Mary Ellen Schneider

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, "Medicaid is a little better than Medicare because there's more upfront money," Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be "meaningful electronic health records users" and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next four years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a "meaningful" user—haven't yet been made clear. "What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?" Dr. Jessee said.

The incentive also comes with a "stick" attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, he said.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, "you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive."

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels.

Although there has been speculation about whether the government was going to come out with a free EHR for providers, "my guess is, don't hold your breath," Dr. Jessee said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. "If you liked HIPAA, you'll love the privacy provisions" in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. "The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade" for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014 to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

Feds Offer Free Software to Share Data

The federal government has released free software that will enable health care organizations to exchange information over the Nationwide Health Information Network in the near future.

The Nationwide Health Information Network (NHIN) is currently under development as a "network of networks," designed to securely link the electronic health records at hospitals, physician offices, pharmacies, payers, and labs.

The new software is designed to be an "on-ramp," allowing different systems to connect to the NHIN once it is fully operational in the next few years. The open source software, called CONNECT, is available online at

www.connectopensource.org

The release of the CONNECT software is just a first step, according to the DHHS. At this stage, vendors in the health information technology market are likely to begin examining CONNECT and may integrate some of its elements into their products for health care providers.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, "Medicaid is a little better than Medicare because there's more upfront money," Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be "meaningful electronic health records users" and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next four years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a "meaningful" user—haven't yet been made clear. "What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?" Dr. Jessee said.

The incentive also comes with a "stick" attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, he said.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, "you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive."

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels.

Although there has been speculation about whether the government was going to come out with a free EHR for providers, "my guess is, don't hold your breath," Dr. Jessee said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. "If you liked HIPAA, you'll love the privacy provisions" in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. "The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade" for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014 to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

Feds Offer Free Software to Share Data

The federal government has released free software that will enable health care organizations to exchange information over the Nationwide Health Information Network in the near future.

The Nationwide Health Information Network (NHIN) is currently under development as a "network of networks," designed to securely link the electronic health records at hospitals, physician offices, pharmacies, payers, and labs.

The new software is designed to be an "on-ramp," allowing different systems to connect to the NHIN once it is fully operational in the next few years. The open source software, called CONNECT, is available online at

www.connectopensource.org

The release of the CONNECT software is just a first step, according to the DHHS. At this stage, vendors in the health information technology market are likely to begin examining CONNECT and may integrate some of its elements into their products for health care providers.

While Medicare is almost always a better payer than Medicaid, one notable exception is the health information technology funding contained in the Recovery Act.

For physicians applying for incentive money to purchase electronic health record (EHR) systems, "Medicaid is a little better than Medicare because there's more upfront money," Dr. William Jessee, president and CEO of the Medical Group Management Association (MGMA), said during a teleconference on the bill.

The Recovery Act—formally known as the American Recovery and Reinvestment Act of 2009—includes about $19 billion for spending on health IT, said Dr. Jessee. Physicians can apply for money through either Medicare or through Medicaid, but not both. Other clinicians eligible for the Medicare incentive include dentists, podiatrists, optometrists, and chiropractors.

To qualify for the incentive, physicians must be "meaningful electronic health records users" and use electronic prescribing. In addition, the EHR must have the capability of exchanging information with other users, and physicians must report clinical quality measures to the Health and Human Services department, presumably through the Physician Quality Reporting Initiative, Dr. Jessee said.

To be eligible for the Medicaid incentive, at least 30% of a provider's practice base must be Medicaid recipients. Pediatricians have a lower threshold—just 20%, he said.

The states administering the Medicaid portion of the incentive can make payments to Medicaid providers for up to 85% of net average allowable costs, to a maximum of $63,750 over 6 years for a certified EHR. The maximum incentive starts at $25,000 in the first year and then gradually decreases each year.

Under the Medicare incentive, physicians who are using an EHR in 2011 or 2012 can receive an incentive equal to as much as 75% of their Medicare allowable charges per year for the cost of their hardware and software, up to a maximum of $44,000 over a 5-year period. (The maximum allowable benefit per provider is $15,000 in the first year and gradually decreases over the next four years.) Physicians practicing in health professional shortage areas can receive a 10% additional payment, he noted.

Many provisions—such as who is a "meaningful" user—haven't yet been made clear. "What's [also] still fuzzy is, do you report in 2010 and get your first payment in 2011, or report in 2011 for a first payment in 2012?" Dr. Jessee said.

The incentive also comes with a "stick" attached: Physicians who are not using an EHR by 2015 will see a decrease in their Medicare payments, he said.

Also still to be determined is what constitutes a certified EHR. Still, Dr. Jessee said, "you need to be very careful to make sure that the product you use or are contemplating investing in will be a certified product that qualifies for an incentive. We suggest putting a [clause] in your contract saying that the vendor will make sure the product you're using will qualify for the incentive."

In addition to the federal EHR incentives, Congress allocated another $2 billion for indirect grants to support HIT, primarily at state and regional levels.

Although there has been speculation about whether the government was going to come out with a free EHR for providers, "my guess is, don't hold your breath," Dr. Jessee said.

The Recovery Act also contains additional health care privacy provisions, according to Dr. Jessee. "If you liked HIPAA, you'll love the privacy provisions" in this bill, he said. For instance, providers are required to have the ability to track every disclosure of personally identifiable health information, including information released for payment purposes. "The patient has a right to request who you've disclosed their information to for 3 years; this is probably going to require a system upgrade" for those who already have an EHR, he said.

If the patient's information has been disclosed because of a breach of privacy, providers must notify the patient or their next of kin within 60 days; if the breach affects more than 500 patients the local media must be notified along with HHS, so it can be posted on the department's Web site, he added.

The interim regulation spelling out all the EHR requirements is due to be published no later than July of this year. Practices that already have EHRs will have until Jan. 1, 2014 to comply with the new rules; those who buy EHRs from now on will have to comply either by the day they purchase the system or by Jan. 1, 2011, whichever is later, he said.

The teleconference was sponsored by MGMA, MedFusion, Athena health, and MicroMD.

Feds Offer Free Software to Share Data

The federal government has released free software that will enable health care organizations to exchange information over the Nationwide Health Information Network in the near future.

The Nationwide Health Information Network (NHIN) is currently under development as a "network of networks," designed to securely link the electronic health records at hospitals, physician offices, pharmacies, payers, and labs.

The new software is designed to be an "on-ramp," allowing different systems to connect to the NHIN once it is fully operational in the next few years. The open source software, called CONNECT, is available online at

www.connectopensource.org

The release of the CONNECT software is just a first step, according to the DHHS. At this stage, vendors in the health information technology market are likely to begin examining CONNECT and may integrate some of its elements into their products for health care providers.

Physicians should stop accepting gifts or meals from industry representatives, according to a new 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 are now 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 patient's 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 during a press briefing.

In a 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.

For starters, 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 to cut down on variation and reduce administrative burdens for physicians.

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.

While disclosure of financial ties was a major focus of the committee's recommendations, it was only the beginning. Institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said.

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 IOM committee also challenged the medical community to come up with a new system for funding accredited CMEs 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 for industry. Additionally, they should try to exclude individuals with conflicts of interest from serving on guideline development panels.

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 continuing medical education could negatively affect patient care, the group said.

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.

Physicians should stop accepting gifts or meals from industry representatives, according to a new 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 are now 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 patient's 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 during a press briefing.

In a 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.

For starters, 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 to cut down on variation and reduce administrative burdens for physicians.

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.

While disclosure of financial ties was a major focus of the committee's recommendations, it was only the beginning. Institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said.

