Mary Ellen Schneider

New patients wait about 28 days on average to get an appointment with an ob.gyn., according to a survey of wait times in 15 large cities.

A new patient seeking an appointment for a routine well-woman gynecologic exam could wait anywhere between 2.5 and 98.7 days, with an average wait time of 27.5 days. The survey, conducted by the national physician search firm Merritt Hawkins & Associates, polled 1,162 physician offices including 228 ob.gyn. practices. The survey also examined wait times for cardiologists, dermatologists, orthopedic surgeons, and family physicians. (See chart.)

The survey showed wide variation in wait times for new patient appointments both nationally and within cities. For example, the average wait for an ob.gyn. appointment in Boston was 70 days, compared with just 5 days in Minneapolis. But within Boston, the wait times for appointments ranged from 14 days to 200 days.

“Finding an available physician can be challenging today, even in large urban areas where most doctors practice,” said Mark Smith, president of Merritt Hawkins & Associates. Physician access may be even more of a problem in areas with fewer physicians, the report on the survey findings concluded.

From September 2008 through March 2009, researchers at Merritt Hawkins called physician offices in the 15 cities to schedule the first available appointment for a new patient with a nonemergent health need. The offices were selected at random through online searches.

The survey involved physician offices in Atlanta; Boston; Dallas; Denver; Detroit; Houston; Los Angeles; Miami; Minneapolis; New York; Philadelphia; Portland, Ore.; San Diego; Seattle; and Washington.

ELSEVIER GLOBAL MEDICAL NEWS

New patients wait about 28 days on average to get an appointment with an ob.gyn., according to a survey of wait times in 15 large cities.

A new patient seeking an appointment for a routine well-woman gynecologic exam could wait anywhere between 2.5 and 98.7 days, with an average wait time of 27.5 days. The survey, conducted by the national physician search firm Merritt Hawkins & Associates, polled 1,162 physician offices including 228 ob.gyn. practices. The survey also examined wait times for cardiologists, dermatologists, orthopedic surgeons, and family physicians. (See chart.)

The survey showed wide variation in wait times for new patient appointments both nationally and within cities. For example, the average wait for an ob.gyn. appointment in Boston was 70 days, compared with just 5 days in Minneapolis. But within Boston, the wait times for appointments ranged from 14 days to 200 days.

“Finding an available physician can be challenging today, even in large urban areas where most doctors practice,” said Mark Smith, president of Merritt Hawkins & Associates. Physician access may be even more of a problem in areas with fewer physicians, the report on the survey findings concluded.

From September 2008 through March 2009, researchers at Merritt Hawkins called physician offices in the 15 cities to schedule the first available appointment for a new patient with a nonemergent health need. The offices were selected at random through online searches.

The survey involved physician offices in Atlanta; Boston; Dallas; Denver; Detroit; Houston; Los Angeles; Miami; Minneapolis; New York; Philadelphia; Portland, Ore.; San Diego; Seattle; and Washington.

ELSEVIER GLOBAL MEDICAL NEWS

New patients wait about 28 days on average to get an appointment with an ob.gyn., according to a survey of wait times in 15 large cities.

A new patient seeking an appointment for a routine well-woman gynecologic exam could wait anywhere between 2.5 and 98.7 days, with an average wait time of 27.5 days. The survey, conducted by the national physician search firm Merritt Hawkins & Associates, polled 1,162 physician offices including 228 ob.gyn. practices. The survey also examined wait times for cardiologists, dermatologists, orthopedic surgeons, and family physicians. (See chart.)

The survey showed wide variation in wait times for new patient appointments both nationally and within cities. For example, the average wait for an ob.gyn. appointment in Boston was 70 days, compared with just 5 days in Minneapolis. But within Boston, the wait times for appointments ranged from 14 days to 200 days.

“Finding an available physician can be challenging today, even in large urban areas where most doctors practice,” said Mark Smith, president of Merritt Hawkins & Associates. Physician access may be even more of a problem in areas with fewer physicians, the report on the survey findings concluded.

From September 2008 through March 2009, researchers at Merritt Hawkins called physician offices in the 15 cities to schedule the first available appointment for a new patient with a nonemergent health need. The offices were selected at random through online searches.

The survey involved physician offices in Atlanta; Boston; Dallas; Denver; Detroit; Houston; Los Angeles; Miami; Minneapolis; New York; Philadelphia; Portland, Ore.; San Diego; Seattle; and Washington.

ELSEVIER GLOBAL MEDICAL NEWS

Nearly two-thirds of physicians receive additional pay for providing on-call emergency department services, according to a survey from the Medical Group Management Association.

The survey of more than 2,500 physicians and other health care providers found that 38% of respondents did not receive additional compensation for on-call coverage, while 62% received some type of added payment. Of those who received additional payment, the most common method of payment was a daily stipend.

This is the first year that MGMA has surveyed physicians and other health care providers about on-call compensation levels.

“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.”

For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day.

Also at the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

Among the specialists earning lower median daily rates for on-call compensation were family medicine without obstetrics ($300), ob.gyn. ($750), gastroenterology ($500), ophthalmology ($300), psychiatry ($500), and general surgery ($500), according to the MGMA survey data.

The survey also found that for most specialties, physicians working in multispecialty group practices received higher on-call compensation than those in single-specialty practices.

Regional pay variations also were seen. For example, orthopedic specialists received higher compensation in the East, while general surgeons were paid at a higher rate in the Midwest than other areas of the country.

Some of the regional variation is likely due to the medical malpractice climate in the state, said Crystal Taylor, MGMA assistant director of survey operations, adding that physicians also were likely to be paid more if they provided on-call duties in a trauma center.

But Michael Fleischman, a principal at the health care consulting firm Gates, Moore & Company, is skeptical of the MGMA survey findings. The survey, which included responses from more than 2,500 physicians, is too small to provide meaningful trend data, he said. “I just don't think the numbers are valid,” he said.

Mr. Fleischman, who works with physicians to negotiate pay for on-call coverage, said the hospital administration's willingness to pay for on-call ob.gyn. coverage generally depends on the supply of ob.gyns. in the area. In Atlanta, where he works, there is little opportunity for ob.gyns. to get paid for call. However, an ob.gyn. working in a rural area, where there may be physician supply issues, has much more leverage when seeking compensation, he said.

Other factors that influence whether a hospital will compensate physicians for on-call coverage include whether the ob.gyns. are at a higher risk of being sued when they take call, he said. For example, if they are performing a large number of deliveries for unassigned patients who haven't had prenatal care, they would have a stronger case to receive additional compensation.

The MGMA survey findings appear on target, said Dr. Robert W. Yelverton, chief medical officer of Women's Care Florida, a 100-physician ob.gyn. practice with offices in central Florida.

But whether a physician will be paid for on-call coverage and how much he or she will receive varies by region and by hospital, he said.

In the Tampa area, for example, some hospitals will pay ob.gyns. for on-call coverage if they don't have a laborist program in place or have a residency program.

For those hospitals that don't have in-house staff to handle call, many seem willing to consider paying for on-call coverage, he said.

“There seems to be gradual acceptance of this,” he noted.

The payment arrangement also varies by hospital and by region, with some contracting for a set amount, and others reimbursing for the hours spent on call, Dr. Yelverton said.

Nearly two-thirds of physicians receive additional pay for providing on-call emergency department services, according to a survey from the Medical Group Management Association.

The survey of more than 2,500 physicians and other health care providers found that 38% of respondents did not receive additional compensation for on-call coverage, while 62% received some type of added payment. Of those who received additional payment, the most common method of payment was a daily stipend.

This is the first year that MGMA has surveyed physicians and other health care providers about on-call compensation levels.

“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.”

For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day.

Also at the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

Among the specialists earning lower median daily rates for on-call compensation were family medicine without obstetrics ($300), ob.gyn. ($750), gastroenterology ($500), ophthalmology ($300), psychiatry ($500), and general surgery ($500), according to the MGMA survey data.

The survey also found that for most specialties, physicians working in multispecialty group practices received higher on-call compensation than those in single-specialty practices.

Regional pay variations also were seen. For example, orthopedic specialists received higher compensation in the East, while general surgeons were paid at a higher rate in the Midwest than other areas of the country.

Some of the regional variation is likely due to the medical malpractice climate in the state, said Crystal Taylor, MGMA assistant director of survey operations, adding that physicians also were likely to be paid more if they provided on-call duties in a trauma center.

But Michael Fleischman, a principal at the health care consulting firm Gates, Moore & Company, is skeptical of the MGMA survey findings. The survey, which included responses from more than 2,500 physicians, is too small to provide meaningful trend data, he said. “I just don't think the numbers are valid,” he said.

Mr. Fleischman, who works with physicians to negotiate pay for on-call coverage, said the hospital administration's willingness to pay for on-call ob.gyn. coverage generally depends on the supply of ob.gyns. in the area. In Atlanta, where he works, there is little opportunity for ob.gyns. to get paid for call. However, an ob.gyn. working in a rural area, where there may be physician supply issues, has much more leverage when seeking compensation, he said.

Other factors that influence whether a hospital will compensate physicians for on-call coverage include whether the ob.gyns. are at a higher risk of being sued when they take call, he said. For example, if they are performing a large number of deliveries for unassigned patients who haven't had prenatal care, they would have a stronger case to receive additional compensation.

The MGMA survey findings appear on target, said Dr. Robert W. Yelverton, chief medical officer of Women's Care Florida, a 100-physician ob.gyn. practice with offices in central Florida.

