Mary Ellen Schneider

Emergency Contraceptives: Fall In

Women in the U.S. military now have easier access to emergency contraception, thanks to a recent decision by the Department of Defense to make the hormone pills available to all U.S. military hospitals and health centers around the world. The change came after the Pentagon's Pharmacy and Therapeutics Committee recommended that the medications be offered at all bases overseas. The move was praised by the American Civil Liberties Union and Planned Parenthood. “We applaud the Pentagon for ensuring that every woman honorably serving our country and the spouses of military personnel stationed around the world will have access to the same basic reproductive health care available to women in the United States,” Planned Parenthood President Cecile Richards said in a statement. “For far too long, politics trumped medical reason.”

IVF Produces Well-Adjusted Kids

Children conceived through in vitro fertilization are generally as healthy and well adjusted as the general population, according to a study published in Fertility and Sterility. Researchers at Eastern Virginia Medical School analyzed 90-item questionnaires returned by 173 young adults who were conceived through IVF at the school's reproductive medicine clinic between 1981 and 1990. However, the individuals conceived through IVF had more clinical depression and attention deficit or attention-deficit/hyperactivity disorder and did more binge drinking than other studies have shown in the general population. The gap was large for AD/ADHD, which affects 3%–5% of the general population, but was reported as a current or past diagnosis in 27% of the IVF group. “It is comforting to see that the data bears out what we have believed, that children conceived via IVF are generally as healthy as other children, even as those children become adults,” Dr. James Goldfarb, president of the Society for Assisted Reproductive Technology, said in a statement. “While the finding of increased depression and AD/ADHD is notable, other studies have not shown these increases.”

Obama Budget Gets Mixed Reviews

The Obama administration's budget proposal for fiscal year 2011 is a mixed bag when it comes to reproductive health, according to abortion rights groups. The proposal includes “modest” improvements to family planning programs run by the federal government and increased funding for teen pregnancy prevention, according to the Guttmacher Institute. For example, the Title X family planning program would get a 3%, or $10 million, increase, pushing its budget to $327 million. The Center for Reproductive Rights criticized the administration for staying silent about current restrictions on federal funding for abortions. “Failure to provide access to abortion services—a medical procedure that only women need and that one in three will have in their lifetime—is discrimination, plain and simple,” Nancy Northup, president of the Center for Reproductive Rights, said in a statement. “Bans on public funding for abortion services further disadvantage women who are already struggling to obtain timely, high-quality health care.”

ACOG Wants a 'Just' Health System

Although most people think about politics and economics as the main drivers of the health care reform debate, a new committee opinion from the American College of Obstetricians and Gynecologists says it is primarily a moral issue (Obstet. Gynecol. 2010;115:672-7). The opinion, from the Committee on Ethics, reiterates the college's policy that health care should be available to all U.S. residents, regardless of citizenship or employment status. It also states that meaningful health care reform must include an emphasis on wellness, not just efficiencies in medical practice. The committee opinion reminded ob.gyns. that as experts in health care, they have an opportunity to influence the policy debate.

HPV Vaccination as Parenting

The decision by parents to have their daughters get the human papillomavirus (HPV) vaccine is more likely to be influenced by parents' own health habits rather than purely medical considerations, according to a study. For example, current and former smokers, as well as parents who get regular exercise, were more likely to say they'd let their daughters get the vaccine. Researchers analyzed survey data from more than 1,300 parents who had daughters under age 18 and had answered the 2007 Health Information National Trends Survey. “Some prior research suggests that risky health behaviors tend to co-occur (i.e., smoking, alcohol use) and are associated with lower uptake of harm prevention strategies, such as vaccinations,” lead author Carolyn Y. Fang, Ph.D., said in a statement. “This was not the case in the current study. It may be that parents who are former or current smokers have a heightened awareness of cancer and its related risks, therefore, may be more willing to vaccinate their daughters to prevent cancer.” The study was published in the February issue of Cancer Epidemiology, Biomarkers & Prevention.

Emergency Contraceptives: Fall In

Women in the U.S. military now have easier access to emergency contraception, thanks to a recent decision by the Department of Defense to make the hormone pills available to all U.S. military hospitals and health centers around the world. The change came after the Pentagon's Pharmacy and Therapeutics Committee recommended that the medications be offered at all bases overseas. The move was praised by the American Civil Liberties Union and Planned Parenthood. “We applaud the Pentagon for ensuring that every woman honorably serving our country and the spouses of military personnel stationed around the world will have access to the same basic reproductive health care available to women in the United States,” Planned Parenthood President Cecile Richards said in a statement. “For far too long, politics trumped medical reason.”

IVF Produces Well-Adjusted Kids

Children conceived through in vitro fertilization are generally as healthy and well adjusted as the general population, according to a study published in Fertility and Sterility. Researchers at Eastern Virginia Medical School analyzed 90-item questionnaires returned by 173 young adults who were conceived through IVF at the school's reproductive medicine clinic between 1981 and 1990. However, the individuals conceived through IVF had more clinical depression and attention deficit or attention-deficit/hyperactivity disorder and did more binge drinking than other studies have shown in the general population. The gap was large for AD/ADHD, which affects 3%–5% of the general population, but was reported as a current or past diagnosis in 27% of the IVF group. “It is comforting to see that the data bears out what we have believed, that children conceived via IVF are generally as healthy as other children, even as those children become adults,” Dr. James Goldfarb, president of the Society for Assisted Reproductive Technology, said in a statement. “While the finding of increased depression and AD/ADHD is notable, other studies have not shown these increases.”

Obama Budget Gets Mixed Reviews

The Obama administration's budget proposal for fiscal year 2011 is a mixed bag when it comes to reproductive health, according to abortion rights groups. The proposal includes “modest” improvements to family planning programs run by the federal government and increased funding for teen pregnancy prevention, according to the Guttmacher Institute. For example, the Title X family planning program would get a 3%, or $10 million, increase, pushing its budget to $327 million. The Center for Reproductive Rights criticized the administration for staying silent about current restrictions on federal funding for abortions. “Failure to provide access to abortion services—a medical procedure that only women need and that one in three will have in their lifetime—is discrimination, plain and simple,” Nancy Northup, president of the Center for Reproductive Rights, said in a statement. “Bans on public funding for abortion services further disadvantage women who are already struggling to obtain timely, high-quality health care.”

ACOG Wants a 'Just' Health System

Although most people think about politics and economics as the main drivers of the health care reform debate, a new committee opinion from the American College of Obstetricians and Gynecologists says it is primarily a moral issue (Obstet. Gynecol. 2010;115:672-7). The opinion, from the Committee on Ethics, reiterates the college's policy that health care should be available to all U.S. residents, regardless of citizenship or employment status. It also states that meaningful health care reform must include an emphasis on wellness, not just efficiencies in medical practice. The committee opinion reminded ob.gyns. that as experts in health care, they have an opportunity to influence the policy debate.

HPV Vaccination as Parenting

The decision by parents to have their daughters get the human papillomavirus (HPV) vaccine is more likely to be influenced by parents' own health habits rather than purely medical considerations, according to a study. For example, current and former smokers, as well as parents who get regular exercise, were more likely to say they'd let their daughters get the vaccine. Researchers analyzed survey data from more than 1,300 parents who had daughters under age 18 and had answered the 2007 Health Information National Trends Survey. “Some prior research suggests that risky health behaviors tend to co-occur (i.e., smoking, alcohol use) and are associated with lower uptake of harm prevention strategies, such as vaccinations,” lead author Carolyn Y. Fang, Ph.D., said in a statement. “This was not the case in the current study. It may be that parents who are former or current smokers have a heightened awareness of cancer and its related risks, therefore, may be more willing to vaccinate their daughters to prevent cancer.” The study was published in the February issue of Cancer Epidemiology, Biomarkers & Prevention.

Emergency Contraceptives: Fall In

Women in the U.S. military now have easier access to emergency contraception, thanks to a recent decision by the Department of Defense to make the hormone pills available to all U.S. military hospitals and health centers around the world. The change came after the Pentagon's Pharmacy and Therapeutics Committee recommended that the medications be offered at all bases overseas. The move was praised by the American Civil Liberties Union and Planned Parenthood. “We applaud the Pentagon for ensuring that every woman honorably serving our country and the spouses of military personnel stationed around the world will have access to the same basic reproductive health care available to women in the United States,” Planned Parenthood President Cecile Richards said in a statement. “For far too long, politics trumped medical reason.”

IVF Produces Well-Adjusted Kids

Children conceived through in vitro fertilization are generally as healthy and well adjusted as the general population, according to a study published in Fertility and Sterility. Researchers at Eastern Virginia Medical School analyzed 90-item questionnaires returned by 173 young adults who were conceived through IVF at the school's reproductive medicine clinic between 1981 and 1990. However, the individuals conceived through IVF had more clinical depression and attention deficit or attention-deficit/hyperactivity disorder and did more binge drinking than other studies have shown in the general population. The gap was large for AD/ADHD, which affects 3%–5% of the general population, but was reported as a current or past diagnosis in 27% of the IVF group. “It is comforting to see that the data bears out what we have believed, that children conceived via IVF are generally as healthy as other children, even as those children become adults,” Dr. James Goldfarb, president of the Society for Assisted Reproductive Technology, said in a statement. “While the finding of increased depression and AD/ADHD is notable, other studies have not shown these increases.”

