Mary Ellen Schneider

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 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 briefing to release the HHS budget proposal.

The FY 2011 budget proposal focuses on fraud prevention, wellness, and building the public health infrastructure. The budget documents note that the HHS proposal lays the “groundwork” for health reform, but the plan 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 although 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 not accompanied by health care 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 coverage gap, or provide security to those with coverage, she said.

Overall, the Obama administration is seeking $911 billion in funding for HHS in FY 2011, an increase of $51 billion over the current fiscal year. The bulk of HHS's funding is tied up in mandatory obligations including Medicare and Medicaid, so the budget includes just $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. Currently, physicians are scheduled to face a 21% across-the-board cut to their Medicare payments on March 1, unless Congress passes 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 budget request also calls for nearly $1 billion, an increase of about $33 million, to help shore up the health care workforce. The money will help to expand loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.

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

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

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

The FY 2011 budget proposal focuses on fraud prevention, wellness, and building the public health infrastructure. The budget documents note that the HHS proposal lays the “groundwork” for health reform, but the plan 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 although 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 not accompanied by health care 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 coverage gap, or provide security to those with coverage, she said.

Overall, the Obama administration is seeking $911 billion in funding for HHS in FY 2011, an increase of $51 billion over the current fiscal year. The bulk of HHS's funding is tied up in mandatory obligations including Medicare and Medicaid, so the budget includes just $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. Currently, physicians are scheduled to face a 21% across-the-board cut to their Medicare payments on March 1, unless Congress passes 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 budget request also calls for nearly $1 billion, an increase of about $33 million, to help shore up the health care workforce. The money will help to expand loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.

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

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

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

The FY 2011 budget proposal focuses on fraud prevention, wellness, and building the public health infrastructure. The budget documents note that the HHS proposal lays the “groundwork” for health reform, but the plan 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 although 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 not accompanied by health care 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 coverage gap, or provide security to those with coverage, she said.

Overall, the Obama administration is seeking $911 billion in funding for HHS in FY 2011, an increase of $51 billion over the current fiscal year. The bulk of HHS's funding is tied up in mandatory obligations including Medicare and Medicaid, so the budget includes just $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. Currently, physicians are scheduled to face a 21% across-the-board cut to their Medicare payments on March 1, unless Congress passes 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 budget request also calls for nearly $1 billion, an increase of about $33 million, to help shore up the health care workforce. The money will help to expand loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.

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

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP).

In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP.

And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services wasdriven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend could be attributed mainly to the recession.

As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP).

In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP.

And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services wasdriven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend could be attributed mainly to the recession.

As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP).

In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP.

And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services wasdriven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend could be attributed mainly to the recession.

As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Focus Is on Meds in Pregnancy

The Food and Drug Administration is partnering with several health maintenance organizations to study the effects of prescription medications during pregnancy. The new Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) will give researchers access to data from 11 health plan–affiliated sites across the country. In total, the sites have information on about 1 million births between 2001 and 2007. Studies will address the effects of medication in both pregnant women and their children, Dr. Gerald Dal Pan, director of surveillance and epidemiology at the FDA's Center for Drug Evaluation and Research, said in a statement. “Results of these studies will provide valuable information for patients and physicians when making decisions about medication during pregnancy.” The new program is a collaboration among the FDA, the HMO Research Network Center for Education and Research in Therapeutics, Kaiser Permanente's multiple research centers, and Vanderbilt University in Nashville, Tenn.

IOM to Study LGBT Health Issues

The Institute of Medicine plans to review the state of science concerning the health of lesbian, gay, bisexual, and transgender (LGBT) people. An IOM committee will be charged with identifying knowledge gaps and outlining a specific research agenda for the National Institutes of Health. The committee is to examine LGBT health risks, health disparities, access to health care, and utilization. Late last year, the Center for American Progress found in its own study that there are significant disparities when it comes to LGBT health status. For instance, researchers for the think tank found that lesbian, gay, and bisexual adults are twice as likely as heterosexual adults to experience psychological distress.

ACOG Backs Depression Screening

Ob.gyns. should strongly consider screening women for depression both during and after pregnancy, according to a new position statement from the American College of Obstetricians and Gynecologists. There are significant benefits to women and their families if depression is diagnosed and treated, the statement said. ACOG estimates that 14%-23% of pregnant women experience depression symptoms and that 5%-25% of women experience postpartum depression. “With over 4 million births in the [United States] every year, we're talking about a huge number of women with postpartum depression—between 200,000 to more than 1 million each year,” ACOG President Gerald F. Joseph said in a statement. The ACOG statement includes information on seven depression screening tools, each taking less than 10 minutes to perform. Practices should have a referral program in place for women who have depression symptoms. The position statement was published in the February issue of Obstetrics & Gynecology (2010;115:394-5).

Mixed Bag for Reproductive Rights

Supporters of abortion rights scored some major victories in 2009, but those were offset by abortion restrictions proposed as part of health care reform, according to the NARAL Pro-Choice America Foundation. The organization made the assessment in its annual report on abortion-related legislation and court decisions affecting reproductive rights. NARAL officials credited the Obama administration with lifting the Mexico City policy, which had barred federal funding of overseas programs that offer abortion services or referrals. The Obama administration also nominated several individuals with “prochoice records” to federal posts, NARAL noted. But Nancy Keenan, the organization's president, criticized lawmakers who put abortion restrictions in the health care reform bills passed in the House and Senate late last year. “For prochoice Americans, 2009 was a roller coaster ride,” Ms. Keenan said in a statement. “On one hand, we saw positive changes in policies that will make a difference in the lives of women and their families. On the other hand, antichoice politicians used health reform to advance destructive and divisive attacks on women's access to abortion coverage.”

Young Adults Skip Contraception

While the vast majority of unmarried adults under age 30 believe that pregnancies should be planned, only about half of them say they consistently use contraception. The findings come from a survey conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy. It also found that 19% of the sexually active, unmarried adults said that they had not used contraception at all in the past 3 months. One factor may be misconceptions about birth control. The poll found that 27% of the young women and 34% of the men think it likely that using hormonal methods of contraception will lead to a serious health problem, such as cancer. Additionally, 59% of women and 49% of men said they believe that they might be infertile. The survey included 1,800 unmarried adults aged 18-29 years.