But whether a physician will be paid for on-call coverage and how much he or she will receive varies by region and by hospital, he said.

In the Tampa area, for example, some hospitals will pay ob.gyns. for on-call coverage if they don't have a laborist program in place or have a residency program.

For those hospitals that don't have in-house staff to handle call, many seem willing to consider paying for on-call coverage, he said.

“There seems to be gradual acceptance of this,” he noted.

The payment arrangement also varies by hospital and by region, with some contracting for a set amount, and others reimbursing for the hours spent on call, Dr. Yelverton said.

Nearly two-thirds of physicians receive additional pay for providing on-call emergency department services, according to a survey from the Medical Group Management Association.

The survey of more than 2,500 physicians and other health care providers found that 38% of respondents did not receive additional compensation for on-call coverage, while 62% received some type of added payment. Of those who received additional payment, the most common method of payment was a daily stipend.

This is the first year that MGMA has surveyed physicians and other health care providers about on-call compensation levels.

“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.”

For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day.

Also at the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

Among the specialists earning lower median daily rates for on-call compensation were family medicine without obstetrics ($300), ob.gyn. ($750), gastroenterology ($500), ophthalmology ($300), psychiatry ($500), and general surgery ($500), according to the MGMA survey data.

The survey also found that for most specialties, physicians working in multispecialty group practices received higher on-call compensation than those in single-specialty practices.

Regional pay variations also were seen. For example, orthopedic specialists received higher compensation in the East, while general surgeons were paid at a higher rate in the Midwest than other areas of the country.

Some of the regional variation is likely due to the medical malpractice climate in the state, said Crystal Taylor, MGMA assistant director of survey operations, adding that physicians also were likely to be paid more if they provided on-call duties in a trauma center.

But Michael Fleischman, a principal at the health care consulting firm Gates, Moore & Company, is skeptical of the MGMA survey findings. The survey, which included responses from more than 2,500 physicians, is too small to provide meaningful trend data, he said. “I just don't think the numbers are valid,” he said.

Mr. Fleischman, who works with physicians to negotiate pay for on-call coverage, said the hospital administration's willingness to pay for on-call ob.gyn. coverage generally depends on the supply of ob.gyns. in the area. In Atlanta, where he works, there is little opportunity for ob.gyns. to get paid for call. However, an ob.gyn. working in a rural area, where there may be physician supply issues, has much more leverage when seeking compensation, he said.

Other factors that influence whether a hospital will compensate physicians for on-call coverage include whether the ob.gyns. are at a higher risk of being sued when they take call, he said. For example, if they are performing a large number of deliveries for unassigned patients who haven't had prenatal care, they would have a stronger case to receive additional compensation.

The MGMA survey findings appear on target, said Dr. Robert W. Yelverton, chief medical officer of Women's Care Florida, a 100-physician ob.gyn. practice with offices in central Florida.

But whether a physician will be paid for on-call coverage and how much he or she will receive varies by region and by hospital, he said.

In the Tampa area, for example, some hospitals will pay ob.gyns. for on-call coverage if they don't have a laborist program in place or have a residency program.

For those hospitals that don't have in-house staff to handle call, many seem willing to consider paying for on-call coverage, he said.

“There seems to be gradual acceptance of this,” he noted.

The payment arrangement also varies by hospital and by region, with some contracting for a set amount, and others reimbursing for the hours spent on call, Dr. Yelverton said.

New Bill to Increase IVIG Access

Congress is seeking to expand access to intravenous immunoglobulin by allowing higher reimbursement through Medicare. The Medicare Patient IVIG Access Act (H.R. 2002) directs the Health and Human Services secretary to review pricing data from hospitals and physicians and to determine within 7 months whether an add-on payment is necessary. Current law requires Medicare to pay for all Part B drugs, including IVIG, using the average sales price methodology. However, outpatient facilities pay higher prices because they don't have access to the group discounts that are received by large hospital systems. As a result, physicians are sending patients to the hospital for IVIG treatment, because they cannot purchase IVIG at prices below Medicare payment amounts, according to the bill sponsors, Rep. Steve Israel (D-N.Y.), Rep. Kevin Brady (R-Tex.), and Rep. Allyson Schwartz (D-Pa.). Similar legislation was introduced in the Senate earlier this year (S. 701).

Funds for Rheumatic Research

The Obama administration's fiscal year 2010 budget request includes $531 million for the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about $6 million more than Congress budgeted this year. The FY 2010 funds would be used to continue the agency's support for pain research related to arthritis and rheumatic diseases. NIAMS will also be part of the administration's push to accelerate cancer research by doubling NIH-wide cancer research spending by 2017. NIAMS plans to support investigator-initiated research that focuses on the effects of anticancer therapies on bone quality and muscle strength, as well as the cellular mechanisms associated with autoimmune diseases and cancer.

Sharp Increase in Drug Spending

Spending on rheumatologic drugs rose more than 17% between 2007 and 2008, driven by increases in utilization and higher unit costs, according to Medco Health Solutions Inc. Their report tracks year-over-year increases in prescription spending among its clients. For example, use of adalimumab (Humira) was up following its approval for chronic plaque psoriasis and juvenile idiopathic arthritis in 2008 and for Crohn's disease in 2007. Use of etanercept (Enbrel) also increased in 2008, according to the report. However, overall drug spending growth was only 3.3% in 2008, kept low by the increased use of generic drugs. Generic drugs accounted for about 64% of all prescriptions dispensed by Medco clients in 2008, according to the report.

Imaging Penalties Proposed

In the first of a series of reports on potential health reform options issued by the Senate Finance Committee, the panel said it was proposing a “lower payment for ordering physicians who were determined to be outliers for inappropriate ordering” of imaging. According to the proposal, the Department of Health and Human Services would work with national groups to create appropriateness criteria for imaging services. The Senate committee also envisioned a monitoring system that would report how imaging is being used. Among many other options is the use of radiology benefit managers. In a written statement, the Access to Medical Imaging Coalition said that it endorsed the committee's plan to create and promote appropriateness criteria and a proposal to establish a network to give physicians access to patients' previous imaging studies. But the coalition said it “remains very concerned” about radiology benefit managers.

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because it is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. In 2017, the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. Premiums for Medicare Parts B and D are predicted to continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers who are considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Promo Items Influence Students

Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure.

New Bill to Increase IVIG Access

Congress is seeking to expand access to intravenous immunoglobulin by allowing higher reimbursement through Medicare. The Medicare Patient IVIG Access Act (H.R. 2002) directs the Health and Human Services secretary to review pricing data from hospitals and physicians and to determine within 7 months whether an add-on payment is necessary. Current law requires Medicare to pay for all Part B drugs, including IVIG, using the average sales price methodology. However, outpatient facilities pay higher prices because they don't have access to the group discounts that are received by large hospital systems. As a result, physicians are sending patients to the hospital for IVIG treatment, because they cannot purchase IVIG at prices below Medicare payment amounts, according to the bill sponsors, Rep. Steve Israel (D-N.Y.), Rep. Kevin Brady (R-Tex.), and Rep. Allyson Schwartz (D-Pa.). Similar legislation was introduced in the Senate earlier this year (S. 701).

Funds for Rheumatic Research

The Obama administration's fiscal year 2010 budget request includes $531 million for the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about $6 million more than Congress budgeted this year. The FY 2010 funds would be used to continue the agency's support for pain research related to arthritis and rheumatic diseases. NIAMS will also be part of the administration's push to accelerate cancer research by doubling NIH-wide cancer research spending by 2017. NIAMS plans to support investigator-initiated research that focuses on the effects of anticancer therapies on bone quality and muscle strength, as well as the cellular mechanisms associated with autoimmune diseases and cancer.

Sharp Increase in Drug Spending

Spending on rheumatologic drugs rose more than 17% between 2007 and 2008, driven by increases in utilization and higher unit costs, according to Medco Health Solutions Inc. Their report tracks year-over-year increases in prescription spending among its clients. For example, use of adalimumab (Humira) was up following its approval for chronic plaque psoriasis and juvenile idiopathic arthritis in 2008 and for Crohn's disease in 2007. Use of etanercept (Enbrel) also increased in 2008, according to the report. However, overall drug spending growth was only 3.3% in 2008, kept low by the increased use of generic drugs. Generic drugs accounted for about 64% of all prescriptions dispensed by Medco clients in 2008, according to the report.

Imaging Penalties Proposed

In the first of a series of reports on potential health reform options issued by the Senate Finance Committee, the panel said it was proposing a “lower payment for ordering physicians who were determined to be outliers for inappropriate ordering” of imaging. According to the proposal, the Department of Health and Human Services would work with national groups to create appropriateness criteria for imaging services. The Senate committee also envisioned a monitoring system that would report how imaging is being used. Among many other options is the use of radiology benefit managers. In a written statement, the Access to Medical Imaging Coalition said that it endorsed the committee's plan to create and promote appropriateness criteria and a proposal to establish a network to give physicians access to patients' previous imaging studies. But the coalition said it “remains very concerned” about radiology benefit managers.

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because it is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. In 2017, the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. Premiums for Medicare Parts B and D are predicted to continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers who are considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Promo Items Influence Students

Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure.