Obama Budget Gets Mixed Reviews

The Obama administration's budget proposal for fiscal year 2011 is a mixed bag when it comes to reproductive health, according to abortion rights groups. The proposal includes “modest” improvements to family planning programs run by the federal government and increased funding for teen pregnancy prevention, according to the Guttmacher Institute. For example, the Title X family planning program would get a 3%, or $10 million, increase, pushing its budget to $327 million. The Center for Reproductive Rights criticized the administration for staying silent about current restrictions on federal funding for abortions. “Failure to provide access to abortion services—a medical procedure that only women need and that one in three will have in their lifetime—is discrimination, plain and simple,” Nancy Northup, president of the Center for Reproductive Rights, said in a statement. “Bans on public funding for abortion services further disadvantage women who are already struggling to obtain timely, high-quality health care.”

ACOG Wants a 'Just' Health System

Although most people think about politics and economics as the main drivers of the health care reform debate, a new committee opinion from the American College of Obstetricians and Gynecologists says it is primarily a moral issue (Obstet. Gynecol. 2010;115:672-7). The opinion, from the Committee on Ethics, reiterates the college's policy that health care should be available to all U.S. residents, regardless of citizenship or employment status. It also states that meaningful health care reform must include an emphasis on wellness, not just efficiencies in medical practice. The committee opinion reminded ob.gyns. that as experts in health care, they have an opportunity to influence the policy debate.

HPV Vaccination as Parenting

The decision by parents to have their daughters get the human papillomavirus (HPV) vaccine is more likely to be influenced by parents' own health habits rather than purely medical considerations, according to a study. For example, current and former smokers, as well as parents who get regular exercise, were more likely to say they'd let their daughters get the vaccine. Researchers analyzed survey data from more than 1,300 parents who had daughters under age 18 and had answered the 2007 Health Information National Trends Survey. “Some prior research suggests that risky health behaviors tend to co-occur (i.e., smoking, alcohol use) and are associated with lower uptake of harm prevention strategies, such as vaccinations,” lead author Carolyn Y. Fang, Ph.D., said in a statement. “This was not the case in the current study. It may be that parents who are former or current smokers have a heightened awareness of cancer and its related risks, therefore, may be more willing to vaccinate their daughters to prevent cancer.” The study was published in the February issue of Cancer Epidemiology, Biomarkers & Prevention.

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. With the prospect for passing comprehensive health reform legislation waning, there was a much smaller emphasis on health reform in the current budget proposal.

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.

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 passed legislation to avert the cut. The budget proposal assumes no growth in Medicare physician payment over the next 10 years, at a cost of $371 billion, Ms. Sebelius said.

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 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. With the prospect for passing comprehensive health reform legislation waning, there was a much smaller emphasis on health reform in the current budget proposal.

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.

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 passed legislation to avert the cut. The budget proposal assumes no growth in Medicare physician payment over the next 10 years, at a cost of $371 billion, Ms. Sebelius said.

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 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. With the prospect for passing comprehensive health reform legislation waning, there was a much smaller emphasis on health reform in the current budget proposal.

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.

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 passed legislation to avert the cut. The budget proposal assumes no growth in Medicare physician payment over the next 10 years, at a cost of $371 billion, Ms. Sebelius said.

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.

Texting for Stroke Awareness

The American Heart Association is asking people to text their friends the warning signs of stroke as part of the campaign “Take 2 to Save 2”—that is, take 2 minutes to send the message to two people at risk. People can text “Take 2” to 64244, and the AHA will send out a health message that can be passed along. “Think about two people you care about who smoke, are overweight, have high blood pressure, diabetes, or a family history of heart disease or stroke,” Dr. Clyde W. Yancy, AHA president, said in a statement.

Speeding Up Epilepsy Research

The National Institute of Neurological Disorders and Stroke is moving forward with a plan to energize epilepsy research. At a meeting last month, the institute's National Advisory Neurological Disorders and Stroke Council (NANDSC) approved an initiative that gives researchers opportunities for targeted grants and “virtual” collaboration. The research plan features a “Center Without Walls” modeled after successful programs elsewhere in the National Institutes of Health. The new center would enable scientists at different sites to collaborate on epilepsy research. The institute is also planning to offer grants in areas such as epilepsy prevention, treatment-resistant epilepsy, and novel approaches to epilepsy research.

NINDS Names New Advisors

NIH officials have appointed four new members to the NANDSC. The 18-member group reviews applications for National Institute of Neurological Disorders and Stroke support for research and training. The new members are Dr. Thomas G. Brott, a pioneer in stroke and cerebrovascular disease research and professor at the Mayo Clinic, Jacksonville, Fla.; Dr. Donna M. Ferriero, chief of child neurology at the University of California, San Francisco; Dr. Barbara G. Vickrey, who directs the health services research program in neurology at the University of California, Los Angeles; and Kimberly S. Zellmer, a Columbus, Ohio, lawyer and advocate for research on Batten disease.

Award for Dementia Researchers

Two dementia researchers from the University of California, San Francisco, will share the $100,000 Potamkin Prize for their work on Alzheimer's disease and frontotemporal lobar degeneration (FTLD). Dr. Bruce L. Miller is receiving his part of the award for 25 years of research into FTLD, also known as Pick's disease. The work has improved diagnosis of the disease and led to several treatments, said the American Academy of Neurology, which bestows the award. The other recipient is Dr. Lennart Mucke, who uncovered strategies to prevent and even reverse cognitive impairments in mouse models of Alzheimer's disease. The annual prize, for advancing understanding of Alzheimer's disease and related disorders, is to be used for continuing research and will be awarded at the AAN annual meeting in Toronto in April.

Big Market for Stimulation Kalorama

Kalorama Information is predicting that within 5 years, the market for electrical and magnetic neurostimulation devices for treating depression could reach $16 billion a year. Currently, the market is limited because there is only one device—Cyberonic Inc.'s vagus nerve stimulator—and the cost of device treatment outweighs that of drug therapy, according to a report by the medical market research company. The analysis notes, however, that several manufacturers are developing external devices, such as Neuronetics Inc.'s repetitive TMS therapy system. Medtronic Inc., St. Jude Medical Inc., and Boston Scientific Corp. are also looking into adapting their deep brain and spinal cord stimulators to depression treatment, according to Kalorama.

Texting for Stroke Awareness

The American Heart Association is asking people to text their friends the warning signs of stroke as part of the campaign “Take 2 to Save 2”—that is, take 2 minutes to send the message to two people at risk. People can text “Take 2” to 64244, and the AHA will send out a health message that can be passed along. “Think about two people you care about who smoke, are overweight, have high blood pressure, diabetes, or a family history of heart disease or stroke,” Dr. Clyde W. Yancy, AHA president, said in a statement.

Speeding Up Epilepsy Research

The National Institute of Neurological Disorders and Stroke is moving forward with a plan to energize epilepsy research. At a meeting last month, the institute's National Advisory Neurological Disorders and Stroke Council (NANDSC) approved an initiative that gives researchers opportunities for targeted grants and “virtual” collaboration. The research plan features a “Center Without Walls” modeled after successful programs elsewhere in the National Institutes of Health. The new center would enable scientists at different sites to collaborate on epilepsy research. The institute is also planning to offer grants in areas such as epilepsy prevention, treatment-resistant epilepsy, and novel approaches to epilepsy research.

NINDS Names New Advisors

NIH officials have appointed four new members to the NANDSC. The 18-member group reviews applications for National Institute of Neurological Disorders and Stroke support for research and training. The new members are Dr. Thomas G. Brott, a pioneer in stroke and cerebrovascular disease research and professor at the Mayo Clinic, Jacksonville, Fla.; Dr. Donna M. Ferriero, chief of child neurology at the University of California, San Francisco; Dr. Barbara G. Vickrey, who directs the health services research program in neurology at the University of California, Los Angeles; and Kimberly S. Zellmer, a Columbus, Ohio, lawyer and advocate for research on Batten disease.

Award for Dementia Researchers

Two dementia researchers from the University of California, San Francisco, will share the $100,000 Potamkin Prize for their work on Alzheimer's disease and frontotemporal lobar degeneration (FTLD). Dr. Bruce L. Miller is receiving his part of the award for 25 years of research into FTLD, also known as Pick's disease. The work has improved diagnosis of the disease and led to several treatments, said the American Academy of Neurology, which bestows the award. The other recipient is Dr. Lennart Mucke, who uncovered strategies to prevent and even reverse cognitive impairments in mouse models of Alzheimer's disease. The annual prize, for advancing understanding of Alzheimer's disease and related disorders, is to be used for continuing research and will be awarded at the AAN annual meeting in Toronto in April.

Big Market for Stimulation Kalorama

Kalorama Information is predicting that within 5 years, the market for electrical and magnetic neurostimulation devices for treating depression could reach $16 billion a year. Currently, the market is limited because there is only one device—Cyberonic Inc.'s vagus nerve stimulator—and the cost of device treatment outweighs that of drug therapy, according to a report by the medical market research company. The analysis notes, however, that several manufacturers are developing external devices, such as Neuronetics Inc.'s repetitive TMS therapy system. Medtronic Inc., St. Jude Medical Inc., and Boston Scientific Corp. are also looking into adapting their deep brain and spinal cord stimulators to depression treatment, according to Kalorama.

