Mary Ellen Schneider

For Medicare beneficiaries who had little or no drug coverage before the implementation of Medicare Part D, improved access to prescription drugs has increased drug spending but lowered spending on other medical services, according to an analysis of Medicare Advantage claims.

The decrease in nondrug medical spending is likely due to improved adherence to medications among beneficiaries with chronic health conditions, researchers wrote (N. Engl. J. Med. 2009;361:52-61).

But it's unclear from these findings whether better drug coverage for seniors will yield savings overall for the Medicare system. While the researchers identified savings in medical care among certain beneficiaries, they found that spending on medical care increased for those Medicare beneficiaries who had more comprehensive drug coverage before the implementation of Part D.

Additionally, the study evaluates only beneficiaries who were enrolled in Medicare Advantage, which integrates coverage for prescription drugs, and physician and hospital care. The study does not examine whether drug coverage through a stand-alone Medicare Part D plan would impact the use of other medical services.

Researchers from the University of Pittsburgh, Highmark health insurer in Pittsburgh, and Harvard University in Boston, conducted a time-series analysis of data from more than 35,000 elderly Medicare beneficiaries who were continuously enrolled in a Medicare Advantage plan offered by a large insurer in Pennsylvania. The researchers, led by Yuting Zhang, Ph.D., measured expenditures for prescription drugs and nondrug medical care for 2 years before and after the implementation of Medicare Part D in January 2006.

The researchers compared Medicare beneficiaries who had drug coverage with no caps on spending before the implementation of Medicare Part D to three groups of beneficiaries who had no or limited prescription drug coverage before the Part D program went into effect. Those beneficiaries with limited coverage had drug benefits with either a $150 or $350 quarterly cap on plan payments.

Spending on prescription drugs increased in all groups after the implementation of Medicare Part D, compared with beneficiaries with no caps on their coverage, the researchers found. For example, 2 years before the implementation of Medicare Part D, expenditures for beneficiaries with no caps on their drug coverage were on average $166 per month, compared with only $46 a month for the group that previously had no drug coverage.

But 2 years after the implementation of the Part D program, expenditures for the group that was previously without drug coverage were rising faster than those with no caps on their coverage. Between December 2005 and December 2007, the average monthly drug spending increased by $41 in the group without previous coverage, compared with the group with no cap coverage.

Similarly, after the implementation of Part D, average monthly drug spending increased by $27 among beneficiaries who previously had a $150 quarterly drug coverage cap, compared with expenditures in the no-cap group. And the average monthly spending increased $13 among beneficiaries who previously had a $350 quarterly drug coverage cap.

There were also increases in the number of oral medications filled by beneficiaries with hyperlipidemia and diabetes. During the 2 years after implementation of Medicare Part D, the number of monthly prescriptions for lipid-lowering drugs increased 0.21 among beneficiaries with hyperlipidemia who were previously without coverage, compared with those with no-cap coverage. This is a 44% increase from the December 2005 level.

Similarly, the number of monthly prescriptions for diabetes drugs increased 0.27 among those in the no-coverage group, compared with those with no cap coverage. This is also a 44% increase from December 2005.

When the researchers evaluated the impact of Part D coverage on other medical care expenses, they found that nondrug costs dropped for those who previously had the greatest limits on their drug coverage.

For example, 2 years before the start of the Medicare Part D program, the average monthly medical spending was $380 for beneficiaries in both the no cap drug coverage group and those with no previous drug coverage. Spending was also increasing an average of about $4.98 per month for both groups.

However, after the implementation of Medicare Part D, the average monthly increase in spending dropped to $3.60 in the group with no previous drug coverage. By December 2007, 2 years after the start of Medicare Part D, cumulative medical spending in the no-coverage group had dropped by $33, compared with the group with no caps on coverage. A similar trend was seen in beneficiaries who previously had a $150 quarterly cap on their drug coverage.

However, for those beneficiaries who previously had a $350 quarterly cap on their drug coverage, there was an increase in medical spending after the start of the Part D program. In that group, cumulative medical spending increased by $30, compared with the no-cap group.

The researchers wrote that part of the reason for this medical spending increase could be an overuse of certain drugs. An overuse of drugs can lead to increased adverse drug events and greater use of health services.

The research was supported by grants from the National Institutes of Health. One researcher reported serving on the Board of Health Advisors for the Congressional Budget Office as well as being a director of and having equity in Aetna, which sells Medicare Advantage and Part D products.

For Medicare beneficiaries who had little or no drug coverage before the implementation of Medicare Part D, improved access to prescription drugs has increased drug spending but lowered spending on other medical services, according to an analysis of Medicare Advantage claims.

The decrease in nondrug medical spending is likely due to improved adherence to medications among beneficiaries with chronic health conditions, researchers wrote (N. Engl. J. Med. 2009;361:52-61).

But it's unclear from these findings whether better drug coverage for seniors will yield savings overall for the Medicare system. While the researchers identified savings in medical care among certain beneficiaries, they found that spending on medical care increased for those Medicare beneficiaries who had more comprehensive drug coverage before the implementation of Part D.

Additionally, the study evaluates only beneficiaries who were enrolled in Medicare Advantage, which integrates coverage for prescription drugs, and physician and hospital care. The study does not examine whether drug coverage through a stand-alone Medicare Part D plan would impact the use of other medical services.

Researchers from the University of Pittsburgh, Highmark health insurer in Pittsburgh, and Harvard University in Boston, conducted a time-series analysis of data from more than 35,000 elderly Medicare beneficiaries who were continuously enrolled in a Medicare Advantage plan offered by a large insurer in Pennsylvania. The researchers, led by Yuting Zhang, Ph.D., measured expenditures for prescription drugs and nondrug medical care for 2 years before and after the implementation of Medicare Part D in January 2006.

The researchers compared Medicare beneficiaries who had drug coverage with no caps on spending before the implementation of Medicare Part D to three groups of beneficiaries who had no or limited prescription drug coverage before the Part D program went into effect. Those beneficiaries with limited coverage had drug benefits with either a $150 or $350 quarterly cap on plan payments.

Spending on prescription drugs increased in all groups after the implementation of Medicare Part D, compared with beneficiaries with no caps on their coverage, the researchers found. For example, 2 years before the implementation of Medicare Part D, expenditures for beneficiaries with no caps on their drug coverage were on average $166 per month, compared with only $46 a month for the group that previously had no drug coverage.

But 2 years after the implementation of the Part D program, expenditures for the group that was previously without drug coverage were rising faster than those with no caps on their coverage. Between December 2005 and December 2007, the average monthly drug spending increased by $41 in the group without previous coverage, compared with the group with no cap coverage.

Similarly, after the implementation of Part D, average monthly drug spending increased by $27 among beneficiaries who previously had a $150 quarterly drug coverage cap, compared with expenditures in the no-cap group. And the average monthly spending increased $13 among beneficiaries who previously had a $350 quarterly drug coverage cap.

There were also increases in the number of oral medications filled by beneficiaries with hyperlipidemia and diabetes. During the 2 years after implementation of Medicare Part D, the number of monthly prescriptions for lipid-lowering drugs increased 0.21 among beneficiaries with hyperlipidemia who were previously without coverage, compared with those with no-cap coverage. This is a 44% increase from the December 2005 level.

Similarly, the number of monthly prescriptions for diabetes drugs increased 0.27 among those in the no-coverage group, compared with those with no cap coverage. This is also a 44% increase from December 2005.

When the researchers evaluated the impact of Part D coverage on other medical care expenses, they found that nondrug costs dropped for those who previously had the greatest limits on their drug coverage.