New Bill to Increase IVIG Access

Congress is seeking to expand access to intravenous immunoglobulin by allowing higher reimbursement through Medicare. The Medicare Patient IVIG Access Act (H.R. 2002) directs the Health and Human Services secretary to review pricing data from hospitals and physicians and to determine within 7 months whether an add-on payment is necessary. Current law requires Medicare to pay for all Part B drugs, including IVIG, using the average sales price methodology. However, outpatient facilities pay higher prices because they don't have access to the group discounts that are received by large hospital systems. As a result, physicians are sending patients to the hospital for IVIG treatment, because they cannot purchase IVIG at prices below Medicare payment amounts, according to the bill sponsors, Rep. Steve Israel (D-N.Y.), Rep. Kevin Brady (R-Tex.), and Rep. Allyson Schwartz (D-Pa.). Similar legislation was introduced in the Senate earlier this year (S. 701).

Funds for Rheumatic Research

The Obama administration's fiscal year 2010 budget request includes $531 million for the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about $6 million more than Congress budgeted this year. The FY 2010 funds would be used to continue the agency's support for pain research related to arthritis and rheumatic diseases. NIAMS will also be part of the administration's push to accelerate cancer research by doubling NIH-wide cancer research spending by 2017. NIAMS plans to support investigator-initiated research that focuses on the effects of anticancer therapies on bone quality and muscle strength, as well as the cellular mechanisms associated with autoimmune diseases and cancer.

Sharp Increase in Drug Spending

Spending on rheumatologic drugs rose more than 17% between 2007 and 2008, driven by increases in utilization and higher unit costs, according to Medco Health Solutions Inc. Their report tracks year-over-year increases in prescription spending among its clients. For example, use of adalimumab (Humira) was up following its approval for chronic plaque psoriasis and juvenile idiopathic arthritis in 2008 and for Crohn's disease in 2007. Use of etanercept (Enbrel) also increased in 2008, according to the report. However, overall drug spending growth was only 3.3% in 2008, kept low by the increased use of generic drugs. Generic drugs accounted for about 64% of all prescriptions dispensed by Medco clients in 2008, according to the report.

Imaging Penalties Proposed

In the first of a series of reports on potential health reform options issued by the Senate Finance Committee, the panel said it was proposing a “lower payment for ordering physicians who were determined to be outliers for inappropriate ordering” of imaging. According to the proposal, the Department of Health and Human Services would work with national groups to create appropriateness criteria for imaging services. The Senate committee also envisioned a monitoring system that would report how imaging is being used. Among many other options is the use of radiology benefit managers. In a written statement, the Access to Medical Imaging Coalition said that it endorsed the committee's plan to create and promote appropriateness criteria and a proposal to establish a network to give physicians access to patients' previous imaging studies. But the coalition said it “remains very concerned” about radiology benefit managers.

Part A to Go Broke in 2017

The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because it is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. In 2017, the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. Premiums for Medicare Parts B and D are predicted to continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers who are considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”

Promo Items Influence Students

Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure.

The Obama administration plans to finance a portion of its health care reform plan through changes to the Medicare and Medicaid programs, including the bundling of payments for inpatient and postacute care.

The new details were provided as part of the administration's fiscal year 2010 budget request sent to Congress. President Obama had released the highlights of his budget plans back in February but had not provided specifics on his legislative and regulatory proposals.

The centerpiece of the detailed budget proposal is health care reform. The budget would establish a “reserve fund” of about $635 billion over 10 years to finance at least part of the comprehensive health reform efforts, which would come from new revenue resulting from tax changes, as well as from savings within the Medicare and Medicaid programs.

“This budget sends a clear message that we can't afford to wait any longer if we want to get health care costs under control and improve our fiscal outlook,” said Kathleen Sebelius, secretary of Health and Human Services. The Obama administration proposes to trim $287.5 billion from Medicare over 10 years, with $520 million in savings coming in FY 2010. The budget proposal also counts $22 billion in savings over 10 years from the Medicaid program, with $1.5 billion in savings being realized in FY 2010.

Among the legislative proposals that would contribute to those savings is a plan to tie a portion of hospital Medicare payments to performance on quality measures starting in 2011. The administration also is proposing to cut payments to hospitals with high readmission rates starting in 2012. The budget proposal seeks to allow physicians to form voluntary groups to coordinate care for Medicare beneficiaries. Those groups would be eligible to receive bonus payments from Medicare if they improved the quality of care and produced savings.

The administration hopes to begin bundling Medicare payments for inpatient hospital services and postacute care within 30 days of discharge, beginning in 2013. Savings would also be generated, according to the administration, by a new competitive bidding system for Medicare Advantage plans. Under such a system, payments to Medicare Advantage plans would be based on the average of plan bids submitted to Medicare. This type of market-based system would reduce costs, they say.

The FY 2010 budget lacks a fix for the Medicare physician payment system, which is set to make significant cuts to physician payments in January 2010. However, the budget document includes support for changing the payment formula, including assessing whether physician-administered drugs should be covered under the payment formula.

The administration is planning to invest $1 billion into health care workforce initiatives including expanding loan repayment and scholarship programs for physicians, nurses, and dentists who work in underserved areas.

The administration asserted its commitment to lowering drug costs with a policy proposal in the Food and Drug Administration budget to create a regulatory pathway for the approval of generic biologics. Under this pathway, innovative products would be given a period of exclusivity. However, brand name manufacturers would be barred from reformulating existing products into new products in order to restart the exclusivity process. The FDA budget includes $5 million to explore ways for Americans to safely import drugs from other countries.

We can't afford to wait any longer if we want to control health care costs and improve the fiscal outlook. MS. SEBELIUS

The FY 2010 budget documents are available online at www.hhs.gov/asrt/ob/docbudget/index.html

The Obama administration plans to finance a portion of its health care reform plan through changes to the Medicare and Medicaid programs, including the bundling of payments for inpatient and postacute care.

The new details were provided as part of the administration's fiscal year 2010 budget request sent to Congress. President Obama had released the highlights of his budget plans back in February but had not provided specifics on his legislative and regulatory proposals.

The centerpiece of the detailed budget proposal is health care reform. The budget would establish a “reserve fund” of about $635 billion over 10 years to finance at least part of the comprehensive health reform efforts, which would come from new revenue resulting from tax changes, as well as from savings within the Medicare and Medicaid programs.

“This budget sends a clear message that we can't afford to wait any longer if we want to get health care costs under control and improve our fiscal outlook,” said Kathleen Sebelius, secretary of Health and Human Services. The Obama administration proposes to trim $287.5 billion from Medicare over 10 years, with $520 million in savings coming in FY 2010. The budget proposal also counts $22 billion in savings over 10 years from the Medicaid program, with $1.5 billion in savings being realized in FY 2010.

Among the legislative proposals that would contribute to those savings is a plan to tie a portion of hospital Medicare payments to performance on quality measures starting in 2011. The administration also is proposing to cut payments to hospitals with high readmission rates starting in 2012. The budget proposal seeks to allow physicians to form voluntary groups to coordinate care for Medicare beneficiaries. Those groups would be eligible to receive bonus payments from Medicare if they improved the quality of care and produced savings.

The administration hopes to begin bundling Medicare payments for inpatient hospital services and postacute care within 30 days of discharge, beginning in 2013. Savings would also be generated, according to the administration, by a new competitive bidding system for Medicare Advantage plans. Under such a system, payments to Medicare Advantage plans would be based on the average of plan bids submitted to Medicare. This type of market-based system would reduce costs, they say.

The FY 2010 budget lacks a fix for the Medicare physician payment system, which is set to make significant cuts to physician payments in January 2010. However, the budget document includes support for changing the payment formula, including assessing whether physician-administered drugs should be covered under the payment formula.

The administration is planning to invest $1 billion into health care workforce initiatives including expanding loan repayment and scholarship programs for physicians, nurses, and dentists who work in underserved areas.

The administration asserted its commitment to lowering drug costs with a policy proposal in the Food and Drug Administration budget to create a regulatory pathway for the approval of generic biologics. Under this pathway, innovative products would be given a period of exclusivity. However, brand name manufacturers would be barred from reformulating existing products into new products in order to restart the exclusivity process. The FDA budget includes $5 million to explore ways for Americans to safely import drugs from other countries.

We can't afford to wait any longer if we want to control health care costs and improve the fiscal outlook. MS. SEBELIUS

The FY 2010 budget documents are available online at www.hhs.gov/asrt/ob/docbudget/index.html

The Obama administration plans to finance a portion of its health care reform plan through changes to the Medicare and Medicaid programs, including the bundling of payments for inpatient and postacute care.

The new details were provided as part of the administration's fiscal year 2010 budget request sent to Congress. President Obama had released the highlights of his budget plans back in February but had not provided specifics on his legislative and regulatory proposals.

The centerpiece of the detailed budget proposal is health care reform. The budget would establish a “reserve fund” of about $635 billion over 10 years to finance at least part of the comprehensive health reform efforts, which would come from new revenue resulting from tax changes, as well as from savings within the Medicare and Medicaid programs.

“This budget sends a clear message that we can't afford to wait any longer if we want to get health care costs under control and improve our fiscal outlook,” said Kathleen Sebelius, secretary of Health and Human Services. The Obama administration proposes to trim $287.5 billion from Medicare over 10 years, with $520 million in savings coming in FY 2010. The budget proposal also counts $22 billion in savings over 10 years from the Medicaid program, with $1.5 billion in savings being realized in FY 2010.

Among the legislative proposals that would contribute to those savings is a plan to tie a portion of hospital Medicare payments to performance on quality measures starting in 2011. The administration also is proposing to cut payments to hospitals with high readmission rates starting in 2012. The budget proposal seeks to allow physicians to form voluntary groups to coordinate care for Medicare beneficiaries. Those groups would be eligible to receive bonus payments from Medicare if they improved the quality of care and produced savings.

