Mary Ellen Schneider

NEW YORK — Giving returning service members the time and resources to transition back into civilian life is essential to prevent substance abuse and identify mental health issues, according to experts.

Some veterans are literally in Iraq one day and in their living rooms the next, said Monica L. Martocci, clinical director of New Directions Inc., Los Angeles, a drug and alcohol treatment, and co-occurring disorders program serving homeless veterans.

Many veterans are young men and women with little life experience outside of the structured environments of school and the military, Ms. Martocci said. Some veterans might return home with drug or alcohol problems.

“They are popped right back into family life or real life without knowing what to do there,” Ms. Martocci said during a panel discussion on substance abuse and mental health issues among veterans and active duty military personnel at a meeting sponsored by the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

Ideally, returning veterans should spend some time learning about their benefits and getting a physical and mental health assessment, she said. The idea is to identify veterans with substance abuse issues or symptoms of posttraumatic stress disorder before they are back with their families and less likely to get professional support, she said.

Military leaders have started some programs aimed at addressing that issue. The Yellow Ribbon Reintegration Program aims to help soldiers and their families prepare for deployment and get help adjusting to life when they return. Before deployment, soldiers and their families attend educational sessions about what to expect and what benefits will be available to them. During deployment, families learn about PTSD symptoms and the potential for marital stress.

When soldiers return, they attend workshops with their families and fellow soldiers at 30 and 60 days after their return home. The program began at the state level, and in 2008 Congress mandated that it be rolled out nationally to all National Guard and Army Reserve members and their families.

This program, already underway in Montana, has helped soldiers reconnect with their families in a healthy way, said Eric Newhouse, a Pulitzer Prize–winning journalist and author of a book on PTSD. Before beginning the Yellow Ribbon program, National Guard and Army Reserve troops were given a 90-day break from drills. But that extended period of leave only served to break apart their support system and left them with no one to talk to about their experiences in combat, he said.

The sessions feature seminars on marriage, anger management, and taxes. They even learn how to drive like civilians again, Mr. Newhouse said.

'They are popped right back into family life or real life without knowing what to do there.'

Source MS. MARTOCCI

NEW YORK — Giving returning service members the time and resources to transition back into civilian life is essential to prevent substance abuse and identify mental health issues, according to experts.

Some veterans are literally in Iraq one day and in their living rooms the next, said Monica L. Martocci, clinical director of New Directions Inc., Los Angeles, a drug and alcohol treatment, and co-occurring disorders program serving homeless veterans.

Many veterans are young men and women with little life experience outside of the structured environments of school and the military, Ms. Martocci said. Some veterans might return home with drug or alcohol problems.

“They are popped right back into family life or real life without knowing what to do there,” Ms. Martocci said during a panel discussion on substance abuse and mental health issues among veterans and active duty military personnel at a meeting sponsored by the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

Ideally, returning veterans should spend some time learning about their benefits and getting a physical and mental health assessment, she said. The idea is to identify veterans with substance abuse issues or symptoms of posttraumatic stress disorder before they are back with their families and less likely to get professional support, she said.

Military leaders have started some programs aimed at addressing that issue. The Yellow Ribbon Reintegration Program aims to help soldiers and their families prepare for deployment and get help adjusting to life when they return. Before deployment, soldiers and their families attend educational sessions about what to expect and what benefits will be available to them. During deployment, families learn about PTSD symptoms and the potential for marital stress.

When soldiers return, they attend workshops with their families and fellow soldiers at 30 and 60 days after their return home. The program began at the state level, and in 2008 Congress mandated that it be rolled out nationally to all National Guard and Army Reserve members and their families.

This program, already underway in Montana, has helped soldiers reconnect with their families in a healthy way, said Eric Newhouse, a Pulitzer Prize–winning journalist and author of a book on PTSD. Before beginning the Yellow Ribbon program, National Guard and Army Reserve troops were given a 90-day break from drills. But that extended period of leave only served to break apart their support system and left them with no one to talk to about their experiences in combat, he said.

The sessions feature seminars on marriage, anger management, and taxes. They even learn how to drive like civilians again, Mr. Newhouse said.

'They are popped right back into family life or real life without knowing what to do there.'

Source MS. MARTOCCI

NEW YORK — Giving returning service members the time and resources to transition back into civilian life is essential to prevent substance abuse and identify mental health issues, according to experts.

Some veterans are literally in Iraq one day and in their living rooms the next, said Monica L. Martocci, clinical director of New Directions Inc., Los Angeles, a drug and alcohol treatment, and co-occurring disorders program serving homeless veterans.

Many veterans are young men and women with little life experience outside of the structured environments of school and the military, Ms. Martocci said. Some veterans might return home with drug or alcohol problems.

“They are popped right back into family life or real life without knowing what to do there,” Ms. Martocci said during a panel discussion on substance abuse and mental health issues among veterans and active duty military personnel at a meeting sponsored by the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

Ideally, returning veterans should spend some time learning about their benefits and getting a physical and mental health assessment, she said. The idea is to identify veterans with substance abuse issues or symptoms of posttraumatic stress disorder before they are back with their families and less likely to get professional support, she said.

Military leaders have started some programs aimed at addressing that issue. The Yellow Ribbon Reintegration Program aims to help soldiers and their families prepare for deployment and get help adjusting to life when they return. Before deployment, soldiers and their families attend educational sessions about what to expect and what benefits will be available to them. During deployment, families learn about PTSD symptoms and the potential for marital stress.

When soldiers return, they attend workshops with their families and fellow soldiers at 30 and 60 days after their return home. The program began at the state level, and in 2008 Congress mandated that it be rolled out nationally to all National Guard and Army Reserve members and their families.

This program, already underway in Montana, has helped soldiers reconnect with their families in a healthy way, said Eric Newhouse, a Pulitzer Prize–winning journalist and author of a book on PTSD. Before beginning the Yellow Ribbon program, National Guard and Army Reserve troops were given a 90-day break from drills. But that extended period of leave only served to break apart their support system and left them with no one to talk to about their experiences in combat, he said.

The sessions feature seminars on marriage, anger management, and taxes. They even learn how to drive like civilians again, Mr. Newhouse said.

'They are popped right back into family life or real life without knowing what to do there.'

Source MS. MARTOCCI

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, before they have to comply with new requirements aimed at preventing identity theft.

The rule, issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation. "The Federal Trade Commission went too far and went beyond the intent of Congress," Rep. Adler said on the House floor.

The rule also is being challenged in court. The U.S. District Court for the District of Columbia ruled that the FTC cannot apply the regulation to lawyers.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule also requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

"For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation," Dr. Cecil Wilson, the AMA's president-elect, said in a statement. "The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies."

The FTC has a list of frequently asked questions on its Web site at www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm.

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, before they have to comply with new requirements aimed at preventing identity theft.

The rule, issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation. "The Federal Trade Commission went too far and went beyond the intent of Congress," Rep. Adler said on the House floor.

The rule also is being challenged in court. The U.S. District Court for the District of Columbia ruled that the FTC cannot apply the regulation to lawyers.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule also requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

"For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation," Dr. Cecil Wilson, the AMA's president-elect, said in a statement. "The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies."

The FTC has a list of frequently asked questions on its Web site at www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm.

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, before they have to comply with new requirements aimed at preventing identity theft.

The rule, issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation. "The Federal Trade Commission went too far and went beyond the intent of Congress," Rep. Adler said on the House floor.