For example, 2 years before the start of the Medicare Part D program, the average monthly medical spending was $380 for beneficiaries in both the no cap drug coverage group and those with no previous drug coverage. Spending was also increasing an average of about $4.98 per month for both groups.

However, after the implementation of Medicare Part D, the average monthly increase in spending dropped to $3.60 in the group with no previous drug coverage. By December 2007, 2 years after the start of Medicare Part D, cumulative medical spending in the no-coverage group had dropped by $33, compared with the group with no caps on coverage. A similar trend was seen in beneficiaries who previously had a $150 quarterly cap on their drug coverage.

However, for those beneficiaries who previously had a $350 quarterly cap on their drug coverage, there was an increase in medical spending after the start of the Part D program. In that group, cumulative medical spending increased by $30, compared with the no-cap group.

The researchers wrote that part of the reason for this medical spending increase could be an overuse of certain drugs. An overuse of drugs can lead to increased adverse drug events and greater use of health services.

The research was supported by grants from the National Institutes of Health. One researcher reported serving on the Board of Health Advisors for the Congressional Budget Office as well as being a director of and having equity in Aetna, which sells Medicare Advantage and Part D products.

For Medicare beneficiaries who had little or no drug coverage before the implementation of Medicare Part D, improved access to prescription drugs has increased drug spending but lowered spending on other medical services, according to an analysis of Medicare Advantage claims.

The decrease in nondrug medical spending is likely due to improved adherence to medications among beneficiaries with chronic health conditions, researchers wrote (N. Engl. J. Med. 2009;361:52-61).

But it's unclear from these findings whether better drug coverage for seniors will yield savings overall for the Medicare system. While the researchers identified savings in medical care among certain beneficiaries, they found that spending on medical care increased for those Medicare beneficiaries who had more comprehensive drug coverage before the implementation of Part D.

Additionally, the study evaluates only beneficiaries who were enrolled in Medicare Advantage, which integrates coverage for prescription drugs, and physician and hospital care. The study does not examine whether drug coverage through a stand-alone Medicare Part D plan would impact the use of other medical services.

Researchers from the University of Pittsburgh, Highmark health insurer in Pittsburgh, and Harvard University in Boston, conducted a time-series analysis of data from more than 35,000 elderly Medicare beneficiaries who were continuously enrolled in a Medicare Advantage plan offered by a large insurer in Pennsylvania. The researchers, led by Yuting Zhang, Ph.D., measured expenditures for prescription drugs and nondrug medical care for 2 years before and after the implementation of Medicare Part D in January 2006.

The researchers compared Medicare beneficiaries who had drug coverage with no caps on spending before the implementation of Medicare Part D to three groups of beneficiaries who had no or limited prescription drug coverage before the Part D program went into effect. Those beneficiaries with limited coverage had drug benefits with either a $150 or $350 quarterly cap on plan payments.

Spending on prescription drugs increased in all groups after the implementation of Medicare Part D, compared with beneficiaries with no caps on their coverage, the researchers found. For example, 2 years before the implementation of Medicare Part D, expenditures for beneficiaries with no caps on their drug coverage were on average $166 per month, compared with only $46 a month for the group that previously had no drug coverage.

But 2 years after the implementation of the Part D program, expenditures for the group that was previously without drug coverage were rising faster than those with no caps on their coverage. Between December 2005 and December 2007, the average monthly drug spending increased by $41 in the group without previous coverage, compared with the group with no cap coverage.

Similarly, after the implementation of Part D, average monthly drug spending increased by $27 among beneficiaries who previously had a $150 quarterly drug coverage cap, compared with expenditures in the no-cap group. And the average monthly spending increased $13 among beneficiaries who previously had a $350 quarterly drug coverage cap.

There were also increases in the number of oral medications filled by beneficiaries with hyperlipidemia and diabetes. During the 2 years after implementation of Medicare Part D, the number of monthly prescriptions for lipid-lowering drugs increased 0.21 among beneficiaries with hyperlipidemia who were previously without coverage, compared with those with no-cap coverage. This is a 44% increase from the December 2005 level.

Similarly, the number of monthly prescriptions for diabetes drugs increased 0.27 among those in the no-coverage group, compared with those with no cap coverage. This is also a 44% increase from December 2005.

When the researchers evaluated the impact of Part D coverage on other medical care expenses, they found that nondrug costs dropped for those who previously had the greatest limits on their drug coverage.

For example, 2 years before the start of the Medicare Part D program, the average monthly medical spending was $380 for beneficiaries in both the no cap drug coverage group and those with no previous drug coverage. Spending was also increasing an average of about $4.98 per month for both groups.

However, after the implementation of Medicare Part D, the average monthly increase in spending dropped to $3.60 in the group with no previous drug coverage. By December 2007, 2 years after the start of Medicare Part D, cumulative medical spending in the no-coverage group had dropped by $33, compared with the group with no caps on coverage. A similar trend was seen in beneficiaries who previously had a $150 quarterly cap on their drug coverage.

However, for those beneficiaries who previously had a $350 quarterly cap on their drug coverage, there was an increase in medical spending after the start of the Part D program. In that group, cumulative medical spending increased by $30, compared with the no-cap group.

The researchers wrote that part of the reason for this medical spending increase could be an overuse of certain drugs. An overuse of drugs can lead to increased adverse drug events and greater use of health services.

The research was supported by grants from the National Institutes of Health. One researcher reported serving on the Board of Health Advisors for the Congressional Budget Office as well as being a director of and having equity in Aetna, which sells Medicare Advantage and Part D products.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry now relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out whether their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry now relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out whether their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry now relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out whether their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

NEW YORK – When diagnosing adolescents with eating disorders, be aware that they may try to trick you to avoid admitting their behavior, one expert says.

“These kids go on the Internet and they know the diagnostic criteria–often better than the psychiatrist,” Dr. Katherine A. Halmi, professor of psychiatry at Weill Cornell Medical College in New York, said at the annual meeting of the American Society for Adolescent Psychiatry.

“They know all the mechanisms for how to fool you.”

That makes conducting a careful interview with both the adolescent and the family members critical, she said.

Be suspicious of eating disorders in adolescents with marked weight fluctuations or significant weight loss, Dr. Halmi advised. It also is important to look for excessive levels of activity such as constant jogging, biking, and aerobic exercise.

These adolescents often will pace around the house and never seem to sit down, she said.

The family and patient interviews should also include thorough questions about purging behaviors–self-induced vomiting, laxative abuse, diuretic abuse, and enemas.

But keep in mind that sometimes the parents choose to ignore this behavior or may not know about it, Dr. Halmi said.

For example, the psychiatrist often ends up seeing the family because the adolescent's friends have called the parents to alert them to the problem.

The core eating disorder psychopathology often consists of preoccupations and rituals. All teenage girls look in the mirror frequently, Dr. Halmi said, but when this behavior becomes excessive, become concerned.

Other common preoccupations among adolescents with eating disorders include fear of getting fat, frequent weighing, calorie counting, and excessive concern about the fat content and other ingredients in foods.

Anorexic patients who are underweight might develop a preoccupation with food. Sometimes adolescents with anorexia actually collect recipes and cook for their families.

However, these patients will refrain from eating, according to Dr. Halmi.

Many patients with bulimia have a fear of not being able to stop eating. Frequently, they will stop eating with family members and become more and more isolated, she said.

Clinicians also can look for physical signs to diagnose eating disorder behavior. When looking to confirm purging behavior in an adolescent, perform a blood analysis, Dr. Halmi advised.