The administration hopes to begin bundling Medicare payments for inpatient hospital services and postacute care within 30 days of discharge, beginning in 2013. Savings would also be generated, according to the administration, by a new competitive bidding system for Medicare Advantage plans. Under such a system, payments to Medicare Advantage plans would be based on the average of plan bids submitted to Medicare. This type of market-based system would reduce costs, they say.

The FY 2010 budget lacks a fix for the Medicare physician payment system, which is set to make significant cuts to physician payments in January 2010. However, the budget document includes support for changing the payment formula, including assessing whether physician-administered drugs should be covered under the payment formula.

The administration is planning to invest $1 billion into health care workforce initiatives including expanding loan repayment and scholarship programs for physicians, nurses, and dentists who work in underserved areas.

The administration asserted its commitment to lowering drug costs with a policy proposal in the Food and Drug Administration budget to create a regulatory pathway for the approval of generic biologics. Under this pathway, innovative products would be given a period of exclusivity. However, brand name manufacturers would be barred from reformulating existing products into new products in order to restart the exclusivity process. The FDA budget includes $5 million to explore ways for Americans to safely import drugs from other countries.

We can't afford to wait any longer if we want to control health care costs and improve the fiscal outlook. MS. SEBELIUS

The FY 2010 budget documents are available online at www.hhs.gov/asrt/ob/docbudget/index.html

The health reform package being crafted in Congress could include Medicare payment bonuses to primary care physicians and general surgeons, according to policy options released by leaders of the Senate Finance Committee.

The 52-page paper is a first look at the proposals on the table in this year's health reform debate. But these proposals are just a starting point, according to Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, and Sen. Chuck Grassley (R-Iowa), the committee's ranking member. They said they will be seeking comment from the public and other members of Congress before developing more concrete proposals.

Among the options under consideration is a proposal to boost payment to primary care physicians and general surgeons working in certain rural areas. Under the proposal, these physicians would receive a Medicare payment bonus of at least 5% for 5 years. But since the proposal is budget neutral, at least part of the funding would come from an across-the-board payment cut for other non-primary care services, according to the Senate Finance Committee document.

The Finance Committee's policy paper also includes a proposal to bundle payments for acute hospital care and post-acute services. Under that proposal, Medicare would begin in October 2014 to provide a single, bundled payment for acute hospital services and post-acute services that occur within 30 days of discharge. The post-acute payments affected by the proposal would be those made to home health care, skilled nursing facilities, rehabilitation hospitals, and long-term care hospital services. Under the proposal, the bundled payment would be phased in starting with conditions that account for the top 20% of post-acute spending.

The paper also includes proposals to expand the Medicare pay for the Physician Quality Reporting Initiative (PQRI). Under the policy proposals being considered, physicians involved in the program would also be eligible to earn bonus payments for participating in a qualified Maintenance of Certification program and a related practice assessment.

The policy options paper is the first of three sets of such documents that will be released before the committee's markup of comprehensive health reform legislation this summer.

The health reform package being crafted in Congress could include Medicare payment bonuses to primary care physicians and general surgeons, according to policy options released by leaders of the Senate Finance Committee.

The 52-page paper is a first look at the proposals on the table in this year's health reform debate. But these proposals are just a starting point, according to Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, and Sen. Chuck Grassley (R-Iowa), the committee's ranking member. They said they will be seeking comment from the public and other members of Congress before developing more concrete proposals.

Among the options under consideration is a proposal to boost payment to primary care physicians and general surgeons working in certain rural areas. Under the proposal, these physicians would receive a Medicare payment bonus of at least 5% for 5 years. But since the proposal is budget neutral, at least part of the funding would come from an across-the-board payment cut for other non-primary care services, according to the Senate Finance Committee document.

The Finance Committee's policy paper also includes a proposal to bundle payments for acute hospital care and post-acute services. Under that proposal, Medicare would begin in October 2014 to provide a single, bundled payment for acute hospital services and post-acute services that occur within 30 days of discharge. The post-acute payments affected by the proposal would be those made to home health care, skilled nursing facilities, rehabilitation hospitals, and long-term care hospital services. Under the proposal, the bundled payment would be phased in starting with conditions that account for the top 20% of post-acute spending.

The paper also includes proposals to expand the Medicare pay for the Physician Quality Reporting Initiative (PQRI). Under the policy proposals being considered, physicians involved in the program would also be eligible to earn bonus payments for participating in a qualified Maintenance of Certification program and a related practice assessment.

The policy options paper is the first of three sets of such documents that will be released before the committee's markup of comprehensive health reform legislation this summer.

The health reform package being crafted in Congress could include Medicare payment bonuses to primary care physicians and general surgeons, according to policy options released by leaders of the Senate Finance Committee.

The 52-page paper is a first look at the proposals on the table in this year's health reform debate. But these proposals are just a starting point, according to Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, and Sen. Chuck Grassley (R-Iowa), the committee's ranking member. They said they will be seeking comment from the public and other members of Congress before developing more concrete proposals.

Among the options under consideration is a proposal to boost payment to primary care physicians and general surgeons working in certain rural areas. Under the proposal, these physicians would receive a Medicare payment bonus of at least 5% for 5 years. But since the proposal is budget neutral, at least part of the funding would come from an across-the-board payment cut for other non-primary care services, according to the Senate Finance Committee document.

The Finance Committee's policy paper also includes a proposal to bundle payments for acute hospital care and post-acute services. Under that proposal, Medicare would begin in October 2014 to provide a single, bundled payment for acute hospital services and post-acute services that occur within 30 days of discharge. The post-acute payments affected by the proposal would be those made to home health care, skilled nursing facilities, rehabilitation hospitals, and long-term care hospital services. Under the proposal, the bundled payment would be phased in starting with conditions that account for the top 20% of post-acute spending.

The paper also includes proposals to expand the Medicare pay for the Physician Quality Reporting Initiative (PQRI). Under the policy proposals being considered, physicians involved in the program would also be eligible to earn bonus payments for participating in a qualified Maintenance of Certification program and a related practice assessment.

The policy options paper is the first of three sets of such documents that will be released before the committee's markup of comprehensive health reform legislation this summer.

In less than 5 years, physicians and other health care providers will be required to begin using a new system of code sets to report health care diagnoses and procedures.

Under a final rule published in the Federal Register, the Health and Human Services department is replacing the International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) code sets now used with a significantly expanded ICD-10 code sets. Providers and health plans will have until Oct. 1, 2013, to implement the new code sets.

In addition, HHS also issued a final rule adopting new standards for certain electronic health care transactions. The rule requires health care providers to come into compliance with the updated X12 standard, Version 5010, which includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Use of the updated standard is necessary to use the ICD-10 code sets, according to HHS. Providers and health plans must be in compliance with the updated transaction standard by Jan. 1, 2012.

At press time, the Obama administration was in the process of reviewing and approving all new and pending regulations written under the previous administration, including the ICD-10 rules. However, a spokesman for the Centers for Medicare and Medicaid Services said that until the review is complete, it is not possible to determine which regulations are affected.

The move to the new code sets was necessary, according to HHS, to replace the outdated ICD-9 code sets. The ICD-9-CM contains about 17,000 codes, compared with 155,000 codes in the ICD-10 code sets.

The final rule gives health care providers and plans almost 2 extra years to implement the Version 5010 transaction standard and a full 2 years to switch to ICD-10, compared with the timeline originally proposed last year. HHS officials said they decided to allow extra time for implementation in response to concerns that a short implementation phase would result in high implementation costs and inadequate time for training and testing.

Physician groups praised HHS for providing additional time for implementation but said other issues persist.

Officials at the American College of Physicians said that they believe that the benefits of switching to the ICD-10 code sets in the ambulatory setting do not outweigh the collective costs, said Brett Baker, director of regulatory affairs. The costs and administrative burdens related to adopting ICD-10 could slow adoption of health information technology and make it more difficult for physicians to engage in quality improvement efforts, according to ACP.

ACP is urging the Department of Health and Human Services to explore alternatives to the implementation plan outlined in the final rule. For example, the department could delay implementation of ICD-10 in the outpatient setting until a certain percentage of physicians adopted interoperable electronic health record systems.

Since electronic health records would ease the adoption burden for physicians, it makes sense to wait until adoption of health information technology reaches a certain threshold point, Mr. Baker said.

The Medical Group Management Association also expressed concern that physician practices will struggle to implement the new code sets. The association is calling on the federal government to develop some type of implementation assistance program to help physicians, especially those in small practices and rural communities.

If the value to the health system is as significant as HHS estimates, government officials should be prepared to invest that savings early on to ensure implementation runs smoothly, said Robert Tennant, senior policy advisor at MGMA.

HHS also should extend its outreach to the vendor community, Mr. Tennant said, since they will be the ones to provide updates to the practice management software. HHS also needs to work with private health plans to ensure there is no disruption in payments. For their part, Mr. Tennant advised physician practices to get started by becoming familiar with the requirements and the compliance dates.

Next, reach out to vendors of practice management software and find out their plans for updating the software, including the timeline and costs. With that information in hand, practices can formulate a budget for implementation that includes training and testing, he said.

In less than 5 years, physicians and other health care providers will be required to begin using a new system of code sets to report health care diagnoses and procedures.