Focus Is on Meds in Pregnancy

The Food and Drug Administration is partnering with several health maintenance organizations to study the effects of prescription medications during pregnancy. The new Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) will give researchers access to data from 11 health plan–affiliated sites across the country. In total, the sites have information on about 1 million births between 2001 and 2007. Studies will address the effects of medication in both pregnant women and their children, Dr. Gerald Dal Pan, director of surveillance and epidemiology at the FDA's Center for Drug Evaluation and Research, said in a statement. “Results of these studies will provide valuable information for patients and physicians when making decisions about medication during pregnancy.” The new program is a collaboration among the FDA, the HMO Research Network Center for Education and Research in Therapeutics, Kaiser Permanente's multiple research centers, and Vanderbilt University in Nashville, Tenn.

IOM to Study LGBT Health Issues

The Institute of Medicine plans to review the state of science concerning the health of lesbian, gay, bisexual, and transgender (LGBT) people. An IOM committee will be charged with identifying knowledge gaps and outlining a specific research agenda for the National Institutes of Health. The committee is to examine LGBT health risks, health disparities, access to health care, and utilization. Late last year, the Center for American Progress found in its own study that there are significant disparities when it comes to LGBT health status. For instance, researchers for the think tank found that lesbian, gay, and bisexual adults are twice as likely as heterosexual adults to experience psychological distress.

ACOG Backs Depression Screening

Ob.gyns. should strongly consider screening women for depression both during and after pregnancy, according to a new position statement from the American College of Obstetricians and Gynecologists. There are significant benefits to women and their families if depression is diagnosed and treated, the statement said. ACOG estimates that 14%-23% of pregnant women experience depression symptoms and that 5%-25% of women experience postpartum depression. “With over 4 million births in the [United States] every year, we're talking about a huge number of women with postpartum depression—between 200,000 to more than 1 million each year,” ACOG President Gerald F. Joseph said in a statement. The ACOG statement includes information on seven depression screening tools, each taking less than 10 minutes to perform. Practices should have a referral program in place for women who have depression symptoms. The position statement was published in the February issue of Obstetrics & Gynecology (2010;115:394-5).

Mixed Bag for Reproductive Rights

Supporters of abortion rights scored some major victories in 2009, but those were offset by abortion restrictions proposed as part of health care reform, according to the NARAL Pro-Choice America Foundation. The organization made the assessment in its annual report on abortion-related legislation and court decisions affecting reproductive rights. NARAL officials credited the Obama administration with lifting the Mexico City policy, which had barred federal funding of overseas programs that offer abortion services or referrals. The Obama administration also nominated several individuals with “prochoice records” to federal posts, NARAL noted. But Nancy Keenan, the organization's president, criticized lawmakers who put abortion restrictions in the health care reform bills passed in the House and Senate late last year. “For prochoice Americans, 2009 was a roller coaster ride,” Ms. Keenan said in a statement. “On one hand, we saw positive changes in policies that will make a difference in the lives of women and their families. On the other hand, antichoice politicians used health reform to advance destructive and divisive attacks on women's access to abortion coverage.”

Young Adults Skip Contraception

While the vast majority of unmarried adults under age 30 believe that pregnancies should be planned, only about half of them say they consistently use contraception. The findings come from a survey conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy. It also found that 19% of the sexually active, unmarried adults said that they had not used contraception at all in the past 3 months. One factor may be misconceptions about birth control. The poll found that 27% of the young women and 34% of the men think it likely that using hormonal methods of contraception will lead to a serious health problem, such as cancer. Additionally, 59% of women and 49% of men said they believe that they might be infertile. The survey included 1,800 unmarried adults aged 18-29 years.

Focus Is on Meds in Pregnancy

The Food and Drug Administration is partnering with several health maintenance organizations to study the effects of prescription medications during pregnancy. The new Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) will give researchers access to data from 11 health plan–affiliated sites across the country. In total, the sites have information on about 1 million births between 2001 and 2007. Studies will address the effects of medication in both pregnant women and their children, Dr. Gerald Dal Pan, director of surveillance and epidemiology at the FDA's Center for Drug Evaluation and Research, said in a statement. “Results of these studies will provide valuable information for patients and physicians when making decisions about medication during pregnancy.” The new program is a collaboration among the FDA, the HMO Research Network Center for Education and Research in Therapeutics, Kaiser Permanente's multiple research centers, and Vanderbilt University in Nashville, Tenn.

IOM to Study LGBT Health Issues

The Institute of Medicine plans to review the state of science concerning the health of lesbian, gay, bisexual, and transgender (LGBT) people. An IOM committee will be charged with identifying knowledge gaps and outlining a specific research agenda for the National Institutes of Health. The committee is to examine LGBT health risks, health disparities, access to health care, and utilization. Late last year, the Center for American Progress found in its own study that there are significant disparities when it comes to LGBT health status. For instance, researchers for the think tank found that lesbian, gay, and bisexual adults are twice as likely as heterosexual adults to experience psychological distress.

ACOG Backs Depression Screening

Ob.gyns. should strongly consider screening women for depression both during and after pregnancy, according to a new position statement from the American College of Obstetricians and Gynecologists. There are significant benefits to women and their families if depression is diagnosed and treated, the statement said. ACOG estimates that 14%-23% of pregnant women experience depression symptoms and that 5%-25% of women experience postpartum depression. “With over 4 million births in the [United States] every year, we're talking about a huge number of women with postpartum depression—between 200,000 to more than 1 million each year,” ACOG President Gerald F. Joseph said in a statement. The ACOG statement includes information on seven depression screening tools, each taking less than 10 minutes to perform. Practices should have a referral program in place for women who have depression symptoms. The position statement was published in the February issue of Obstetrics & Gynecology (2010;115:394-5).