If the adolescents are purging, they will have an elevated serum amylase level, and if they are purging repeatedly this will be especially prominent.

Bulimia nervosa is frequently diagnosed by a dentist, because of the telltale physical signs such as tooth erosion and poor gum hygiene.

Swollen parotid glands and scars on the dorsum of the hand also are indications of bulimia.

NEW YORK – When diagnosing adolescents with eating disorders, be aware that they may try to trick you to avoid admitting their behavior, one expert says.

“These kids go on the Internet and they know the diagnostic criteria–often better than the psychiatrist,” Dr. Katherine A. Halmi, professor of psychiatry at Weill Cornell Medical College in New York, said at the annual meeting of the American Society for Adolescent Psychiatry.

“They know all the mechanisms for how to fool you.”

That makes conducting a careful interview with both the adolescent and the family members critical, she said.

Be suspicious of eating disorders in adolescents with marked weight fluctuations or significant weight loss, Dr. Halmi advised. It also is important to look for excessive levels of activity such as constant jogging, biking, and aerobic exercise.

These adolescents often will pace around the house and never seem to sit down, she said.

The family and patient interviews should also include thorough questions about purging behaviors–self-induced vomiting, laxative abuse, diuretic abuse, and enemas.

But keep in mind that sometimes the parents choose to ignore this behavior or may not know about it, Dr. Halmi said.

For example, the psychiatrist often ends up seeing the family because the adolescent's friends have called the parents to alert them to the problem.

The core eating disorder psychopathology often consists of preoccupations and rituals. All teenage girls look in the mirror frequently, Dr. Halmi said, but when this behavior becomes excessive, become concerned.

Other common preoccupations among adolescents with eating disorders include fear of getting fat, frequent weighing, calorie counting, and excessive concern about the fat content and other ingredients in foods.

Anorexic patients who are underweight might develop a preoccupation with food. Sometimes adolescents with anorexia actually collect recipes and cook for their families.

However, these patients will refrain from eating, according to Dr. Halmi.

Many patients with bulimia have a fear of not being able to stop eating. Frequently, they will stop eating with family members and become more and more isolated, she said.

Clinicians also can look for physical signs to diagnose eating disorder behavior. When looking to confirm purging behavior in an adolescent, perform a blood analysis, Dr. Halmi advised.

If the adolescents are purging, they will have an elevated serum amylase level, and if they are purging repeatedly this will be especially prominent.

Bulimia nervosa is frequently diagnosed by a dentist, because of the telltale physical signs such as tooth erosion and poor gum hygiene.

Swollen parotid glands and scars on the dorsum of the hand also are indications of bulimia.

NEW YORK – When diagnosing adolescents with eating disorders, be aware that they may try to trick you to avoid admitting their behavior, one expert says.

“These kids go on the Internet and they know the diagnostic criteria–often better than the psychiatrist,” Dr. Katherine A. Halmi, professor of psychiatry at Weill Cornell Medical College in New York, said at the annual meeting of the American Society for Adolescent Psychiatry.

“They know all the mechanisms for how to fool you.”

That makes conducting a careful interview with both the adolescent and the family members critical, she said.

Be suspicious of eating disorders in adolescents with marked weight fluctuations or significant weight loss, Dr. Halmi advised. It also is important to look for excessive levels of activity such as constant jogging, biking, and aerobic exercise.

These adolescents often will pace around the house and never seem to sit down, she said.

The family and patient interviews should also include thorough questions about purging behaviors–self-induced vomiting, laxative abuse, diuretic abuse, and enemas.

But keep in mind that sometimes the parents choose to ignore this behavior or may not know about it, Dr. Halmi said.

For example, the psychiatrist often ends up seeing the family because the adolescent's friends have called the parents to alert them to the problem.

The core eating disorder psychopathology often consists of preoccupations and rituals. All teenage girls look in the mirror frequently, Dr. Halmi said, but when this behavior becomes excessive, become concerned.

Other common preoccupations among adolescents with eating disorders include fear of getting fat, frequent weighing, calorie counting, and excessive concern about the fat content and other ingredients in foods.

Anorexic patients who are underweight might develop a preoccupation with food. Sometimes adolescents with anorexia actually collect recipes and cook for their families.

However, these patients will refrain from eating, according to Dr. Halmi.

Many patients with bulimia have a fear of not being able to stop eating. Frequently, they will stop eating with family members and become more and more isolated, she said.

Clinicians also can look for physical signs to diagnose eating disorder behavior. When looking to confirm purging behavior in an adolescent, perform a blood analysis, Dr. Halmi advised.

If the adolescents are purging, they will have an elevated serum amylase level, and if they are purging repeatedly this will be especially prominent.

Bulimia nervosa is frequently diagnosed by a dentist, because of the telltale physical signs such as tooth erosion and poor gum hygiene.

Swollen parotid glands and scars on the dorsum of the hand also are indications of bulimia.

As the first editor-in-chief of the Journal of Hospital Medicine, Dr. Mark V. Williams has played a key role in documenting the history of this new field.

In that role, he has watched hospital medicine grow and mature. The peer-reviewed journal, launched in January 2006, was once home to articles aimed at proving the value of adding hospitalists to an institution's roster. But now most articles focus on how to optimize care within the hospitalist model and how to more efficiently manage the hospital itself.

“We have actually rejected articles in the recent past that were descriptions of the implementation of a hospitalist program,” he said. “That's already been done.”

Dr. Williams, chief of the division of hospital medicine at the Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital in Chicago, is a former president of the Society of Hospital Medicine. In 1998, he established the first hospitalist program at a public hospital at Grady Memorial Hospital in Atlanta.

Despite his credentials, Dr. Williams said he was a little anxious about accepting the editor-in-chief job in 2005, not knowing what to expect. But his training in evidence-based medicine and the team of editors assembled by the Society of Hospital Medicine have made the job a lot of fun, he said.

The job has not been without challenges, he said, but not always the ones he anticipated. Dr. Williams said he was expecting to have trouble finding high-quality research articles to fill all the pages of a newly launched journal in a new field. It turned out that his biggest challenge has been sorting through the large volume of submissions and having to reject interesting articles. He and the rest of the staff have tried to address this by publishing more articles online, and in the future they hope to expand the number of issues and the number of pages.

The number of submissions shows that hospital medicine is maturing as a field, he said. “There has never been a journal focused on care delivery in the hospital, and yet this is where one-third of federal health care funding is expended.”

The volume of high-quality research being conducted by hospitalists is likely to grow, Dr. Williams said, as academic institutions begin establishing divisions of hospital medicine and devoting research dollars to this area. For example, the Feinberg School of Medicine has just hired four hospitalists who will devote most of their time to research on hospital medicine. And many other physicians at the institution are involved in smaller research projects.

“It's this investment in hospital medicine research that's going to grow the entire field long term, demonstrating the importance of hospitalists in improving care delivery and quality improvement at hospitals,” Dr. Williams said.

As for the journal, he sees his next big task as helping to prepare to hand over the reins to the next editor. He also hopes to see the journal become a monthly publication sometime in the next 2 years. But he's pleased with the progress so far. For instance, the journal was listed in Medline, the National Library of Medicine's bibliographic medical database, in its first year. And a recent measurement of the journal's most recent “impact factor” (how often it's cited by other journals) showed that it is gaining credibility within the research community.

“I've been surprised that we've achieved everything that we set out to do so fast,” Dr. Williams said.

'I've been surprised that we've achieved everything that we set out to do so fast.'

Source DR. WILLIAMS

As the first editor-in-chief of the Journal of Hospital Medicine, Dr. Mark V. Williams has played a key role in documenting the history of this new field.