Texting for Stroke Awareness

The American Heart Association is asking people to text their friends the warning signs of stroke as part of the campaign “Take 2 to Save 2”—that is, take 2 minutes to send the message to two people at risk. People can text “Take 2” to 64244, and the AHA will send out a health message that can be passed along. “Think about two people you care about who smoke, are overweight, have high blood pressure, diabetes, or a family history of heart disease or stroke,” Dr. Clyde W. Yancy, AHA president, said in a statement.

Speeding Up Epilepsy Research

The National Institute of Neurological Disorders and Stroke is moving forward with a plan to energize epilepsy research. At a meeting last month, the institute's National Advisory Neurological Disorders and Stroke Council (NANDSC) approved an initiative that gives researchers opportunities for targeted grants and “virtual” collaboration. The research plan features a “Center Without Walls” modeled after successful programs elsewhere in the National Institutes of Health. The new center would enable scientists at different sites to collaborate on epilepsy research. The institute is also planning to offer grants in areas such as epilepsy prevention, treatment-resistant epilepsy, and novel approaches to epilepsy research.

NINDS Names New Advisors

NIH officials have appointed four new members to the NANDSC. The 18-member group reviews applications for National Institute of Neurological Disorders and Stroke support for research and training. The new members are Dr. Thomas G. Brott, a pioneer in stroke and cerebrovascular disease research and professor at the Mayo Clinic, Jacksonville, Fla.; Dr. Donna M. Ferriero, chief of child neurology at the University of California, San Francisco; Dr. Barbara G. Vickrey, who directs the health services research program in neurology at the University of California, Los Angeles; and Kimberly S. Zellmer, a Columbus, Ohio, lawyer and advocate for research on Batten disease.

Award for Dementia Researchers

Two dementia researchers from the University of California, San Francisco, will share the $100,000 Potamkin Prize for their work on Alzheimer's disease and frontotemporal lobar degeneration (FTLD). Dr. Bruce L. Miller is receiving his part of the award for 25 years of research into FTLD, also known as Pick's disease. The work has improved diagnosis of the disease and led to several treatments, said the American Academy of Neurology, which bestows the award. The other recipient is Dr. Lennart Mucke, who uncovered strategies to prevent and even reverse cognitive impairments in mouse models of Alzheimer's disease. The annual prize, for advancing understanding of Alzheimer's disease and related disorders, is to be used for continuing research and will be awarded at the AAN annual meeting in Toronto in April.

Big Market for Stimulation Kalorama

Kalorama Information is predicting that within 5 years, the market for electrical and magnetic neurostimulation devices for treating depression could reach $16 billion a year. Currently, the market is limited because there is only one device—Cyberonic Inc.'s vagus nerve stimulator—and the cost of device treatment outweighs that of drug therapy, according to a report by the medical market research company. The analysis notes, however, that several manufacturers are developing external devices, such as Neuronetics Inc.'s repetitive TMS therapy system. Medtronic Inc., St. Jude Medical Inc., and Boston Scientific Corp. are also looking into adapting their deep brain and spinal cord stimulators to depression treatment, according to Kalorama.

LAS VEGAS — The federal government is stepping up its audit activities in Medicare, and that could mean greater scrutiny of billing practices, including the use of observation codes.

One development that physicians should keep a close eye on is the recent nationwide rollout of Medicare's Recovery Audit Contractor (RAC) program, said Edward R. Gaines III, vice president and chief compliance officer at CBIZ Medical Management Professionals Inc. The program, known as the RAC, began as a demonstration project in New York, California, and Florida.

Under the program, private contractors are given contingency fees for identifying improper Medicare payments to health care providers, including over- and underpayments.

But Mr. Gaines said the experience in the demonstration project showed that the contractors concentrated much more on detecting overpayments made to providers.

Now that the RAC program has been rolled out nationwide, four private contractors, each assigned to different regions of the country, will use data mining, outlier analysis, and referrals to root out improper payments. The RACs will earn contingency fees for finding errors, with fees that vary from around 9% to 12%.

Physicians need to be aware of the RAC activities and do their own outlier analyses so they can be ready to defend against an audit, Mr. Gaines advised during a meeting on reimbursement sponsored by the American College of Emergency Physicians.

One area that could be part of the review by the RACs is observation services. The RACs focused on that area during the demonstration phase, Mr. Gaines said. One option available to RACs is to perform a concordance review, in which they compare the consistency of hospital and physician claims for the same patient. That may be one way for RACs to evaluate whether observation services were appropriate, he said.

The RACs also will look at evaluation and management services. During the demonstration project, evaluation and management services were exempt from audit—but that is not the case now that the program is permanent.

Medicare is raising the bar for audits because they are in a financial squeeze, Mr. Gaines said.

Right now, Medicare receives more than 1.2 billion medical claims a year—and that's before the bulk of the baby boomer generation has entered the program. Add to that recent news reports that the Medicare and Medicaid programs are hemorrhaging tens of billions of dollars to fraud, and the federal government is in a position in which it needs to act to contain costs.

The RAC program makes financial sense for the government, he said. During the pilot phase of the program, the RACs collected $1 for every 20 cents spent by the government. “So, if you can get five times the rate of return and you're the federal government, this is a no-brainer,” Mr. Gaines said.

One area of specific concern with the RACs is that they have the power, at least in certain limited circumstances, to extrapolate an error rate across a larger number of Medicare claims. For example, if a RAC finds a 10% error rate on 50 medical records, extrapolation would allow the contractor to apply that error rate across all of a physician's Medicare patients over multiple years—potentially dramatically increasing the penalty.

There are restrictions to that power. For example, it can't be applied during the initial audit phase, and officials at the Centers for Medicare and Medicaid Services have stated that it can only be used in cases where there is a sustained or a high level of payment error, or a failure to correct the error. In addition, penalties cannot be applied to claims before Oct. 1, 2007.

But the ability to perform extrapolation at all is making physicians uneasy.

Although there are restrictions on when extrapolation could be applied, Mr. Gaines said, it's unclear how CMS would put it into practice. And the fact that the RACs would earn contingency fees on extrapolated claims seems to increase the likelihood that the method will be used, he said. “That's where the money is,” Mr. Gaines noted.

Physicians who are audited by the RAC and have errors in 1 out of 50 charts would likely be at low risk for extrapolation, Mr. Gaines said. However, the risk likely is higher for a physician or group that has been subject to corrective action or audits in the past.

The best defense is to be prepared by knowing how the physicians in your group compare with others in the area by performing your own internal outlier analysis, he said. If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision-making involved, Mr. Gaines said.

While the standard Medicare appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.

So, if physicians are dealing with an RAC dispute, they must file the request for redetermination within 30 days to halt recoupment of the payment, rather than the 120 days allowed for most Medicare disputes, Mr. Gaines said.

LAS VEGAS — The federal government is stepping up its audit activities in Medicare, and that could mean greater scrutiny of billing practices, including the use of observation codes.

One development that physicians should keep a close eye on is the recent nationwide rollout of Medicare's Recovery Audit Contractor (RAC) program, said Edward R. Gaines III, vice president and chief compliance officer at CBIZ Medical Management Professionals Inc. The program, known as the RAC, began as a demonstration project in New York, California, and Florida.

Under the program, private contractors are given contingency fees for identifying improper Medicare payments to health care providers, including over- and underpayments.

But Mr. Gaines said the experience in the demonstration project showed that the contractors concentrated much more on detecting overpayments made to providers.

Now that the RAC program has been rolled out nationwide, four private contractors, each assigned to different regions of the country, will use data mining, outlier analysis, and referrals to root out improper payments. The RACs will earn contingency fees for finding errors, with fees that vary from around 9% to 12%.

Physicians need to be aware of the RAC activities and do their own outlier analyses so they can be ready to defend against an audit, Mr. Gaines advised during a meeting on reimbursement sponsored by the American College of Emergency Physicians.

One area that could be part of the review by the RACs is observation services. The RACs focused on that area during the demonstration phase, Mr. Gaines said. One option available to RACs is to perform a concordance review, in which they compare the consistency of hospital and physician claims for the same patient. That may be one way for RACs to evaluate whether observation services were appropriate, he said.

The RACs also will look at evaluation and management services. During the demonstration project, evaluation and management services were exempt from audit—but that is not the case now that the program is permanent.

Medicare is raising the bar for audits because they are in a financial squeeze, Mr. Gaines said.

Right now, Medicare receives more than 1.2 billion medical claims a year—and that's before the bulk of the baby boomer generation has entered the program. Add to that recent news reports that the Medicare and Medicaid programs are hemorrhaging tens of billions of dollars to fraud, and the federal government is in a position in which it needs to act to contain costs.

The RAC program makes financial sense for the government, he said. During the pilot phase of the program, the RACs collected $1 for every 20 cents spent by the government. “So, if you can get five times the rate of return and you're the federal government, this is a no-brainer,” Mr. Gaines said.

One area of specific concern with the RACs is that they have the power, at least in certain limited circumstances, to extrapolate an error rate across a larger number of Medicare claims. For example, if a RAC finds a 10% error rate on 50 medical records, extrapolation would allow the contractor to apply that error rate across all of a physician's Medicare patients over multiple years—potentially dramatically increasing the penalty.