Mixed Bag for Reproductive Rights

Supporters of abortion rights scored some major victories in 2009, but those were offset by abortion restrictions proposed as part of health care reform, according to the NARAL Pro-Choice America Foundation. The organization made the assessment in its annual report on abortion-related legislation and court decisions affecting reproductive rights. NARAL officials credited the Obama administration with lifting the Mexico City policy, which had barred federal funding of overseas programs that offer abortion services or referrals. The Obama administration also nominated several individuals with “prochoice records” to federal posts, NARAL noted. But Nancy Keenan, the organization's president, criticized lawmakers who put abortion restrictions in the health care reform bills passed in the House and Senate late last year. “For prochoice Americans, 2009 was a roller coaster ride,” Ms. Keenan said in a statement. “On one hand, we saw positive changes in policies that will make a difference in the lives of women and their families. On the other hand, antichoice politicians used health reform to advance destructive and divisive attacks on women's access to abortion coverage.”

Young Adults Skip Contraception

While the vast majority of unmarried adults under age 30 believe that pregnancies should be planned, only about half of them say they consistently use contraception. The findings come from a survey conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy. It also found that 19% of the sexually active, unmarried adults said that they had not used contraception at all in the past 3 months. One factor may be misconceptions about birth control. The poll found that 27% of the young women and 34% of the men think it likely that using hormonal methods of contraception will lead to a serious health problem, such as cancer. Additionally, 59% of women and 49% of men said they believe that they might be infertile. The survey included 1,800 unmarried adults aged 18-29 years.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP).

In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of the GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession.

As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008.

The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP).

In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of the GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession.

As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008.

The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP).

In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of the GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession.

As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008.

The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Initiative Aims to Propel ALS Research

New York–based Project A.L.S. has partnered with the Robert Packard Center for ALS Research at Johns Hopkins University on a new research initiative designed to rapidly advance the science behind ALS. The 3-year, $15 million project will bring together leading researchers in genetics, stem cell reprogramming, and glial-neuron signaling to get a better handle on the key genetic, biochemical, and cellular pathways that lead to ALS. The researchers will also focus on defining the primary molecular targets for the development of new ALS treatments.

The project, called P2ALS, is designed to speed up research because scientists from different disciplines will be able to rapidly test each other's discoveries. “P2ALS is the most exciting undertaking in ALS research ever,” Dr. Jeff Rothstein, medical director for the Robert Packard Center for ALS, said in a statement. “The opportunity to bring a group of highly productive creative leaders from the Packard Center with those funded by Project A.L.S., including iPS biology, motor neuron and glial biology, and experts in drug discovery, with a milestone driven approach provides a fantastic opportunity to synergize ALS research in a way I have never seen.”

Autism Research Gets Boost in Budget

The Obama administration is seeking $222 million in fiscal year 2011 to expand research into autism spectrum disorders. The funding, which would be spread through the Health and Human Services department, would focus on detection, treatment, and other activities with the potential to improve the lives of families affected by autism.

The National Institutes of Health is also putting a focus on the disorder. The agency plans to undertake a complete genome sequencing and DNA analysis of 300 autism spectrum disorder cases. Officials at the National Institutes of Health are also planning to launch the first epigenomic studies of brain samples from individuals who have autism spectrum disorders and those without the disorder. The National Institutes of Health will also investigate patterns of environmental exposure during pregnancy and the perinatal period.

Neuro Expert Will Lead Bioethics Org

Dr. Joseph J. Fins, an expert on ethical and policy issues in brain injury and neurology, has been chosen to lead the American Society for Bioethics and Humanities. He will assume his 2-year term as president in 2011. Dr. Fins is the chief of the division of medical ethics in the departments of public health and medicine at Weill Cornell Medical College. He is also a professor of public health and medicine in psychiatry. Dr. Fins is well known for his work in research ethics in neurology and psychiatry. He was a coauthor of a 2007 paper in Nature that described the first use of deep brain stimulation during a minimally conscious state. In a statement, Dr. Fins said he looks forward to assuming the presidency and working to “improve patient care, enrich medical education, and inform health policy.”

CMS Launches Provider Survey

The Centers for Medicare and Medicaid Services kicked off its fifth annual survey to determine provider satisfaction with Medicare fee-for-service contractors. The contractors process and pay more than $370 billion in Medicare claims each year. The Medicare Contractor Provider Satisfaction Survey offers physicians and other providers a chance to say how well their contractor handles inquiries, outreach, education, claims processing, appeals, reviews, and audits. The Centers for Medicare and Medicaid Services said it is sending the 2010 survey to approximately 30,000 randomly selected providers, including practitioners, suppliers, and institutions. Participants can submit their responses confidentially online or via mail, fax, or telephone, according to the Centers for Medicare and Medicaid Services. Results of the survey, which will take several months to complete, will be released on the CMS Web site this summer, the agency said.

Initiative Aims to Propel ALS Research

New York–based Project A.L.S. has partnered with the Robert Packard Center for ALS Research at Johns Hopkins University on a new research initiative designed to rapidly advance the science behind ALS. The 3-year, $15 million project will bring together leading researchers in genetics, stem cell reprogramming, and glial-neuron signaling to get a better handle on the key genetic, biochemical, and cellular pathways that lead to ALS. The researchers will also focus on defining the primary molecular targets for the development of new ALS treatments.

The project, called P2ALS, is designed to speed up research because scientists from different disciplines will be able to rapidly test each other's discoveries. “P2ALS is the most exciting undertaking in ALS research ever,” Dr. Jeff Rothstein, medical director for the Robert Packard Center for ALS, said in a statement. “The opportunity to bring a group of highly productive creative leaders from the Packard Center with those funded by Project A.L.S., including iPS biology, motor neuron and glial biology, and experts in drug discovery, with a milestone driven approach provides a fantastic opportunity to synergize ALS research in a way I have never seen.”

Autism Research Gets Boost in Budget

The Obama administration is seeking $222 million in fiscal year 2011 to expand research into autism spectrum disorders. The funding, which would be spread through the Health and Human Services department, would focus on detection, treatment, and other activities with the potential to improve the lives of families affected by autism.

The National Institutes of Health is also putting a focus on the disorder. The agency plans to undertake a complete genome sequencing and DNA analysis of 300 autism spectrum disorder cases. Officials at the National Institutes of Health are also planning to launch the first epigenomic studies of brain samples from individuals who have autism spectrum disorders and those without the disorder. The National Institutes of Health will also investigate patterns of environmental exposure during pregnancy and the perinatal period.