The rule also is being challenged in court. The U.S. District Court for the District of Columbia ruled that the FTC cannot apply the regulation to lawyers.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule also requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

"For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation," Dr. Cecil Wilson, the AMA's president-elect, said in a statement. "The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies."

The FTC has a list of frequently asked questions on its Web site at www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm.

BOSTON — Physicians enticed by the federal health information technology incentives may think now is the time to buy that electronic health records system.

That is not necessarily true, according to health IT experts who spoke at the annual meeting of the American Academy of Family Physicians.

Dr. David C. Kibbe, a senior adviser to the AAFP's Center for Health Information Technology, said that now is the time to investigate EHR systems, not necessarily to buy one. Physicians may be best served by waiting several more months for the federal government to finalize its standards and for vendors to get ready to offer products that will meet federal requirements, he said.

“When things are this uncertain, regardless of what the vendors say, I wouldn't purchase anything. At the same time, [you should] educate yourself,” Dr. Kibbe recommended. “It's really still very fuzzy.”

Under the American Recovery and Reinvestment Act, physicians who treat Medicare patients can get up to $44,000 over 5 years for the “meaningful use” of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

There are, however, a few caveats. The incentives payments are spread out over 5 years starting in 2011, with no money paid up front. Physicians cannot get payments from both Medicare and Medicaid.

And starting in 2016, physicians will see a 2% reduction in their Medicare payments if they aren't engaged in meaningful use of an EHR.

The federal government is in the process of developing its definition of “meaningful use,” but a final version, which has gone through the full federal rule-making process, probably won't be ready until late spring. Federal committees are also still working on the criteria for certifying products under this program.

While the certification criteria are still being developed, it is expected that physicians will be able to buy products on a modular basis, with one product for e-prescribing and another for quality reporting through a registry, for example, rather than purchasing a single EHR that performs all the required functions. Physicians also will be able to apply for site-specific certification if they have a “home grown” EHR, said Dr. Steven E. Waldren, director of the AAFP's Center for Health Information Technology.

The news was frustrating for some of the family physicians who attended the AAFP's annual meeting. Dr. Norah Walsh, a family physician from Los Lunas, N.M., wanted to know what she should be doing with so much uncertainty in the marketplace.

Dr. Walsh, who spent $50,000 about a decade ago on an EHR system that was useless to her practice, said she's not going to rush to buy anything based on the new federal incentives. Right now she's planning to investigate freely available EHR software.

The decision to buy a health IT system is an individual one for each practice, Dr. Waldren said. Physicians need to keep in mind that the longer they wait, the more likely it is that they will choose a system that will qualify for federal incentive payments. On the other hand, by waiting, they also increase the chances that they won't have the system implemented in time to get the federal funds.

Health IT systems can't be implemented in a matter of a week or even a month, so physicians need to do the work to select a product now, rather than waiting until just before the incentives payments start in 2011, Dr. Waldren said. If physicians purchase a product before the certification process has begun, they can ask the IT vendor to include a clause in the contract that says the product will be certified for meaningful use.

BOSTON — Physicians enticed by the federal health information technology incentives may think now is the time to buy that electronic health records system.

That is not necessarily true, according to health IT experts who spoke at the annual meeting of the American Academy of Family Physicians.

Dr. David C. Kibbe, a senior adviser to the AAFP's Center for Health Information Technology, said that now is the time to investigate EHR systems, not necessarily to buy one. Physicians may be best served by waiting several more months for the federal government to finalize its standards and for vendors to get ready to offer products that will meet federal requirements, he said.

“When things are this uncertain, regardless of what the vendors say, I wouldn't purchase anything. At the same time, [you should] educate yourself,” Dr. Kibbe recommended. “It's really still very fuzzy.”

Under the American Recovery and Reinvestment Act, physicians who treat Medicare patients can get up to $44,000 over 5 years for the “meaningful use” of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

There are, however, a few caveats. The incentives payments are spread out over 5 years starting in 2011, with no money paid up front. Physicians cannot get payments from both Medicare and Medicaid.

And starting in 2016, physicians will see a 2% reduction in their Medicare payments if they aren't engaged in meaningful use of an EHR.

The federal government is in the process of developing its definition of “meaningful use,” but a final version, which has gone through the full federal rule-making process, probably won't be ready until late spring. Federal committees are also still working on the criteria for certifying products under this program.

While the certification criteria are still being developed, it is expected that physicians will be able to buy products on a modular basis, with one product for e-prescribing and another for quality reporting through a registry, for example, rather than purchasing a single EHR that performs all the required functions. Physicians also will be able to apply for site-specific certification if they have a “home grown” EHR, said Dr. Steven E. Waldren, director of the AAFP's Center for Health Information Technology.

The news was frustrating for some of the family physicians who attended the AAFP's annual meeting. Dr. Norah Walsh, a family physician from Los Lunas, N.M., wanted to know what she should be doing with so much uncertainty in the marketplace.

Dr. Walsh, who spent $50,000 about a decade ago on an EHR system that was useless to her practice, said she's not going to rush to buy anything based on the new federal incentives. Right now she's planning to investigate freely available EHR software.

The decision to buy a health IT system is an individual one for each practice, Dr. Waldren said. Physicians need to keep in mind that the longer they wait, the more likely it is that they will choose a system that will qualify for federal incentive payments. On the other hand, by waiting, they also increase the chances that they won't have the system implemented in time to get the federal funds.

Health IT systems can't be implemented in a matter of a week or even a month, so physicians need to do the work to select a product now, rather than waiting until just before the incentives payments start in 2011, Dr. Waldren said. If physicians purchase a product before the certification process has begun, they can ask the IT vendor to include a clause in the contract that says the product will be certified for meaningful use.

BOSTON — Physicians enticed by the federal health information technology incentives may think now is the time to buy that electronic health records system.

That is not necessarily true, according to health IT experts who spoke at the annual meeting of the American Academy of Family Physicians.

Dr. David C. Kibbe, a senior adviser to the AAFP's Center for Health Information Technology, said that now is the time to investigate EHR systems, not necessarily to buy one. Physicians may be best served by waiting several more months for the federal government to finalize its standards and for vendors to get ready to offer products that will meet federal requirements, he said.

“When things are this uncertain, regardless of what the vendors say, I wouldn't purchase anything. At the same time, [you should] educate yourself,” Dr. Kibbe recommended. “It's really still very fuzzy.”

Under the American Recovery and Reinvestment Act, physicians who treat Medicare patients can get up to $44,000 over 5 years for the “meaningful use” of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology.

There are, however, a few caveats. The incentives payments are spread out over 5 years starting in 2011, with no money paid up front. Physicians cannot get payments from both Medicare and Medicaid.

And starting in 2016, physicians will see a 2% reduction in their Medicare payments if they aren't engaged in meaningful use of an EHR.

The federal government is in the process of developing its definition of “meaningful use,” but a final version, which has gone through the full federal rule-making process, probably won't be ready until late spring. Federal committees are also still working on the criteria for certifying products under this program.

While the certification criteria are still being developed, it is expected that physicians will be able to buy products on a modular basis, with one product for e-prescribing and another for quality reporting through a registry, for example, rather than purchasing a single EHR that performs all the required functions. Physicians also will be able to apply for site-specific certification if they have a “home grown” EHR, said Dr. Steven E. Waldren, director of the AAFP's Center for Health Information Technology.

The news was frustrating for some of the family physicians who attended the AAFP's annual meeting. Dr. Norah Walsh, a family physician from Los Lunas, N.M., wanted to know what she should be doing with so much uncertainty in the marketplace.