In that role, he has watched hospital medicine grow and mature. The peer-reviewed journal, launched in January 2006, was once home to articles aimed at proving the value of adding hospitalists to an institution's roster. But now most articles focus on how to optimize care within the hospitalist model and how to more efficiently manage the hospital itself.

“We have actually rejected articles in the recent past that were descriptions of the implementation of a hospitalist program,” he said. “That's already been done.”

Dr. Williams, chief of the division of hospital medicine at the Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital in Chicago, is a former president of the Society of Hospital Medicine. In 1998, he established the first hospitalist program at a public hospital at Grady Memorial Hospital in Atlanta.

Despite his credentials, Dr. Williams said he was a little anxious about accepting the editor-in-chief job in 2005, not knowing what to expect. But his training in evidence-based medicine and the team of editors assembled by the Society of Hospital Medicine have made the job a lot of fun, he said.

The job has not been without challenges, he said, but not always the ones he anticipated. Dr. Williams said he was expecting to have trouble finding high-quality research articles to fill all the pages of a newly launched journal in a new field. It turned out that his biggest challenge has been sorting through the large volume of submissions and having to reject interesting articles. He and the rest of the staff have tried to address this by publishing more articles online, and in the future they hope to expand the number of issues and the number of pages.

The number of submissions shows that hospital medicine is maturing as a field, he said. “There has never been a journal focused on care delivery in the hospital, and yet this is where one-third of federal health care funding is expended.”

The volume of high-quality research being conducted by hospitalists is likely to grow, Dr. Williams said, as academic institutions begin establishing divisions of hospital medicine and devoting research dollars to this area. For example, the Feinberg School of Medicine has just hired four hospitalists who will devote most of their time to research on hospital medicine. And many other physicians at the institution are involved in smaller research projects.

“It's this investment in hospital medicine research that's going to grow the entire field long term, demonstrating the importance of hospitalists in improving care delivery and quality improvement at hospitals,” Dr. Williams said.

As for the journal, he sees his next big task as helping to prepare to hand over the reins to the next editor. He also hopes to see the journal become a monthly publication sometime in the next 2 years. But he's pleased with the progress so far. For instance, the journal was listed in Medline, the National Library of Medicine's bibliographic medical database, in its first year. And a recent measurement of the journal's most recent “impact factor” (how often it's cited by other journals) showed that it is gaining credibility within the research community.

“I've been surprised that we've achieved everything that we set out to do so fast,” Dr. Williams said.

'I've been surprised that we've achieved everything that we set out to do so fast.'

Source DR. WILLIAMS

As the first editor-in-chief of the Journal of Hospital Medicine, Dr. Mark V. Williams has played a key role in documenting the history of this new field.

In that role, he has watched hospital medicine grow and mature. The peer-reviewed journal, launched in January 2006, was once home to articles aimed at proving the value of adding hospitalists to an institution's roster. But now most articles focus on how to optimize care within the hospitalist model and how to more efficiently manage the hospital itself.

“We have actually rejected articles in the recent past that were descriptions of the implementation of a hospitalist program,” he said. “That's already been done.”

Dr. Williams, chief of the division of hospital medicine at the Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital in Chicago, is a former president of the Society of Hospital Medicine. In 1998, he established the first hospitalist program at a public hospital at Grady Memorial Hospital in Atlanta.

Despite his credentials, Dr. Williams said he was a little anxious about accepting the editor-in-chief job in 2005, not knowing what to expect. But his training in evidence-based medicine and the team of editors assembled by the Society of Hospital Medicine have made the job a lot of fun, he said.

The job has not been without challenges, he said, but not always the ones he anticipated. Dr. Williams said he was expecting to have trouble finding high-quality research articles to fill all the pages of a newly launched journal in a new field. It turned out that his biggest challenge has been sorting through the large volume of submissions and having to reject interesting articles. He and the rest of the staff have tried to address this by publishing more articles online, and in the future they hope to expand the number of issues and the number of pages.

The number of submissions shows that hospital medicine is maturing as a field, he said. “There has never been a journal focused on care delivery in the hospital, and yet this is where one-third of federal health care funding is expended.”

The volume of high-quality research being conducted by hospitalists is likely to grow, Dr. Williams said, as academic institutions begin establishing divisions of hospital medicine and devoting research dollars to this area. For example, the Feinberg School of Medicine has just hired four hospitalists who will devote most of their time to research on hospital medicine. And many other physicians at the institution are involved in smaller research projects.

“It's this investment in hospital medicine research that's going to grow the entire field long term, demonstrating the importance of hospitalists in improving care delivery and quality improvement at hospitals,” Dr. Williams said.

As for the journal, he sees his next big task as helping to prepare to hand over the reins to the next editor. He also hopes to see the journal become a monthly publication sometime in the next 2 years. But he's pleased with the progress so far. For instance, the journal was listed in Medline, the National Library of Medicine's bibliographic medical database, in its first year. And a recent measurement of the journal's most recent “impact factor” (how often it's cited by other journals) showed that it is gaining credibility within the research community.

“I've been surprised that we've achieved everything that we set out to do so fast,” Dr. Williams said.

'I've been surprised that we've achieved everything that we set out to do so fast.'

Source DR. WILLIAMS

Nearly 20% of Medicare patients who are admitted to the hospital after an acute myocardial infarction will be readmitted within 30 days, according to historical data released by the Centers for Medicare and Medicaid Services.

The all-cause, 30-day readmission rate for acute MI (19.9%) is similar to rates for patients originally admitted for heart failure (24.5%) and pneumonia (18.2%). The figures, which are based on 3 years of data, were posted to Medicare's Hospital Compare Web site. The 30-day readmission rates were produced using statistical models that rely on Medicare claims and enrollment information, according to the CMS.

The Web site (www.hospitalcompare.hhs.gov

“The President and Congress have both identified the reduction of readmissions as a target area for health reform,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “When we reduce readmissions, we improve the quality of care patients receive and cut health care costs.”

The Hospital Compare readmissions data include individual hospital information, as well as national figures. It allows consumers to learn if a hospital's readmission rate is better, the same, or worse than the national rate.

The readmission data do not include planned hospital treatments such as a readmission for a scheduled heart bypass or coronary angioplasty. The data also exclude readmission of patients who left the hospital against medical advice.

Launched in 2005, the Hospital Compare Web site also includes mortality data and scores on patient satisfaction measures, 25 process of care measures, and 2 children's asthma care measures.

Nearly 20% of Medicare patients who are admitted to the hospital after an acute myocardial infarction will be readmitted within 30 days, according to historical data released by the Centers for Medicare and Medicaid Services.

The all-cause, 30-day readmission rate for acute MI (19.9%) is similar to rates for patients originally admitted for heart failure (24.5%) and pneumonia (18.2%). The figures, which are based on 3 years of data, were posted to Medicare's Hospital Compare Web site. The 30-day readmission rates were produced using statistical models that rely on Medicare claims and enrollment information, according to the CMS.

The Web site (www.hospitalcompare.hhs.gov

“The President and Congress have both identified the reduction of readmissions as a target area for health reform,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “When we reduce readmissions, we improve the quality of care patients receive and cut health care costs.”

The Hospital Compare readmissions data include individual hospital information, as well as national figures. It allows consumers to learn if a hospital's readmission rate is better, the same, or worse than the national rate.

The readmission data do not include planned hospital treatments such as a readmission for a scheduled heart bypass or coronary angioplasty. The data also exclude readmission of patients who left the hospital against medical advice.