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 IOM committee also challenged the medical community to come up with a new system for funding accredited CMEs 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 for industry. Additionally, they should try to exclude individuals with conflicts of interest from serving on guideline development panels.

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 continuing medical education could negatively affect patient care, the group said.

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.

Physicians should stop accepting gifts or meals from industry representatives, according to a new 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 are now 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 patient's 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 during a press briefing.

In a 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.

For starters, 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 to cut down on variation and reduce administrative burdens for physicians.

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.

While disclosure of financial ties was a major focus of the committee's recommendations, it was only the beginning. Institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said.

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 IOM committee also challenged the medical community to come up with a new system for funding accredited CMEs 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 for industry. Additionally, they should try to exclude individuals with conflicts of interest from serving on guideline development panels.

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 continuing medical education could negatively affect patient care, the group said.

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 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 ambitious 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 in February but had not provided specifics on his legislative and regulatory proposals.

As expected, 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 the Department 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.

The FY 2010 budget does not include a fix for the Medicare physician payment system, which is again set to make significant cuts to physician payments in January. However, the budget document includes support for changing the payment formula, including assessing the coverage of physician-administered drugs under the payment formula.

The FY 2010 budget proposal includes a total of $879 billion for HHS, a $63 billion increase over FY 2009 levels.

The administration also is moving to bolster cancer research as part of the budget proposal. The proposal includes nearly $31 billion for the National Institutes of Health, with more than $6 billion dedicated to cancer research.

In addition, the budget addresses concerns about the response to the 2009-H1N1 "swine" flu. Aside from the $1.5 billion supplemental request, the administration is seeking $584 million in the FY 2010 budget proposal. The money would go toward developing, producing and distributing antivirals, vaccines, and personal protective equipment.

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 FDA budget to create a regulatory pathway for the approval of generic biologicals. 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 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 ambitious 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 in February but had not provided specifics on his legislative and regulatory proposals.

As expected, 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 the Department 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.

The FY 2010 budget does not include a fix for the Medicare physician payment system, which is again set to make significant cuts to physician payments in January. However, the budget document includes support for changing the payment formula, including assessing the coverage of physician-administered drugs under the payment formula.

The FY 2010 budget proposal includes a total of $879 billion for HHS, a $63 billion increase over FY 2009 levels.

The administration also is moving to bolster cancer research as part of the budget proposal. The proposal includes nearly $31 billion for the National Institutes of Health, with more than $6 billion dedicated to cancer research.

In addition, the budget addresses concerns about the response to the 2009-H1N1 "swine" flu. Aside from the $1.5 billion supplemental request, the administration is seeking $584 million in the FY 2010 budget proposal. The money would go toward developing, producing and distributing antivirals, vaccines, and personal protective equipment.

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 FDA budget to create a regulatory pathway for the approval of generic biologicals. 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 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 ambitious 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 in February but had not provided specifics on his legislative and regulatory proposals.

As expected, 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 the Department 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.

The FY 2010 budget does not include a fix for the Medicare physician payment system, which is again set to make significant cuts to physician payments in January. However, the budget document includes support for changing the payment formula, including assessing the coverage of physician-administered drugs under the payment formula.

The FY 2010 budget proposal includes a total of $879 billion for HHS, a $63 billion increase over FY 2009 levels.

The administration also is moving to bolster cancer research as part of the budget proposal. The proposal includes nearly $31 billion for the National Institutes of Health, with more than $6 billion dedicated to cancer research.

In addition, the budget addresses concerns about the response to the 2009-H1N1 "swine" flu. Aside from the $1.5 billion supplemental request, the administration is seeking $584 million in the FY 2010 budget proposal. The money would go toward developing, producing and distributing antivirals, vaccines, and personal protective equipment.

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 FDA budget to create a regulatory pathway for the approval of generic biologicals. 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.

Physicians should stop accepting gifts or meals from industry representatives, according to a new 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 patient's 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 during a press briefing.

In a 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.

For starters, 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 to cut down on variation and reduce administrative burdens for physicians.

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 disclosure information from researchers and physicians, the committee said.

While disclosure of financial ties was a major focus of the committee's recommendations, it was only the beginning. Institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said.

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 and that physicians avoid presenting or publishing any material whose contract is controlled or ghostwritten by industry.

The IOM committee also challenged the medical community to come up with a new system for funding accredited CMEs 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 for 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 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 continuing medical education could negatively affect patient care, according to the group.

“In the end, 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 new 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 patient's 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 during a press briefing.

In a 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.

For starters, 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 to cut down on variation and reduce administrative burdens for physicians.

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 disclosure information from researchers and physicians, the committee said.

While disclosure of financial ties was a major focus of the committee's recommendations, it was only the beginning. Institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said.

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 and that physicians avoid presenting or publishing any material whose contract is controlled or ghostwritten by industry.

The IOM committee also challenged the medical community to come up with a new system for funding accredited CMEs 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 for 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 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 continuing medical education could negatively affect patient care, according to the group.

“In the end, 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 new 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 patient's 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 during a press briefing.

In a 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.

For starters, 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 to cut down on variation and reduce administrative burdens for physicians.

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 disclosure information from researchers and physicians, the committee said.

While disclosure of financial ties was a major focus of the committee's recommendations, it was only the beginning. Institutions also must act to prohibit certain relationships with industry and strictly manage others, Dr. Lo said.

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 and that physicians avoid presenting or publishing any material whose contract is controlled or ghostwritten by industry.

The IOM committee also challenged the medical community to come up with a new system for funding accredited CMEs 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 for 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 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 continuing medical education could negatively affect patient care, according to the group.

“In the end, 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

President Obama now has a Health and Human Services secretary to help shepherd his health reform agenda through Congress and deal with the swine flu outbreak and other challenges.

In a 65–31 vote, the Senate confirmed Kansas Gov. Kathleen Sebelius, a Democrat, as HHS secretary on April 28. Under an agreement reached between Senate Democrats and Republicans, 60 votes were required for confirmation. She is the last member of President Obama's cabinet to be confirmed by the Senate.

Gov. Sebelius, a two-term governor and former state insurance commissioner, has been praised for her bipartisan approach to governing in Kansas. Her confirmation was initially slowed in the Senate over conservatives' concerns about her position on abortion. For example, antiabortion advocates called her unfit for the HHS post after her April 23 veto of controversial state legislation that would have increased reporting requirements on late-term abortions and left physicians who perform abortions open to civil litigation if the abortion was later deemed illegal.

The American Medical Association praised Gov. Sebelius for her work to expand health coverage to children in Kansas, and for her role in blocking a major insurance merger in her state.

President Obama now has a Health and Human Services secretary to help shepherd his health reform agenda through Congress and deal with the swine flu outbreak and other challenges.

In a 65–31 vote, the Senate confirmed Kansas Gov. Kathleen Sebelius, a Democrat, as HHS secretary on April 28. Under an agreement reached between Senate Democrats and Republicans, 60 votes were required for confirmation. She is the last member of President Obama's cabinet to be confirmed by the Senate.

Gov. Sebelius, a two-term governor and former state insurance commissioner, has been praised for her bipartisan approach to governing in Kansas. Her confirmation was initially slowed in the Senate over conservatives' concerns about her position on abortion. For example, antiabortion advocates called her unfit for the HHS post after her April 23 veto of controversial state legislation that would have increased reporting requirements on late-term abortions and left physicians who perform abortions open to civil litigation if the abortion was later deemed illegal.