Neuro Expert Will Lead Bioethics Org

Dr. Joseph J. Fins, an expert on ethical and policy issues in brain injury and neurology, has been chosen to lead the American Society for Bioethics and Humanities. He will assume his 2-year term as president in 2011. Dr. Fins is the chief of the division of medical ethics in the departments of public health and medicine at Weill Cornell Medical College. He is also a professor of public health and medicine in psychiatry. Dr. Fins is well known for his work in research ethics in neurology and psychiatry. He was a coauthor of a 2007 paper in Nature that described the first use of deep brain stimulation during a minimally conscious state. In a statement, Dr. Fins said he looks forward to assuming the presidency and working to “improve patient care, enrich medical education, and inform health policy.”

CMS Launches Provider Survey

The Centers for Medicare and Medicaid Services kicked off its fifth annual survey to determine provider satisfaction with Medicare fee-for-service contractors. The contractors process and pay more than $370 billion in Medicare claims each year. The Medicare Contractor Provider Satisfaction Survey offers physicians and other providers a chance to say how well their contractor handles inquiries, outreach, education, claims processing, appeals, reviews, and audits. The Centers for Medicare and Medicaid Services said it is sending the 2010 survey to approximately 30,000 randomly selected providers, including practitioners, suppliers, and institutions. Participants can submit their responses confidentially online or via mail, fax, or telephone, according to the Centers for Medicare and Medicaid Services. Results of the survey, which will take several months to complete, will be released on the CMS Web site this summer, the agency said.

Initiative Aims to Propel ALS Research

New York–based Project A.L.S. has partnered with the Robert Packard Center for ALS Research at Johns Hopkins University on a new research initiative designed to rapidly advance the science behind ALS. The 3-year, $15 million project will bring together leading researchers in genetics, stem cell reprogramming, and glial-neuron signaling to get a better handle on the key genetic, biochemical, and cellular pathways that lead to ALS. The researchers will also focus on defining the primary molecular targets for the development of new ALS treatments.

The project, called P2ALS, is designed to speed up research because scientists from different disciplines will be able to rapidly test each other's discoveries. “P2ALS is the most exciting undertaking in ALS research ever,” Dr. Jeff Rothstein, medical director for the Robert Packard Center for ALS, said in a statement. “The opportunity to bring a group of highly productive creative leaders from the Packard Center with those funded by Project A.L.S., including iPS biology, motor neuron and glial biology, and experts in drug discovery, with a milestone driven approach provides a fantastic opportunity to synergize ALS research in a way I have never seen.”

Autism Research Gets Boost in Budget

The Obama administration is seeking $222 million in fiscal year 2011 to expand research into autism spectrum disorders. The funding, which would be spread through the Health and Human Services department, would focus on detection, treatment, and other activities with the potential to improve the lives of families affected by autism.

The National Institutes of Health is also putting a focus on the disorder. The agency plans to undertake a complete genome sequencing and DNA analysis of 300 autism spectrum disorder cases. Officials at the National Institutes of Health are also planning to launch the first epigenomic studies of brain samples from individuals who have autism spectrum disorders and those without the disorder. The National Institutes of Health will also investigate patterns of environmental exposure during pregnancy and the perinatal period.

Neuro Expert Will Lead Bioethics Org

Dr. Joseph J. Fins, an expert on ethical and policy issues in brain injury and neurology, has been chosen to lead the American Society for Bioethics and Humanities. He will assume his 2-year term as president in 2011. Dr. Fins is the chief of the division of medical ethics in the departments of public health and medicine at Weill Cornell Medical College. He is also a professor of public health and medicine in psychiatry. Dr. Fins is well known for his work in research ethics in neurology and psychiatry. He was a coauthor of a 2007 paper in Nature that described the first use of deep brain stimulation during a minimally conscious state. In a statement, Dr. Fins said he looks forward to assuming the presidency and working to “improve patient care, enrich medical education, and inform health policy.”

CMS Launches Provider Survey

The Centers for Medicare and Medicaid Services kicked off its fifth annual survey to determine provider satisfaction with Medicare fee-for-service contractors. The contractors process and pay more than $370 billion in Medicare claims each year. The Medicare Contractor Provider Satisfaction Survey offers physicians and other providers a chance to say how well their contractor handles inquiries, outreach, education, claims processing, appeals, reviews, and audits. The Centers for Medicare and Medicaid Services said it is sending the 2010 survey to approximately 30,000 randomly selected providers, including practitioners, suppliers, and institutions. Participants can submit their responses confidentially online or via mail, fax, or telephone, according to the Centers for Medicare and Medicaid Services. Results of the survey, which will take several months to complete, will be released on the CMS Web site this summer, the agency said.

U.K. Set to Clear Use of New RA Tx

The United Kingdom's National Institute for Health and Clinical Excellence (NICE) recently recommended that Cimzia (certolizumab pegol) be available as a treatment option for adults with severe active rheumatoid arthritis. But the recommendation is still in draft form, and the NICE will hear appeals before it formally issues its guidance to the U.K.'s National Health Service. Under the recommendation, Cimzia would be used in combination with methotrexate for those patients who have had an inadequate response to disease-modifying antirheumatic drugs. The new treatment could also be used as monotherapy in cases where continued treatment with methotrexate is not appropriate. As part of an agreement with the U.K. Department of Health, Cimzia maker UCB Pharma has agreed to provide the drug for free to patients during the first 12 weeks of treatment.

Enbrel to Retain Hold of Top Spot

Enbrel (etanercept) is likely to maintain its position as the clinical standard and sales leader in RA treatment through 2018, according to an analysis from the market research firm Decision Resources Inc. One major factor is that rheumatologists don't want to prescribe drugs that may be less efficacious, even if they are less costly. As part of its new analysis, researchers at Decision Resources surveyed rheumatologists and found that their prescribing decisions are most affected by a drug's impact on reducing the signs and symptoms of RA at 1 year, and they see Enbrel as currently unmatched at inhibiting structural damage progression. “High price, intravenous delivery route, and the potential for harmful side effects are all drawbacks to current biologic agents used to treat TNF-alpha inhibitor-refractory patients,” Kyle Crowell, a Decision Resources analyst, said in a statement. “However, given a drug with incremental safety, delivery, and even cost advantages, physicians are still unwilling to compromise on efficacy,” according to Mr. Crowell.