Launched in 2005, the Hospital Compare Web site also includes mortality data and scores on patient satisfaction measures, 25 process of care measures, and 2 children's asthma care measures.

Nearly 20% of Medicare patients who are admitted to the hospital after an acute myocardial infarction will be readmitted within 30 days, according to historical data released by the Centers for Medicare and Medicaid Services.

The all-cause, 30-day readmission rate for acute MI (19.9%) is similar to rates for patients originally admitted for heart failure (24.5%) and pneumonia (18.2%). The figures, which are based on 3 years of data, were posted to Medicare's Hospital Compare Web site. The 30-day readmission rates were produced using statistical models that rely on Medicare claims and enrollment information, according to the CMS.

The Web site (www.hospitalcompare.hhs.gov

“The President and Congress have both identified the reduction of readmissions as a target area for health reform,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “When we reduce readmissions, we improve the quality of care patients receive and cut health care costs.”

The Hospital Compare readmissions data include individual hospital information, as well as national figures. It allows consumers to learn if a hospital's readmission rate is better, the same, or worse than the national rate.

The readmission data do not include planned hospital treatments such as a readmission for a scheduled heart bypass or coronary angioplasty. The data also exclude readmission of patients who left the hospital against medical advice.

Launched in 2005, the Hospital Compare Web site also includes mortality data and scores on patient satisfaction measures, 25 process of care measures, and 2 children's asthma care measures.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be found at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Another reason that physicians should pay attention to the 5010 transition is that it paves the way for the move from the International Classification of Diseases, 9th ed., Clinical Modification (ICD-9-CM) code sets now used to the significantly expanded ICD-10 code sets on Oct. 1, 2013.

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be found at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Another reason that physicians should pay attention to the 5010 transition is that it paves the way for the move from the International Classification of Diseases, 9th ed., Clinical Modification (ICD-9-CM) code sets now used to the significantly expanded ICD-10 code sets on Oct. 1, 2013.

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The new standard replaces the version 4010A1 currently in use. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

“There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour,” said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. “There are real changes in these formats,” Ms. Stahlecker said.

A comparison of the current and new formats can be found at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Another reason that physicians should pay attention to the 5010 transition is that it paves the way for the move from the International Classification of Diseases, 9th ed., Clinical Modification (ICD-9-CM) code sets now used to the significantly expanded ICD-10 code sets on Oct. 1, 2013.

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

"There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour," said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. "There are real changes in these formats," Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

"There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour," said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. "There are real changes in these formats," Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Physicians have a little more than 2 years to complete their transition to new HIPAA X12 standards for submitting administrative transactions electronically, according to Medicare officials.

As of Jan. 1, 2012, physicians and all other entities covered under HIPAA (Health Insurance Portability and Accountability Act) will be required to use the HIPAA X12 version 5010 format when submitting claims, receiving remittances, and sending claim status or eligibility inquiries electronically. The change will affect dealings not only with Medicare, but also with all private payers.

The Medicare fee-for-service program will begin its own system testing next year and will begin accepting administrative transactions using the 5010 version as of Jan. 1, 2011. Throughout 2011, the Centers for Medicare and Medicaid Services will accept both the 5010 and 4010A1 versions. However, beginning on Jan. 1, 2012, only transactions submitted using the 5010 version will be accepted.

During a recent conference call to update providers, officials at the Centers for Medicare and Medicaid Services urged physicians not to wait until the last minute to make the transition to the new format.

"There's no room to delay. We cannot possibly convert all of the Medicare trading partners at the 11th hour," said Christine Stahlecker, director of the Division of Medicare Billing Procedures in the CMS Office of Information Services.

The switch is necessary, according to the CMS, because the 4010A1 version is outdated. For example, the industry currently relies heavily on companion guides to implement the standards, which limits their value. The new version includes some new functions aimed at improving claims processing, such as resolving ambiguities in the situational rules and providing more consistency across transactions.

But Medicare officials urged physicians to analyze the new version carefully prior to implementation. Billing software will need to be updated, and business processes may need to be changed as well. "There are real changes in these formats," Ms. Stahlecker said.

A comparison of the current and new formats can be viewed online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Ms. Stahlecker advised physicians to contact their system vendors as soon as possible to find out if their licensing agreement includes regulatory updates and to get the vendor's timeline for upgrading its systems.

Just as patients are beginning to come into the office seeking eyelashes as long and thick as those belonging to Brooke Shields, Dr. Christopher B. Zachary gave his run-down on the safety and efficacy of bimatoprost 0.03%.

The bottom line appears to be that the product has a clinically meaningful benefit and is well tolerated in healthy adults, Dr. Zachary said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

"Appropriate studies have been performed to demonstrate the efficacy and safety of this product," he said in an interview. "But as with any new cosmetic procedure, patients need to be aware of the potential for side effects."

Eyelash growth using bimatoprost was first characterized in two controlled phase III trials in glaucoma. The discovery of a secondary application for bimatoprost is not a surprise, said Dr. Zachary, chair of the department of dermatology at the University of California, Irvine. "Many products when developed and utilized extensively for one indication will inevitably be associated with effects in other systems," said Dr. Zachary, who serves on various academic advisory boards for Allergan Inc.

Since the benefit was first observed in glaucoma patients, researchers performed an open-label trial showing the efficacy of bimatoprost when directly applied to the eyelid margin.

The open label, proof-of-concept study included 28 women who applied the product daily over the course of 12 weeks. The study demonstrated the effectiveness of the product, with all women who responded to questions about efficacy reporting at least some improvement in their eyelashes. None of the patients discontinued treatment as a result of adverse events, and only minor, transient adverse events were reported. Additionally, changes in intraocular pressure were not statistically significant, Dr. Zachary said.

A confirmatory phase III trial of 278 patients used a global eyelash assessment, digital image analysis, and patient-reported outcome measures to assess the efficacy of the product. At the end of 16 weeks, a statistically significant percentage of patients in the bimatoprost group had improvements in eyelash prominence, length, thickness, and darkness, compared with the vehicle group. The results of the randomized, double-blind, placebo-controlled study were consistent across age and race.

In terms of safety, four patients in the bimatoprost group and four patients in the control group discontinued due to adverse events. All of the treatment-related events were minor: eczematous change, irritant dermatitis, dry eye, eyelid erythema, and low intraocular pressure.

When used by glaucoma patients over long periods, bimatoprost resulted in darkening of the iris in some, Dr. Zachary said. Although this effect was not found in any of the cosmetic trials, patients should be informed of this possibility.

SDEF and this news organization are owned by Elsevier.

'As with any new cosmetic procedure, patients need to be aware of the potential for side effects.'

Source DR. ZACHARY

Treatment results can be seen in these photos from Allergan's clinical trial.

Source Courtesy Allergan Inc.

Just as patients are beginning to come into the office seeking eyelashes as long and thick as those belonging to Brooke Shields, Dr. Christopher B. Zachary gave his run-down on the safety and efficacy of bimatoprost 0.03%.

The bottom line appears to be that the product has a clinically meaningful benefit and is well tolerated in healthy adults, Dr. Zachary said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

"Appropriate studies have been performed to demonstrate the efficacy and safety of this product," he said in an interview. "But as with any new cosmetic procedure, patients need to be aware of the potential for side effects."

Eyelash growth using bimatoprost was first characterized in two controlled phase III trials in glaucoma. The discovery of a secondary application for bimatoprost is not a surprise, said Dr. Zachary, chair of the department of dermatology at the University of California, Irvine. "Many products when developed and utilized extensively for one indication will inevitably be associated with effects in other systems," said Dr. Zachary, who serves on various academic advisory boards for Allergan Inc.