Dr. Walsh, who spent $50,000 about a decade ago on an EHR system that was useless to her practice, said she's not going to rush to buy anything based on the new federal incentives. Right now she's planning to investigate freely available EHR software.

The decision to buy a health IT system is an individual one for each practice, Dr. Waldren said. Physicians need to keep in mind that the longer they wait, the more likely it is that they will choose a system that will qualify for federal incentive payments. On the other hand, by waiting, they also increase the chances that they won't have the system implemented in time to get the federal funds.

Health IT systems can't be implemented in a matter of a week or even a month, so physicians need to do the work to select a product now, rather than waiting until just before the incentives payments start in 2011, Dr. Waldren said. If physicians purchase a product before the certification process has begun, they can ask the IT vendor to include a clause in the contract that says the product will be certified for meaningful use.

BOSTON — Social difficulty and repetitive behaviors are better early flags of autism than are communication problems, according to one family physician.

Lack of spontaneous sharing is an early indicator of autism, said Dr. David Gregory, an assistant professor of clinical family medicine at the University of Virginia in Lynchburg and director of pediatric education.

Children with an autism spectrum disorder tend not to volunteer information about what they are thinking, doing, or feeling, Dr. Gregory said. “They have a sense of self that separates them from others.”

Autistic children often engage in repetitive, compulsive behaviors that can be difficult to distinguish from obsessive-compulsive disorder. If you see a 2-year-old who is engaging in repetitive behaviors frequently, it could be an early indicator of autism.

Repetitive behaviors are common in the normal toddler, but the autistic child's repetitive behavior will be focused on the parts, rather than the whole. For example, the autistic child will spend hours focused on the wheel of a truck but not seem to notice that the truck can move. Older autistic children tend to focus on more complex subjects, he said.

One tool that physicians can use is the joint attention screen. The test involves shaking keys or making another loud noise. Watch to see if the child looks to the source of the noise, then at their parents to “share” the experience, and back to the object.

It is a good sign if the child looks toward the object making the noise. However, the most important part of the test is for the child to look at the parent for acknowledgment and then focus back on the object together.

Shared attention is an important potential indicator of social impairment that can be observed in the office in a brief amount of time.

Dr. Gregory recommends using a joint attention screen at the 6- or 9-month well visit. If a child fails to demonstrate joint attention, consider an earlier evaluation of the child with a standardized autism screening test, he said.

BOSTON — Social difficulty and repetitive behaviors are better early flags of autism than are communication problems, according to one family physician.

Lack of spontaneous sharing is an early indicator of autism, said Dr. David Gregory, an assistant professor of clinical family medicine at the University of Virginia in Lynchburg and director of pediatric education.

Children with an autism spectrum disorder tend not to volunteer information about what they are thinking, doing, or feeling, Dr. Gregory said. “They have a sense of self that separates them from others.”

Autistic children often engage in repetitive, compulsive behaviors that can be difficult to distinguish from obsessive-compulsive disorder. If you see a 2-year-old who is engaging in repetitive behaviors frequently, it could be an early indicator of autism.

Repetitive behaviors are common in the normal toddler, but the autistic child's repetitive behavior will be focused on the parts, rather than the whole. For example, the autistic child will spend hours focused on the wheel of a truck but not seem to notice that the truck can move. Older autistic children tend to focus on more complex subjects, he said.

One tool that physicians can use is the joint attention screen. The test involves shaking keys or making another loud noise. Watch to see if the child looks to the source of the noise, then at their parents to “share” the experience, and back to the object.

It is a good sign if the child looks toward the object making the noise. However, the most important part of the test is for the child to look at the parent for acknowledgment and then focus back on the object together.

Shared attention is an important potential indicator of social impairment that can be observed in the office in a brief amount of time.

Dr. Gregory recommends using a joint attention screen at the 6- or 9-month well visit. If a child fails to demonstrate joint attention, consider an earlier evaluation of the child with a standardized autism screening test, he said.

BOSTON — Social difficulty and repetitive behaviors are better early flags of autism than are communication problems, according to one family physician.

Lack of spontaneous sharing is an early indicator of autism, said Dr. David Gregory, an assistant professor of clinical family medicine at the University of Virginia in Lynchburg and director of pediatric education.

Children with an autism spectrum disorder tend not to volunteer information about what they are thinking, doing, or feeling, Dr. Gregory said. “They have a sense of self that separates them from others.”

Autistic children often engage in repetitive, compulsive behaviors that can be difficult to distinguish from obsessive-compulsive disorder. If you see a 2-year-old who is engaging in repetitive behaviors frequently, it could be an early indicator of autism.

Repetitive behaviors are common in the normal toddler, but the autistic child's repetitive behavior will be focused on the parts, rather than the whole. For example, the autistic child will spend hours focused on the wheel of a truck but not seem to notice that the truck can move. Older autistic children tend to focus on more complex subjects, he said.

One tool that physicians can use is the joint attention screen. The test involves shaking keys or making another loud noise. Watch to see if the child looks to the source of the noise, then at their parents to “share” the experience, and back to the object.

It is a good sign if the child looks toward the object making the noise. However, the most important part of the test is for the child to look at the parent for acknowledgment and then focus back on the object together.

Shared attention is an important potential indicator of social impairment that can be observed in the office in a brief amount of time.

Dr. Gregory recommends using a joint attention screen at the 6- or 9-month well visit. If a child fails to demonstrate joint attention, consider an earlier evaluation of the child with a standardized autism screening test, he said.

BOSTON — Struggling to help your diabetic patients stay in control?

The answer may be to get those patients together for a group visit, said Dr. Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville.

During a traditional one-on-one office visit, physicians generally assess the patient and give out instructions. But diabetes is a self-management disease that requires patients to change their behavior, something that isn't likely to happen based solely on advice received during an office visit, Dr. Shahady said at the annual meeting of the American Academy of Family Physicians.

The evidence for this is in the national statistics on diabetes: Less than half of diabetic patients in the U.S. achieve recommended hemoglobin A_1c goals, and only about a third reach their LDL cholesterol and blood pressure goals. “Just the simple office visit is not working,” he said.

Dr. Shahady and his colleagues at the Florida Academy of Family Physicians Foundation have developed a model for group visits that has improved satisfaction among diabetic patients, while allowing physicians to get paid for seeing complex patients.

Under the model, group visits can occur every month to every 3 months with the same group of patients. The group visit may replace some of the routine diabetes visits and last about two-and-a-half hours. During the first hour, a nurse or medical assistant takes vital signs, helps patients complete questionnaires and other forms, and provides individual “report cards” with hemoglobin A_1c levels and other clinical values. The nurse then gets the conversation started on the visit topic, which may be on some aspect of nutrition, exercise, foot care, or lipids.

The nurse also fields questions, for which Dr. Shahady recommends that practices use a “parking lot” sheet to keep questions unrelated to diabetes from taking up time in the group discussion. Putting unrelated questions on the sheet lets patients know that their questions are important, but that the group visit is for discussing their diabetes, he said. The physician can get to those questions at the end of the session or address them later during individual office visits.

During the second hour, a physician, nurse practitioner or physician assistant joins the group to reinforce the curriculum point for the day. Leave extra time at the beginning and end of the group visit for checking in, filling out paperwork, and writing prescriptions, he advised.

While each visit has a set topic, the idea is not for the visits to be lectures. Instead, patients should drive the conversation. This group dynamic can have a huge impact. If one patient admits to having difficulty finding time to exercise, other members may have valuable suggestions about how they fit exercise into their schedules. “Patients like to share solutions with each other,” he said. This interaction is much more effective than getting the suggestions from the physician, Dr. Shahady said.