Under a final rule published in the Federal Register, the Health and Human Services department is replacing the International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) code sets now used with a significantly expanded ICD-10 code sets. Providers and health plans will have until Oct. 1, 2013, to implement the new code sets.

In addition, HHS also issued a final rule adopting new standards for certain electronic health care transactions. The rule requires health care providers to come into compliance with the updated X12 standard, Version 5010, which includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Use of the updated standard is necessary to use the ICD-10 code sets, according to HHS. Providers and health plans must be in compliance with the updated transaction standard by Jan. 1, 2012.

At press time, the Obama administration was in the process of reviewing and approving all new and pending regulations written under the previous administration, including the ICD-10 rules. However, a spokesman for the Centers for Medicare and Medicaid Services said that until the review is complete, it is not possible to determine which regulations are affected.

The move to the new code sets was necessary, according to HHS, to replace the outdated ICD-9 code sets. The ICD-9-CM contains about 17,000 codes, compared with 155,000 codes in the ICD-10 code sets.

The final rule gives health care providers and plans almost 2 extra years to implement the Version 5010 transaction standard and a full 2 years to switch to ICD-10, compared with the timeline originally proposed last year. HHS officials said they decided to allow extra time for implementation in response to concerns that a short implementation phase would result in high implementation costs and inadequate time for training and testing.

Physician groups praised HHS for providing additional time for implementation but said other issues persist.

Officials at the American College of Physicians said that they believe that the benefits of switching to the ICD-10 code sets in the ambulatory setting do not outweigh the collective costs, said Brett Baker, director of regulatory affairs. The costs and administrative burdens related to adopting ICD-10 could slow adoption of health information technology and make it more difficult for physicians to engage in quality improvement efforts, according to ACP.

ACP is urging the Department of Health and Human Services to explore alternatives to the implementation plan outlined in the final rule. For example, the department could delay implementation of ICD-10 in the outpatient setting until a certain percentage of physicians adopted interoperable electronic health record systems.

Since electronic health records would ease the adoption burden for physicians, it makes sense to wait until adoption of health information technology reaches a certain threshold point, Mr. Baker said.

The Medical Group Management Association also expressed concern that physician practices will struggle to implement the new code sets. The association is calling on the federal government to develop some type of implementation assistance program to help physicians, especially those in small practices and rural communities.

If the value to the health system is as significant as HHS estimates, government officials should be prepared to invest that savings early on to ensure implementation runs smoothly, said Robert Tennant, senior policy advisor at MGMA.

HHS also should extend its outreach to the vendor community, Mr. Tennant said, since they will be the ones to provide updates to the practice management software. HHS also needs to work with private health plans to ensure there is no disruption in payments. For their part, Mr. Tennant advised physician practices to get started by becoming familiar with the requirements and the compliance dates.

Next, reach out to vendors of practice management software and find out their plans for updating the software, including the timeline and costs. With that information in hand, practices can formulate a budget for implementation that includes training and testing, he said.

In less than 5 years, physicians and other health care providers will be required to begin using a new system of code sets to report health care diagnoses and procedures.

Under a final rule published in the Federal Register, the Health and Human Services department is replacing the International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) code sets now used with a significantly expanded ICD-10 code sets. Providers and health plans will have until Oct. 1, 2013, to implement the new code sets.

In addition, HHS also issued a final rule adopting new standards for certain electronic health care transactions. The rule requires health care providers to come into compliance with the updated X12 standard, Version 5010, which includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Use of the updated standard is necessary to use the ICD-10 code sets, according to HHS. Providers and health plans must be in compliance with the updated transaction standard by Jan. 1, 2012.

At press time, the Obama administration was in the process of reviewing and approving all new and pending regulations written under the previous administration, including the ICD-10 rules. However, a spokesman for the Centers for Medicare and Medicaid Services said that until the review is complete, it is not possible to determine which regulations are affected.

The move to the new code sets was necessary, according to HHS, to replace the outdated ICD-9 code sets. The ICD-9-CM contains about 17,000 codes, compared with 155,000 codes in the ICD-10 code sets.

The final rule gives health care providers and plans almost 2 extra years to implement the Version 5010 transaction standard and a full 2 years to switch to ICD-10, compared with the timeline originally proposed last year. HHS officials said they decided to allow extra time for implementation in response to concerns that a short implementation phase would result in high implementation costs and inadequate time for training and testing.

Physician groups praised HHS for providing additional time for implementation but said other issues persist.

Officials at the American College of Physicians said that they believe that the benefits of switching to the ICD-10 code sets in the ambulatory setting do not outweigh the collective costs, said Brett Baker, director of regulatory affairs. The costs and administrative burdens related to adopting ICD-10 could slow adoption of health information technology and make it more difficult for physicians to engage in quality improvement efforts, according to ACP.

ACP is urging the Department of Health and Human Services to explore alternatives to the implementation plan outlined in the final rule. For example, the department could delay implementation of ICD-10 in the outpatient setting until a certain percentage of physicians adopted interoperable electronic health record systems.

Since electronic health records would ease the adoption burden for physicians, it makes sense to wait until adoption of health information technology reaches a certain threshold point, Mr. Baker said.

The Medical Group Management Association also expressed concern that physician practices will struggle to implement the new code sets. The association is calling on the federal government to develop some type of implementation assistance program to help physicians, especially those in small practices and rural communities.

If the value to the health system is as significant as HHS estimates, government officials should be prepared to invest that savings early on to ensure implementation runs smoothly, said Robert Tennant, senior policy advisor at MGMA.

HHS also should extend its outreach to the vendor community, Mr. Tennant said, since they will be the ones to provide updates to the practice management software. HHS also needs to work with private health plans to ensure there is no disruption in payments. For their part, Mr. Tennant advised physician practices to get started by becoming familiar with the requirements and the compliance dates.

Next, reach out to vendors of practice management software and find out their plans for updating the software, including the timeline and costs. With that information in hand, practices can formulate a budget for implementation that includes training and testing, he said.

The controversial Medicare Recovery Audit Contractor program is continuing as planned after federal officials cleared up some contracting disputes.

The rollout of the permanent, national Recovery Audit Contractor (RAC) program is proceeding, with the full implementation of the program expected across the country by Jan. 1, 2010.

Under the program, Medicare contracts with private companies to identify and correct improper payments made through the Medicare fee-for-service program. The contractors will be paid on a contingency fee basis for both the over- and underpayments that they identify.

During its demonstration phase, the RAC program came under fire from physician testers who said it placed the burden on physicians to prove that payments they received were correct.

Last November, officials at the Centers for Medicare and Medicaid Services imposed an automatic stay on the program due to protests filed by two contractors who bid unsuccessfully to be part of the program. Under federal statute, the disputes were reviewed by the Government Accountability Office and a decision was issued earlier this year. As part of the settlement, two subcontractors have been retained to work with the four RACs announced last October.

With the RAC program back on track, the CMS will resume provider outreach activities over the next few months.

The demonstration resulted in the return of more than $900 million in overpayments between 2005 and 2008 and nearly $38 million in underpayments, according to the CMS.

The controversial Medicare Recovery Audit Contractor program is continuing as planned after federal officials cleared up some contracting disputes.

The rollout of the permanent, national Recovery Audit Contractor (RAC) program is proceeding, with the full implementation of the program expected across the country by Jan. 1, 2010.

Under the program, Medicare contracts with private companies to identify and correct improper payments made through the Medicare fee-for-service program. The contractors will be paid on a contingency fee basis for both the over- and underpayments that they identify.

During its demonstration phase, the RAC program came under fire from physician testers who said it placed the burden on physicians to prove that payments they received were correct.

Last November, officials at the Centers for Medicare and Medicaid Services imposed an automatic stay on the program due to protests filed by two contractors who bid unsuccessfully to be part of the program. Under federal statute, the disputes were reviewed by the Government Accountability Office and a decision was issued earlier this year. As part of the settlement, two subcontractors have been retained to work with the four RACs announced last October.

With the RAC program back on track, the CMS will resume provider outreach activities over the next few months.

The demonstration resulted in the return of more than $900 million in overpayments between 2005 and 2008 and nearly $38 million in underpayments, according to the CMS.

The controversial Medicare Recovery Audit Contractor program is continuing as planned after federal officials cleared up some contracting disputes.

The rollout of the permanent, national Recovery Audit Contractor (RAC) program is proceeding, with the full implementation of the program expected across the country by Jan. 1, 2010.

Under the program, Medicare contracts with private companies to identify and correct improper payments made through the Medicare fee-for-service program. The contractors will be paid on a contingency fee basis for both the over- and underpayments that they identify.

During its demonstration phase, the RAC program came under fire from physician testers who said it placed the burden on physicians to prove that payments they received were correct.

Last November, officials at the Centers for Medicare and Medicaid Services imposed an automatic stay on the program due to protests filed by two contractors who bid unsuccessfully to be part of the program. Under federal statute, the disputes were reviewed by the Government Accountability Office and a decision was issued earlier this year. As part of the settlement, two subcontractors have been retained to work with the four RACs announced last October.

With the RAC program back on track, the CMS will resume provider outreach activities over the next few months.

The demonstration resulted in the return of more than $900 million in overpayments between 2005 and 2008 and nearly $38 million in underpayments, according to the CMS.

Over the last decade, hospitals have increasingly come to rely on the unique skill set offered by hospitalists.

But the University of California at Irvine has gone even further. For the past year, Dr. Alpesh Amin, founder and executive director of the university's hospitalist program, has also served as the interim chair of the department of medicine.