Since the benefit was first observed in glaucoma patients, researchers performed an open-label trial showing the efficacy of bimatoprost when directly applied to the eyelid margin.

The open label, proof-of-concept study included 28 women who applied the product daily over the course of 12 weeks. The study demonstrated the effectiveness of the product, with all women who responded to questions about efficacy reporting at least some improvement in their eyelashes. None of the patients discontinued treatment as a result of adverse events, and only minor, transient adverse events were reported. Additionally, changes in intraocular pressure were not statistically significant, Dr. Zachary said.

A confirmatory phase III trial of 278 patients used a global eyelash assessment, digital image analysis, and patient-reported outcome measures to assess the efficacy of the product. At the end of 16 weeks, a statistically significant percentage of patients in the bimatoprost group had improvements in eyelash prominence, length, thickness, and darkness, compared with the vehicle group. The results of the randomized, double-blind, placebo-controlled study were consistent across age and race.

In terms of safety, four patients in the bimatoprost group and four patients in the control group discontinued due to adverse events. All of the treatment-related events were minor: eczematous change, irritant dermatitis, dry eye, eyelid erythema, and low intraocular pressure.

When used by glaucoma patients over long periods, bimatoprost resulted in darkening of the iris in some, Dr. Zachary said. Although this effect was not found in any of the cosmetic trials, patients should be informed of this possibility.

SDEF and this news organization are owned by Elsevier.

'As with any new cosmetic procedure, patients need to be aware of the potential for side effects.'

Source DR. ZACHARY

Treatment results can be seen in these photos from Allergan's clinical trial.

Source Courtesy Allergan Inc.

Just as patients are beginning to come into the office seeking eyelashes as long and thick as those belonging to Brooke Shields, Dr. Christopher B. Zachary gave his run-down on the safety and efficacy of bimatoprost 0.03%.

The bottom line appears to be that the product has a clinically meaningful benefit and is well tolerated in healthy adults, Dr. Zachary said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

"Appropriate studies have been performed to demonstrate the efficacy and safety of this product," he said in an interview. "But as with any new cosmetic procedure, patients need to be aware of the potential for side effects."

Eyelash growth using bimatoprost was first characterized in two controlled phase III trials in glaucoma. The discovery of a secondary application for bimatoprost is not a surprise, said Dr. Zachary, chair of the department of dermatology at the University of California, Irvine. "Many products when developed and utilized extensively for one indication will inevitably be associated with effects in other systems," said Dr. Zachary, who serves on various academic advisory boards for Allergan Inc.

Since the benefit was first observed in glaucoma patients, researchers performed an open-label trial showing the efficacy of bimatoprost when directly applied to the eyelid margin.

The open label, proof-of-concept study included 28 women who applied the product daily over the course of 12 weeks. The study demonstrated the effectiveness of the product, with all women who responded to questions about efficacy reporting at least some improvement in their eyelashes. None of the patients discontinued treatment as a result of adverse events, and only minor, transient adverse events were reported. Additionally, changes in intraocular pressure were not statistically significant, Dr. Zachary said.

A confirmatory phase III trial of 278 patients used a global eyelash assessment, digital image analysis, and patient-reported outcome measures to assess the efficacy of the product. At the end of 16 weeks, a statistically significant percentage of patients in the bimatoprost group had improvements in eyelash prominence, length, thickness, and darkness, compared with the vehicle group. The results of the randomized, double-blind, placebo-controlled study were consistent across age and race.

In terms of safety, four patients in the bimatoprost group and four patients in the control group discontinued due to adverse events. All of the treatment-related events were minor: eczematous change, irritant dermatitis, dry eye, eyelid erythema, and low intraocular pressure.

When used by glaucoma patients over long periods, bimatoprost resulted in darkening of the iris in some, Dr. Zachary said. Although this effect was not found in any of the cosmetic trials, patients should be informed of this possibility.

SDEF and this news organization are owned by Elsevier.

'As with any new cosmetic procedure, patients need to be aware of the potential for side effects.'

Source DR. ZACHARY

Treatment results can be seen in these photos from Allergan's clinical trial.

Source Courtesy Allergan Inc.

A special panel convened by the Institute of Medicine has identified 100 areas ripe for study as part of a federal comparative effectiveness research program.

The panel called on the federal government to use new research funding to compare treatments for atrial fibrillation, strategies to prevent falls among the elderly, and methods to prevent and treat methicillin resistant Staphylococcus aureus (MRSA), among others. A complete list of the research topics is available online at www.iom.edu/cerpriorities

When Congress passed the American Recovery and Reinvestment Act earlier this year, it included $1.1 billion for comparative effectiveness research. It also instructed the IOM to recommend national priorities for spending a portion of that money—the $400 million that will be spent at the discretion of the Health and Human Services secretary. The work of the IOM panel was sponsored by HHS.

In selecting the initial priorities for research, the panel considered the total burden of illness, current gaps in the medical literature, and the potential for the research to actually change practice. The IOM panel suggested research questions that focus on comparing active treatments in patient populations that are typical of the types of patients seen in daily practice.

The panel also used cost as one of the criteria in determining which research topics would make its list. The panel did not discuss cost-effectiveness as a tool for decision-making, Dr. Harold C. Sox, co-chair of the IOM panel and outgoing editor of the Annals of Internal Medicine, said during a news conference.

In addition to identifying specific research areas that should be funded, the IOM panel recommended that HHS establish some type of federal infrastructure to select priority areas for comparative studies and carry out that research in the future.

“Priority setting needs to be a continuous process,” Dr. Sox said. “Gaps in the evidence will be filled as [comparative effectiveness] research is carried out and new technologies will come along that require careful evaluation in order to facilitate decision making about them.”

The IOM panel recommended that HHS set up an advisory body that would organize, monitor, and evaluate the implementation of a comparative effectiveness research program. The panel also urged HHS to establish large-scale clinical and administrative data networks to encourage better use of data gathered in day-to-day patient care. And the panel called on HHS to develop a plan for research workforce development that includes long-term funding for early career development.

The IOM recommendations appear to complement work done by another congressionally-mandated panel of experts. The Federal Coordinating Council for Comparative Effectiveness Research issued its report in June, which outlines a framework for spending comparative effectiveness research funding.

That panel concluded that the primary focus for HHS should be investing in data infrastructure that would link current data sources like patient registries. The group also recommended that funding be focused on the dissemination of research findings and research that focuses on “priority populations,” such as racial and ethnic minorities, individuals with disabilities, and individuals with multiple chronic health conditions.

The recommendations from both groups will be used by HHS Secretary Kathleen Sebelius to formulate a specific plan on how to spend the full $1.1 billion in comparative effectiveness research funds allocated by Congress. Under the Recovery Act, she was required to submit her plan to Congress by July 30.

A special panel convened by the Institute of Medicine has identified 100 areas ripe for study as part of a federal comparative effectiveness research program.

The panel called on the federal government to use new research funding to compare treatments for atrial fibrillation, strategies to prevent falls among the elderly, and methods to prevent and treat methicillin resistant Staphylococcus aureus (MRSA), among others. A complete list of the research topics is available online at www.iom.edu/cerpriorities

When Congress passed the American Recovery and Reinvestment Act earlier this year, it included $1.1 billion for comparative effectiveness research. It also instructed the IOM to recommend national priorities for spending a portion of that money—the $400 million that will be spent at the discretion of the Health and Human Services secretary. The work of the IOM panel was sponsored by HHS.