Ideally, groups should be kept to about 10 patients. Most of the group members should be patients whose diabetes is not well controlled, since they will benefit the most. But it's also valuable to include a couple of patients who are in good control, since they may be offer advice to other group members.

If properly documented, most group visits will qualify for billing with a 99214 code, Dr. Shahady said. It's not necessary to conduct a physical exam to use the 99213 or 99214 codes for established patients. Clinicians need only collect vital signs, provided that they have already satisfied the history and level of complexity requirements. The ICD-9 code should reflect the level of control, the type of diabetes, and any complications.

BOSTON — Struggling to help your diabetic patients stay in control?

The answer may be to get those patients together for a group visit, said Dr. Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville.

During a traditional one-on-one office visit, physicians generally assess the patient and give out instructions. But diabetes is a self-management disease that requires patients to change their behavior, something that isn't likely to happen based solely on advice received during an office visit, Dr. Shahady said at the annual meeting of the American Academy of Family Physicians.

The evidence for this is in the national statistics on diabetes: Less than half of diabetic patients in the U.S. achieve recommended hemoglobin A_1c goals, and only about a third reach their LDL cholesterol and blood pressure goals. “Just the simple office visit is not working,” he said.

Dr. Shahady and his colleagues at the Florida Academy of Family Physicians Foundation have developed a model for group visits that has improved satisfaction among diabetic patients, while allowing physicians to get paid for seeing complex patients.

Under the model, group visits can occur every month to every 3 months with the same group of patients. The group visit may replace some of the routine diabetes visits and last about two-and-a-half hours. During the first hour, a nurse or medical assistant takes vital signs, helps patients complete questionnaires and other forms, and provides individual “report cards” with hemoglobin A_1c levels and other clinical values. The nurse then gets the conversation started on the visit topic, which may be on some aspect of nutrition, exercise, foot care, or lipids.

The nurse also fields questions, for which Dr. Shahady recommends that practices use a “parking lot” sheet to keep questions unrelated to diabetes from taking up time in the group discussion. Putting unrelated questions on the sheet lets patients know that their questions are important, but that the group visit is for discussing their diabetes, he said. The physician can get to those questions at the end of the session or address them later during individual office visits.

During the second hour, a physician, nurse practitioner or physician assistant joins the group to reinforce the curriculum point for the day. Leave extra time at the beginning and end of the group visit for checking in, filling out paperwork, and writing prescriptions, he advised.

While each visit has a set topic, the idea is not for the visits to be lectures. Instead, patients should drive the conversation. This group dynamic can have a huge impact. If one patient admits to having difficulty finding time to exercise, other members may have valuable suggestions about how they fit exercise into their schedules. “Patients like to share solutions with each other,” he said. This interaction is much more effective than getting the suggestions from the physician, Dr. Shahady said.

Ideally, groups should be kept to about 10 patients. Most of the group members should be patients whose diabetes is not well controlled, since they will benefit the most. But it's also valuable to include a couple of patients who are in good control, since they may be offer advice to other group members.

If properly documented, most group visits will qualify for billing with a 99214 code, Dr. Shahady said. It's not necessary to conduct a physical exam to use the 99213 or 99214 codes for established patients. Clinicians need only collect vital signs, provided that they have already satisfied the history and level of complexity requirements. The ICD-9 code should reflect the level of control, the type of diabetes, and any complications.

BOSTON — Struggling to help your diabetic patients stay in control?

The answer may be to get those patients together for a group visit, said Dr. Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville.

During a traditional one-on-one office visit, physicians generally assess the patient and give out instructions. But diabetes is a self-management disease that requires patients to change their behavior, something that isn't likely to happen based solely on advice received during an office visit, Dr. Shahady said at the annual meeting of the American Academy of Family Physicians.

The evidence for this is in the national statistics on diabetes: Less than half of diabetic patients in the U.S. achieve recommended hemoglobin A_1c goals, and only about a third reach their LDL cholesterol and blood pressure goals. “Just the simple office visit is not working,” he said.

Dr. Shahady and his colleagues at the Florida Academy of Family Physicians Foundation have developed a model for group visits that has improved satisfaction among diabetic patients, while allowing physicians to get paid for seeing complex patients.

Under the model, group visits can occur every month to every 3 months with the same group of patients. The group visit may replace some of the routine diabetes visits and last about two-and-a-half hours. During the first hour, a nurse or medical assistant takes vital signs, helps patients complete questionnaires and other forms, and provides individual “report cards” with hemoglobin A_1c levels and other clinical values. The nurse then gets the conversation started on the visit topic, which may be on some aspect of nutrition, exercise, foot care, or lipids.

The nurse also fields questions, for which Dr. Shahady recommends that practices use a “parking lot” sheet to keep questions unrelated to diabetes from taking up time in the group discussion. Putting unrelated questions on the sheet lets patients know that their questions are important, but that the group visit is for discussing their diabetes, he said. The physician can get to those questions at the end of the session or address them later during individual office visits.

During the second hour, a physician, nurse practitioner or physician assistant joins the group to reinforce the curriculum point for the day. Leave extra time at the beginning and end of the group visit for checking in, filling out paperwork, and writing prescriptions, he advised.

While each visit has a set topic, the idea is not for the visits to be lectures. Instead, patients should drive the conversation. This group dynamic can have a huge impact. If one patient admits to having difficulty finding time to exercise, other members may have valuable suggestions about how they fit exercise into their schedules. “Patients like to share solutions with each other,” he said. This interaction is much more effective than getting the suggestions from the physician, Dr. Shahady said.

Ideally, groups should be kept to about 10 patients. Most of the group members should be patients whose diabetes is not well controlled, since they will benefit the most. But it's also valuable to include a couple of patients who are in good control, since they may be offer advice to other group members.

If properly documented, most group visits will qualify for billing with a 99214 code, Dr. Shahady said. It's not necessary to conduct a physical exam to use the 99213 or 99214 codes for established patients. Clinicians need only collect vital signs, provided that they have already satisfied the history and level of complexity requirements. The ICD-9 code should reflect the level of control, the type of diabetes, and any complications.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the pandemic influenza A(H1N1) virus.

As part of an ongoing partnership with Surescripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island Department of Health on all antiviral prescriptions written in the state.

At a press briefing, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Additionally, if there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, that could indicate the need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

The statewide initiative, believed to be the first in the nation, lets pharmacies send data that have been stripped of personal information (other than age and zip code) to the health department on a weekly basis, allowing health officials to track the progress of the outbreak in communities.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the pandemic influenza A(H1N1) virus.

As part of an ongoing partnership with Surescripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island Department of Health on all antiviral prescriptions written in the state.

At a press briefing, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Additionally, if there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, that could indicate the need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

The statewide initiative, believed to be the first in the nation, lets pharmacies send data that have been stripped of personal information (other than age and zip code) to the health department on a weekly basis, allowing health officials to track the progress of the outbreak in communities.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the pandemic influenza A(H1N1) virus.

As part of an ongoing partnership with Surescripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island Department of Health on all antiviral prescriptions written in the state.

At a press briefing, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Additionally, if there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, that could indicate the need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

The statewide initiative, believed to be the first in the nation, lets pharmacies send data that have been stripped of personal information (other than age and zip code) to the health department on a weekly basis, allowing health officials to track the progress of the outbreak in communities.