There are restrictions to that power. For example, it can't be applied during the initial audit phase, and officials at the Centers for Medicare and Medicaid Services have stated that it can only be used in cases where there is a sustained or a high level of payment error, or a failure to correct the error. In addition, penalties cannot be applied to claims before Oct. 1, 2007.

But the ability to perform extrapolation at all is making physicians uneasy.

Although there are restrictions on when extrapolation could be applied, Mr. Gaines said, it's unclear how CMS would put it into practice. And the fact that the RACs would earn contingency fees on extrapolated claims seems to increase the likelihood that the method will be used, he said. “That's where the money is,” Mr. Gaines noted.

Physicians who are audited by the RAC and have errors in 1 out of 50 charts would likely be at low risk for extrapolation, Mr. Gaines said. However, the risk likely is higher for a physician or group that has been subject to corrective action or audits in the past.

The best defense is to be prepared by knowing how the physicians in your group compare with others in the area by performing your own internal outlier analysis, he said. If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision-making involved, Mr. Gaines said.

While the standard Medicare appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.

So, if physicians are dealing with an RAC dispute, they must file the request for redetermination within 30 days to halt recoupment of the payment, rather than the 120 days allowed for most Medicare disputes, Mr. Gaines said.

LAS VEGAS — The federal government is stepping up its audit activities in Medicare, and that could mean greater scrutiny of billing practices, including the use of observation codes.

One development that physicians should keep a close eye on is the recent nationwide rollout of Medicare's Recovery Audit Contractor (RAC) program, said Edward R. Gaines III, vice president and chief compliance officer at CBIZ Medical Management Professionals Inc. The program, known as the RAC, began as a demonstration project in New York, California, and Florida.

Under the program, private contractors are given contingency fees for identifying improper Medicare payments to health care providers, including over- and underpayments.

But Mr. Gaines said the experience in the demonstration project showed that the contractors concentrated much more on detecting overpayments made to providers.

Now that the RAC program has been rolled out nationwide, four private contractors, each assigned to different regions of the country, will use data mining, outlier analysis, and referrals to root out improper payments. The RACs will earn contingency fees for finding errors, with fees that vary from around 9% to 12%.

Physicians need to be aware of the RAC activities and do their own outlier analyses so they can be ready to defend against an audit, Mr. Gaines advised during a meeting on reimbursement sponsored by the American College of Emergency Physicians.

One area that could be part of the review by the RACs is observation services. The RACs focused on that area during the demonstration phase, Mr. Gaines said. One option available to RACs is to perform a concordance review, in which they compare the consistency of hospital and physician claims for the same patient. That may be one way for RACs to evaluate whether observation services were appropriate, he said.

The RACs also will look at evaluation and management services. During the demonstration project, evaluation and management services were exempt from audit—but that is not the case now that the program is permanent.

Medicare is raising the bar for audits because they are in a financial squeeze, Mr. Gaines said.

Right now, Medicare receives more than 1.2 billion medical claims a year—and that's before the bulk of the baby boomer generation has entered the program. Add to that recent news reports that the Medicare and Medicaid programs are hemorrhaging tens of billions of dollars to fraud, and the federal government is in a position in which it needs to act to contain costs.

The RAC program makes financial sense for the government, he said. During the pilot phase of the program, the RACs collected $1 for every 20 cents spent by the government. “So, if you can get five times the rate of return and you're the federal government, this is a no-brainer,” Mr. Gaines said.

One area of specific concern with the RACs is that they have the power, at least in certain limited circumstances, to extrapolate an error rate across a larger number of Medicare claims. For example, if a RAC finds a 10% error rate on 50 medical records, extrapolation would allow the contractor to apply that error rate across all of a physician's Medicare patients over multiple years—potentially dramatically increasing the penalty.

There are restrictions to that power. For example, it can't be applied during the initial audit phase, and officials at the Centers for Medicare and Medicaid Services have stated that it can only be used in cases where there is a sustained or a high level of payment error, or a failure to correct the error. In addition, penalties cannot be applied to claims before Oct. 1, 2007.

But the ability to perform extrapolation at all is making physicians uneasy.

Although there are restrictions on when extrapolation could be applied, Mr. Gaines said, it's unclear how CMS would put it into practice. And the fact that the RACs would earn contingency fees on extrapolated claims seems to increase the likelihood that the method will be used, he said. “That's where the money is,” Mr. Gaines noted.

Physicians who are audited by the RAC and have errors in 1 out of 50 charts would likely be at low risk for extrapolation, Mr. Gaines said. However, the risk likely is higher for a physician or group that has been subject to corrective action or audits in the past.

The best defense is to be prepared by knowing how the physicians in your group compare with others in the area by performing your own internal outlier analysis, he said. If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision-making involved, Mr. Gaines said.

While the standard Medicare appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.

So, if physicians are dealing with an RAC dispute, they must file the request for redetermination within 30 days to halt recoupment of the payment, rather than the 120 days allowed for most Medicare disputes, Mr. Gaines 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. It can take weeks for patients to submit requests to get paper records and then bring those to another physician, but the 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, chief medical information officer for Kaiser Permanente Southern California.

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 2010, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA. Three-fourths of 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 patients are getting outside 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. The Web-based exchange required patients to opt in at both sites of care. “While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

—Mary Ellen Schneider

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. It can take weeks for patients to submit requests to get paper records and then bring those to another physician, but the 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, chief medical information officer for Kaiser Permanente Southern California.

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 2010, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA. Three-fourths of 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 patients are getting outside 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. The Web-based exchange required patients to opt in at both sites of care. “While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

—Mary Ellen Schneider

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. It can take weeks for patients to submit requests to get paper records and then bring those to another physician, but the 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, chief medical information officer for Kaiser Permanente Southern California.

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 2010, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA. Three-fourths of 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 patients are getting outside 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. The Web-based exchange required patients to opt in at both sites of care. “While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

—Mary Ellen Schneider

Plan Targets Osteoarthritis Burden

The Centers for Disease Control and Prevention has joined the Arthritis Foundation in an action plan to reduce the burden of osteoarthritis (OA) on the nation. Recommendations include expanding self-management education, improving work environments, and preventing the onset and progression of some OA cases through programs in all 50 states. The action plan also calls for more OA research, including using the National Health and Nutrition Examination Survey to assess the prevalence and impact of OA, identify risk factors, and clarify the natural history of the condition. Officials at the CDC and the Arthritis Foundation worked for 18 months to develop the action plan, leading up to its February release. The effort included a summit meeting of 75 experts who discussed strategies for reducing the impact of osteoarthritis. “This important report will help the public health community speak with a unified voice and focus our collective efforts on actions that we know will make a difference in the lives of people suffering from osteoarthritis,” Ursula Bauer, Ph.D., director of CDC's National Center for Chronic Disease Prevention and Health Promotion, said in a statement. The action plan is available online at

www.arthritis.org/media/Ad%20Council%20101/OA_Agenda_2010.pdf

Ads, Web Site Will Follow Up

Following recommendations in the new OA action plan, the Arthritis Foundation, the American College of Rheumatology, and the Ad Council have launched a public awareness campaign called Fight Arthritis Pain. Aimed at both people with OA and those at risk, the message is that some simple steps can reduce pain, increase mobility, and prevent disability. The campaign will include ads on television and radio, in print, and online. The campaign's Web site,

www.fightarthritispain.org

'Extraordinary' Drug Price Hikes

The Government Accountability Office said that 416 brand-name pharmaceutical products had “extraordinary” price increases from 2000 to 2008. Although this represents only 0.5% of all brand-name products, most of the increases ranged from 100% to 499%, the GAO said in a report released in early January (GAO-10-201). More than half of those products were in three therapeutic classes: central nervous system, anti-infective, and cardiovascular. One possible reason for the price inflation, said the agency, is that the drugs are bought from wholesalers, then repackaged and resold at higher prices to physicians or hospitals. But increases also were driven by a lack of generic or other therapeutic alternatives for various drugs, the GAO said. The Pharmaceutical Research and Manufacturers of America (PhRMA) industry group said that the report “focuses only on a small number of selected brand medicines rather than the entire prescription drug market.” PhRMA Senior Vice President Ken Johnson said that national data show a decline in retail drug spending in 2008.