In selecting the initial priorities for research, the panel considered the total burden of illness, current gaps in the medical literature, and the potential for the research to actually change practice. The IOM panel suggested research questions that focus on comparing active treatments in patient populations that are typical of the types of patients seen in daily practice.

The panel also used cost as one of the criteria in determining which research topics would make its list. The panel did not discuss cost-effectiveness as a tool for decision-making, Dr. Harold C. Sox, co-chair of the IOM panel and outgoing editor of the Annals of Internal Medicine, said during a news conference.

In addition to identifying specific research areas that should be funded, the IOM panel recommended that HHS establish some type of federal infrastructure to select priority areas for comparative studies and carry out that research in the future.

“Priority setting needs to be a continuous process,” Dr. Sox said. “Gaps in the evidence will be filled as [comparative effectiveness] research is carried out and new technologies will come along that require careful evaluation in order to facilitate decision making about them.”

The IOM panel recommended that HHS set up an advisory body that would organize, monitor, and evaluate the implementation of a comparative effectiveness research program. The panel also urged HHS to establish large-scale clinical and administrative data networks to encourage better use of data gathered in day-to-day patient care. And the panel called on HHS to develop a plan for research workforce development that includes long-term funding for early career development.

The IOM recommendations appear to complement work done by another congressionally-mandated panel of experts. The Federal Coordinating Council for Comparative Effectiveness Research issued its report in June, which outlines a framework for spending comparative effectiveness research funding.

That panel concluded that the primary focus for HHS should be investing in data infrastructure that would link current data sources like patient registries. The group also recommended that funding be focused on the dissemination of research findings and research that focuses on “priority populations,” such as racial and ethnic minorities, individuals with disabilities, and individuals with multiple chronic health conditions.

The recommendations from both groups will be used by HHS Secretary Kathleen Sebelius to formulate a specific plan on how to spend the full $1.1 billion in comparative effectiveness research funds allocated by Congress. Under the Recovery Act, she was required to submit her plan to Congress by July 30.

A special panel convened by the Institute of Medicine has identified 100 areas ripe for study as part of a federal comparative effectiveness research program.

The panel called on the federal government to use new research funding to compare treatments for atrial fibrillation, strategies to prevent falls among the elderly, and methods to prevent and treat methicillin resistant Staphylococcus aureus (MRSA), among others. A complete list of the research topics is available online at www.iom.edu/cerpriorities

When Congress passed the American Recovery and Reinvestment Act earlier this year, it included $1.1 billion for comparative effectiveness research. It also instructed the IOM to recommend national priorities for spending a portion of that money—the $400 million that will be spent at the discretion of the Health and Human Services secretary. The work of the IOM panel was sponsored by HHS.

In selecting the initial priorities for research, the panel considered the total burden of illness, current gaps in the medical literature, and the potential for the research to actually change practice. The IOM panel suggested research questions that focus on comparing active treatments in patient populations that are typical of the types of patients seen in daily practice.

The panel also used cost as one of the criteria in determining which research topics would make its list. The panel did not discuss cost-effectiveness as a tool for decision-making, Dr. Harold C. Sox, co-chair of the IOM panel and outgoing editor of the Annals of Internal Medicine, said during a news conference.

In addition to identifying specific research areas that should be funded, the IOM panel recommended that HHS establish some type of federal infrastructure to select priority areas for comparative studies and carry out that research in the future.

“Priority setting needs to be a continuous process,” Dr. Sox said. “Gaps in the evidence will be filled as [comparative effectiveness] research is carried out and new technologies will come along that require careful evaluation in order to facilitate decision making about them.”

The IOM panel recommended that HHS set up an advisory body that would organize, monitor, and evaluate the implementation of a comparative effectiveness research program. The panel also urged HHS to establish large-scale clinical and administrative data networks to encourage better use of data gathered in day-to-day patient care. And the panel called on HHS to develop a plan for research workforce development that includes long-term funding for early career development.

The IOM recommendations appear to complement work done by another congressionally-mandated panel of experts. The Federal Coordinating Council for Comparative Effectiveness Research issued its report in June, which outlines a framework for spending comparative effectiveness research funding.

That panel concluded that the primary focus for HHS should be investing in data infrastructure that would link current data sources like patient registries. The group also recommended that funding be focused on the dissemination of research findings and research that focuses on “priority populations,” such as racial and ethnic minorities, individuals with disabilities, and individuals with multiple chronic health conditions.

The recommendations from both groups will be used by HHS Secretary Kathleen Sebelius to formulate a specific plan on how to spend the full $1.1 billion in comparative effectiveness research funds allocated by Congress. Under the Recovery Act, she was required to submit her plan to Congress by July 30.

Dermatologists could see a 3% increase in their Medicare payments next year, provided Congress steps in to stop a projected 21.5% across-the-board payment cut.

The estimates on reimbursement were part of the 2010 Medicare Physician Fee Schedule proposed rule, from the Centers for Medicare and Medicaid Services.

The proposal also includes increased pay for primary care physicians, decreased pay for some specialists, and a potential way to get rid of the sustainable growth rate formula. A final rule is expected in November.

Dermatologists could end up with a positive update mainly due to increases in the practice expense relative value units, which were recalculated based on new survey information.

But overall, the proposed fee schedule is not good for dermatologists or any specialist, said Dr. Brett Coldiron, of the department of dermatology at the University of Cincinnati and a member of the board of directors of the American Academy of Dermatology.

The main problem, he said, is the loss of consultation codes. Under the proposal, the CMS would eliminate the use of all consultation codes except telehealth codes starting Jan. 1. At the same time, the agency would increase the work relative value units for new and established office visits, increase the work values for initial hospital and initial nursing facility visits, and incorporate the increased use of these visits into the practice expense and malpractice relative value unit calculations.

“We believe the rationale for a different payment for a consultation service is no longer supported because documentation requirements are now similar across all [evaluation and management] E&M services,” the CMS wrote in the proposed rule.

The elimination of consultation codes will hurt academic dermatologists the most because they perform a lot of consults for patients with complex conditions, Dr. Coldiron said. “I think we ought to be supporting medical dermatology.”

The proposed rule is considered good news for primary care. For example, the proposed rule includes plans to increase payments for E&M services and increased payment for the Welcome to Medicare physical, which focuses on primary care, health promotion, and disease prevention.

The CMS estimates that the combination of the various proposals would mean a 6%-8% payment increase for primary care physicians, excluding the impact of the 21.5% cut.

Another major part of the proposal is a plan to remove physician-administered drugs from the sustainable growth rate (SGR)—the statutory formula used to set physician payment rates under Medicare. Physicians' organizations have sought the repeal of the SGR for many years saying that it is flawed and does not reflect the true cost of providing medical care. A major criticism of the formula is that it counts the price of physician-administered drugs, over which physicians have little control, as a physician service.

Since the SGR is designed to cut payments when health care expenditures rise above a certain target, the inclusion of drugs has caused physicians to exceed those targets more rapidly and has contributed to pay cuts over the years.

The removal of physician-administered drugs from the SGR should reduce the number of years that physicians see pay cuts, according to the CMS. And the American Medical Association is betting that the change will make it less expensive for Congress to repeal the SGR, which would also benefit physicians.

Even if enacted, the proposal will not stop the 21.5% pay cut slated to go into effect on Jan. 1, 2010. However, several physicians interviewed said they were hopeful that Congress would step in again this year to roll back this cut, whether through health reform legislation or in a separate bill.

The fee schedule proposal also includes policy changes related to imaging. The proposed rule would cut payments for certain high-cost imaging services by assuming that imaging equipment priced at more than $1 million is used 90% of the time, compared with the current assumption of use at 50%.