The American Medical Association praised Gov. Sebelius for her work to expand health coverage to children in Kansas, and for her role in blocking a major insurance merger in her state.

President Obama now has a Health and Human Services secretary to help shepherd his health reform agenda through Congress and deal with the swine flu outbreak and other challenges.

In a 65–31 vote, the Senate confirmed Kansas Gov. Kathleen Sebelius, a Democrat, as HHS secretary on April 28. Under an agreement reached between Senate Democrats and Republicans, 60 votes were required for confirmation. She is the last member of President Obama's cabinet to be confirmed by the Senate.

Gov. Sebelius, a two-term governor and former state insurance commissioner, has been praised for her bipartisan approach to governing in Kansas. Her confirmation was initially slowed in the Senate over conservatives' concerns about her position on abortion. For example, antiabortion advocates called her unfit for the HHS post after her April 23 veto of controversial state legislation that would have increased reporting requirements on late-term abortions and left physicians who perform abortions open to civil litigation if the abortion was later deemed illegal.

The American Medical Association praised Gov. Sebelius for her work to expand health coverage to children in Kansas, and for her role in blocking a major insurance merger in her state.

The Obama administration plans to finance a portion of its ambitious 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 fiscal year 2010 budget request that the administration sent to Congress in early May. President Obama had released the highlights of his budget plans back in February but had not provided specifics on his legislative and regulatory proposals.

As expected, 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 the U.S. Department of Health and Human Services.

“Investing in health reform today will help bring down costs tomorrow and ensure all Americans have access to the quality care they need and deserve,” she added.

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 administration is hoping to begin bundling Medicare payments for inpatient hospital services and postacute care within 30 days of discharge, a change that would start in 2013.

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.

Savings also would 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, according to the Obama administration.

The FY 2010 budget does not include a fix for the Medicare physician payment system, which is once again 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 FY 2010 budget proposal includes a total of $879 billion for HHS, which is a $63 billion increase over the amount in the FY 2009 budget.

The administration also is moving to bolster cancer research as part of the budget proposal. The proposal includes nearly $31 billion for the National Institutes of Health, with more than $6 billion dedicated to cancer research across the agency. This is the first installment in President Obama's plan to double NIH cancer research by FY 2017.

In addition, the budget addresses concerns about the response to the 2009-H1N1 “swine” flu. Aside from the $1.5 billion supplemental request, the administration is seeking $584 million in the FY 2010 budget proposal. The money would go toward developing, producing, and distributing antivirals, vaccines, and personal protective equipment. It would be used for surveillance and response efforts, as well.

The administration also is planning to invest $1 billion into health care workforce initiatives, which would include expansion of loan repayment and scholarship programs for physicians, nurses, and dentists who agree to 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 biologicals. 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. Additionally, the FDA budget includes $5 million to explore ways for Americans to safely import drugs from other countries.

The FY2010 budget documents are available online at www.hhs.gov/asrt/ob/docbudget/index.html

'Investing in health reform today will help bring down costs tomorrow.' MS. SEBELIUS

The Obama administration plans to finance a portion of its ambitious 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 fiscal year 2010 budget request that the administration sent to Congress in early May. President Obama had released the highlights of his budget plans back in February but had not provided specifics on his legislative and regulatory proposals.

As expected, 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 the U.S. Department of Health and Human Services.

“Investing in health reform today will help bring down costs tomorrow and ensure all Americans have access to the quality care they need and deserve,” she added.

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 administration is hoping to begin bundling Medicare payments for inpatient hospital services and postacute care within 30 days of discharge, a change that would start in 2013.

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.

Savings also would 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, according to the Obama administration.

The FY 2010 budget does not include a fix for the Medicare physician payment system, which is once again 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 FY 2010 budget proposal includes a total of $879 billion for HHS, which is a $63 billion increase over the amount in the FY 2009 budget.

The administration also is moving to bolster cancer research as part of the budget proposal. The proposal includes nearly $31 billion for the National Institutes of Health, with more than $6 billion dedicated to cancer research across the agency. This is the first installment in President Obama's plan to double NIH cancer research by FY 2017.

In addition, the budget addresses concerns about the response to the 2009-H1N1 “swine” flu. Aside from the $1.5 billion supplemental request, the administration is seeking $584 million in the FY 2010 budget proposal. The money would go toward developing, producing, and distributing antivirals, vaccines, and personal protective equipment. It would be used for surveillance and response efforts, as well.

The administration also is planning to invest $1 billion into health care workforce initiatives, which would include expansion of loan repayment and scholarship programs for physicians, nurses, and dentists who agree to 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 biologicals. 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. Additionally, the FDA budget includes $5 million to explore ways for Americans to safely import drugs from other countries.

The FY2010 budget documents are available online at www.hhs.gov/asrt/ob/docbudget/index.html

'Investing in health reform today will help bring down costs tomorrow.' MS. SEBELIUS

The Obama administration plans to finance a portion of its ambitious 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 fiscal year 2010 budget request that the administration sent to Congress in early May. President Obama had released the highlights of his budget plans back in February but had not provided specifics on his legislative and regulatory proposals.

As expected, 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 the U.S. Department of Health and Human Services.

“Investing in health reform today will help bring down costs tomorrow and ensure all Americans have access to the quality care they need and deserve,” she added.

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 administration is hoping to begin bundling Medicare payments for inpatient hospital services and postacute care within 30 days of discharge, a change that would start in 2013.

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.

Savings also would 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, according to the Obama administration.

The FY 2010 budget does not include a fix for the Medicare physician payment system, which is once again 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 FY 2010 budget proposal includes a total of $879 billion for HHS, which is a $63 billion increase over the amount in the FY 2009 budget.

The administration also is moving to bolster cancer research as part of the budget proposal. The proposal includes nearly $31 billion for the National Institutes of Health, with more than $6 billion dedicated to cancer research across the agency. This is the first installment in President Obama's plan to double NIH cancer research by FY 2017.

In addition, the budget addresses concerns about the response to the 2009-H1N1 “swine” flu. Aside from the $1.5 billion supplemental request, the administration is seeking $584 million in the FY 2010 budget proposal. The money would go toward developing, producing, and distributing antivirals, vaccines, and personal protective equipment. It would be used for surveillance and response efforts, as well.

The administration also is planning to invest $1 billion into health care workforce initiatives, which would include expansion of loan repayment and scholarship programs for physicians, nurses, and dentists who agree to 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 biologicals. 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. Additionally, the FDA budget includes $5 million to explore ways for Americans to safely import drugs from other countries.

The FY2010 budget documents are available online at www.hhs.gov/asrt/ob/docbudget/index.html

'Investing in health reform today will help bring down costs tomorrow.' MS. SEBELIUS

Physicians and health care organizations must implement a formal identity theft prevention program to protect their patients under a little-known set of regulations called the Identity Theft Red Flags Rule.

The rule, issued by the Federal Trade Commission (FTC) in 2007, and to be enforced in August 2009, is aimed primarily at creditors and financial institutions. However, after publication of the rule, the FTC informed physician groups that it was interpreting the term creditor broadly to include health care professionals who regularly allow consumers to defer payment for services. Therefore, any medical practices that allow patients to defer payment while they bill insurance would be covered under the rule.

Physicians and other health care professionals are required to come into compliance with the rule as of Aug. 1.

The rule requires that health care professionals develop and implement a written identity theft prevention and detection program to protect consumers. Organizations must conduct a risk assessment to determine their vulnerability to identity theft. Next, they must develop and implement a written identity theft program to identify, detect, and respond to those risks.

As part of the plan, organizations must specify how they will detect the “red flags” alerting them to potential identity theft. The program also must include how the organization will respond once a red flag is detected.