FDA Names New Device Chief

The Food and Drug Administration has named a new permanent head of the Center for Devices and Radiological Health. Dr. Jeffrey Shuren, who has been acting director since early September, will now direct the center. He replaces Dr. Daniel Schultz, who resigned last year after critics claimed he was too cozy with device makers. In a statement, the head of the device industry trade group Advanced Medical Technology Association (AdvaMed) applauded Dr. Shuren's appointment. “His more than 10 years experience at FDA, in various high-level policy and planning positions within the commissioner's office, will serve him well as he takes control of an organization that oversees such a wide range of life-saving and life-enhancing products,” said AdvaMed CEO Stephen J. Ubl. The center also unveiled its strategic plan for 2010, with four areas of priority: the effective regulation of products throughout their development and marketing; the enhancement of communications and transparency; the strengthening of the center's workforce and workplace; and efforts to spur innovation and address unmet public health needs. The strategic plan is available at

www.fda.gov/medicaldevices

—Mary Ellen Schneider

Plan Targets Osteoarthritis Burden

The Centers for Disease Control and Prevention has joined the Arthritis Foundation in an action plan to reduce the burden of osteoarthritis (OA) on the nation. Recommendations include expanding self-management education, improving work environments, and preventing the onset and progression of some OA cases through programs in all 50 states. The action plan also calls for more OA research, including using the National Health and Nutrition Examination Survey to assess the prevalence and impact of OA, identify risk factors, and clarify the natural history of the condition. Officials at the CDC and the Arthritis Foundation worked for 18 months to develop the action plan, leading up to its February release. The effort included a summit meeting of 75 experts who discussed strategies for reducing the impact of osteoarthritis. “This important report will help the public health community speak with a unified voice and focus our collective efforts on actions that we know will make a difference in the lives of people suffering from osteoarthritis,” Ursula Bauer, Ph.D., director of CDC's National Center for Chronic Disease Prevention and Health Promotion, said in a statement. The action plan is available online at

www.arthritis.org/media/Ad%20Council%20101/OA_Agenda_2010.pdf

Ads, Web Site Will Follow Up

Following recommendations in the new OA action plan, the Arthritis Foundation, the American College of Rheumatology, and the Ad Council have launched a public awareness campaign called Fight Arthritis Pain. Aimed at both people with OA and those at risk, the message is that some simple steps can reduce pain, increase mobility, and prevent disability. The campaign will include ads on television and radio, in print, and online. The campaign's Web site,

www.fightarthritispain.org

'Extraordinary' Drug Price Hikes

The Government Accountability Office said that 416 brand-name pharmaceutical products had “extraordinary” price increases from 2000 to 2008. Although this represents only 0.5% of all brand-name products, most of the increases ranged from 100% to 499%, the GAO said in a report released in early January (GAO-10-201). More than half of those products were in three therapeutic classes: central nervous system, anti-infective, and cardiovascular. One possible reason for the price inflation, said the agency, is that the drugs are bought from wholesalers, then repackaged and resold at higher prices to physicians or hospitals. But increases also were driven by a lack of generic or other therapeutic alternatives for various drugs, the GAO said. The Pharmaceutical Research and Manufacturers of America (PhRMA) industry group said that the report “focuses only on a small number of selected brand medicines rather than the entire prescription drug market.” PhRMA Senior Vice President Ken Johnson said that national data show a decline in retail drug spending in 2008.

FDA Names New Device Chief

The Food and Drug Administration has named a new permanent head of the Center for Devices and Radiological Health. Dr. Jeffrey Shuren, who has been acting director since early September, will now direct the center. He replaces Dr. Daniel Schultz, who resigned last year after critics claimed he was too cozy with device makers. In a statement, the head of the device industry trade group Advanced Medical Technology Association (AdvaMed) applauded Dr. Shuren's appointment. “His more than 10 years experience at FDA, in various high-level policy and planning positions within the commissioner's office, will serve him well as he takes control of an organization that oversees such a wide range of life-saving and life-enhancing products,” said AdvaMed CEO Stephen J. Ubl. The center also unveiled its strategic plan for 2010, with four areas of priority: the effective regulation of products throughout their development and marketing; the enhancement of communications and transparency; the strengthening of the center's workforce and workplace; and efforts to spur innovation and address unmet public health needs. The strategic plan is available at

www.fda.gov/medicaldevices

—Mary Ellen Schneider

Plan Targets Osteoarthritis Burden

The Centers for Disease Control and Prevention has joined the Arthritis Foundation in an action plan to reduce the burden of osteoarthritis (OA) on the nation. Recommendations include expanding self-management education, improving work environments, and preventing the onset and progression of some OA cases through programs in all 50 states. The action plan also calls for more OA research, including using the National Health and Nutrition Examination Survey to assess the prevalence and impact of OA, identify risk factors, and clarify the natural history of the condition. Officials at the CDC and the Arthritis Foundation worked for 18 months to develop the action plan, leading up to its February release. The effort included a summit meeting of 75 experts who discussed strategies for reducing the impact of osteoarthritis. “This important report will help the public health community speak with a unified voice and focus our collective efforts on actions that we know will make a difference in the lives of people suffering from osteoarthritis,” Ursula Bauer, Ph.D., director of CDC's National Center for Chronic Disease Prevention and Health Promotion, said in a statement. The action plan is available online at

www.arthritis.org/media/Ad%20Council%20101/OA_Agenda_2010.pdf

Ads, Web Site Will Follow Up

Following recommendations in the new OA action plan, the Arthritis Foundation, the American College of Rheumatology, and the Ad Council have launched a public awareness campaign called Fight Arthritis Pain. Aimed at both people with OA and those at risk, the message is that some simple steps can reduce pain, increase mobility, and prevent disability. The campaign will include ads on television and radio, in print, and online. The campaign's Web site,

www.fightarthritispain.org

'Extraordinary' Drug Price Hikes

The Government Accountability Office said that 416 brand-name pharmaceutical products had “extraordinary” price increases from 2000 to 2008. Although this represents only 0.5% of all brand-name products, most of the increases ranged from 100% to 499%, the GAO said in a report released in early January (GAO-10-201). More than half of those products were in three therapeutic classes: central nervous system, anti-infective, and cardiovascular. One possible reason for the price inflation, said the agency, is that the drugs are bought from wholesalers, then repackaged and resold at higher prices to physicians or hospitals. But increases also were driven by a lack of generic or other therapeutic alternatives for various drugs, the GAO said. The Pharmaceutical Research and Manufacturers of America (PhRMA) industry group said that the report “focuses only on a small number of selected brand medicines rather than the entire prescription drug market.” PhRMA Senior Vice President Ken Johnson said that national data show a decline in retail drug spending in 2008.

FDA Names New Device Chief

The Food and Drug Administration has named a new permanent head of the Center for Devices and Radiological Health. Dr. Jeffrey Shuren, who has been acting director since early September, will now direct the center. He replaces Dr. Daniel Schultz, who resigned last year after critics claimed he was too cozy with device makers. In a statement, the head of the device industry trade group Advanced Medical Technology Association (AdvaMed) applauded Dr. Shuren's appointment. “His more than 10 years experience at FDA, in various high-level policy and planning positions within the commissioner's office, will serve him well as he takes control of an organization that oversees such a wide range of life-saving and life-enhancing products,” said AdvaMed CEO Stephen J. Ubl. The center also unveiled its strategic plan for 2010, with four areas of priority: the effective regulation of products throughout their development and marketing; the enhancement of communications and transparency; the strengthening of the center's workforce and workplace; and efforts to spur innovation and address unmet public health needs. The strategic plan is available at

www.fda.gov/medicaldevices

—Mary Ellen Schneider

LAS VEGAS — The federal government is stepping up its audit activities in Medicare, and that could mean greater scrutiny of billing practices, including the use of observation codes.

One development that physicians should keep a close eye on is the recent nationwide rollout of Medicare's Recovery Audit Contractor program, said Edward R. Gaines III, vice president and chief compliance officer at CBIZ Medical Management Professionals Inc. The program, known as the RAC, began as a demonstration project in New York, California, and Florida.

Under the program, private contractors are given contingency fees for identifying improper Medicare payments to health care providers, including over- and underpayments. But Mr. Gaines said the experience in the demonstration project showed that the contractors concentrated much more on detecting overpayments.

Now that the RAC program has been rolled out nationwide, four private contractors, each assigned to different regions of the country, will use data mining, outlier analysis, and referrals to root out improper payments. The RACs will earn contingency fees for finding errors, with fees that vary from around 9% to 12%.

Physicians need to be aware of the RAC activities and do their own outlier analyses so they can be ready to defend against an audit, Mr. Gaines advised during a meeting on reimbursement sponsored by the American College of Emergency Physicians.

One area that could be part of the review by the RACs is observation services. The RACs focused on that area during the demonstration phase, Mr. Gaines said. One option available to RACs is to perform a concordance review, in which they compare the consistency of hospital and physician claims for the same patient. That may be one way for RACs to evaluate whether observation services were appropriate, he said.

The RACs also will look at evaluation and management services. During the demonstration project, evaluation and management services were exempt from audit, but that is not the case now that the RAC is a permanent program.

Medicare is raising the bar for audits because they are in a financial squeeze, Mr. Gaines said. Right now, Medicare receives more than 1.2 billion medical claims a year—and that's before the bulk of the baby boomer generation has entered the program. Add to that recent news reports that the Medicare and Medicaid programs are hemorrhaging tens of billions of dollars to fraud, and the federal government is in a position in which it needs to act to contain costs.

The RAC program makes financial sense for the government, he said. During the pilot phase of the program, the RACs collected $1 for every 20 cents spent by the government. “So, if you can get five times the rate of return and you're the federal government, this is a no-brainer,” Mr. Gaines said.

One area of specific concern with the RACs is that they have the power, at least in certain limited circumstances, to extrapolate an error rate across a larger number of Medicare claims.

For example, if a RAC finds a 10% error rate on 50 medical records, extrapolation would allow the contractor to apply that error rate across all of a physician's Medicare patients over multiple years—potentially dramatically increasing the penalty.

There are restrictions to that power. For example, it can't be applied during the initial audit phase, and officials at the Centers for Medicare and Medicaid Services have stated that it can be employed only in cases where there is a sustained or a high level of payment error, or a failure to correct the error. In addition, penalties cannot be applied to claims before Oct. 1, 2007.

But the ability to perform extrapolation at all is making physicians uneasy. Although there are restrictions on when extrapolation could be applied, Mr. Gaines said, it's unclear how CMS would put it into practice. And the fact that the RACs would earn contingency fees on extrapolated claims seems to increase the likelihood that the method would be used, he said. “That's where the money is,” Mr. Gaines noted.