Dr. Amin is the first and only hospitalist to head a department of medicine at an academic medical center. The promotion, from his previous post as vice chair for clinical affairs and quality, puts him in the upper echelon of hospital and medical school leaders. And Dr. Amin said he thinks it's good for hospitalists all around.

“The message that this puts out there is that hospitalists over time can be important leaders in the institution,” he said.

Since taking on this new role in June 2008, Dr. Amin has been busy on several fronts. He oversees 11 divisions across three hospital sites and is responsible for the clinical, educational, research, and administrative missions within the department of medicine.

He is also using his perspective as a hospitalist to improve his department. On the clinical side, Dr. Amin and his colleagues have been seeking a greater alignment of services and units. They have also been working to increase collaboration among the faculty of various medical subspecialties. And on the research side, Dr. Amin has been trying to ramp up mentorship of junior faculty and aid them in pursuing grant opportunities.

“Hospitalists tend to look at things more broadly because of the nature of the work that they do,” he said. Hospitalists are in contact with virtually every member of the care team. In caring for patients, hospitalists often interact with subspecialists, surgeons, and primary care physicians who practice in the community. Hospitalists also work with pharmacists, case managers, social workers, and hospital administrators.

Hospitalists are “kind of the quarterback of the process,” Dr. Amin said.

Dr. Amin may be the only hospitalist serving this role in academia today, but that is likely to change, he said. One reason that hospitalists have not been the first choice for leadership roles in departments of medicine is that the specialty just hasn't been around that long. But as the field matures, hospitalists could be ideally positioned to help institutions face future challenges, he said.

Medical centers, both in academia and in the community, are under increasing pressure in terms of quality of care, throughput, and systems-based practice—all areas where hospitalists bring expertise, Dr. Amin said. “I think there's a lot of focus on that today, so having someone with many of those skills becomes helpful and important,” he said.

Dr. Amin was a natural fit to take over as interim chair of the department of medicine because he has a health care MBA and experience in finance and administration. At a time of scarce resources, having a record of managing assets efficiently is an advantage. Hospitalists have an excellent track record in this area, as they have ample experience in balancing tight resources with the need to make advances in quality of care, he said.

For hospitalists looking to take on greater leadership roles in their institutions, Dr. Amin recommended not only being engaged within a team of providers, but also showing individual initiative. He advised fellow hospitalists to be visible and to communicate with their colleagues and administrators about the challenges they see as well as their ideas for meeting those challenges.

'Hospitalists tend to look at things more broadly because of the nature of the work that they do.' DR. AMIN

Over the last decade, hospitals have increasingly come to rely on the unique skill set offered by hospitalists.

But the University of California at Irvine has gone even further. For the past year, Dr. Alpesh Amin, founder and executive director of the university's hospitalist program, has also served as the interim chair of the department of medicine.

Dr. Amin is the first and only hospitalist to head a department of medicine at an academic medical center. The promotion, from his previous post as vice chair for clinical affairs and quality, puts him in the upper echelon of hospital and medical school leaders. And Dr. Amin said he thinks it's good for hospitalists all around.

“The message that this puts out there is that hospitalists over time can be important leaders in the institution,” he said.

Since taking on this new role in June 2008, Dr. Amin has been busy on several fronts. He oversees 11 divisions across three hospital sites and is responsible for the clinical, educational, research, and administrative missions within the department of medicine.

He is also using his perspective as a hospitalist to improve his department. On the clinical side, Dr. Amin and his colleagues have been seeking a greater alignment of services and units. They have also been working to increase collaboration among the faculty of various medical subspecialties. And on the research side, Dr. Amin has been trying to ramp up mentorship of junior faculty and aid them in pursuing grant opportunities.

“Hospitalists tend to look at things more broadly because of the nature of the work that they do,” he said. Hospitalists are in contact with virtually every member of the care team. In caring for patients, hospitalists often interact with subspecialists, surgeons, and primary care physicians who practice in the community. Hospitalists also work with pharmacists, case managers, social workers, and hospital administrators.

Hospitalists are “kind of the quarterback of the process,” Dr. Amin said.

Dr. Amin may be the only hospitalist serving this role in academia today, but that is likely to change, he said. One reason that hospitalists have not been the first choice for leadership roles in departments of medicine is that the specialty just hasn't been around that long. But as the field matures, hospitalists could be ideally positioned to help institutions face future challenges, he said.

Medical centers, both in academia and in the community, are under increasing pressure in terms of quality of care, throughput, and systems-based practice—all areas where hospitalists bring expertise, Dr. Amin said. “I think there's a lot of focus on that today, so having someone with many of those skills becomes helpful and important,” he said.

Dr. Amin was a natural fit to take over as interim chair of the department of medicine because he has a health care MBA and experience in finance and administration. At a time of scarce resources, having a record of managing assets efficiently is an advantage. Hospitalists have an excellent track record in this area, as they have ample experience in balancing tight resources with the need to make advances in quality of care, he said.

For hospitalists looking to take on greater leadership roles in their institutions, Dr. Amin recommended not only being engaged within a team of providers, but also showing individual initiative. He advised fellow hospitalists to be visible and to communicate with their colleagues and administrators about the challenges they see as well as their ideas for meeting those challenges.

'Hospitalists tend to look at things more broadly because of the nature of the work that they do.' DR. AMIN

Over the last decade, hospitals have increasingly come to rely on the unique skill set offered by hospitalists.

But the University of California at Irvine has gone even further. For the past year, Dr. Alpesh Amin, founder and executive director of the university's hospitalist program, has also served as the interim chair of the department of medicine.

Dr. Amin is the first and only hospitalist to head a department of medicine at an academic medical center. The promotion, from his previous post as vice chair for clinical affairs and quality, puts him in the upper echelon of hospital and medical school leaders. And Dr. Amin said he thinks it's good for hospitalists all around.

“The message that this puts out there is that hospitalists over time can be important leaders in the institution,” he said.

Since taking on this new role in June 2008, Dr. Amin has been busy on several fronts. He oversees 11 divisions across three hospital sites and is responsible for the clinical, educational, research, and administrative missions within the department of medicine.

He is also using his perspective as a hospitalist to improve his department. On the clinical side, Dr. Amin and his colleagues have been seeking a greater alignment of services and units. They have also been working to increase collaboration among the faculty of various medical subspecialties. And on the research side, Dr. Amin has been trying to ramp up mentorship of junior faculty and aid them in pursuing grant opportunities.

“Hospitalists tend to look at things more broadly because of the nature of the work that they do,” he said. Hospitalists are in contact with virtually every member of the care team. In caring for patients, hospitalists often interact with subspecialists, surgeons, and primary care physicians who practice in the community. Hospitalists also work with pharmacists, case managers, social workers, and hospital administrators.

Hospitalists are “kind of the quarterback of the process,” Dr. Amin said.

Dr. Amin may be the only hospitalist serving this role in academia today, but that is likely to change, he said. One reason that hospitalists have not been the first choice for leadership roles in departments of medicine is that the specialty just hasn't been around that long. But as the field matures, hospitalists could be ideally positioned to help institutions face future challenges, he said.

Medical centers, both in academia and in the community, are under increasing pressure in terms of quality of care, throughput, and systems-based practice—all areas where hospitalists bring expertise, Dr. Amin said. “I think there's a lot of focus on that today, so having someone with many of those skills becomes helpful and important,” he said.

Dr. Amin was a natural fit to take over as interim chair of the department of medicine because he has a health care MBA and experience in finance and administration. At a time of scarce resources, having a record of managing assets efficiently is an advantage. Hospitalists have an excellent track record in this area, as they have ample experience in balancing tight resources with the need to make advances in quality of care, he said.

For hospitalists looking to take on greater leadership roles in their institutions, Dr. Amin recommended not only being engaged within a team of providers, but also showing individual initiative. He advised fellow hospitalists to be visible and to communicate with their colleagues and administrators about the challenges they see as well as their ideas for meeting those challenges.

'Hospitalists tend to look at things more broadly because of the nature of the work that they do.' DR. AMIN

Physicians should stop accepting gifts or meals from industry representatives, according to a report from the Institute of Medicine that offers 16 recommendations aimed at limiting financial conflicts of interest in medicine.

While some relationships with industry are beneficial, the widespread industry ties that have become common among physicians and researchers could undermine public confidence in medicine, according to the report from the IOM Committee on Conflict of Interest in Medical Research, Education, and Practice.

“This is a vital issue that really goes to the heart of patients' trust that they are receiving the best medical advice and medical care,” Dr. Bernard Lo, chair of the IOM committee and director of the program in medical ethics at the University of California, San Francisco, said at a press briefing.

In the 300-plus page report, the IOM committee provides recommendations for physicians and institutions to identify and manage financial conflicts of interest in medical research, education, and practice. The report focuses specifically on financial relationships with pharmaceutical, medical device, and biotechnology companies.

First, all institutions engaged in medical research, education, and practice should establish conflict of interest policies that require all physicians, researchers, and senior officials to disclose their ties to industry. The committee also recommended that the medical community come together to create a universal, standardized, electronic disclosure form.

Beyond these voluntary disclosure efforts, the IOM committee recommended that Congress require drug and device makers and industry foundations to publicly report any payments to physicians, researchers, health care institutions, professional societies, patient advocacy and disease groups, continuing medical education (CME) providers, and related foundations.

This type of searchable public database would allow medical institutions and journal publishers to verify the disclosure information they receive from researchers and physicians, the committee said.