Focus on Lupus Provider Education

Patient advocates, rheumatologists, and government officials recently met to discuss efforts to improve the diagnosis and treatment of lupus among minorities. At a meeting held in Atlanta in January, participants discussed how they could develop a national health care provider education initiative. About $1.6 million in government funding is available for projects that promote comprehensive lupus curricula in medical and nursing schools and among health professionals already in practice. A survey from the Lupus Foundation of America shows that, on average, a person will wait 3 years and visit four physicians before receiving an accurate diagnosis of lupus. The condition disproportionately affects women and minorities. More than 90% of individuals with lupus are women, and the condition is two to three times more likely among blacks, Hispanics, Asian Americans, and Native Americans than among whites, according to the Lupus Foundation of America.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president Dr. J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use [in the United States] by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

Adverse Event Reports Are Limited

Little information is being made public about adverse events that occur in hospitals, even though public disclosure can help medical practitioners improve patient safety, according to a government report. The safety data in question are collected by organizations other than the hospitals. The Department of Health and Human Services Inspector General reviewed eight federally approved patient safety organizations and 17 systems that collect adverse event information for states. It found that only seven state systems passed along to providers adverse event analyses that led to changes in practice. The other states passed along reports without any analysis. A nationwide database of adverse events collected by the patient safety organizations won't be operational until at least 2011, according to the report.

U.K. Set to Clear Use of New RA Tx

The United Kingdom's National Institute for Health and Clinical Excellence (NICE) recently recommended that Cimzia (certolizumab pegol) be available as a treatment option for adults with severe active rheumatoid arthritis. But the recommendation is still in draft form, and the NICE will hear appeals before it formally issues its guidance to the U.K.'s National Health Service. Under the recommendation, Cimzia would be used in combination with methotrexate for those patients who have had an inadequate response to disease-modifying antirheumatic drugs. The new treatment could also be used as monotherapy in cases where continued treatment with methotrexate is not appropriate. As part of an agreement with the U.K. Department of Health, Cimzia maker UCB Pharma has agreed to provide the drug for free to patients during the first 12 weeks of treatment.

Enbrel to Retain Hold of Top Spot

Enbrel (etanercept) is likely to maintain its position as the clinical standard and sales leader in RA treatment through 2018, according to an analysis from the market research firm Decision Resources Inc. One major factor is that rheumatologists don't want to prescribe drugs that may be less efficacious, even if they are less costly. As part of its new analysis, researchers at Decision Resources surveyed rheumatologists and found that their prescribing decisions are most affected by a drug's impact on reducing the signs and symptoms of RA at 1 year, and they see Enbrel as currently unmatched at inhibiting structural damage progression. “High price, intravenous delivery route, and the potential for harmful side effects are all drawbacks to current biologic agents used to treat TNF-alpha inhibitor-refractory patients,” Kyle Crowell, a Decision Resources analyst, said in a statement. “However, given a drug with incremental safety, delivery, and even cost advantages, physicians are still unwilling to compromise on efficacy,” according to Mr. Crowell.

Focus on Lupus Provider Education

Patient advocates, rheumatologists, and government officials recently met to discuss efforts to improve the diagnosis and treatment of lupus among minorities. At a meeting held in Atlanta in January, participants discussed how they could develop a national health care provider education initiative. About $1.6 million in government funding is available for projects that promote comprehensive lupus curricula in medical and nursing schools and among health professionals already in practice. A survey from the Lupus Foundation of America shows that, on average, a person will wait 3 years and visit four physicians before receiving an accurate diagnosis of lupus. The condition disproportionately affects women and minorities. More than 90% of individuals with lupus are women, and the condition is two to three times more likely among blacks, Hispanics, Asian Americans, and Native Americans than among whites, according to the Lupus Foundation of America.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president Dr. J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use [in the United States] by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

Adverse Event Reports Are Limited

Little information is being made public about adverse events that occur in hospitals, even though public disclosure can help medical practitioners improve patient safety, according to a government report. The safety data in question are collected by organizations other than the hospitals. The Department of Health and Human Services Inspector General reviewed eight federally approved patient safety organizations and 17 systems that collect adverse event information for states. It found that only seven state systems passed along to providers adverse event analyses that led to changes in practice. The other states passed along reports without any analysis. A nationwide database of adverse events collected by the patient safety organizations won't be operational until at least 2011, according to the report.

U.K. Set to Clear Use of New RA Tx

The United Kingdom's National Institute for Health and Clinical Excellence (NICE) recently recommended that Cimzia (certolizumab pegol) be available as a treatment option for adults with severe active rheumatoid arthritis. But the recommendation is still in draft form, and the NICE will hear appeals before it formally issues its guidance to the U.K.'s National Health Service. Under the recommendation, Cimzia would be used in combination with methotrexate for those patients who have had an inadequate response to disease-modifying antirheumatic drugs. The new treatment could also be used as monotherapy in cases where continued treatment with methotrexate is not appropriate. As part of an agreement with the U.K. Department of Health, Cimzia maker UCB Pharma has agreed to provide the drug for free to patients during the first 12 weeks of treatment.

Enbrel to Retain Hold of Top Spot

Enbrel (etanercept) is likely to maintain its position as the clinical standard and sales leader in RA treatment through 2018, according to an analysis from the market research firm Decision Resources Inc. One major factor is that rheumatologists don't want to prescribe drugs that may be less efficacious, even if they are less costly. As part of its new analysis, researchers at Decision Resources surveyed rheumatologists and found that their prescribing decisions are most affected by a drug's impact on reducing the signs and symptoms of RA at 1 year, and they see Enbrel as currently unmatched at inhibiting structural damage progression. “High price, intravenous delivery route, and the potential for harmful side effects are all drawbacks to current biologic agents used to treat TNF-alpha inhibitor-refractory patients,” Kyle Crowell, a Decision Resources analyst, said in a statement. “However, given a drug with incremental safety, delivery, and even cost advantages, physicians are still unwilling to compromise on efficacy,” according to Mr. Crowell.