Physicians who are audited by the RAC and have errors in 1 out of 50 charts would likely be at low risk for extrapolation, Mr. Gaines said. However, the risk likely is higher for a physician or group that has been subject to audits in the past or has been subject to corrective action.

The best defense is to be prepared by knowing how the physicians in your group compare with others in the area by performing your own internal outlier analysis, he said.

If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision making involved. Also, linking the reason for admission and the emergency physician's work-up is important, Mr. Gaines said.

Emergency medicine groups also should be aware of the standard Medicare appeals process.

Although the standard appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.

LAS VEGAS — The federal government is stepping up its audit activities in Medicare, and that could mean greater scrutiny of billing practices, including the use of observation codes.

One development that physicians should keep a close eye on is the recent nationwide rollout of Medicare's Recovery Audit Contractor program, said Edward R. Gaines III, vice president and chief compliance officer at CBIZ Medical Management Professionals Inc. The program, known as the RAC, began as a demonstration project in New York, California, and Florida.

Under the program, private contractors are given contingency fees for identifying improper Medicare payments to health care providers, including over- and underpayments. But Mr. Gaines said the experience in the demonstration project showed that the contractors concentrated much more on detecting overpayments.

Now that the RAC program has been rolled out nationwide, four private contractors, each assigned to different regions of the country, will use data mining, outlier analysis, and referrals to root out improper payments. The RACs will earn contingency fees for finding errors, with fees that vary from around 9% to 12%.

Physicians need to be aware of the RAC activities and do their own outlier analyses so they can be ready to defend against an audit, Mr. Gaines advised during a meeting on reimbursement sponsored by the American College of Emergency Physicians.

One area that could be part of the review by the RACs is observation services. The RACs focused on that area during the demonstration phase, Mr. Gaines said. One option available to RACs is to perform a concordance review, in which they compare the consistency of hospital and physician claims for the same patient. That may be one way for RACs to evaluate whether observation services were appropriate, he said.

The RACs also will look at evaluation and management services. During the demonstration project, evaluation and management services were exempt from audit, but that is not the case now that the RAC is a permanent program.

Medicare is raising the bar for audits because they are in a financial squeeze, Mr. Gaines said. Right now, Medicare receives more than 1.2 billion medical claims a year—and that's before the bulk of the baby boomer generation has entered the program. Add to that recent news reports that the Medicare and Medicaid programs are hemorrhaging tens of billions of dollars to fraud, and the federal government is in a position in which it needs to act to contain costs.

The RAC program makes financial sense for the government, he said. During the pilot phase of the program, the RACs collected $1 for every 20 cents spent by the government. “So, if you can get five times the rate of return and you're the federal government, this is a no-brainer,” Mr. Gaines said.

One area of specific concern with the RACs is that they have the power, at least in certain limited circumstances, to extrapolate an error rate across a larger number of Medicare claims.

For example, if a RAC finds a 10% error rate on 50 medical records, extrapolation would allow the contractor to apply that error rate across all of a physician's Medicare patients over multiple years—potentially dramatically increasing the penalty.

There are restrictions to that power. For example, it can't be applied during the initial audit phase, and officials at the Centers for Medicare and Medicaid Services have stated that it can be employed only in cases where there is a sustained or a high level of payment error, or a failure to correct the error. In addition, penalties cannot be applied to claims before Oct. 1, 2007.

But the ability to perform extrapolation at all is making physicians uneasy. Although there are restrictions on when extrapolation could be applied, Mr. Gaines said, it's unclear how CMS would put it into practice. And the fact that the RACs would earn contingency fees on extrapolated claims seems to increase the likelihood that the method would be used, he said. “That's where the money is,” Mr. Gaines noted.

Physicians who are audited by the RAC and have errors in 1 out of 50 charts would likely be at low risk for extrapolation, Mr. Gaines said. However, the risk likely is higher for a physician or group that has been subject to audits in the past or has been subject to corrective action.

The best defense is to be prepared by knowing how the physicians in your group compare with others in the area by performing your own internal outlier analysis, he said.

If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision making involved. Also, linking the reason for admission and the emergency physician's work-up is important, Mr. Gaines said.

Emergency medicine groups also should be aware of the standard Medicare appeals process.

Although the standard appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.

LAS VEGAS — The federal government is stepping up its audit activities in Medicare, and that could mean greater scrutiny of billing practices, including the use of observation codes.

One development that physicians should keep a close eye on is the recent nationwide rollout of Medicare's Recovery Audit Contractor program, said Edward R. Gaines III, vice president and chief compliance officer at CBIZ Medical Management Professionals Inc. The program, known as the RAC, began as a demonstration project in New York, California, and Florida.

Under the program, private contractors are given contingency fees for identifying improper Medicare payments to health care providers, including over- and underpayments. But Mr. Gaines said the experience in the demonstration project showed that the contractors concentrated much more on detecting overpayments.

Now that the RAC program has been rolled out nationwide, four private contractors, each assigned to different regions of the country, will use data mining, outlier analysis, and referrals to root out improper payments. The RACs will earn contingency fees for finding errors, with fees that vary from around 9% to 12%.

Physicians need to be aware of the RAC activities and do their own outlier analyses so they can be ready to defend against an audit, Mr. Gaines advised during a meeting on reimbursement sponsored by the American College of Emergency Physicians.

One area that could be part of the review by the RACs is observation services. The RACs focused on that area during the demonstration phase, Mr. Gaines said. One option available to RACs is to perform a concordance review, in which they compare the consistency of hospital and physician claims for the same patient. That may be one way for RACs to evaluate whether observation services were appropriate, he said.

The RACs also will look at evaluation and management services. During the demonstration project, evaluation and management services were exempt from audit, but that is not the case now that the RAC is a permanent program.

Medicare is raising the bar for audits because they are in a financial squeeze, Mr. Gaines said. Right now, Medicare receives more than 1.2 billion medical claims a year—and that's before the bulk of the baby boomer generation has entered the program. Add to that recent news reports that the Medicare and Medicaid programs are hemorrhaging tens of billions of dollars to fraud, and the federal government is in a position in which it needs to act to contain costs.

The RAC program makes financial sense for the government, he said. During the pilot phase of the program, the RACs collected $1 for every 20 cents spent by the government. “So, if you can get five times the rate of return and you're the federal government, this is a no-brainer,” Mr. Gaines said.

One area of specific concern with the RACs is that they have the power, at least in certain limited circumstances, to extrapolate an error rate across a larger number of Medicare claims.

For example, if a RAC finds a 10% error rate on 50 medical records, extrapolation would allow the contractor to apply that error rate across all of a physician's Medicare patients over multiple years—potentially dramatically increasing the penalty.

There are restrictions to that power. For example, it can't be applied during the initial audit phase, and officials at the Centers for Medicare and Medicaid Services have stated that it can be employed only in cases where there is a sustained or a high level of payment error, or a failure to correct the error. In addition, penalties cannot be applied to claims before Oct. 1, 2007.

But the ability to perform extrapolation at all is making physicians uneasy. Although there are restrictions on when extrapolation could be applied, Mr. Gaines said, it's unclear how CMS would put it into practice. And the fact that the RACs would earn contingency fees on extrapolated claims seems to increase the likelihood that the method would be used, he said. “That's where the money is,” Mr. Gaines noted.

Physicians who are audited by the RAC and have errors in 1 out of 50 charts would likely be at low risk for extrapolation, Mr. Gaines said. However, the risk likely is higher for a physician or group that has been subject to audits in the past or has been subject to corrective action.

The best defense is to be prepared by knowing how the physicians in your group compare with others in the area by performing your own internal outlier analysis, he said.

If you are audited, consider doing a case summary of the clinical presentations and the code choices. Write up a narrative of what the patient presented with, how the coder viewed the case, and the medical decision making involved. Also, linking the reason for admission and the emergency physician's work-up is important, Mr. Gaines said.

Emergency medicine groups also should be aware of the standard Medicare appeals process.

Although the standard appeals process applies to the RACs, the timelines for stopping recoupment of an improper payment are shorter than some of the standard appeals deadlines.

Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.

The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services. For example, one of the measures calls for annual hemoglobin A_1c testing in all children and adolescents who are diagnosed with diabetes.

The measures may be familiar to pediatricians, as 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans. They are part of an effort to encourage quality reporting within Medicaid and SCHIP, but they will be voluntary and the requirements of the program would be up to individual states to determine. The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing measures used by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to the CMS.

The CMS sought public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other providers would need to report on these measures. Comments were due by March 1. Under statute, the CMS must make the final measure set available to states by Jan. 1, 2013. Currently, there is no federal funding set aside as financial incentives for successfully reporting on these measures, but the CMS and the states are exploring ways they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to the CMS.

The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set, and encouraged Congress to invest in the development of measures appropriate for children. That's definitely an area in which pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.

There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's not clear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.

Although details about how the measurement program would be set up by the states are still to come, Dr. Cohen said he would like to see an appeals process to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.

CMS officials are working to coordinate the measurement program with health information technology activities at the state and federal levels. Under the CHIP Reauthorization Act that created the quality measures program, the CMS was also tasked with developing a pediatric electronic health record format. CMS officials are working to coordinate that effort—as well as the meaningful-use criteria for EHRs—with the quality-measurement program.

