proposal lays the “groundwork” for health reform, it is a stark contrast to last year's proposal, which included a $635 billion “reserve fund” dedicated to health reform over the next decade.

Ms. Sebelius said that while the current budget proposal tries to increase coverage and curb costs, it would do little to affect the overall trajectory of health care costs if it is not accompanied by health reform legislation. The FY 2011 budget aims to invest in wellness, health information technology, and comparative effectiveness research, but it won't significantly alter the rise in health care costs, fill the coverage gap, or provide security to those with coverage that they can remain insured, she said.

Overall, the Obama administration is seeking $911 billion in funding for HHS in FY 2011, an increase of $51 billion over the current fiscal year. Since the bulk of HHS's funding is tied up in mandatory obligations including Medicare and Medicaid, the budget includes $81 billion in discretionary program spending, an increase of $2.3 billion over last year.

The Obama administration's budget request assumes that Congress will step in to correct the Medicare physician payment formula, known as the Sustainable Growth Rate. At press time, physicians were scheduled to face a 21% across-the-board cut to their Medicare payments on March 1, unless Congress acted to avert the cut.

The budget request also calls for a $290 million investment in community health centers, bringing their funding to $2.5 billion. The increase should allow the health centers to continue to serve the new patients they began caring for when the centers got an infusion of funding under the American Recovery and Reinvestment Act (stimulus bill) last year. HHS estimates that community health centers will be able to serve more than 20 million patients in FY 2011.

The budget request also calls for nearly $1 billion, an increase of about $33 million, to help shore up the health care workforce. The money will help to expand loan repayment programs for physicians, nurses, and dentists who agree to practice medically underserved areas.

The Obama administration also proposes to spend $4 billion to fund the Food and Drug Administration, with $1.4 billion going toward medical product safety, including drugs, devices, vaccines, and the blood supply. The funding represents an increase of $101 million in FY 2011. The new money would go toward import safety, high-risk products, and partnerships for patient safety. About $40 million of that new funding is slated to go toward the generic drugs program, including new investments in postmarket drug safety and the establishment of a medical device registry.

Middle-aged women aren't being routinely assessed for osteoporosis during their ob.gyn. visits, despite this group's increased awareness of the condition, survey results released by the North American Menopause Society showed.

In a poll of 881 women, most of whom were either perimenopausal or postmenopausal, nearly all (98%) said they considered bone strength to be an important health concern. But 45% reported that osteoporosis was not addressed during their last routine ob.gyn. visit, and 26% said they had never discussed osteoporosis with their gynecologist.

Dr. Wulf H. Utian, the honorary founding president and executive director emeritus of the North American Menopause Society (NAMS), said that the survey shows there is more work to be done in raising awareness among ob.gyns. but that the results aren't a cause for concern. “Some important issues don't get attention during the consultation, and that may be a reflection of modern medicine and the limited time that's available,” he said in an interview.

In fact, Dr. Utian said both the public and health care providers have significantly greater awareness of osteoporosis and bone health than they did only a decade ago.

But there are barriers to making bone health a regular part of ob.gyn. care, he said. One issue is a lack of reimbursement for performing bone density testing. In some instances, physicians may not be recommending bone density testing because they think it won't be reimbursed, and they believe they can get an adequate risk assessment without the test.

In other cases, physicians are recommending bone density testing, but patients are rejecting it because they will have to pay out of pocket, Dr. Utian said. In fact, the survey found that even though nearly 63% of women reported that their ob.gyn. had recommended a bone scan, 27% of women surveyed had never had one.

Another barrier is the confusion among physicians about who should get a bone density test. There has been a good deal of variation among the recommendations coming out of various medical organizations, Dr. Utian said, creating a sense of uncertainty. In an effort to spell out more clearly the appropriate diagnosis, prevention, and treatment for postmenopausal osteoporosis, NAMS recently issued a new position statement on osteoporosis in midlife (February 2010, p. 1.).

In the position statement, NAMS recommends the use of the World Health Organization's FRAX (Fracture Risk Assessment) tool as well as increased vitamin D₃ intake. NAMS plans to take the scientific paper, which was issued last month, and translate it into a series of consumer education pieces, he said.

The NAMS survey also points to a possible communication gap between women and their ob.gyns. about the risk factors for osteoporosis. For example, among the women surveyed, 45 women said they had a broken bone in the past 5 years that occurred in a site associated with osteoporosis such as the hip, spine, wrist, collarbone, arm, leg, or pelvis. However, 35 of those women said their ob.gyn. was not aware of the break.

Additionally, while most women surveyed said that their ob.gyns. had told them that broken bones could be a sign of osteoporosis, the women were not as well informed about other possible consequences, including loss of height, dowager's hump, and disability or immobility.

The survey results could indicate that physicians are failing to take an adequate history during routine exams, Dr. Utian said. It also could mean that patients are failing to understand the association between bone fracture and menopause. “In other words, the woman doesn't tie the fact that she's had a fracture with anything that's to do with her visit to the gynecologist,” he said.

Dr. Utian said that all gynecologists who see women in their middle years should routinely ask about risk factors for bone loss and fracture.

Middle-aged women aren't being routinely assessed for osteoporosis during their ob.gyn. visits, despite this group's increased awareness of the condition, survey results released by the North American Menopause Society showed.

In a poll of 881 women, most of whom were either perimenopausal or postmenopausal, nearly all (98%) said they considered bone strength to be an important health concern. But 45% reported that osteoporosis was not addressed during their last routine ob.gyn. visit, and 26% said they had never discussed osteoporosis with their gynecologist.