Identify theft is most commonly associated with financial transactions, but there is increasing concern about it in the health care sector, according to the FTC. For example, medical identify theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians working in settings with a low risk for fraud, an identity theft program could be simple, according to the FTC. For example, staff members at the practice could check a photo identification at the time services are sought. Another part of a basic program would be to develop steps to take in the event that someone's identity has been misused. That might include not collecting debt from the “true consumer” and not reporting the debt on the consumer's credit report. Practices should ensure that the correct medical information is in the patient's chart, according to the FTC.

But the interpretation of physicians as creditors has raised the hackles of the American Association of Clinical Endocrinologists, the American College of Physicians, the American Medical Association, and several other physician organizations. Those groups contend that physicians are being inappropriately labeled as creditors, and that the requirements place an undue burden on physicians that could adversely affect patients' access to services.

“It will create more bureaucratic burden at a time when we aren't getting any breaks with reimbursement,” said Dr. R. Mack Harrell, a member of the AACE board of directors and chair of the organization's socioeconomics committee.

Most physicians will likely need to purchase some type of new software and updates to comply with the FTC's requirements for an identity theft prevention program, creating additional costs for medical practices, Dr. Harrell said. When federal lawmakers establish these types of regulatory mandates, they need to factor in the costs to implement them and adjust physician payments accordingly, he added. “It's an ongoing tale of rising expenses.”

Another objection that many physician groups have to the Red Flags Rule is that they did not have an opportunity to comment on its impact before it was issued. Since the 2007 rule did not explicitly mention physicians, the AMA and others contend that the FTC must publish a new rule and put that new rule out for public comment.

Expert Offers Tips for Compliance With Red Flags Rule

Physician practices that seek to comply with the Red Flags Rule can begin by appointing a compliance officer for the identity-theft prevention program, said Sai Huda, an expert in financial services regulation.

The next step is to conduct an inventory of medical services that are covered by the rule, said Mr. Huda, chairman and CEO of Compliance Coach Inc., a provider of regulatory compliance software in the financial services industry. Under the rule, practices also must identify the applicable red flags for each of their covered services and develop procedures to detect and respond to potential identity fraud.

Those steps will go into the written prevention plan, but the work isn't done once the plan has been written, Mr. Huda said.

Other key elements of compliance with the Red Flags Rule include staff training on the program and periodic updates to the plan based on new trends in identity theft and experiences within the practice.

Another area to consider in formulating a strategy to combat identity theft is the risk of fraud from practice staff members. Mr. Huda recommended tightening up hiring and retention practices and spending the money for background and credit checks on new hires.

Compliance Coach sells an online tool to help in the formulation of an identity theft prevention plan, but there are free resources that can be used to help set up a program. The actual Red Flags Rule can be viewed at

edocket.access.gpo.gov/2007/pdf/07-5453.pdf

www.ftc.gov/bcp/edu/pubs/articles/art11.shtm

The American Medical Association offers guidance at

www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml

www.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdf

Physicians and health care organizations must implement a formal identity theft prevention program to protect their patients under a little-known set of regulations called the Identity Theft Red Flags Rule.

The rule, issued by the Federal Trade Commission (FTC) in 2007, and to be enforced in August 2009, is aimed primarily at creditors and financial institutions. However, after publication of the rule, the FTC informed physician groups that it was interpreting the term creditor broadly to include health care professionals who regularly allow consumers to defer payment for services. Therefore, any medical practices that allow patients to defer payment while they bill insurance would be covered under the rule.

Physicians and other health care professionals are required to come into compliance with the rule as of Aug. 1.

The rule requires that health care professionals develop and implement a written identity theft prevention and detection program to protect consumers. Organizations must conduct a risk assessment to determine their vulnerability to identity theft. Next, they must develop and implement a written identity theft program to identify, detect, and respond to those risks.

As part of the plan, organizations must specify how they will detect the “red flags” alerting them to potential identity theft. The program also must include how the organization will respond once a red flag is detected.

Identify theft is most commonly associated with financial transactions, but there is increasing concern about it in the health care sector, according to the FTC. For example, medical identify theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians working in settings with a low risk for fraud, an identity theft program could be simple, according to the FTC. For example, staff members at the practice could check a photo identification at the time services are sought. Another part of a basic program would be to develop steps to take in the event that someone's identity has been misused. That might include not collecting debt from the “true consumer” and not reporting the debt on the consumer's credit report. Practices should ensure that the correct medical information is in the patient's chart, according to the FTC.

But the interpretation of physicians as creditors has raised the hackles of the American Association of Clinical Endocrinologists, the American College of Physicians, the American Medical Association, and several other physician organizations. Those groups contend that physicians are being inappropriately labeled as creditors, and that the requirements place an undue burden on physicians that could adversely affect patients' access to services.

“It will create more bureaucratic burden at a time when we aren't getting any breaks with reimbursement,” said Dr. R. Mack Harrell, a member of the AACE board of directors and chair of the organization's socioeconomics committee.

Most physicians will likely need to purchase some type of new software and updates to comply with the FTC's requirements for an identity theft prevention program, creating additional costs for medical practices, Dr. Harrell said. When federal lawmakers establish these types of regulatory mandates, they need to factor in the costs to implement them and adjust physician payments accordingly, he added. “It's an ongoing tale of rising expenses.”

Another objection that many physician groups have to the Red Flags Rule is that they did not have an opportunity to comment on its impact before it was issued. Since the 2007 rule did not explicitly mention physicians, the AMA and others contend that the FTC must publish a new rule and put that new rule out for public comment.

Expert Offers Tips for Compliance With Red Flags Rule

Physician practices that seek to comply with the Red Flags Rule can begin by appointing a compliance officer for the identity-theft prevention program, said Sai Huda, an expert in financial services regulation.

The next step is to conduct an inventory of medical services that are covered by the rule, said Mr. Huda, chairman and CEO of Compliance Coach Inc., a provider of regulatory compliance software in the financial services industry. Under the rule, practices also must identify the applicable red flags for each of their covered services and develop procedures to detect and respond to potential identity fraud.

Those steps will go into the written prevention plan, but the work isn't done once the plan has been written, Mr. Huda said.

Other key elements of compliance with the Red Flags Rule include staff training on the program and periodic updates to the plan based on new trends in identity theft and experiences within the practice.

Another area to consider in formulating a strategy to combat identity theft is the risk of fraud from practice staff members. Mr. Huda recommended tightening up hiring and retention practices and spending the money for background and credit checks on new hires.

Compliance Coach sells an online tool to help in the formulation of an identity theft prevention plan, but there are free resources that can be used to help set up a program. The actual Red Flags Rule can be viewed at

edocket.access.gpo.gov/2007/pdf/07-5453.pdf

www.ftc.gov/bcp/edu/pubs/articles/art11.shtm

The American Medical Association offers guidance at

www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml

www.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdf

Physicians and health care organizations must implement a formal identity theft prevention program to protect their patients under a little-known set of regulations called the Identity Theft Red Flags Rule.

The rule, issued by the Federal Trade Commission (FTC) in 2007, and to be enforced in August 2009, is aimed primarily at creditors and financial institutions. However, after publication of the rule, the FTC informed physician groups that it was interpreting the term creditor broadly to include health care professionals who regularly allow consumers to defer payment for services. Therefore, any medical practices that allow patients to defer payment while they bill insurance would be covered under the rule.

Physicians and other health care professionals are required to come into compliance with the rule as of Aug. 1.