A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm

Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.

The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services. For example, one of the measures calls for annual hemoglobin A_1c testing in all children and adolescents who are diagnosed with diabetes.

The measures may be familiar to pediatricians, as 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans. They are part of an effort to encourage quality reporting within Medicaid and SCHIP, but they will be voluntary and the requirements of the program would be up to individual states to determine. The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing measures used by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to the CMS.

The CMS sought public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other providers would need to report on these measures. Comments were due by March 1. Under statute, the CMS must make the final measure set available to states by Jan. 1, 2013. Currently, there is no federal funding set aside as financial incentives for successfully reporting on these measures, but the CMS and the states are exploring ways they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to the CMS.

The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set, and encouraged Congress to invest in the development of measures appropriate for children. That's definitely an area in which pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.

There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's not clear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.

Although details about how the measurement program would be set up by the states are still to come, Dr. Cohen said he would like to see an appeals process to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.

CMS officials are working to coordinate the measurement program with health information technology activities at the state and federal levels. Under the CHIP Reauthorization Act that created the quality measures program, the CMS was also tasked with developing a pediatric electronic health record format. CMS officials are working to coordinate that effort—as well as the meaningful-use criteria for EHRs—with the quality-measurement program.

A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm

Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.

The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services. For example, one of the measures calls for annual hemoglobin A_1c testing in all children and adolescents who are diagnosed with diabetes.

The measures may be familiar to pediatricians, as 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans. They are part of an effort to encourage quality reporting within Medicaid and SCHIP, but they will be voluntary and the requirements of the program would be up to individual states to determine. The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing measures used by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to the CMS.

The CMS sought public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other providers would need to report on these measures. Comments were due by March 1. Under statute, the CMS must make the final measure set available to states by Jan. 1, 2013. Currently, there is no federal funding set aside as financial incentives for successfully reporting on these measures, but the CMS and the states are exploring ways they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to the CMS.

The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set, and encouraged Congress to invest in the development of measures appropriate for children. That's definitely an area in which pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.

There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's not clear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.

Although details about how the measurement program would be set up by the states are still to come, Dr. Cohen said he would like to see an appeals process to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.

CMS officials are working to coordinate the measurement program with health information technology activities at the state and federal levels. Under the CHIP Reauthorization Act that created the quality measures program, the CMS was also tasked with developing a pediatric electronic health record format. CMS officials are working to coordinate that effort—as well as the meaningful-use criteria for EHRs—with the quality-measurement program.

A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm

U.S. hospitals have significantly improved the care they provide for patients with myocardial infarction, heart failure, and pneumonia, according to a new report from the Joint Commission.

Hospitals accredited by the commission are adhering to quality measures for MI patients 96.7% of the time, up from 86.9% just 7 years earlier. The results are part of the Joint Commission's annual report on quality and safety, which was issued last month.

The report also highlights major improvements in heart failure and pneumonia. In 2008, hospitals provided evidence-based heart failure care 91.6% of the time, up from 59.7% in 2002. Evidence-based pneumonia care was provided 92.9% of the time in 2008, up from 72.3% in 2002. (See box.)

These national findings are based on aggregated data drawn from all Joint Commission–accredited hospitals between 2002 and 2008. Scores for care for heart failure, for example, are composite scores based on a set of specific quality measures in that area. There is no composite score for surgical care, which is measured according to several subcategories, including antibiotic use. Children's asthma care was surveyed for the first time in 2008, with both subcategories scoring over 99%.

The findings are cause for celebration, according to Jerod M. Loeb, Ph.D., executive vice president for quality measurement and research at the Joint Commission in Oakbrook Terrace, Ill. “This improvement translates into significant enhancements in terms of morbidity and mortality across the conditions that we're measuring,” he said in an interview.

In addition to improvements on several measure sets over time, the report also found that hospitals are getting more consistent. For 8 of the 28 measures that the Joint Commission tracked in 2008, hospitals had consistently high performance. Approximately 90% of hospitals scored 90% or more on those eight measures in 2008.

Dr. Loeb credited hospitalists as being one of the driving forces behind this success. Although there is no literature to back up the claim at this point, Dr. Loeb said he believes that in organizations with hospitalists, fewer things fall through the cracks and there is greater attention paid to standardization.

“I think the hospitalist community has been a strong proponent of these measures over the years and of the standardization upon which this measurement strategy is based,” he said.

But while the Joint Commission philosophy is that variation in care is detrimental, Dr. Loeb said the organization does not advocate “cookbook medicine.” In fact, the quality measures endorsed by the Joint Commission were constructed to allow for clinical judgment, he said. And organizations' scores are not negatively affected when they deliver care that is contrary to the measures but clinically appropriate for the individual patient, Dr. Loeb said.

Despite the successes documented in the report, hospitals are still struggling on a few measures. For example, in 2008, hospitals scored only 52.4% on providing fibrinolytic therapy to heart attack patients within 30 minutes of arrival. Similarly, in 2008, hospitals scored only 60.3% on providing antibiotics to ICU pneumonia patients within 24 hours of arrival. Both of the measures were first introduced in 2005.

There are many reasons why hospitals could be falling behind on those measures, Dr. Loeb said. In some cases it takes a few years for hospitals to make progress on a new measure. Joint Commission officials saw this with measures calling for clinicians to provide smoking cessation advice. In 2002, hospitals scored 37.2% on providing smoking cessation advice to pneumonia patients, but that number jumped to 96% in 2008.

“The learning curve in health care is lengthy,” Dr. Loeb said. “For those things that we've been measuring for a longer period of time, organizations are doing better.”

For measures related to antibiotic administration, the numbers have been slower to climb because of ongoing controversy about when antibiotics are appropriate, Dr. Loeb said.

Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009 is available online at www.jointcommission.org

Elsevier Global Medical News

U.S. hospitals have significantly improved the care they provide for patients with myocardial infarction, heart failure, and pneumonia, according to a new report from the Joint Commission.

Hospitals accredited by the commission are adhering to quality measures for MI patients 96.7% of the time, up from 86.9% just 7 years earlier. The results are part of the Joint Commission's annual report on quality and safety, which was issued last month.

The report also highlights major improvements in heart failure and pneumonia. In 2008, hospitals provided evidence-based heart failure care 91.6% of the time, up from 59.7% in 2002. Evidence-based pneumonia care was provided 92.9% of the time in 2008, up from 72.3% in 2002. (See box.)

These national findings are based on aggregated data drawn from all Joint Commission–accredited hospitals between 2002 and 2008. Scores for care for heart failure, for example, are composite scores based on a set of specific quality measures in that area. There is no composite score for surgical care, which is measured according to several subcategories, including antibiotic use. Children's asthma care was surveyed for the first time in 2008, with both subcategories scoring over 99%.

The findings are cause for celebration, according to Jerod M. Loeb, Ph.D., executive vice president for quality measurement and research at the Joint Commission in Oakbrook Terrace, Ill. “This improvement translates into significant enhancements in terms of morbidity and mortality across the conditions that we're measuring,” he said in an interview.

In addition to improvements on several measure sets over time, the report also found that hospitals are getting more consistent. For 8 of the 28 measures that the Joint Commission tracked in 2008, hospitals had consistently high performance. Approximately 90% of hospitals scored 90% or more on those eight measures in 2008.

Dr. Loeb credited hospitalists as being one of the driving forces behind this success. Although there is no literature to back up the claim at this point, Dr. Loeb said he believes that in organizations with hospitalists, fewer things fall through the cracks and there is greater attention paid to standardization.

“I think the hospitalist community has been a strong proponent of these measures over the years and of the standardization upon which this measurement strategy is based,” he said.

But while the Joint Commission philosophy is that variation in care is detrimental, Dr. Loeb said the organization does not advocate “cookbook medicine.” In fact, the quality measures endorsed by the Joint Commission were constructed to allow for clinical judgment, he said. And organizations' scores are not negatively affected when they deliver care that is contrary to the measures but clinically appropriate for the individual patient, Dr. Loeb said.

Despite the successes documented in the report, hospitals are still struggling on a few measures. For example, in 2008, hospitals scored only 52.4% on providing fibrinolytic therapy to heart attack patients within 30 minutes of arrival. Similarly, in 2008, hospitals scored only 60.3% on providing antibiotics to ICU pneumonia patients within 24 hours of arrival. Both of the measures were first introduced in 2005.

There are many reasons why hospitals could be falling behind on those measures, Dr. Loeb said. In some cases it takes a few years for hospitals to make progress on a new measure. Joint Commission officials saw this with measures calling for clinicians to provide smoking cessation advice. In 2002, hospitals scored 37.2% on providing smoking cessation advice to pneumonia patients, but that number jumped to 96% in 2008.

“The learning curve in health care is lengthy,” Dr. Loeb said. “For those things that we've been measuring for a longer period of time, organizations are doing better.”

For measures related to antibiotic administration, the numbers have been slower to climb because of ongoing controversy about when antibiotics are appropriate, Dr. Loeb said.

Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009 is available online at www.jointcommission.org

Elsevier Global Medical News

U.S. hospitals have significantly improved the care they provide for patients with myocardial infarction, heart failure, and pneumonia, according to a new report from the Joint Commission.