Dr. Wulf H. Utian, the honorary founding president and executive director emeritus of the North American Menopause Society (NAMS), said that the survey shows there is more work to be done in raising awareness among ob.gyns. but that the results aren't a cause for concern. “Some important issues don't get attention during the consultation, and that may be a reflection of modern medicine and the limited time that's available,” he said in an interview.

In fact, Dr. Utian said both the public and health care providers have significantly greater awareness of osteoporosis and bone health than they did only a decade ago.

But there are barriers to making bone health a regular part of ob.gyn. care, he said. One issue is a lack of reimbursement for performing bone density testing. In some instances, physicians may not be recommending bone density testing because they think it won't be reimbursed, and they believe they can get an adequate risk assessment without the test.

In other cases, physicians are recommending bone density testing, but patients are rejecting it because they will have to pay out of pocket, Dr. Utian said. In fact, the survey found that even though nearly 63% of women reported that their ob.gyn. had recommended a bone scan, 27% of women surveyed had never had one.

Another barrier is the confusion among physicians about who should get a bone density test. There has been a good deal of variation among the recommendations coming out of various medical organizations, Dr. Utian said, creating a sense of uncertainty. In an effort to spell out more clearly the appropriate diagnosis, prevention, and treatment for postmenopausal osteoporosis, NAMS recently issued a new position statement on osteoporosis in midlife (February 2010, p. 1.).

In the position statement, NAMS recommends the use of the World Health Organization's FRAX (Fracture Risk Assessment) tool as well as increased vitamin D₃ intake. NAMS plans to take the scientific paper, which was issued last month, and translate it into a series of consumer education pieces, he said.

The NAMS survey also points to a possible communication gap between women and their ob.gyns. about the risk factors for osteoporosis. For example, among the women surveyed, 45 women said they had a broken bone in the past 5 years that occurred in a site associated with osteoporosis such as the hip, spine, wrist, collarbone, arm, leg, or pelvis. However, 35 of those women said their ob.gyn. was not aware of the break.

Additionally, while most women surveyed said that their ob.gyns. had told them that broken bones could be a sign of osteoporosis, the women were not as well informed about other possible consequences, including loss of height, dowager's hump, and disability or immobility.

The survey results could indicate that physicians are failing to take an adequate history during routine exams, Dr. Utian said. It also could mean that patients are failing to understand the association between bone fracture and menopause. “In other words, the woman doesn't tie the fact that she's had a fracture with anything that's to do with her visit to the gynecologist,” he said.

Dr. Utian said that all gynecologists who see women in their middle years should routinely ask about risk factors for bone loss and fracture.

Middle-aged women aren't being routinely assessed for osteoporosis during their ob.gyn. visits, despite this group's increased awareness of the condition, survey results released by the North American Menopause Society showed.

In a poll of 881 women, most of whom were either perimenopausal or postmenopausal, nearly all (98%) said they considered bone strength to be an important health concern. But 45% reported that osteoporosis was not addressed during their last routine ob.gyn. visit, and 26% said they had never discussed osteoporosis with their gynecologist.

Dr. Wulf H. Utian, the honorary founding president and executive director emeritus of the North American Menopause Society (NAMS), said that the survey shows there is more work to be done in raising awareness among ob.gyns. but that the results aren't a cause for concern. “Some important issues don't get attention during the consultation, and that may be a reflection of modern medicine and the limited time that's available,” he said in an interview.

In fact, Dr. Utian said both the public and health care providers have significantly greater awareness of osteoporosis and bone health than they did only a decade ago.

But there are barriers to making bone health a regular part of ob.gyn. care, he said. One issue is a lack of reimbursement for performing bone density testing. In some instances, physicians may not be recommending bone density testing because they think it won't be reimbursed, and they believe they can get an adequate risk assessment without the test.

In other cases, physicians are recommending bone density testing, but patients are rejecting it because they will have to pay out of pocket, Dr. Utian said. In fact, the survey found that even though nearly 63% of women reported that their ob.gyn. had recommended a bone scan, 27% of women surveyed had never had one.

Another barrier is the confusion among physicians about who should get a bone density test. There has been a good deal of variation among the recommendations coming out of various medical organizations, Dr. Utian said, creating a sense of uncertainty. In an effort to spell out more clearly the appropriate diagnosis, prevention, and treatment for postmenopausal osteoporosis, NAMS recently issued a new position statement on osteoporosis in midlife (February 2010, p. 1.).

In the position statement, NAMS recommends the use of the World Health Organization's FRAX (Fracture Risk Assessment) tool as well as increased vitamin D₃ intake. NAMS plans to take the scientific paper, which was issued last month, and translate it into a series of consumer education pieces, he said.

The NAMS survey also points to a possible communication gap between women and their ob.gyns. about the risk factors for osteoporosis. For example, among the women surveyed, 45 women said they had a broken bone in the past 5 years that occurred in a site associated with osteoporosis such as the hip, spine, wrist, collarbone, arm, leg, or pelvis. However, 35 of those women said their ob.gyn. was not aware of the break.

Additionally, while most women surveyed said that their ob.gyns. had told them that broken bones could be a sign of osteoporosis, the women were not as well informed about other possible consequences, including loss of height, dowager's hump, and disability or immobility.

The survey results could indicate that physicians are failing to take an adequate history during routine exams, Dr. Utian said. It also could mean that patients are failing to understand the association between bone fracture and menopause. “In other words, the woman doesn't tie the fact that she's had a fracture with anything that's to do with her visit to the gynecologist,” he said.

Dr. Utian said that all gynecologists who see women in their middle years should routinely ask about risk factors for bone loss and fracture.