In November, physicians in Ohio and New Jersey will begin to test a single, online portal through which they can access health insurance eligibility and benefits information for most of their privately insured patients.

Physicians and their staffs in those states will have access to data on copayments, deductibles, in-network and out-of-network coverage, and the status of claims from multiple plans in one place. They will also be able to submit referrals, pre-authorization requests, and claims under a test project spearheaded nationally by America's Health Insurance Plans and the Blue Cross and Blue Shield Association.

Ultimately, the initiative will be rolled out across the country, AHIP President and CEO Karen Ignagni said at a press conference.

“It's a step that will ultimately transform our system to one that takes advantage of technology to the benefits of clinicians and their patients,” she said.

The changes are significant, Ms. Ignagni said, and are akin to what the banks did when they first allowed consumers to withdraw money from any ATM worldwide.

The initiative is expected to decrease hassles for physicians and significantly reduce costs for both physicians and health plans. Ms. Ignagni estimated that the entire health system could see savings of hundreds of billions of dollars once these administrative simplification tools are available around the country, based on estimates of savings automating administrative tasks and implementing consistent business practices.

The insurers' announcement comes as Congress debates comprehensive health reform, including tighter regulation of the insurance industry. Ms. Ignagni said AHIP has been exploring projects to simplify insurance administration over the last year and has kept the Obama administration and congressional leaders apprised of their progress. Some simplifications are already part of health reform proposals circulating in Congress, she said.

“Most policy makers understand that health reform that doesn't address the cost of care will fail.” She added that projects like the ones in Ohio and New Jersey have “great potential to slow the growth in the cost of care and contribute to savings needed nationally for reform.”

Although this type of Web-based tool has been possible for years, the standards for sharing information across multiple health plans were only recently completed, Ms. Ignagni said. With the standards in place, the state-level pilot projects will focus on making sure the Web portal is user friendly for physicians and learning which functions are most helpful. The project will begin with physicians and will be extended to hospitals later, according to AHIP.

The initiative was praised by physician organizations that are working on the project in Ohio, where eight health plans representing 91% of privately insured residents will participate in the Web portal. Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, said the ability to access insurance information through one online source will make administrative tasks easier, faster, and more accurate.

This type of tool is critical, he said, because it allows the physician's staff to let patients know up front what their coverage is and how much they will end up paying. “If you can have that conversation before the encounter, the transaction works much better and [is] less confusing than if you're trying to chase it after.”

Mr. Jarvis estimated that the average physician spends 3–4 hours a week on administrative dealings with insurance companies, while his or her staff spends another 58 hours on insurance-related administration in a given week. Creating a one-stop shop for insurance information is a great “first step” to try to reduce the administrative burden on physician practices, he said.

In November, physicians in Ohio and New Jersey will begin to test a single, online portal through which they can access health insurance eligibility and benefits information for most of their privately insured patients.

Physicians and their staffs in those states will have access to data on copayments, deductibles, in-network and out-of-network coverage, and the status of claims from multiple plans in one place. They will also be able to submit referrals, pre-authorization requests, and claims under a test project spearheaded nationally by America's Health Insurance Plans and the Blue Cross and Blue Shield Association.

Ultimately, the initiative will be rolled out across the country, AHIP President and CEO Karen Ignagni said at a press conference.

“It's a step that will ultimately transform our system to one that takes advantage of technology to the benefits of clinicians and their patients,” she said.

The changes are significant, Ms. Ignagni said, and are akin to what the banks did when they first allowed consumers to withdraw money from any ATM worldwide.

The initiative is expected to decrease hassles for physicians and significantly reduce costs for both physicians and health plans. Ms. Ignagni estimated that the entire health system could see savings of hundreds of billions of dollars once these administrative simplification tools are available around the country, based on estimates of savings automating administrative tasks and implementing consistent business practices.

The insurers' announcement comes as Congress debates comprehensive health reform, including tighter regulation of the insurance industry. Ms. Ignagni said AHIP has been exploring projects to simplify insurance administration over the last year and has kept the Obama administration and congressional leaders apprised of their progress. Some simplifications are already part of health reform proposals circulating in Congress, she said.

“Most policy makers understand that health reform that doesn't address the cost of care will fail.” She added that projects like the ones in Ohio and New Jersey have “great potential to slow the growth in the cost of care and contribute to savings needed nationally for reform.”

Although this type of Web-based tool has been possible for years, the standards for sharing information across multiple health plans were only recently completed, Ms. Ignagni said. With the standards in place, the state-level pilot projects will focus on making sure the Web portal is user friendly for physicians and learning which functions are most helpful. The project will begin with physicians and will be extended to hospitals later, according to AHIP.

The initiative was praised by physician organizations that are working on the project in Ohio, where eight health plans representing 91% of privately insured residents will participate in the Web portal. Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, said the ability to access insurance information through one online source will make administrative tasks easier, faster, and more accurate.

This type of tool is critical, he said, because it allows the physician's staff to let patients know up front what their coverage is and how much they will end up paying. “If you can have that conversation before the encounter, the transaction works much better and [is] less confusing than if you're trying to chase it after.”

Mr. Jarvis estimated that the average physician spends 3–4 hours a week on administrative dealings with insurance companies, while his or her staff spends another 58 hours on insurance-related administration in a given week. Creating a one-stop shop for insurance information is a great “first step” to try to reduce the administrative burden on physician practices, he said.

In November, physicians in Ohio and New Jersey will begin to test a single, online portal through which they can access health insurance eligibility and benefits information for most of their privately insured patients.

Physicians and their staffs in those states will have access to data on copayments, deductibles, in-network and out-of-network coverage, and the status of claims from multiple plans in one place. They will also be able to submit referrals, pre-authorization requests, and claims under a test project spearheaded nationally by America's Health Insurance Plans and the Blue Cross and Blue Shield Association.

Ultimately, the initiative will be rolled out across the country, AHIP President and CEO Karen Ignagni said at a press conference.

“It's a step that will ultimately transform our system to one that takes advantage of technology to the benefits of clinicians and their patients,” she said.

The changes are significant, Ms. Ignagni said, and are akin to what the banks did when they first allowed consumers to withdraw money from any ATM worldwide.

The initiative is expected to decrease hassles for physicians and significantly reduce costs for both physicians and health plans. Ms. Ignagni estimated that the entire health system could see savings of hundreds of billions of dollars once these administrative simplification tools are available around the country, based on estimates of savings automating administrative tasks and implementing consistent business practices.

The insurers' announcement comes as Congress debates comprehensive health reform, including tighter regulation of the insurance industry. Ms. Ignagni said AHIP has been exploring projects to simplify insurance administration over the last year and has kept the Obama administration and congressional leaders apprised of their progress. Some simplifications are already part of health reform proposals circulating in Congress, she said.

“Most policy makers understand that health reform that doesn't address the cost of care will fail.” She added that projects like the ones in Ohio and New Jersey have “great potential to slow the growth in the cost of care and contribute to savings needed nationally for reform.”

Although this type of Web-based tool has been possible for years, the standards for sharing information across multiple health plans were only recently completed, Ms. Ignagni said. With the standards in place, the state-level pilot projects will focus on making sure the Web portal is user friendly for physicians and learning which functions are most helpful. The project will begin with physicians and will be extended to hospitals later, according to AHIP.

The initiative was praised by physician organizations that are working on the project in Ohio, where eight health plans representing 91% of privately insured residents will participate in the Web portal. Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, said the ability to access insurance information through one online source will make administrative tasks easier, faster, and more accurate.