While disclosure of financial ties was a major focus of the committee's recommendations, institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said. “Disclosure is a necessary first step, but it's a limited first step,” Dr. Lo said. “If you don't disclose relationships to the institution you work for, they can't figure out what to do.”

In addition to refusing to accept gifts and meals from industry, the IOM committee recommended that physicians set restrictions on their contacts with sales representatives and use drug samples only for patients who can't afford medications. The committee also recommended that physicians enter into only bona fide consultation arrangements with industry provided that these include written contracts. The report includes similar recommendations for faculty, students, residents, and fellows at academic medical centers.

The IOM committee also challenged the medical community to come up with a new system for funding accredited CME that would be free of industry influence.

The report also addressed industry influence in the development of clinical practice guidelines. The committee recommended that groups involved in guideline development not accept direct funding from industry. Additionally, they should try to exclude individuals with conflicts of interest from serving on guideline development panels. If the necessary expertise can't be obtained from experts who are free of conflict, the IOM committee advised that conflicted individuals should be a minority on the panel and should be barred from voting on any topics in which they have a financial interest. The committee also recommended that the chair of the guideline panel be free of conflicts.

In the research arena, the IOM committee recommended that, in general, investigators should not conduct research involving human subjects if they have a financial stake in the outcome of the study. Exceptions are possible but should be made only if the researcher's participation is considered essential to the safety of the research. Even then, a conflict of interest committee should approve the involvement and consider placing restrictions on his or her role in the study, the committee said.

The Pharmaceutical Research and Manufacturers of America (PhRMA) was still reviewing the IOM report at press time. However, the group cautioned policy makers and the medical community to balance the need to manage potential conflicts of interest against the possibility that “overly restrictive policies” could have unintended consequences. For example, prohibitions on the use of drug samples or on industry funding for CME could negatively affect patient care, according to the group.

“Interactions between pharmaceutical sales representatives and health care professionals enhance public health and improve patient care,” Ken Johnson, PhRMA senior vice president, said in a statement. “Pharmaceutical research companies take this responsibility seriously and remain committed to ensuring that these interactions follow the highest standards.”

The IOM study was sponsored by the National Institutes of Health, the Robert Wood Johnson Foundation, the Greenwall Foundation, the American Board of Internal Medicine Foundation, the Burroughs Wellcome Fund, and the Josiah Macy Jr. Foundation.

The report is available at www.nap.edu/catalog.php?record_id=12598#toc

Physicians should stop accepting gifts or meals from industry representatives, according to a report from the Institute of Medicine that offers 16 recommendations aimed at limiting financial conflicts of interest in medicine.

While some relationships with industry are beneficial, the widespread industry ties that have become common among physicians and researchers could undermine public confidence in medicine, according to the report from the IOM Committee on Conflict of Interest in Medical Research, Education, and Practice.

“This is a vital issue that really goes to the heart of patients' trust that they are receiving the best medical advice and medical care,” Dr. Bernard Lo, chair of the IOM committee and director of the program in medical ethics at the University of California, San Francisco, said at a press briefing.

In the 300-plus page report, the IOM committee provides recommendations for physicians and institutions to identify and manage financial conflicts of interest in medical research, education, and practice. The report focuses specifically on financial relationships with pharmaceutical, medical device, and biotechnology companies.

First, all institutions engaged in medical research, education, and practice should establish conflict of interest policies that require all physicians, researchers, and senior officials to disclose their ties to industry. The committee also recommended that the medical community come together to create a universal, standardized, electronic disclosure form.

Beyond these voluntary disclosure efforts, the IOM committee recommended that Congress require drug and device makers and industry foundations to publicly report any payments to physicians, researchers, health care institutions, professional societies, patient advocacy and disease groups, continuing medical education (CME) providers, and related foundations.

This type of searchable public database would allow medical institutions and journal publishers to verify the disclosure information they receive from researchers and physicians, the committee said.

While disclosure of financial ties was a major focus of the committee's recommendations, institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said. “Disclosure is a necessary first step, but it's a limited first step,” Dr. Lo said. “If you don't disclose relationships to the institution you work for, they can't figure out what to do.”

In addition to refusing to accept gifts and meals from industry, the IOM committee recommended that physicians set restrictions on their contacts with sales representatives and use drug samples only for patients who can't afford medications. The committee also recommended that physicians enter into only bona fide consultation arrangements with industry provided that these include written contracts. The report includes similar recommendations for faculty, students, residents, and fellows at academic medical centers.

The IOM committee also challenged the medical community to come up with a new system for funding accredited CME that would be free of industry influence.

The report also addressed industry influence in the development of clinical practice guidelines. The committee recommended that groups involved in guideline development not accept direct funding from industry. Additionally, they should try to exclude individuals with conflicts of interest from serving on guideline development panels. If the necessary expertise can't be obtained from experts who are free of conflict, the IOM committee advised that conflicted individuals should be a minority on the panel and should be barred from voting on any topics in which they have a financial interest. The committee also recommended that the chair of the guideline panel be free of conflicts.

In the research arena, the IOM committee recommended that, in general, investigators should not conduct research involving human subjects if they have a financial stake in the outcome of the study. Exceptions are possible but should be made only if the researcher's participation is considered essential to the safety of the research. Even then, a conflict of interest committee should approve the involvement and consider placing restrictions on his or her role in the study, the committee said.

The Pharmaceutical Research and Manufacturers of America (PhRMA) was still reviewing the IOM report at press time. However, the group cautioned policy makers and the medical community to balance the need to manage potential conflicts of interest against the possibility that “overly restrictive policies” could have unintended consequences. For example, prohibitions on the use of drug samples or on industry funding for CME could negatively affect patient care, according to the group.

“Interactions between pharmaceutical sales representatives and health care professionals enhance public health and improve patient care,” Ken Johnson, PhRMA senior vice president, said in a statement. “Pharmaceutical research companies take this responsibility seriously and remain committed to ensuring that these interactions follow the highest standards.”

The IOM study was sponsored by the National Institutes of Health, the Robert Wood Johnson Foundation, the Greenwall Foundation, the American Board of Internal Medicine Foundation, the Burroughs Wellcome Fund, and the Josiah Macy Jr. Foundation.

The report is available at www.nap.edu/catalog.php?record_id=12598#toc

Physicians should stop accepting gifts or meals from industry representatives, according to a report from the Institute of Medicine that offers 16 recommendations aimed at limiting financial conflicts of interest in medicine.

While some relationships with industry are beneficial, the widespread industry ties that have become common among physicians and researchers could undermine public confidence in medicine, according to the report from the IOM Committee on Conflict of Interest in Medical Research, Education, and Practice.

“This is a vital issue that really goes to the heart of patients' trust that they are receiving the best medical advice and medical care,” Dr. Bernard Lo, chair of the IOM committee and director of the program in medical ethics at the University of California, San Francisco, said at a press briefing.

In the 300-plus page report, the IOM committee provides recommendations for physicians and institutions to identify and manage financial conflicts of interest in medical research, education, and practice. The report focuses specifically on financial relationships with pharmaceutical, medical device, and biotechnology companies.

First, all institutions engaged in medical research, education, and practice should establish conflict of interest policies that require all physicians, researchers, and senior officials to disclose their ties to industry. The committee also recommended that the medical community come together to create a universal, standardized, electronic disclosure form.

Beyond these voluntary disclosure efforts, the IOM committee recommended that Congress require drug and device makers and industry foundations to publicly report any payments to physicians, researchers, health care institutions, professional societies, patient advocacy and disease groups, continuing medical education (CME) providers, and related foundations.

This type of searchable public database would allow medical institutions and journal publishers to verify the disclosure information they receive from researchers and physicians, the committee said.

While disclosure of financial ties was a major focus of the committee's recommendations, institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said. “Disclosure is a necessary first step, but it's a limited first step,” Dr. Lo said. “If you don't disclose relationships to the institution you work for, they can't figure out what to do.”

In addition to refusing to accept gifts and meals from industry, the IOM committee recommended that physicians set restrictions on their contacts with sales representatives and use drug samples only for patients who can't afford medications. The committee also recommended that physicians enter into only bona fide consultation arrangements with industry provided that these include written contracts. The report includes similar recommendations for faculty, students, residents, and fellows at academic medical centers.

The IOM committee also challenged the medical community to come up with a new system for funding accredited CME that would be free of industry influence.

The report also addressed industry influence in the development of clinical practice guidelines. The committee recommended that groups involved in guideline development not accept direct funding from industry. Additionally, they should try to exclude individuals with conflicts of interest from serving on guideline development panels. If the necessary expertise can't be obtained from experts who are free of conflict, the IOM committee advised that conflicted individuals should be a minority on the panel and should be barred from voting on any topics in which they have a financial interest. The committee also recommended that the chair of the guideline panel be free of conflicts.

In the research arena, the IOM committee recommended that, in general, investigators should not conduct research involving human subjects if they have a financial stake in the outcome of the study. Exceptions are possible but should be made only if the researcher's participation is considered essential to the safety of the research. Even then, a conflict of interest committee should approve the involvement and consider placing restrictions on his or her role in the study, the committee said.

The Pharmaceutical Research and Manufacturers of America (PhRMA) was still reviewing the IOM report at press time. However, the group cautioned policy makers and the medical community to balance the need to manage potential conflicts of interest against the possibility that “overly restrictive policies” could have unintended consequences. For example, prohibitions on the use of drug samples or on industry funding for CME could negatively affect patient care, according to the group.