The rule requires that health care professionals develop and implement a written identity theft prevention and detection program to protect consumers. Organizations must conduct a risk assessment to determine their vulnerability to identity theft. Next, they must develop and implement a written identity theft program to identify, detect, and respond to those risks.

As part of the plan, organizations must specify how they will detect the “red flags” alerting them to potential identity theft. The program also must include how the organization will respond once a red flag is detected.

Identify theft is most commonly associated with financial transactions, but there is increasing concern about it in the health care sector, according to the FTC. For example, medical identify theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians working in settings with a low risk for fraud, an identity theft program could be simple, according to the FTC. For example, staff members at the practice could check a photo identification at the time services are sought. Another part of a basic program would be to develop steps to take in the event that someone's identity has been misused. That might include not collecting debt from the “true consumer” and not reporting the debt on the consumer's credit report. Practices should ensure that the correct medical information is in the patient's chart, according to the FTC.

But the interpretation of physicians as creditors has raised the hackles of the American Association of Clinical Endocrinologists, the American College of Physicians, the American Medical Association, and several other physician organizations. Those groups contend that physicians are being inappropriately labeled as creditors, and that the requirements place an undue burden on physicians that could adversely affect patients' access to services.

“It will create more bureaucratic burden at a time when we aren't getting any breaks with reimbursement,” said Dr. R. Mack Harrell, a member of the AACE board of directors and chair of the organization's socioeconomics committee.

Most physicians will likely need to purchase some type of new software and updates to comply with the FTC's requirements for an identity theft prevention program, creating additional costs for medical practices, Dr. Harrell said. When federal lawmakers establish these types of regulatory mandates, they need to factor in the costs to implement them and adjust physician payments accordingly, he added. “It's an ongoing tale of rising expenses.”

Another objection that many physician groups have to the Red Flags Rule is that they did not have an opportunity to comment on its impact before it was issued. Since the 2007 rule did not explicitly mention physicians, the AMA and others contend that the FTC must publish a new rule and put that new rule out for public comment.

Expert Offers Tips for Compliance With Red Flags Rule

Physician practices that seek to comply with the Red Flags Rule can begin by appointing a compliance officer for the identity-theft prevention program, said Sai Huda, an expert in financial services regulation.

The next step is to conduct an inventory of medical services that are covered by the rule, said Mr. Huda, chairman and CEO of Compliance Coach Inc., a provider of regulatory compliance software in the financial services industry. Under the rule, practices also must identify the applicable red flags for each of their covered services and develop procedures to detect and respond to potential identity fraud.

Those steps will go into the written prevention plan, but the work isn't done once the plan has been written, Mr. Huda said.

Other key elements of compliance with the Red Flags Rule include staff training on the program and periodic updates to the plan based on new trends in identity theft and experiences within the practice.

Another area to consider in formulating a strategy to combat identity theft is the risk of fraud from practice staff members. Mr. Huda recommended tightening up hiring and retention practices and spending the money for background and credit checks on new hires.

Compliance Coach sells an online tool to help in the formulation of an identity theft prevention plan, but there are free resources that can be used to help set up a program. The actual Red Flags Rule can be viewed at

edocket.access.gpo.gov/2007/pdf/07-5453.pdf

www.ftc.gov/bcp/edu/pubs/articles/art11.shtm

The American Medical Association offers guidance at

www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml

www.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdf

Physicians and health care organizations must now implement a formal identity theft prevention program to protect their patients under a little-known set of regulations called the “Identity Theft Red Flags Rule.”

The rule, which was issued by the Federal Trade Commission (FTC) in 2007 but will be enforced starting this month, is aimed primarily at creditors and financial institutions. However, after publication of the rule, the FTC informed physician groups that it was interpreting the term creditor broadly to include health care professionals who regularly allow consumers to defer payment for services. Therefore, any medical practices that allow patients to defer payment while they bill insurance would be covered under the rule.

Physicians and other health care professionals are required to come into compliance with the rule as of May 1, 2009.

The rule requires health care professionals to develop and implement a written identity-theft prevention and detection program to protect consumers. Specifically, the rule calls for organizations to conduct a risk assessment to determine their vulnerability to identity theft. Next, they must develop and implement a written identity-theft program to identify, detect, and respond to those risks.

As part of the plan, organizations must specify how they will detect the “red flags” alerting them to potential identity theft. The program also must include how the organization will respond once a red flag is detected.

While identify theft is most commonly associated with financial transactions, there is increasing concern about identity theft in the health care sector, according to the FTC. For example, medical identity theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians working in settings with a low risk for fraud, an identity-theft program could be simple, according to the FTC. For example, staff at the practice could check a photo identification at the time services are sought. Another part of a basic program would be to develop steps to take in the event that someone's identity has been misused. That might include not collecting debt from the “true consumer” and not reporting the debt on the consumer's credit report. Also, practices should ensure that the correct medical information is in the patient's chart, according to the FTC.

But the interpretation of physicians as creditors has raised the hackles of the American Medical Association, the American College of Physicians, the American College of Emergency Physicians, the American College of Surgeons, the American Academy of Pediatrics, and several other physician organizations. Those groups contend that physicians are being inappropriately labeled as creditors, and that the requirements place an undue burden on physicians that could adversely affect patients' access to services.

Another objection that many physician groups have to the Red Flags Rule is that they didn't have an opportunity to comment on its impact before it was issued. Since the 2007 rule didn't explicitly mention physicians, the AMA and others contend that the FTC must publish a new rule and put that new rule out for public comment.

“The FTC did not give physicians an appropriate opportunity for notice and comment on the ruling that the Red Flags would be applied to them,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. “The AMA is calling on FTC to republish its rule so that we can make the case that physicians should be excluded from the Red Flags Rule.

A Federal Trade Commission guide explains how to comply with the red flags rule (www.ftc.gov/bcp/edu/pubs/articles/art11.shtmwww.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtmlwww.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdfhttp://edocket.access.gpo.gov?/2007/pdf/07-5453.pdf

Physicians and health care organizations must now implement a formal identity theft prevention program to protect their patients under a little-known set of regulations called the “Identity Theft Red Flags Rule.”

The rule, which was issued by the Federal Trade Commission (FTC) in 2007 but will be enforced starting this month, is aimed primarily at creditors and financial institutions. However, after publication of the rule, the FTC informed physician groups that it was interpreting the term creditor broadly to include health care professionals who regularly allow consumers to defer payment for services. Therefore, any medical practices that allow patients to defer payment while they bill insurance would be covered under the rule.

Physicians and other health care professionals are required to come into compliance with the rule as of May 1, 2009.

The rule requires health care professionals to develop and implement a written identity-theft prevention and detection program to protect consumers. Specifically, the rule calls for organizations to conduct a risk assessment to determine their vulnerability to identity theft. Next, they must develop and implement a written identity-theft program to identify, detect, and respond to those risks.

As part of the plan, organizations must specify how they will detect the “red flags” alerting them to potential identity theft. The program also must include how the organization will respond once a red flag is detected.

While identify theft is most commonly associated with financial transactions, there is increasing concern about identity theft in the health care sector, according to the FTC. For example, medical identity theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians working in settings with a low risk for fraud, an identity-theft program could be simple, according to the FTC. For example, staff at the practice could check a photo identification at the time services are sought. Another part of a basic program would be to develop steps to take in the event that someone's identity has been misused. That might include not collecting debt from the “true consumer” and not reporting the debt on the consumer's credit report. Also, practices should ensure that the correct medical information is in the patient's chart, according to the FTC.