This type of tool is critical, he said, because it allows the physician's staff to let patients know up front what their coverage is and how much they will end up paying. “If you can have that conversation before the encounter, the transaction works much better and [is] less confusing than if you're trying to chase it after.”

Mr. Jarvis estimated that the average physician spends 3–4 hours a week on administrative dealings with insurance companies, while his or her staff spends another 58 hours on insurance-related administration in a given week. Creating a one-stop shop for insurance information is a great “first step” to try to reduce the administrative burden on physician practices, he said.

The federal government has issued new rules spelling out how it intends to police the use of genetic information by health plans.

The regulations bar health insurers from increasing premiums or denying enrollment based on genetic information. The regulations implement certain provisions in the Genetic Information Nondiscrimination Act (GINA), which was signed into law by President Bush in May 2008.

Beefing up consumer protections for genetic information should help accelerate progress in genetic testing and research, said Health and Human Services secretary Kathleen Sebelius.

“Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases,” Ms. Sebelius said in a statement.

“Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.”

In an interim final rule, federal officials provide details on how health plans can obtain and use genetic information.

The regulation generally bars health plans from increasing premiums based on genetic information. They also cannot require, or even request, that individuals or family members undergo genetic testing. And health plans cannot request, require, or purchase genetic information at any time for underwriting purposes, or prior to or in connection with enrollment.

Although the rule bars insurers from charging its members more based on genetic information, it doesn't limit them from doing so because of the manifestation of a disease. However, a health plan can't use the manifestation of a disease in one of its members as genetic information for a family member and raise their premiums, according to the interim final rule.

The rule does allow plans to request limited genetic information if it's necessary to determine the “medical appropriateness” of a certain treatment. Plans also can request that individuals participate in research where genetic testing will be conducted. However, none of the genetic information collected during that research can be used for underwriting purposes.

The interim final rule goes into effect 60 days after publication in the Federal Register.

HHS officials also issued a proposed rule that would modify the Health Insurance Portability and Accountability Act (HIPAA) to comply with the provisions of GINA. Like the GINA rule, the HIPAA rule bars health plans from using and disclosing genetic information for underwriting purposes.

However, since HIPAA applies more broadly, the prohibition in the proposed rule also affects employee welfare benefit plans and long-term care policies. It would exclude nursing home fixed indemnity policies.

If the proposed rule is finalized, then plans would have 180 days to comply with the provisions.

The federal government has issued new rules spelling out how it intends to police the use of genetic information by health plans.

The regulations bar health insurers from increasing premiums or denying enrollment based on genetic information. The regulations implement certain provisions in the Genetic Information Nondiscrimination Act (GINA), which was signed into law by President Bush in May 2008.

Beefing up consumer protections for genetic information should help accelerate progress in genetic testing and research, said Health and Human Services secretary Kathleen Sebelius.

“Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases,” Ms. Sebelius said in a statement.

“Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.”

In an interim final rule, federal officials provide details on how health plans can obtain and use genetic information.

The regulation generally bars health plans from increasing premiums based on genetic information. They also cannot require, or even request, that individuals or family members undergo genetic testing. And health plans cannot request, require, or purchase genetic information at any time for underwriting purposes, or prior to or in connection with enrollment.

Although the rule bars insurers from charging its members more based on genetic information, it doesn't limit them from doing so because of the manifestation of a disease. However, a health plan can't use the manifestation of a disease in one of its members as genetic information for a family member and raise their premiums, according to the interim final rule.

The rule does allow plans to request limited genetic information if it's necessary to determine the “medical appropriateness” of a certain treatment. Plans also can request that individuals participate in research where genetic testing will be conducted. However, none of the genetic information collected during that research can be used for underwriting purposes.

The interim final rule goes into effect 60 days after publication in the Federal Register.

HHS officials also issued a proposed rule that would modify the Health Insurance Portability and Accountability Act (HIPAA) to comply with the provisions of GINA. Like the GINA rule, the HIPAA rule bars health plans from using and disclosing genetic information for underwriting purposes.

However, since HIPAA applies more broadly, the prohibition in the proposed rule also affects employee welfare benefit plans and long-term care policies. It would exclude nursing home fixed indemnity policies.

If the proposed rule is finalized, then plans would have 180 days to comply with the provisions.

The federal government has issued new rules spelling out how it intends to police the use of genetic information by health plans.

The regulations bar health insurers from increasing premiums or denying enrollment based on genetic information. The regulations implement certain provisions in the Genetic Information Nondiscrimination Act (GINA), which was signed into law by President Bush in May 2008.

Beefing up consumer protections for genetic information should help accelerate progress in genetic testing and research, said Health and Human Services secretary Kathleen Sebelius.

“Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases,” Ms. Sebelius said in a statement.

“Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.”

In an interim final rule, federal officials provide details on how health plans can obtain and use genetic information.

The regulation generally bars health plans from increasing premiums based on genetic information. They also cannot require, or even request, that individuals or family members undergo genetic testing. And health plans cannot request, require, or purchase genetic information at any time for underwriting purposes, or prior to or in connection with enrollment.

Although the rule bars insurers from charging its members more based on genetic information, it doesn't limit them from doing so because of the manifestation of a disease. However, a health plan can't use the manifestation of a disease in one of its members as genetic information for a family member and raise their premiums, according to the interim final rule.

The rule does allow plans to request limited genetic information if it's necessary to determine the “medical appropriateness” of a certain treatment. Plans also can request that individuals participate in research where genetic testing will be conducted. However, none of the genetic information collected during that research can be used for underwriting purposes.

The interim final rule goes into effect 60 days after publication in the Federal Register.

HHS officials also issued a proposed rule that would modify the Health Insurance Portability and Accountability Act (HIPAA) to comply with the provisions of GINA. Like the GINA rule, the HIPAA rule bars health plans from using and disclosing genetic information for underwriting purposes.

However, since HIPAA applies more broadly, the prohibition in the proposed rule also affects employee welfare benefit plans and long-term care policies. It would exclude nursing home fixed indemnity policies.

If the proposed rule is finalized, then plans would have 180 days to comply with the provisions.

The Food and Drug Administration is vowing to get tougher and act faster when it comes to protecting public health.

Over the past several years, the FDA's enforcement activities have declined significantly, and those enforcement actions taken have been hamstrung by delays, mostly due to internal red tape, said Dr. Margaret A. Hamburg, the agency's new commissioner.

“The pathways to enforcement action can be too long and arduous when the public's health is in jeopardy,” Dr. Hamburg said at a Food and Drug Law Institute conference. “We're fixing these pathways to improve the effectiveness of our enforcement system,” she said.

Dr. Hamburg outlined six steps to streamline the way the FDA handles enforcement across all regulated areas—drugs, devices, and food. For example, in cases where agency officials deem that public health is at risk, the FDA is prepared to take enforcement action before issuing a formal warning letter. Agency officials will also work with other regulators—state, local, and international—to figure out who can act fastest in a public health emergency.

The FDA also plans to change some of its internal processes. The agency will establish a 15-day deadline for industry to respond once a significant problem is identified during an inspection. They will also aim to get warning letters out the door more quickly by limiting review to significant legal issues.

Prompt follow-up on warning letters and other enforcement actions is another part of Dr. Hamburg's plan. The FDA will move more quickly in assessing corrective actions taken by industry after a warning letter is issued or a major product recall occurs. And in an effort to motivate industry to act quickly, the FDA is developing a formal warning letter “close-out” process. Once the FDA has confirmed that a firm has fully corrected its violations, the agency will issue a close-out notice and post the information on the FDA Web site.