“Interactions between pharmaceutical sales representatives and health care professionals enhance public health and improve patient care,” Ken Johnson, PhRMA senior vice president, said in a statement. “Pharmaceutical research companies take this responsibility seriously and remain committed to ensuring that these interactions follow the highest standards.”

The IOM study was sponsored by the National Institutes of Health, the Robert Wood Johnson Foundation, the Greenwall Foundation, the American Board of Internal Medicine Foundation, the Burroughs Wellcome Fund, and the Josiah Macy Jr. Foundation.

The report is available at www.nap.edu/catalog.php?record_id=12598#toc

Dr. Ronald L. Moy, who will become president of the American Academy of Dermatology in 2011, wants to help dermatologists handle regulations and practice hassles during his term in office.

Dermatologists need help as they face mounting requirements from the government and payers related to electronic medical records, pay for performance, and maintenance of certification and licensure issues, he said.

“I think there are all kinds of new legislative [requirements] that are going to be imposed on us and we need to find out what members are really doing and what they want,” Dr. Moy said.

Dr. Moy, a professor at the University of California in Los Angeles, was recently chosen as president-elect of the AAD. He will assume his role as president-elect in March 2010 and will begin a 1-year term as president in February 2011. Dr. Moy currently serves as a member of the AAD's board of directors and is a past president of the American Society for Dermatologic Surgery.

As president, Dr. Moy plans to try to better educate the public and policy makers about the expertise that dermatologists have in treating skin, hair, and nail conditions. Everybody wants to practice dermatology these days, he said, so the AAD has to continue to make the case that dermatologists are better educated, and that there are real advantages to seeing a dermatologist.

The scope-of-practice issue has become controversial among AAD members, some of whom have threatened not to give presentations at AAD meetings if the academy allows physician assistants and nondermatologists to attend certain surgical and aesthetic sessions. The issue is currently being studied by the AAD board, Dr. Moy said. The AAD needs to be educating the right people, he said, but the specifics of how to do that are still unclear.

A special focus for Dr. Moy during his term in office will be to promote volunteerism. This may be a tough sell with so many other regulatory and practice burdens facing dermatologists, but it is good for the specialty when dermatologists give back, he said. And he wants to see the AAD make it easier for dermatologists to volunteer their time.

When it comes to the health reform plans being crafted in Congress, Dr. Moy said the AAD has a strong presence on Capitol Hill. His impression is that the reforms under consideration will not have a dramatic impact on medical practice, but AAD leaders are watching carefully as policy makers consider shifting dollars from subspecialty care to primary care. The key, Dr. Moy said, is coming to policy makers with data about the contribution that dermatologists are making to overall health. To that end, the AAD needs to make an investment in research to demonstrate that dermatologists have a positive impact on health outcomes and provide cost-effective care.

Dr. Suzanne M. Connolly, associate professor at the Mayo Graduate School of Medicine in Scottsdale, Ariz., was chosen as vice president-elect. She has served on the AAD's board of directors and several other committees. She will be installed as vice president-elect in March 2010 and will begin her 1-year term as vice president in 2011.

The newly elected members of the board of directors are Dr. Ilona J. Frieden of the University of California in San Francisco; Dr. Dee Anna Glaser of St. Louis University; Dr. Mark Lebwohl of Mount Sinai School of Medicine in New York; and Dr. Ronald P. Rapini of the University of Texas and the M.D. Anderson Cancer Center in Houston. Their 4-year terms will begin in March 2010. All AAD officers will hold the same positions for the AAD Association.

Who can attend certain surgical and aesthetic sessions at AADmeetings is being studied by the AAD board. DR. MOY

Dr. Ronald L. Moy, who will become president of the American Academy of Dermatology in 2011, wants to help dermatologists handle regulations and practice hassles during his term in office.

Dermatologists need help as they face mounting requirements from the government and payers related to electronic medical records, pay for performance, and maintenance of certification and licensure issues, he said.

“I think there are all kinds of new legislative [requirements] that are going to be imposed on us and we need to find out what members are really doing and what they want,” Dr. Moy said.

Dr. Moy, a professor at the University of California in Los Angeles, was recently chosen as president-elect of the AAD. He will assume his role as president-elect in March 2010 and will begin a 1-year term as president in February 2011. Dr. Moy currently serves as a member of the AAD's board of directors and is a past president of the American Society for Dermatologic Surgery.

As president, Dr. Moy plans to try to better educate the public and policy makers about the expertise that dermatologists have in treating skin, hair, and nail conditions. Everybody wants to practice dermatology these days, he said, so the AAD has to continue to make the case that dermatologists are better educated, and that there are real advantages to seeing a dermatologist.

The scope-of-practice issue has become controversial among AAD members, some of whom have threatened not to give presentations at AAD meetings if the academy allows physician assistants and nondermatologists to attend certain surgical and aesthetic sessions. The issue is currently being studied by the AAD board, Dr. Moy said. The AAD needs to be educating the right people, he said, but the specifics of how to do that are still unclear.

A special focus for Dr. Moy during his term in office will be to promote volunteerism. This may be a tough sell with so many other regulatory and practice burdens facing dermatologists, but it is good for the specialty when dermatologists give back, he said. And he wants to see the AAD make it easier for dermatologists to volunteer their time.

When it comes to the health reform plans being crafted in Congress, Dr. Moy said the AAD has a strong presence on Capitol Hill. His impression is that the reforms under consideration will not have a dramatic impact on medical practice, but AAD leaders are watching carefully as policy makers consider shifting dollars from subspecialty care to primary care. The key, Dr. Moy said, is coming to policy makers with data about the contribution that dermatologists are making to overall health. To that end, the AAD needs to make an investment in research to demonstrate that dermatologists have a positive impact on health outcomes and provide cost-effective care.

Dr. Suzanne M. Connolly, associate professor at the Mayo Graduate School of Medicine in Scottsdale, Ariz., was chosen as vice president-elect. She has served on the AAD's board of directors and several other committees. She will be installed as vice president-elect in March 2010 and will begin her 1-year term as vice president in 2011.

The newly elected members of the board of directors are Dr. Ilona J. Frieden of the University of California in San Francisco; Dr. Dee Anna Glaser of St. Louis University; Dr. Mark Lebwohl of Mount Sinai School of Medicine in New York; and Dr. Ronald P. Rapini of the University of Texas and the M.D. Anderson Cancer Center in Houston. Their 4-year terms will begin in March 2010. All AAD officers will hold the same positions for the AAD Association.

Who can attend certain surgical and aesthetic sessions at AADmeetings is being studied by the AAD board. DR. MOY

Dr. Ronald L. Moy, who will become president of the American Academy of Dermatology in 2011, wants to help dermatologists handle regulations and practice hassles during his term in office.

Dermatologists need help as they face mounting requirements from the government and payers related to electronic medical records, pay for performance, and maintenance of certification and licensure issues, he said.

“I think there are all kinds of new legislative [requirements] that are going to be imposed on us and we need to find out what members are really doing and what they want,” Dr. Moy said.

Dr. Moy, a professor at the University of California in Los Angeles, was recently chosen as president-elect of the AAD. He will assume his role as president-elect in March 2010 and will begin a 1-year term as president in February 2011. Dr. Moy currently serves as a member of the AAD's board of directors and is a past president of the American Society for Dermatologic Surgery.

As president, Dr. Moy plans to try to better educate the public and policy makers about the expertise that dermatologists have in treating skin, hair, and nail conditions. Everybody wants to practice dermatology these days, he said, so the AAD has to continue to make the case that dermatologists are better educated, and that there are real advantages to seeing a dermatologist.

The scope-of-practice issue has become controversial among AAD members, some of whom have threatened not to give presentations at AAD meetings if the academy allows physician assistants and nondermatologists to attend certain surgical and aesthetic sessions. The issue is currently being studied by the AAD board, Dr. Moy said. The AAD needs to be educating the right people, he said, but the specifics of how to do that are still unclear.

A special focus for Dr. Moy during his term in office will be to promote volunteerism. This may be a tough sell with so many other regulatory and practice burdens facing dermatologists, but it is good for the specialty when dermatologists give back, he said. And he wants to see the AAD make it easier for dermatologists to volunteer their time.

When it comes to the health reform plans being crafted in Congress, Dr. Moy said the AAD has a strong presence on Capitol Hill. His impression is that the reforms under consideration will not have a dramatic impact on medical practice, but AAD leaders are watching carefully as policy makers consider shifting dollars from subspecialty care to primary care. The key, Dr. Moy said, is coming to policy makers with data about the contribution that dermatologists are making to overall health. To that end, the AAD needs to make an investment in research to demonstrate that dermatologists have a positive impact on health outcomes and provide cost-effective care.

Dr. Suzanne M. Connolly, associate professor at the Mayo Graduate School of Medicine in Scottsdale, Ariz., was chosen as vice president-elect. She has served on the AAD's board of directors and several other committees. She will be installed as vice president-elect in March 2010 and will begin her 1-year term as vice president in 2011.

The newly elected members of the board of directors are Dr. Ilona J. Frieden of the University of California in San Francisco; Dr. Dee Anna Glaser of St. Louis University; Dr. Mark Lebwohl of Mount Sinai School of Medicine in New York; and Dr. Ronald P. Rapini of the University of Texas and the M.D. Anderson Cancer Center in Houston. Their 4-year terms will begin in March 2010. All AAD officers will hold the same positions for the AAD Association.

Who can attend certain surgical and aesthetic sessions at AADmeetings is being studied by the AAD board. DR. MOY