The proposed change is based on studies from the Medicare Payment Advisory Commission (MedPAC) showing that the use of high-cost imaging equipment is higher than previously thought.

For example, MedPAC found that in certain markets, MRIs were being used an average of about 46 hours a week, or 92% of a 50-hour workweek.

The agency said it will continue to examine the data for equipment valued at less than $1 million but is not proposing a change at this time.

Overall, the proposed fee schedule is not good for dermatologists or any specialist.

Source DR. COLDIRON

Dermatologists could see a 3% increase in their Medicare payments next year, provided Congress steps in to stop a projected 21.5% across-the-board payment cut.

The estimates on reimbursement were part of the 2010 Medicare Physician Fee Schedule proposed rule, from the Centers for Medicare and Medicaid Services.

The proposal also includes increased pay for primary care physicians, decreased pay for some specialists, and a potential way to get rid of the sustainable growth rate formula. A final rule is expected in November.

Dermatologists could end up with a positive update mainly due to increases in the practice expense relative value units, which were recalculated based on new survey information.

But overall, the proposed fee schedule is not good for dermatologists or any specialist, said Dr. Brett Coldiron, of the department of dermatology at the University of Cincinnati and a member of the board of directors of the American Academy of Dermatology.

The main problem, he said, is the loss of consultation codes. Under the proposal, the CMS would eliminate the use of all consultation codes except telehealth codes starting Jan. 1. At the same time, the agency would increase the work relative value units for new and established office visits, increase the work values for initial hospital and initial nursing facility visits, and incorporate the increased use of these visits into the practice expense and malpractice relative value unit calculations.

“We believe the rationale for a different payment for a consultation service is no longer supported because documentation requirements are now similar across all [evaluation and management] E&M services,” the CMS wrote in the proposed rule.

The elimination of consultation codes will hurt academic dermatologists the most because they perform a lot of consults for patients with complex conditions, Dr. Coldiron said. “I think we ought to be supporting medical dermatology.”

The proposed rule is considered good news for primary care. For example, the proposed rule includes plans to increase payments for E&M services and increased payment for the Welcome to Medicare physical, which focuses on primary care, health promotion, and disease prevention.

The CMS estimates that the combination of the various proposals would mean a 6%-8% payment increase for primary care physicians, excluding the impact of the 21.5% cut.

Another major part of the proposal is a plan to remove physician-administered drugs from the sustainable growth rate (SGR)—the statutory formula used to set physician payment rates under Medicare. Physicians' organizations have sought the repeal of the SGR for many years saying that it is flawed and does not reflect the true cost of providing medical care. A major criticism of the formula is that it counts the price of physician-administered drugs, over which physicians have little control, as a physician service.

Since the SGR is designed to cut payments when health care expenditures rise above a certain target, the inclusion of drugs has caused physicians to exceed those targets more rapidly and has contributed to pay cuts over the years.

The removal of physician-administered drugs from the SGR should reduce the number of years that physicians see pay cuts, according to the CMS. And the American Medical Association is betting that the change will make it less expensive for Congress to repeal the SGR, which would also benefit physicians.

Even if enacted, the proposal will not stop the 21.5% pay cut slated to go into effect on Jan. 1, 2010. However, several physicians interviewed said they were hopeful that Congress would step in again this year to roll back this cut, whether through health reform legislation or in a separate bill.

The fee schedule proposal also includes policy changes related to imaging. The proposed rule would cut payments for certain high-cost imaging services by assuming that imaging equipment priced at more than $1 million is used 90% of the time, compared with the current assumption of use at 50%.

The proposed change is based on studies from the Medicare Payment Advisory Commission (MedPAC) showing that the use of high-cost imaging equipment is higher than previously thought.

For example, MedPAC found that in certain markets, MRIs were being used an average of about 46 hours a week, or 92% of a 50-hour workweek.

The agency said it will continue to examine the data for equipment valued at less than $1 million but is not proposing a change at this time.

Overall, the proposed fee schedule is not good for dermatologists or any specialist.

Source DR. COLDIRON

Dermatologists could see a 3% increase in their Medicare payments next year, provided Congress steps in to stop a projected 21.5% across-the-board payment cut.

The estimates on reimbursement were part of the 2010 Medicare Physician Fee Schedule proposed rule, from the Centers for Medicare and Medicaid Services.

The proposal also includes increased pay for primary care physicians, decreased pay for some specialists, and a potential way to get rid of the sustainable growth rate formula. A final rule is expected in November.

Dermatologists could end up with a positive update mainly due to increases in the practice expense relative value units, which were recalculated based on new survey information.

But overall, the proposed fee schedule is not good for dermatologists or any specialist, said Dr. Brett Coldiron, of the department of dermatology at the University of Cincinnati and a member of the board of directors of the American Academy of Dermatology.

The main problem, he said, is the loss of consultation codes. Under the proposal, the CMS would eliminate the use of all consultation codes except telehealth codes starting Jan. 1. At the same time, the agency would increase the work relative value units for new and established office visits, increase the work values for initial hospital and initial nursing facility visits, and incorporate the increased use of these visits into the practice expense and malpractice relative value unit calculations.

“We believe the rationale for a different payment for a consultation service is no longer supported because documentation requirements are now similar across all [evaluation and management] E&M services,” the CMS wrote in the proposed rule.

The elimination of consultation codes will hurt academic dermatologists the most because they perform a lot of consults for patients with complex conditions, Dr. Coldiron said. “I think we ought to be supporting medical dermatology.”

The proposed rule is considered good news for primary care. For example, the proposed rule includes plans to increase payments for E&M services and increased payment for the Welcome to Medicare physical, which focuses on primary care, health promotion, and disease prevention.

The CMS estimates that the combination of the various proposals would mean a 6%-8% payment increase for primary care physicians, excluding the impact of the 21.5% cut.

Another major part of the proposal is a plan to remove physician-administered drugs from the sustainable growth rate (SGR)—the statutory formula used to set physician payment rates under Medicare. Physicians' organizations have sought the repeal of the SGR for many years saying that it is flawed and does not reflect the true cost of providing medical care. A major criticism of the formula is that it counts the price of physician-administered drugs, over which physicians have little control, as a physician service.

Since the SGR is designed to cut payments when health care expenditures rise above a certain target, the inclusion of drugs has caused physicians to exceed those targets more rapidly and has contributed to pay cuts over the years.

The removal of physician-administered drugs from the SGR should reduce the number of years that physicians see pay cuts, according to the CMS. And the American Medical Association is betting that the change will make it less expensive for Congress to repeal the SGR, which would also benefit physicians.

Even if enacted, the proposal will not stop the 21.5% pay cut slated to go into effect on Jan. 1, 2010. However, several physicians interviewed said they were hopeful that Congress would step in again this year to roll back this cut, whether through health reform legislation or in a separate bill.

The fee schedule proposal also includes policy changes related to imaging. The proposed rule would cut payments for certain high-cost imaging services by assuming that imaging equipment priced at more than $1 million is used 90% of the time, compared with the current assumption of use at 50%.

The proposed change is based on studies from the Medicare Payment Advisory Commission (MedPAC) showing that the use of high-cost imaging equipment is higher than previously thought.

For example, MedPAC found that in certain markets, MRIs were being used an average of about 46 hours a week, or 92% of a 50-hour workweek.

The agency said it will continue to examine the data for equipment valued at less than $1 million but is not proposing a change at this time.

Overall, the proposed fee schedule is not good for dermatologists or any specialist.

Source DR. COLDIRON