Focus on Lupus Provider Education

Patient advocates, rheumatologists, and government officials recently met to discuss efforts to improve the diagnosis and treatment of lupus among minorities. At a meeting held in Atlanta in January, participants discussed how they could develop a national health care provider education initiative. About $1.6 million in government funding is available for projects that promote comprehensive lupus curricula in medical and nursing schools and among health professionals already in practice. A survey from the Lupus Foundation of America shows that, on average, a person will wait 3 years and visit four physicians before receiving an accurate diagnosis of lupus. The condition disproportionately affects women and minorities. More than 90% of individuals with lupus are women, and the condition is two to three times more likely among blacks, Hispanics, Asian Americans, and Native Americans than among whites, according to the Lupus Foundation of America.

Tobacco Act Gets Singed

A federal district court has struck down parts of the Family Smoking Prevention and Tobacco Control Act of 2009, saying that some of the landmark law violates tobacco makers' free speech rights. The U.S. District Court for the Western District of Kentucky ruled it unconstitutional for government to ban color and images in tobacco advertising. However, the court upheld provisions of the law requiring large, strongly worded warnings on tobacco packaging, prohibiting companies from making health claims about tobacco products without Food and Drug Administration review, and banning tobacco-branded events and merchandise, such as T-shirts. American Thoracic Society president Dr. J.R. Curtis said in a statement that the society is still “confident that the FDA will exercise its new authority to reduce tobacco use [in the United States] by stopping the efforts of big tobacco to market its dangerous products to minors, and by giving current smokers more motivation to stop smoking.”

Adverse Event Reports Are Limited

Little information is being made public about adverse events that occur in hospitals, even though public disclosure can help medical practitioners improve patient safety, according to a government report. The safety data in question are collected by organizations other than the hospitals. The Department of Health and Human Services Inspector General reviewed eight federally approved patient safety organizations and 17 systems that collect adverse event information for states. It found that only seven state systems passed along to providers adverse event analyses that led to changes in practice. The other states passed along reports without any analysis. A nationwide database of adverse events collected by the patient safety organizations won't be operational until at least 2011, according to the report.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product. In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

Although spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the effects of the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

VITALS

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product. In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

Although spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the effects of the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

VITALS

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product. In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

Although spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS.

The increase is due in part to the effects of the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

VITALS

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy (www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. DHHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, DHHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone—governments, communities, families, and individuals,” Ms. Sebelius said in a statement. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Looking back at the challenges that physicians faced during the aftermath of Hurricane Katrina, Dr. Benjamin said that many of those obstacles could have been addressed in a systematic way if a strategy like this one had existed at the time.

This year, DHHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it come to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to DHHS.

Dr. Benjamin said that workforce is a major issue. Although part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice.

For example, practicing internists are trained in a range of emergency skills, but don't use in them in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners—physicians, nurses, physician assistants, and nurse practitioners—are able, he said. “We've never done that in a comprehensive way in our country. We've been very specialized and silo-based in most of what we do.”

In addition to staying current on emergency skills, physicians also need to consider how a major crisis would affect their practice, Dr. Benjamin advised, adding they should identify the most likely emergency scenarios in their area and think through their role in an emergency. That should include examining employment policies and ensuring safe storage of medical records.

Physicians should also plan for the recovery from an emergency, he said. Have a plan for how to get rapidly recredentialed in another hospital or state, if necessary.

“Good planning for those kinds of emergencies, for your own needs as well as your family's and your patients' needs, is probably a good thing to do,” Dr. Benjamin said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy (www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. DHHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, DHHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone—governments, communities, families, and individuals,” Ms. Sebelius said in a statement. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Looking back at the challenges that physicians faced during the aftermath of Hurricane Katrina, Dr. Benjamin said that many of those obstacles could have been addressed in a systematic way if a strategy like this one had existed at the time.

This year, DHHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it come to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to DHHS.

Dr. Benjamin said that workforce is a major issue. Although part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice.

For example, practicing internists are trained in a range of emergency skills, but don't use in them in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners—physicians, nurses, physician assistants, and nurse practitioners—are able, he said. “We've never done that in a comprehensive way in our country. We've been very specialized and silo-based in most of what we do.”

In addition to staying current on emergency skills, physicians also need to consider how a major crisis would affect their practice, Dr. Benjamin advised, adding they should identify the most likely emergency scenarios in their area and think through their role in an emergency. That should include examining employment policies and ensuring safe storage of medical records.

Physicians should also plan for the recovery from an emergency, he said. Have a plan for how to get rapidly recredentialed in another hospital or state, if necessary.

“Good planning for those kinds of emergencies, for your own needs as well as your family's and your patients' needs, is probably a good thing to do,” Dr. Benjamin said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy (www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. DHHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, DHHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone—governments, communities, families, and individuals,” Ms. Sebelius said in a statement. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Looking back at the challenges that physicians faced during the aftermath of Hurricane Katrina, Dr. Benjamin said that many of those obstacles could have been addressed in a systematic way if a strategy like this one had existed at the time.

This year, DHHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it come to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to DHHS.

Dr. Benjamin said that workforce is a major issue. Although part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice.

For example, practicing internists are trained in a range of emergency skills, but don't use in them in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners—physicians, nurses, physician assistants, and nurse practitioners—are able, he said. “We've never done that in a comprehensive way in our country. We've been very specialized and silo-based in most of what we do.”

In addition to staying current on emergency skills, physicians also need to consider how a major crisis would affect their practice, Dr. Benjamin advised, adding they should identify the most likely emergency scenarios in their area and think through their role in an emergency. That should include examining employment policies and ensuring safe storage of medical records.

Physicians should also plan for the recovery from an emergency, he said. Have a plan for how to get rapidly recredentialed in another hospital or state, if necessary.

“Good planning for those kinds of emergencies, for your own needs as well as your family's and your patients' needs, is probably a good thing to do,” Dr. Benjamin said.

NEW YORK — The soft data that can be gathered from self-administered patient questionnaires are more telling about how a patient with rheumatoid arthritis is faring than are x-rays or some lab tests that are wrongly considered to be prognostic.