“What we want to create is really a standard of practice that is a little bit different than what's been happening in recent years, where we commit to being as transparent as possible about our expectations and industry commits to working in as responsive a way as possible to address our concerns,” she said.

The Food and Drug Administration is vowing to get tougher and act faster when it comes to protecting public health.

Over the past several years, the FDA's enforcement activities have declined significantly, and those enforcement actions taken have been hamstrung by delays, mostly due to internal red tape, said Dr. Margaret A. Hamburg, the agency's new commissioner.

“The pathways to enforcement action can be too long and arduous when the public's health is in jeopardy,” Dr. Hamburg said at a Food and Drug Law Institute conference. “We're fixing these pathways to improve the effectiveness of our enforcement system,” she said.

Dr. Hamburg outlined six steps to streamline the way the FDA handles enforcement across all regulated areas—drugs, devices, and food. For example, in cases where agency officials deem that public health is at risk, the FDA is prepared to take enforcement action before issuing a formal warning letter. Agency officials will also work with other regulators—state, local, and international—to figure out who can act fastest in a public health emergency.

The FDA also plans to change some of its internal processes. The agency will establish a 15-day deadline for industry to respond once a significant problem is identified during an inspection. They will also aim to get warning letters out the door more quickly by limiting review to significant legal issues.

Prompt follow-up on warning letters and other enforcement actions is another part of Dr. Hamburg's plan. The FDA will move more quickly in assessing corrective actions taken by industry after a warning letter is issued or a major product recall occurs. And in an effort to motivate industry to act quickly, the FDA is developing a formal warning letter “close-out” process. Once the FDA has confirmed that a firm has fully corrected its violations, the agency will issue a close-out notice and post the information on the FDA Web site.

“What we want to create is really a standard of practice that is a little bit different than what's been happening in recent years, where we commit to being as transparent as possible about our expectations and industry commits to working in as responsive a way as possible to address our concerns,” she said.

The Food and Drug Administration is vowing to get tougher and act faster when it comes to protecting public health.

Over the past several years, the FDA's enforcement activities have declined significantly, and those enforcement actions taken have been hamstrung by delays, mostly due to internal red tape, said Dr. Margaret A. Hamburg, the agency's new commissioner.

“The pathways to enforcement action can be too long and arduous when the public's health is in jeopardy,” Dr. Hamburg said at a Food and Drug Law Institute conference. “We're fixing these pathways to improve the effectiveness of our enforcement system,” she said.

Dr. Hamburg outlined six steps to streamline the way the FDA handles enforcement across all regulated areas—drugs, devices, and food. For example, in cases where agency officials deem that public health is at risk, the FDA is prepared to take enforcement action before issuing a formal warning letter. Agency officials will also work with other regulators—state, local, and international—to figure out who can act fastest in a public health emergency.

The FDA also plans to change some of its internal processes. The agency will establish a 15-day deadline for industry to respond once a significant problem is identified during an inspection. They will also aim to get warning letters out the door more quickly by limiting review to significant legal issues.

Prompt follow-up on warning letters and other enforcement actions is another part of Dr. Hamburg's plan. The FDA will move more quickly in assessing corrective actions taken by industry after a warning letter is issued or a major product recall occurs. And in an effort to motivate industry to act quickly, the FDA is developing a formal warning letter “close-out” process. Once the FDA has confirmed that a firm has fully corrected its violations, the agency will issue a close-out notice and post the information on the FDA Web site.

“What we want to create is really a standard of practice that is a little bit different than what's been happening in recent years, where we commit to being as transparent as possible about our expectations and industry commits to working in as responsive a way as possible to address our concerns,” she said.

Women's Health Is Up for Debate

Women's issues made their way to the forefront of the health reform debate in Washington. House Speaker Nancy Pelosi (D-Calif.) asserted last month that women have the most to gain under health reform. On her Web site, the speaker said, for instance, that women are charged up to 48% more than are men for individual health insurance. The version of health care reform that Rep. Pelosi favors would forbid insurance companies from using “gender rating” to charge women more for the same coverage. It also would make maternity care an essential service required in all insurance plans that participate in the health insurance exchanges that are proposed in some bills in Congress. Currently, only 14 states require maternity coverage in policies available on the individual market, and most policies available to individuals do not include it, according to the speaker. Rep. Pelosi's report did not mention abortion, but that issue loomed large in the reform debate. Abortion opponents slammed health reform bills for not explicitly banning public funding for abortions. They also decried inadequate discrimination protection for health care providers who refuse to perform abortions because of moral objections.

Economy Affects Family Planning

Nearly half of women aged 18–34 years said they planned to delay having children or have fewer children because of the economic downturn. The Guttmacher Institute's national, Internet-based survey of 947 women, conducted this summer, found respondents concerned that they wouldn't have the financial means to raise their children if they got pregnant. All the women surveyed were in families with incomes less than $75,000, and 44% said they were cutting back their plans for having children. Financial worries also made some women more careful about getting pregnant. About 29% of respondents said they are more careful to use birth control every time they have sex. Forty-six percent, saying they didn't want more children, reported that they've considered sterilization because of the economy. But the surveyors also discovered that the economy is causing some women to use birth control inconsistently. For example, 4% of women who use oral contraceptives reported skipping pills, 12% said they had delayed getting a prescription filled, 11% had gone off the pill for at least a month, and 8% said they were getting fewer pill packs at a time.

Routine Deliveries Declining

The number of routine, uncomplicated births is dropping, according to data released by the Agency for Healthcare Research and Quality. Although the number of hospital stays for childbirth climbed 16% in the decade ending in 2007, the number of stays for women with “normal” or “uncomplicated” births dropped by 43%, from 544,000 stays in 1997 to 312,000 in 2007. In contrast, hospital stays increased 107% for births by women with previous cesarean sections (to 562,000), 28% by women with high blood pressure that complicated their pregnancies or childbirths (to 235,000), and 22% by women with increases in perineal trauma during childbirth (to 868,000). However, some complications declined. Hospital stays for women who had umbilical cord complications dropped 15%, from 259,000 in 1997 to 219,000 a decade later. The data come from the 2007 Nationwide Inpatient Sample, part of the agency's Healthcare Cost and Utilization Project.

Sister Study Enrolls 50,000th

The National Institutes of Health has enrolled 50,884 women to participate in its study of those with sisters who had breast cancer. The Sister Study was launched in 2004, and this year reached a milestone when it enrolled more than 50,000 women. The 10-year study of environmental and genetic factors that influence breast cancer risk examines why some women who appear to be at increased risk don't develop the disease. Participants are asked to complete brief yearly updates on their health and to share more detailed information on changes in health, jobs, and lifestyle every 2 or 3 years. Approximately 900 participants have reported being diagnosed with breast cancer since 2004. For those women, the researchers are collecting additional information about diagnoses and treatments. For more information, visit the Web site

www.sisterstudy.org

State Bans Insurance Gender Bias

It will soon be illegal for health insurance companies in California to charge higher premiums to women based solely on their gender, thanks to a new law signed by California Gov. Arnold Schwarzenegger (R) last month. The law closes a loophole that allowed insurers to charge women more if the companies could point to specific actuarial data. The law eliminates the exception for all insurance contracts issued, amended, or renewed on or after Jan. 1, 2011. Only 10 other states ban this practice, called gender rating, in the individual insurance market, and two states limit it, according to the National Women's Law Center.