But the interpretation of physicians as creditors has raised the hackles of the American Medical Association, the American College of Physicians, the American College of Emergency Physicians, the American College of Surgeons, the American Academy of Pediatrics, and several other physician organizations. Those groups contend that physicians are being inappropriately labeled as creditors, and that the requirements place an undue burden on physicians that could adversely affect patients' access to services.

Another objection that many physician groups have to the Red Flags Rule is that they didn't have an opportunity to comment on its impact before it was issued. Since the 2007 rule didn't explicitly mention physicians, the AMA and others contend that the FTC must publish a new rule and put that new rule out for public comment.

“The FTC did not give physicians an appropriate opportunity for notice and comment on the ruling that the Red Flags would be applied to them,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. “The AMA is calling on FTC to republish its rule so that we can make the case that physicians should be excluded from the Red Flags Rule.

A Federal Trade Commission guide explains how to comply with the red flags rule (www.ftc.gov/bcp/edu/pubs/articles/art11.shtmwww.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtmlwww.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdfhttp://edocket.access.gpo.gov?/2007/pdf/07-5453.pdf

Physicians and health care organizations must now implement a formal identity theft prevention program to protect their patients under a little-known set of regulations called the “Identity Theft Red Flags Rule.”

The rule, which was issued by the Federal Trade Commission (FTC) in 2007 but will be enforced starting this month, is aimed primarily at creditors and financial institutions. However, after publication of the rule, the FTC informed physician groups that it was interpreting the term creditor broadly to include health care professionals who regularly allow consumers to defer payment for services. Therefore, any medical practices that allow patients to defer payment while they bill insurance would be covered under the rule.

Physicians and other health care professionals are required to come into compliance with the rule as of May 1, 2009.

The rule requires health care professionals to develop and implement a written identity-theft prevention and detection program to protect consumers. Specifically, the rule calls for organizations to conduct a risk assessment to determine their vulnerability to identity theft. Next, they must develop and implement a written identity-theft program to identify, detect, and respond to those risks.

As part of the plan, organizations must specify how they will detect the “red flags” alerting them to potential identity theft. The program also must include how the organization will respond once a red flag is detected.

While identify theft is most commonly associated with financial transactions, there is increasing concern about identity theft in the health care sector, according to the FTC. For example, medical identity theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians working in settings with a low risk for fraud, an identity-theft program could be simple, according to the FTC. For example, staff at the practice could check a photo identification at the time services are sought. Another part of a basic program would be to develop steps to take in the event that someone's identity has been misused. That might include not collecting debt from the “true consumer” and not reporting the debt on the consumer's credit report. Also, practices should ensure that the correct medical information is in the patient's chart, according to the FTC.

But the interpretation of physicians as creditors has raised the hackles of the American Medical Association, the American College of Physicians, the American College of Emergency Physicians, the American College of Surgeons, the American Academy of Pediatrics, and several other physician organizations. Those groups contend that physicians are being inappropriately labeled as creditors, and that the requirements place an undue burden on physicians that could adversely affect patients' access to services.

Another objection that many physician groups have to the Red Flags Rule is that they didn't have an opportunity to comment on its impact before it was issued. Since the 2007 rule didn't explicitly mention physicians, the AMA and others contend that the FTC must publish a new rule and put that new rule out for public comment.

“The FTC did not give physicians an appropriate opportunity for notice and comment on the ruling that the Red Flags would be applied to them,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. “The AMA is calling on FTC to republish its rule so that we can make the case that physicians should be excluded from the Red Flags Rule.

A Federal Trade Commission guide explains how to comply with the red flags rule (www.ftc.gov/bcp/edu/pubs/articles/art11.shtmwww.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtmlwww.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdfhttp://edocket.access.gpo.gov?/2007/pdf/07-5453.pdf

CDC Proposes New Vaccine Criteria

The Centers for Disease Control and Prevention is proposing new criteria for setting vaccination requirements for U.S. immigrants. Currently, those seeking entry to the country or wishing to change their legal status must receive vaccinations recommended by the Advisory Committee on Immunization Practices. This system created controversy last summer when the ACIP recommended vaccination against the human papillomavirus (HPV). Many groups, including the American College of Obstetricians and Gynecologists, objected that the vaccine is prohibitively expensive at $360 for the three-dose series. ACOG also argued that unlike other infectious diseases on the vaccination list, HPV doesn't pose an immediate threat to public health. Under the criteria proposed by CDC, a required vaccine must be age appropriate and recommended for the general U.S. population by ACIP. It also must protect against a disease meeting at least one of the following criteria: has the potential to cause an outbreak, has been eliminated in the United States, or is in the process of being eliminated here. CDC would continue to require that immigrants be vaccinated against mumps, measles, rubella, polio, tetanus, diphtheria, pertussis, Haemophilus influenzae type B, and hepatitis—but not HPV.

Bill Backs Better Biomarkers

Federal lawmakers have reintroduced legislation aimed at improving ovarian cancer screening. The Ovarian Cancer Biomarker Research Act (H.R. 1816 and S. 755) would authorize $100 million over 4 years for research into biomarkers that detect or indicate a woman's risk of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. The research would be conducted at centers of excellence around the country. The bill would also establish a committee to help design a large clinical trial of such biomarkers. The bill is sponsored by Rep. Howard L. Berman (D-Calif.) in the House and Sen. Barbara Boxer (D-Calif.) in the Senate.

HIV Bill Would Expand Medicaid

House Speaker Nancy Pelosi (D-Calif.) and a bipartisan group of representatives are seeking to allow low-income individuals with HIV to enroll earlier in Medicaid. Rep. Pelosi, Rep. Eliot Engel (D-N.Y.), and Rep. Ileana Ros-Lehtinen (R-Fla.) recently reintroduced the Early Treatment for HIV Act (H.R. 1616). The bill is modeled after a law that provides early access to Medicaid for women with breast or cervical cancer. The HIV bill failed to make it out of committee in the previous Congress. But the chances for success for greater this time around, according to Speaker Pelosi, given the bipartisan support for the legislation and President Obama's support of the concept.

Bill Seeks Payment Floor for Tests

Ob.gyns., rheumatologists, endocrinologists, and others are throwing their support behind federal legislation that would establish a payment floor for dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). The “Medicare Fracture Prevention and Osteoporosis Testing Act of 2009” (S. 769, H.R. 1894), would mandate payments not less than the 2006 Medicare rates for these services (CPT codes 77080 and 77082, respectively). The legislation would counteract deep Medicare payment cuts for the services that began in 2007. The new bill is supported by the DXA Task Force, which includes ACOG, the National Osteoporosis Foundation, the American Association of Clinical Endocrinologists, and the American College of Rheumatology.

Awareness Campaign Targets AIDS

The federal government plans to spend $45 million over the next 5 years on a new public-awareness campaign to fight growing complacency about HIV/AIDS in the United States. The effort, called Act Against AIDS, will include public service announcements, online communications, and targeted messages to African Americans, Latinos, and other groups that are disproportionately affected by HIV/AIDS. “Act Against AIDS seeks to put the HIV crisis back on the national radar screen,” Melody Barnes, director of the White House Domestic Policy Council, said in a statement. “Our goal is to remind Americans that HIV/AIDS continues to pose a serious health threat in the United States and encourage them to get the facts they need to take action for themselves and their communities.” More information on the campaign is available at

www.cdc.gov/hiv/aaa

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. In addition, nearly 40% of the applications were for new EHR products, rather than renewals, according to the federally recognized commission. Nearly two-thirds of the applicants qualified as small businesses, the commission noted. The biggest category of applications, including 26, was for EMR products concerning health records for children. Other applications covered cardiovascular medicine, emergency departments, and inpatient records. So far, 25 of the products have been certified, the commission said.