Dr. Theodore Pincus recently told a group of rheumatologists at a course sponsored by New York University that “patient questionnaire scores are the most valuable data we collect in taking care of patients.”

“The rheumatologist should be leading the world in recognizing these matters, rather than trying to say that we can be like cardiologists and look at images,” said Dr. Pincus of the department of medicine at the university.

That's why he encourages physicians to make patient questionnaires a standard part of the assessment of RA patients and then document those numerical measurements for easy reference.

Questionnaires like the Routine Assessment of Patient Index Data 3 (RAPID3) can be administered cheaply—for just the cost of pencils and photocopies—and scored by physicians in 5–10 seconds, he said.

These types of patient-oriented measures are especially important in rheumatology where there is no single standard measure when it comes to diagnosis or predicting functionality, said Dr. Pincus.

Functional disability, patient global estimate, socioeconomic status, and age are better predictors of cost, work disability, and death in RA than are rheumatoid factor and radiographs, he noted.

Although the conventional measures that make up the American College of Rheumatology core data set have served the specialty well, they all have their limitations, said Dr. Pincus.

Joint counts are the most specific measure to assess patients with RA, but the measure is not necessarily the most significant when it comes to prognosis and management, he said. Joint counts may improve over time, even while joint damage and functional disability continue to progress.

It also takes physicians significantly longer to perform a joint count than to score a patient self-assessment (about 1.5 minutes vs. about 5–10 seconds).

And many rheumatologists don't actually perform formal tender and swollen joint counts on the patients they examine, he said.

Radiographs also have drawbacks, Dr. Pincus said. Although clinical trials have shown statistically significant data from radiographs, it's still unclear how important they are clinically in individual patients, he said.

The usefulness of x-rays is also limited because treatment is often initiated prior to the emergence of erosions.

Laboratory tests, which are often seen by physicians and patients as the most important measures, also fall short in rheumatology. For example, medical textbooks have said for years that the erythrocyte sedimentation rate is increased in nearly all patients with active RA, but today the data show that many patients with active RA do not have an increased ESR, Dr. Pincus said.

Studies from around the world have shown that as many as 37%–45% of RA patients have an ESR value less than 28 mm/hour, which is within normal limits (J. Rheumatol. 1994;21:1227–37).

While a complete blood count test is often of great value, generally laboratory tests tend to be overrated in rheumatology, he said.

Disclosures: Dr. Pincus disclosed a financial relationship with a number of pharmaceutical companies including Amgen Inc., Bristol-Myers Squibb Co., Abbott Laboratories, Wyeth Pharmaceuticals, Genentech, and UCB.

Rheumatologists should be leading the way in recognizing the validity of patient-completed questionnaires.

Source DR. PINCUS

NEW YORK — The soft data that can be gathered from self-administered patient questionnaires are more telling about how a patient with rheumatoid arthritis is faring than are x-rays or some lab tests that are wrongly considered to be prognostic.

Dr. Theodore Pincus recently told a group of rheumatologists at a course sponsored by New York University that “patient questionnaire scores are the most valuable data we collect in taking care of patients.”

“The rheumatologist should be leading the world in recognizing these matters, rather than trying to say that we can be like cardiologists and look at images,” said Dr. Pincus of the department of medicine at the university.

That's why he encourages physicians to make patient questionnaires a standard part of the assessment of RA patients and then document those numerical measurements for easy reference.

Questionnaires like the Routine Assessment of Patient Index Data 3 (RAPID3) can be administered cheaply—for just the cost of pencils and photocopies—and scored by physicians in 5–10 seconds, he said.

These types of patient-oriented measures are especially important in rheumatology where there is no single standard measure when it comes to diagnosis or predicting functionality, said Dr. Pincus.

Functional disability, patient global estimate, socioeconomic status, and age are better predictors of cost, work disability, and death in RA than are rheumatoid factor and radiographs, he noted.

Although the conventional measures that make up the American College of Rheumatology core data set have served the specialty well, they all have their limitations, said Dr. Pincus.

Joint counts are the most specific measure to assess patients with RA, but the measure is not necessarily the most significant when it comes to prognosis and management, he said. Joint counts may improve over time, even while joint damage and functional disability continue to progress.

It also takes physicians significantly longer to perform a joint count than to score a patient self-assessment (about 1.5 minutes vs. about 5–10 seconds).

And many rheumatologists don't actually perform formal tender and swollen joint counts on the patients they examine, he said.

Radiographs also have drawbacks, Dr. Pincus said. Although clinical trials have shown statistically significant data from radiographs, it's still unclear how important they are clinically in individual patients, he said.

The usefulness of x-rays is also limited because treatment is often initiated prior to the emergence of erosions.

Laboratory tests, which are often seen by physicians and patients as the most important measures, also fall short in rheumatology. For example, medical textbooks have said for years that the erythrocyte sedimentation rate is increased in nearly all patients with active RA, but today the data show that many patients with active RA do not have an increased ESR, Dr. Pincus said.

Studies from around the world have shown that as many as 37%–45% of RA patients have an ESR value less than 28 mm/hour, which is within normal limits (J. Rheumatol. 1994;21:1227–37).

While a complete blood count test is often of great value, generally laboratory tests tend to be overrated in rheumatology, he said.

Disclosures: Dr. Pincus disclosed a financial relationship with a number of pharmaceutical companies including Amgen Inc., Bristol-Myers Squibb Co., Abbott Laboratories, Wyeth Pharmaceuticals, Genentech, and UCB.

Rheumatologists should be leading the way in recognizing the validity of patient-completed questionnaires.

Source DR. PINCUS

NEW YORK — The soft data that can be gathered from self-administered patient questionnaires are more telling about how a patient with rheumatoid arthritis is faring than are x-rays or some lab tests that are wrongly considered to be prognostic.

Dr. Theodore Pincus recently told a group of rheumatologists at a course sponsored by New York University that “patient questionnaire scores are the most valuable data we collect in taking care of patients.”

“The rheumatologist should be leading the world in recognizing these matters, rather than trying to say that we can be like cardiologists and look at images,” said Dr. Pincus of the department of medicine at the university.