Women's Health Is Up for Debate

Women's issues made their way to the forefront of the health reform debate in Washington. House Speaker Nancy Pelosi (D-Calif.) asserted last month that women have the most to gain under health reform. On her Web site, the speaker said, for instance, that women are charged up to 48% more than are men for individual health insurance. The version of health care reform that Rep. Pelosi favors would forbid insurance companies from using “gender rating” to charge women more for the same coverage. It also would make maternity care an essential service required in all insurance plans that participate in the health insurance exchanges that are proposed in some bills in Congress. Currently, only 14 states require maternity coverage in policies available on the individual market, and most policies available to individuals do not include it, according to the speaker. Rep. Pelosi's report did not mention abortion, but that issue loomed large in the reform debate. Abortion opponents slammed health reform bills for not explicitly banning public funding for abortions. They also decried inadequate discrimination protection for health care providers who refuse to perform abortions because of moral objections.

Economy Affects Family Planning

Nearly half of women aged 18–34 years said they planned to delay having children or have fewer children because of the economic downturn. The Guttmacher Institute's national, Internet-based survey of 947 women, conducted this summer, found respondents concerned that they wouldn't have the financial means to raise their children if they got pregnant. All the women surveyed were in families with incomes less than $75,000, and 44% said they were cutting back their plans for having children. Financial worries also made some women more careful about getting pregnant. About 29% of respondents said they are more careful to use birth control every time they have sex. Forty-six percent, saying they didn't want more children, reported that they've considered sterilization because of the economy. But the surveyors also discovered that the economy is causing some women to use birth control inconsistently. For example, 4% of women who use oral contraceptives reported skipping pills, 12% said they had delayed getting a prescription filled, 11% had gone off the pill for at least a month, and 8% said they were getting fewer pill packs at a time.

Routine Deliveries Declining

The number of routine, uncomplicated births is dropping, according to data released by the Agency for Healthcare Research and Quality. Although the number of hospital stays for childbirth climbed 16% in the decade ending in 2007, the number of stays for women with “normal” or “uncomplicated” births dropped by 43%, from 544,000 stays in 1997 to 312,000 in 2007. In contrast, hospital stays increased 107% for births by women with previous cesarean sections (to 562,000), 28% by women with high blood pressure that complicated their pregnancies or childbirths (to 235,000), and 22% by women with increases in perineal trauma during childbirth (to 868,000). However, some complications declined. Hospital stays for women who had umbilical cord complications dropped 15%, from 259,000 in 1997 to 219,000 a decade later. The data come from the 2007 Nationwide Inpatient Sample, part of the agency's Healthcare Cost and Utilization Project.

Sister Study Enrolls 50,000th

The National Institutes of Health has enrolled 50,884 women to participate in its study of those with sisters who had breast cancer. The Sister Study was launched in 2004, and this year reached a milestone when it enrolled more than 50,000 women. The 10-year study of environmental and genetic factors that influence breast cancer risk examines why some women who appear to be at increased risk don't develop the disease. Participants are asked to complete brief yearly updates on their health and to share more detailed information on changes in health, jobs, and lifestyle every 2 or 3 years. Approximately 900 participants have reported being diagnosed with breast cancer since 2004. For those women, the researchers are collecting additional information about diagnoses and treatments. For more information, visit the Web site

www.sisterstudy.org

State Bans Insurance Gender Bias

It will soon be illegal for health insurance companies in California to charge higher premiums to women based solely on their gender, thanks to a new law signed by California Gov. Arnold Schwarzenegger (R) last month. The law closes a loophole that allowed insurers to charge women more if the companies could point to specific actuarial data. The law eliminates the exception for all insurance contracts issued, amended, or renewed on or after Jan. 1, 2011. Only 10 other states ban this practice, called gender rating, in the individual insurance market, and two states limit it, according to the National Women's Law Center.

Women's Health Is Up for Debate

Women's issues made their way to the forefront of the health reform debate in Washington. House Speaker Nancy Pelosi (D-Calif.) asserted last month that women have the most to gain under health reform. On her Web site, the speaker said, for instance, that women are charged up to 48% more than are men for individual health insurance. The version of health care reform that Rep. Pelosi favors would forbid insurance companies from using “gender rating” to charge women more for the same coverage. It also would make maternity care an essential service required in all insurance plans that participate in the health insurance exchanges that are proposed in some bills in Congress. Currently, only 14 states require maternity coverage in policies available on the individual market, and most policies available to individuals do not include it, according to the speaker. Rep. Pelosi's report did not mention abortion, but that issue loomed large in the reform debate. Abortion opponents slammed health reform bills for not explicitly banning public funding for abortions. They also decried inadequate discrimination protection for health care providers who refuse to perform abortions because of moral objections.

Economy Affects Family Planning

Nearly half of women aged 18–34 years said they planned to delay having children or have fewer children because of the economic downturn. The Guttmacher Institute's national, Internet-based survey of 947 women, conducted this summer, found respondents concerned that they wouldn't have the financial means to raise their children if they got pregnant. All the women surveyed were in families with incomes less than $75,000, and 44% said they were cutting back their plans for having children. Financial worries also made some women more careful about getting pregnant. About 29% of respondents said they are more careful to use birth control every time they have sex. Forty-six percent, saying they didn't want more children, reported that they've considered sterilization because of the economy. But the surveyors also discovered that the economy is causing some women to use birth control inconsistently. For example, 4% of women who use oral contraceptives reported skipping pills, 12% said they had delayed getting a prescription filled, 11% had gone off the pill for at least a month, and 8% said they were getting fewer pill packs at a time.

Routine Deliveries Declining

The number of routine, uncomplicated births is dropping, according to data released by the Agency for Healthcare Research and Quality. Although the number of hospital stays for childbirth climbed 16% in the decade ending in 2007, the number of stays for women with “normal” or “uncomplicated” births dropped by 43%, from 544,000 stays in 1997 to 312,000 in 2007. In contrast, hospital stays increased 107% for births by women with previous cesarean sections (to 562,000), 28% by women with high blood pressure that complicated their pregnancies or childbirths (to 235,000), and 22% by women with increases in perineal trauma during childbirth (to 868,000). However, some complications declined. Hospital stays for women who had umbilical cord complications dropped 15%, from 259,000 in 1997 to 219,000 a decade later. The data come from the 2007 Nationwide Inpatient Sample, part of the agency's Healthcare Cost and Utilization Project.

Sister Study Enrolls 50,000th

The National Institutes of Health has enrolled 50,884 women to participate in its study of those with sisters who had breast cancer. The Sister Study was launched in 2004, and this year reached a milestone when it enrolled more than 50,000 women. The 10-year study of environmental and genetic factors that influence breast cancer risk examines why some women who appear to be at increased risk don't develop the disease. Participants are asked to complete brief yearly updates on their health and to share more detailed information on changes in health, jobs, and lifestyle every 2 or 3 years. Approximately 900 participants have reported being diagnosed with breast cancer since 2004. For those women, the researchers are collecting additional information about diagnoses and treatments. For more information, visit the Web site

www.sisterstudy.org

State Bans Insurance Gender Bias

It will soon be illegal for health insurance companies in California to charge higher premiums to women based solely on their gender, thanks to a new law signed by California Gov. Arnold Schwarzenegger (R) last month. The law closes a loophole that allowed insurers to charge women more if the companies could point to specific actuarial data. The law eliminates the exception for all insurance contracts issued, amended, or renewed on or after Jan. 1, 2011. Only 10 other states ban this practice, called gender rating, in the individual insurance market, and two states limit it, according to the National Women's Law Center.