Hospitals accredited by the commission are adhering to quality measures for MI patients 96.7% of the time, up from 86.9% just 7 years earlier. The results are part of the Joint Commission's annual report on quality and safety, which was issued last month.

The report also highlights major improvements in heart failure and pneumonia. In 2008, hospitals provided evidence-based heart failure care 91.6% of the time, up from 59.7% in 2002. Evidence-based pneumonia care was provided 92.9% of the time in 2008, up from 72.3% in 2002. (See box.)

These national findings are based on aggregated data drawn from all Joint Commission–accredited hospitals between 2002 and 2008. Scores for care for heart failure, for example, are composite scores based on a set of specific quality measures in that area. There is no composite score for surgical care, which is measured according to several subcategories, including antibiotic use. Children's asthma care was surveyed for the first time in 2008, with both subcategories scoring over 99%.

The findings are cause for celebration, according to Jerod M. Loeb, Ph.D., executive vice president for quality measurement and research at the Joint Commission in Oakbrook Terrace, Ill. “This improvement translates into significant enhancements in terms of morbidity and mortality across the conditions that we're measuring,” he said in an interview.

In addition to improvements on several measure sets over time, the report also found that hospitals are getting more consistent. For 8 of the 28 measures that the Joint Commission tracked in 2008, hospitals had consistently high performance. Approximately 90% of hospitals scored 90% or more on those eight measures in 2008.

Dr. Loeb credited hospitalists as being one of the driving forces behind this success. Although there is no literature to back up the claim at this point, Dr. Loeb said he believes that in organizations with hospitalists, fewer things fall through the cracks and there is greater attention paid to standardization.

“I think the hospitalist community has been a strong proponent of these measures over the years and of the standardization upon which this measurement strategy is based,” he said.

But while the Joint Commission philosophy is that variation in care is detrimental, Dr. Loeb said the organization does not advocate “cookbook medicine.” In fact, the quality measures endorsed by the Joint Commission were constructed to allow for clinical judgment, he said. And organizations' scores are not negatively affected when they deliver care that is contrary to the measures but clinically appropriate for the individual patient, Dr. Loeb said.

Despite the successes documented in the report, hospitals are still struggling on a few measures. For example, in 2008, hospitals scored only 52.4% on providing fibrinolytic therapy to heart attack patients within 30 minutes of arrival. Similarly, in 2008, hospitals scored only 60.3% on providing antibiotics to ICU pneumonia patients within 24 hours of arrival. Both of the measures were first introduced in 2005.

There are many reasons why hospitals could be falling behind on those measures, Dr. Loeb said. In some cases it takes a few years for hospitals to make progress on a new measure. Joint Commission officials saw this with measures calling for clinicians to provide smoking cessation advice. In 2002, hospitals scored 37.2% on providing smoking cessation advice to pneumonia patients, but that number jumped to 96% in 2008.

“The learning curve in health care is lengthy,” Dr. Loeb said. “For those things that we've been measuring for a longer period of time, organizations are doing better.”

For measures related to antibiotic administration, the numbers have been slower to climb because of ongoing controversy about when antibiotics are appropriate, Dr. Loeb said.

Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2009 is available online at www.jointcommission.org

Elsevier Global Medical News

The Obama administration has picked a high-profile fight with health insurers, calling the companies to task for proposing double-digit rate hikes while taking in massive profits.

In a report released Feb. 18, the Department of Health and Human Services detailed some of the largest proposed rate increases in the individual insurance market. Some of the increases have gone into effect, while others have been rejected by state health insurance commissioners.

For example, Anthem Blue Cross of California announced that it would raise premiums by as much as 39% for those in the individual market. However, following questions raised by HHS and the California insurance commission, the company delayed those plans for 2 months.

The HHS report also cites significant rate increases in Michigan and Oregon. In 2009, Blue Cross Blue Shield of Michigan requested premium increases of 56% for its plans. In Washington state, premiums for individual health plans were going up by 40% until the state approved tighter regulations on increases, according to the HHS report.

These rate increases highlight the need to focus on comprehensive health reform to address the foundering economy, HHS Secretary Kathleen Sebelius said during a press conference

The health reform proposals pending in Congress would give additional authority to HHS to oversee insurance companies across the country, including proposed rate increases and their justifications. Current proposals also include medical-loss ratios, requiring insurers to spend most of their revenues on paying medical benefits, rather than spending those dollars on advertising, overhead, or CEO salaries, Ms. Sebelius said.

The HHS report also criticizes the insurance industry for raising rates at the same time that it takes in significant profits. In 2009, the five largest insurers in the United States took in more than $12 billion in profits, according to HHS.

According to America's Health Insurance Plans (AHIP), an industry trade group, the increases being seen in the individual insurance market are the result of the growth in underlying medical costs and the fact that younger, healthier people are dropping their coverage in the poor economy. That leaves insurers with a pool of older, sicker customers.

AHIP also noted that average profits in the health plan industry are about 2.2%, putting the industry at number 35 on the Fortune 500 list of profits by industry. That margin is lower than other sectors in the health care industry, AHIP said.

The trade group also accused the government of playing politics. “It's time to stop the politics of vilification and focus on what American need most: real health care reform that addresses the serious and urgent problems facing our nation,” Karen Ignagni, president and CEO of AHIP, said in a statement.

The Obama administration has picked a high-profile fight with health insurers, calling the companies to task for proposing double-digit rate hikes while taking in massive profits.

In a report released Feb. 18, the Department of Health and Human Services detailed some of the largest proposed rate increases in the individual insurance market. Some of the increases have gone into effect, while others have been rejected by state health insurance commissioners.

For example, Anthem Blue Cross of California announced that it would raise premiums by as much as 39% for those in the individual market. However, following questions raised by HHS and the California insurance commission, the company delayed those plans for 2 months.

The HHS report also cites significant rate increases in Michigan and Oregon. In 2009, Blue Cross Blue Shield of Michigan requested premium increases of 56% for its plans. In Washington state, premiums for individual health plans were going up by 40% until the state approved tighter regulations on increases, according to the HHS report.

These rate increases highlight the need to focus on comprehensive health reform to address the foundering economy, HHS Secretary Kathleen Sebelius said during a press conference

The health reform proposals pending in Congress would give additional authority to HHS to oversee insurance companies across the country, including proposed rate increases and their justifications. Current proposals also include medical-loss ratios, requiring insurers to spend most of their revenues on paying medical benefits, rather than spending those dollars on advertising, overhead, or CEO salaries, Ms. Sebelius said.

The HHS report also criticizes the insurance industry for raising rates at the same time that it takes in significant profits. In 2009, the five largest insurers in the United States took in more than $12 billion in profits, according to HHS.

According to America's Health Insurance Plans (AHIP), an industry trade group, the increases being seen in the individual insurance market are the result of the growth in underlying medical costs and the fact that younger, healthier people are dropping their coverage in the poor economy. That leaves insurers with a pool of older, sicker customers.

AHIP also noted that average profits in the health plan industry are about 2.2%, putting the industry at number 35 on the Fortune 500 list of profits by industry. That margin is lower than other sectors in the health care industry, AHIP said.

The trade group also accused the government of playing politics. “It's time to stop the politics of vilification and focus on what American need most: real health care reform that addresses the serious and urgent problems facing our nation,” Karen Ignagni, president and CEO of AHIP, said in a statement.

The Obama administration has picked a high-profile fight with health insurers, calling the companies to task for proposing double-digit rate hikes while taking in massive profits.

In a report released Feb. 18, the Department of Health and Human Services detailed some of the largest proposed rate increases in the individual insurance market. Some of the increases have gone into effect, while others have been rejected by state health insurance commissioners.

For example, Anthem Blue Cross of California announced that it would raise premiums by as much as 39% for those in the individual market. However, following questions raised by HHS and the California insurance commission, the company delayed those plans for 2 months.

The HHS report also cites significant rate increases in Michigan and Oregon. In 2009, Blue Cross Blue Shield of Michigan requested premium increases of 56% for its plans. In Washington state, premiums for individual health plans were going up by 40% until the state approved tighter regulations on increases, according to the HHS report.

These rate increases highlight the need to focus on comprehensive health reform to address the foundering economy, HHS Secretary Kathleen Sebelius said during a press conference

The health reform proposals pending in Congress would give additional authority to HHS to oversee insurance companies across the country, including proposed rate increases and their justifications. Current proposals also include medical-loss ratios, requiring insurers to spend most of their revenues on paying medical benefits, rather than spending those dollars on advertising, overhead, or CEO salaries, Ms. Sebelius said.

The HHS report also criticizes the insurance industry for raising rates at the same time that it takes in significant profits. In 2009, the five largest insurers in the United States took in more than $12 billion in profits, according to HHS.

According to America's Health Insurance Plans (AHIP), an industry trade group, the increases being seen in the individual insurance market are the result of the growth in underlying medical costs and the fact that younger, healthier people are dropping their coverage in the poor economy. That leaves insurers with a pool of older, sicker customers.

AHIP also noted that average profits in the health plan industry are about 2.2%, putting the industry at number 35 on the Fortune 500 list of profits by industry. That margin is lower than other sectors in the health care industry, AHIP said.

The trade group also accused the government of playing politics. “It's time to stop the politics of vilification and focus on what American need most: real health care reform that addresses the serious and urgent problems facing our nation,” Karen Ignagni, president and CEO of AHIP, said in a statement.