CDC Proposes New Vaccine Criteria

The Centers for Disease Control and Prevention is proposing new criteria for setting vaccination requirements for U.S. immigrants. Currently, those seeking entry to the country or wishing to change their legal status must receive vaccinations recommended by the Advisory Committee on Immunization Practices. This system created controversy last summer when the ACIP recommended vaccination against the human papillomavirus (HPV). Many groups, including the American College of Obstetricians and Gynecologists, objected that the vaccine is prohibitively expensive at $360 for the three-dose series. ACOG also argued that unlike other infectious diseases on the vaccination list, HPV doesn't pose an immediate threat to public health. Under the criteria proposed by CDC, a required vaccine must be age appropriate and recommended for the general U.S. population by ACIP. It also must protect against a disease meeting at least one of the following criteria: has the potential to cause an outbreak, has been eliminated in the United States, or is in the process of being eliminated here. CDC would continue to require that immigrants be vaccinated against mumps, measles, rubella, polio, tetanus, diphtheria, pertussis, Haemophilus influenzae type B, and hepatitis—but not HPV.

Bill Backs Better Biomarkers

Federal lawmakers have reintroduced legislation aimed at improving ovarian cancer screening. The Ovarian Cancer Biomarker Research Act (H.R. 1816 and S. 755) would authorize $100 million over 4 years for research into biomarkers that detect or indicate a woman's risk of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. The research would be conducted at centers of excellence around the country. The bill would also establish a committee to help design a large clinical trial of such biomarkers. The bill is sponsored by Rep. Howard L. Berman (D-Calif.) in the House and Sen. Barbara Boxer (D-Calif.) in the Senate.

HIV Bill Would Expand Medicaid

House Speaker Nancy Pelosi (D-Calif.) and a bipartisan group of representatives are seeking to allow low-income individuals with HIV to enroll earlier in Medicaid. Rep. Pelosi, Rep. Eliot Engel (D-N.Y.), and Rep. Ileana Ros-Lehtinen (R-Fla.) recently reintroduced the Early Treatment for HIV Act (H.R. 1616). The bill is modeled after a law that provides early access to Medicaid for women with breast or cervical cancer. The HIV bill failed to make it out of committee in the previous Congress. But the chances for success for greater this time around, according to Speaker Pelosi, given the bipartisan support for the legislation and President Obama's support of the concept.

Bill Seeks Payment Floor for Tests

Ob.gyns., rheumatologists, endocrinologists, and others are throwing their support behind federal legislation that would establish a payment floor for dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). The “Medicare Fracture Prevention and Osteoporosis Testing Act of 2009” (S. 769, H.R. 1894), would mandate payments not less than the 2006 Medicare rates for these services (CPT codes 77080 and 77082, respectively). The legislation would counteract deep Medicare payment cuts for the services that began in 2007. The new bill is supported by the DXA Task Force, which includes ACOG, the National Osteoporosis Foundation, the American Association of Clinical Endocrinologists, and the American College of Rheumatology.

Awareness Campaign Targets AIDS

The federal government plans to spend $45 million over the next 5 years on a new public-awareness campaign to fight growing complacency about HIV/AIDS in the United States. The effort, called Act Against AIDS, will include public service announcements, online communications, and targeted messages to African Americans, Latinos, and other groups that are disproportionately affected by HIV/AIDS. “Act Against AIDS seeks to put the HIV crisis back on the national radar screen,” Melody Barnes, director of the White House Domestic Policy Council, said in a statement. “Our goal is to remind Americans that HIV/AIDS continues to pose a serious health threat in the United States and encourage them to get the facts they need to take action for themselves and their communities.” More information on the campaign is available at

www.cdc.gov/hiv/aaa

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. In addition, nearly 40% of the applications were for new EHR products, rather than renewals, according to the federally recognized commission. Nearly two-thirds of the applicants qualified as small businesses, the commission noted. The biggest category of applications, including 26, was for EMR products concerning health records for children. Other applications covered cardiovascular medicine, emergency departments, and inpatient records. So far, 25 of the products have been certified, the commission said.

CDC Proposes New Vaccine Criteria

The Centers for Disease Control and Prevention is proposing new criteria for setting vaccination requirements for U.S. immigrants. Currently, those seeking entry to the country or wishing to change their legal status must receive vaccinations recommended by the Advisory Committee on Immunization Practices. This system created controversy last summer when the ACIP recommended vaccination against the human papillomavirus (HPV). Many groups, including the American College of Obstetricians and Gynecologists, objected that the vaccine is prohibitively expensive at $360 for the three-dose series. ACOG also argued that unlike other infectious diseases on the vaccination list, HPV doesn't pose an immediate threat to public health. Under the criteria proposed by CDC, a required vaccine must be age appropriate and recommended for the general U.S. population by ACIP. It also must protect against a disease meeting at least one of the following criteria: has the potential to cause an outbreak, has been eliminated in the United States, or is in the process of being eliminated here. CDC would continue to require that immigrants be vaccinated against mumps, measles, rubella, polio, tetanus, diphtheria, pertussis, Haemophilus influenzae type B, and hepatitis—but not HPV.

Bill Backs Better Biomarkers

Federal lawmakers have reintroduced legislation aimed at improving ovarian cancer screening. The Ovarian Cancer Biomarker Research Act (H.R. 1816 and S. 755) would authorize $100 million over 4 years for research into biomarkers that detect or indicate a woman's risk of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. The research would be conducted at centers of excellence around the country. The bill would also establish a committee to help design a large clinical trial of such biomarkers. The bill is sponsored by Rep. Howard L. Berman (D-Calif.) in the House and Sen. Barbara Boxer (D-Calif.) in the Senate.

HIV Bill Would Expand Medicaid

House Speaker Nancy Pelosi (D-Calif.) and a bipartisan group of representatives are seeking to allow low-income individuals with HIV to enroll earlier in Medicaid. Rep. Pelosi, Rep. Eliot Engel (D-N.Y.), and Rep. Ileana Ros-Lehtinen (R-Fla.) recently reintroduced the Early Treatment for HIV Act (H.R. 1616). The bill is modeled after a law that provides early access to Medicaid for women with breast or cervical cancer. The HIV bill failed to make it out of committee in the previous Congress. But the chances for success for greater this time around, according to Speaker Pelosi, given the bipartisan support for the legislation and President Obama's support of the concept.

Bill Seeks Payment Floor for Tests

Ob.gyns., rheumatologists, endocrinologists, and others are throwing their support behind federal legislation that would establish a payment floor for dual-energy x-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). The “Medicare Fracture Prevention and Osteoporosis Testing Act of 2009” (S. 769, H.R. 1894), would mandate payments not less than the 2006 Medicare rates for these services (CPT codes 77080 and 77082, respectively). The legislation would counteract deep Medicare payment cuts for the services that began in 2007. The new bill is supported by the DXA Task Force, which includes ACOG, the National Osteoporosis Foundation, the American Association of Clinical Endocrinologists, and the American College of Rheumatology.