That's why he encourages physicians to make patient questionnaires a standard part of the assessment of RA patients and then document those numerical measurements for easy reference.

Questionnaires like the Routine Assessment of Patient Index Data 3 (RAPID3) can be administered cheaply—for just the cost of pencils and photocopies—and scored by physicians in 5–10 seconds, he said.

These types of patient-oriented measures are especially important in rheumatology where there is no single standard measure when it comes to diagnosis or predicting functionality, said Dr. Pincus.

Functional disability, patient global estimate, socioeconomic status, and age are better predictors of cost, work disability, and death in RA than are rheumatoid factor and radiographs, he noted.

Although the conventional measures that make up the American College of Rheumatology core data set have served the specialty well, they all have their limitations, said Dr. Pincus.

Joint counts are the most specific measure to assess patients with RA, but the measure is not necessarily the most significant when it comes to prognosis and management, he said. Joint counts may improve over time, even while joint damage and functional disability continue to progress.

It also takes physicians significantly longer to perform a joint count than to score a patient self-assessment (about 1.5 minutes vs. about 5–10 seconds).

And many rheumatologists don't actually perform formal tender and swollen joint counts on the patients they examine, he said.

Radiographs also have drawbacks, Dr. Pincus said. Although clinical trials have shown statistically significant data from radiographs, it's still unclear how important they are clinically in individual patients, he said.

The usefulness of x-rays is also limited because treatment is often initiated prior to the emergence of erosions.

Laboratory tests, which are often seen by physicians and patients as the most important measures, also fall short in rheumatology. For example, medical textbooks have said for years that the erythrocyte sedimentation rate is increased in nearly all patients with active RA, but today the data show that many patients with active RA do not have an increased ESR, Dr. Pincus said.

Studies from around the world have shown that as many as 37%–45% of RA patients have an ESR value less than 28 mm/hour, which is within normal limits (J. Rheumatol. 1994;21:1227–37).

While a complete blood count test is often of great value, generally laboratory tests tend to be overrated in rheumatology, he said.

Disclosures: Dr. Pincus disclosed a financial relationship with a number of pharmaceutical companies including Amgen Inc., Bristol-Myers Squibb Co., Abbott Laboratories, Wyeth Pharmaceuticals, Genentech, and UCB.

Rheumatologists should be leading the way in recognizing the validity of patient-completed questionnaires.

Source DR. PINCUS

NEW YORK — Building on the work in developing a clinical definition of remission in rheumatoid arthritis, a group of clinicians and researchers is interested in creating a complementary patient term called “absence of disease.”

Rheumatologists from around the world will begin discussing how to develop this patient-centered definition in Malaysian Borneo in May at the next meeting of OMERACT (Outcome Measures in Rheumatology), an international network aimed at improving outcomes assessment in rheumatology.

It's important to ask patients for their view of what “absence of disease” means, because they see “remission” so differently from the way physicians do, Dr. Maarten Boers, a member of the OMERACT executive committee, said at a rheumatology course sponsored by New York University. The current remission term is a classic physician-centric definition that is largely based on inflammation, he said.

“If you talk to patients, they talk about totally different things than we talk about in terms of disease,” Dr. Boers, a professor at VU University Medical Center in Amsterdam, said in an interview.

Although patients were involved in developing the remission definition by OMERACT, that dimension wasn's fully studied. This time around, the organization plans to spend about 2 years performing qualitative work. They won's have to start from scratch, though, Dr. Boers said, because there has already been qualitative work done on a related issue: the impact of disease, which could be interpreted as the opposite of the “absence of disease” concept.

Disclosures: Dr. Boers said he had no relevant financial disclosures to make.

NEW YORK — Building on the work in developing a clinical definition of remission in rheumatoid arthritis, a group of clinicians and researchers is interested in creating a complementary patient term called “absence of disease.”

Rheumatologists from around the world will begin discussing how to develop this patient-centered definition in Malaysian Borneo in May at the next meeting of OMERACT (Outcome Measures in Rheumatology), an international network aimed at improving outcomes assessment in rheumatology.

It's important to ask patients for their view of what “absence of disease” means, because they see “remission” so differently from the way physicians do, Dr. Maarten Boers, a member of the OMERACT executive committee, said at a rheumatology course sponsored by New York University. The current remission term is a classic physician-centric definition that is largely based on inflammation, he said.

“If you talk to patients, they talk about totally different things than we talk about in terms of disease,” Dr. Boers, a professor at VU University Medical Center in Amsterdam, said in an interview.

Although patients were involved in developing the remission definition by OMERACT, that dimension wasn's fully studied. This time around, the organization plans to spend about 2 years performing qualitative work. They won's have to start from scratch, though, Dr. Boers said, because there has already been qualitative work done on a related issue: the impact of disease, which could be interpreted as the opposite of the “absence of disease” concept.

Disclosures: Dr. Boers said he had no relevant financial disclosures to make.

NEW YORK — Building on the work in developing a clinical definition of remission in rheumatoid arthritis, a group of clinicians and researchers is interested in creating a complementary patient term called “absence of disease.”

Rheumatologists from around the world will begin discussing how to develop this patient-centered definition in Malaysian Borneo in May at the next meeting of OMERACT (Outcome Measures in Rheumatology), an international network aimed at improving outcomes assessment in rheumatology.

It's important to ask patients for their view of what “absence of disease” means, because they see “remission” so differently from the way physicians do, Dr. Maarten Boers, a member of the OMERACT executive committee, said at a rheumatology course sponsored by New York University. The current remission term is a classic physician-centric definition that is largely based on inflammation, he said.

“If you talk to patients, they talk about totally different things than we talk about in terms of disease,” Dr. Boers, a professor at VU University Medical Center in Amsterdam, said in an interview.

Although patients were involved in developing the remission definition by OMERACT, that dimension wasn's fully studied. This time around, the organization plans to spend about 2 years performing qualitative work. They won's have to start from scratch, though, Dr. Boers said, because there has already been qualitative work done on a related issue: the impact of disease, which could be interpreted as the opposite of the “absence of disease” concept.

Disclosures: Dr. Boers said he had no relevant financial disclosures to make.