Awareness Campaign Targets AIDS

The federal government plans to spend $45 million over the next 5 years on a new public-awareness campaign to fight growing complacency about HIV/AIDS in the United States. The effort, called Act Against AIDS, will include public service announcements, online communications, and targeted messages to African Americans, Latinos, and other groups that are disproportionately affected by HIV/AIDS. “Act Against AIDS seeks to put the HIV crisis back on the national radar screen,” Melody Barnes, director of the White House Domestic Policy Council, said in a statement. “Our goal is to remind Americans that HIV/AIDS continues to pose a serious health threat in the United States and encourage them to get the facts they need to take action for themselves and their communities.” More information on the campaign is available at

www.cdc.gov/hiv/aaa

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. In addition, nearly 40% of the applications were for new EHR products, rather than renewals, according to the federally recognized commission. Nearly two-thirds of the applicants qualified as small businesses, the commission noted. The biggest category of applications, including 26, was for EMR products concerning health records for children. Other applications covered cardiovascular medicine, emergency departments, and inpatient records. So far, 25 of the products have been certified, the commission said.

Less than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, according to a survey.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628–38).

The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.

The results are based on a 2008 survey of nearly 3,000 U.S. nonfederal acute care general hospitals. About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions—such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements—across all major clinical units in the hospital.

Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.

The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.

Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas.

“That suggests that we have a good place to start,” Dr. Jha said. “Many hospitals have just not put it together in a way that really would help them deliver high-quality care.”

The study was funded by the Robert Wood Johnson Foundation and the federal government's Office of the National Coordinator for Health Information Technology.

The study was conducted by researchers at Massachusetts General Hospital, the Veterans Affairs Boston Healthcare System, and the Brigham and Women's Hospital, all in Boston, and George Washington University in Washington. The researchers reported receiving consulting fees and grant support from Up To Date Inc. and GE Healthcare.

The goal of the survey was to establish a baseline for EHR adoption in hospital settings. Before the survey, published estimates of EHR adoption by U.S. hospitals ranged widely, from 5% to 59%, reflecting differing definitions of an EHR system, convenience samples, and low response rates.

Cost continues to be a significant barrier to the implementation of EHRs in hospital settings, the survey found. Among hospitals that had not implemented EHR systems, 74% cited inadequate capital for purchase of a system, 44% had concerns about maintenance costs, and 32% were wary of the unclear return on investment.

But responses from hospitals that had successfully implemented an EHR system indicated that financial incentives could spur adoption. About 82% of hospitals that had adopted EHRs said that additional reimbursement for the use of an electronic system could help, and 75% said financial incentives for adoption would be a positive step.

“This is really hard work,” said John P. Glaser, Ph.D., vice president and chief information officer of Partners HealthCare System in Boston, which has put such advanced clinical decision support features as computerized provider-order entry into 11 of its hospitals and has implemented EHRs in outpatient settings for about 3,000 physicians.

The implementation of an EHR system in a large multihospital system can cost hundreds of millions of dollars, involves difficult workflow and behavior changes for the staff, and requires sustained leadership, Dr. Glaser said. “These are not trivial undertakings,” he cautioned.

Some hospitals may not have access to sufficient capital to purchase and implement a system, while others may be hesitant about their ability to recoup some of the costs. At Dr. Glaser's institution, they have worked with area managed care companies to build financial incentives into the contracts, so their physicians are more willing to adopt EHRs, he explained.

Less than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, according to a survey.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628–38).

The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.

The results are based on a 2008 survey of nearly 3,000 U.S. nonfederal acute care general hospitals. About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions—such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements—across all major clinical units in the hospital.

Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.

The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.

Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas.

“That suggests that we have a good place to start,” Dr. Jha said. “Many hospitals have just not put it together in a way that really would help them deliver high-quality care.”

The study was funded by the Robert Wood Johnson Foundation and the federal government's Office of the National Coordinator for Health Information Technology.

The study was conducted by researchers at Massachusetts General Hospital, the Veterans Affairs Boston Healthcare System, and the Brigham and Women's Hospital, all in Boston, and George Washington University in Washington. The researchers reported receiving consulting fees and grant support from Up To Date Inc. and GE Healthcare.

The goal of the survey was to establish a baseline for EHR adoption in hospital settings. Before the survey, published estimates of EHR adoption by U.S. hospitals ranged widely, from 5% to 59%, reflecting differing definitions of an EHR system, convenience samples, and low response rates.

Cost continues to be a significant barrier to the implementation of EHRs in hospital settings, the survey found. Among hospitals that had not implemented EHR systems, 74% cited inadequate capital for purchase of a system, 44% had concerns about maintenance costs, and 32% were wary of the unclear return on investment.

But responses from hospitals that had successfully implemented an EHR system indicated that financial incentives could spur adoption. About 82% of hospitals that had adopted EHRs said that additional reimbursement for the use of an electronic system could help, and 75% said financial incentives for adoption would be a positive step.

“This is really hard work,” said John P. Glaser, Ph.D., vice president and chief information officer of Partners HealthCare System in Boston, which has put such advanced clinical decision support features as computerized provider-order entry into 11 of its hospitals and has implemented EHRs in outpatient settings for about 3,000 physicians.

The implementation of an EHR system in a large multihospital system can cost hundreds of millions of dollars, involves difficult workflow and behavior changes for the staff, and requires sustained leadership, Dr. Glaser said. “These are not trivial undertakings,” he cautioned.

Some hospitals may not have access to sufficient capital to purchase and implement a system, while others may be hesitant about their ability to recoup some of the costs. At Dr. Glaser's institution, they have worked with area managed care companies to build financial incentives into the contracts, so their physicians are more willing to adopt EHRs, he explained.

Less than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, according to a survey.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628–38).

The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.

The results are based on a 2008 survey of nearly 3,000 U.S. nonfederal acute care general hospitals. About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions—such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements—across all major clinical units in the hospital.

Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.

The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.

Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas.

“That suggests that we have a good place to start,” Dr. Jha said. “Many hospitals have just not put it together in a way that really would help them deliver high-quality care.”

The study was funded by the Robert Wood Johnson Foundation and the federal government's Office of the National Coordinator for Health Information Technology.

The study was conducted by researchers at Massachusetts General Hospital, the Veterans Affairs Boston Healthcare System, and the Brigham and Women's Hospital, all in Boston, and George Washington University in Washington. The researchers reported receiving consulting fees and grant support from Up To Date Inc. and GE Healthcare.

The goal of the survey was to establish a baseline for EHR adoption in hospital settings. Before the survey, published estimates of EHR adoption by U.S. hospitals ranged widely, from 5% to 59%, reflecting differing definitions of an EHR system, convenience samples, and low response rates.

Cost continues to be a significant barrier to the implementation of EHRs in hospital settings, the survey found. Among hospitals that had not implemented EHR systems, 74% cited inadequate capital for purchase of a system, 44% had concerns about maintenance costs, and 32% were wary of the unclear return on investment.

But responses from hospitals that had successfully implemented an EHR system indicated that financial incentives could spur adoption. About 82% of hospitals that had adopted EHRs said that additional reimbursement for the use of an electronic system could help, and 75% said financial incentives for adoption would be a positive step.

“This is really hard work,” said John P. Glaser, Ph.D., vice president and chief information officer of Partners HealthCare System in Boston, which has put such advanced clinical decision support features as computerized provider-order entry into 11 of its hospitals and has implemented EHRs in outpatient settings for about 3,000 physicians.

The implementation of an EHR system in a large multihospital system can cost hundreds of millions of dollars, involves difficult workflow and behavior changes for the staff, and requires sustained leadership, Dr. Glaser said. “These are not trivial undertakings,” he cautioned.

Some hospitals may not have access to sufficient capital to purchase and implement a system, while others may be hesitant about their ability to recoup some of the costs. At Dr. Glaser's institution, they have worked with area managed care companies to build financial incentives into the contracts, so their physicians are more willing to adopt EHRs, he explained.