Mary Ellen Schneider

Makeover for Medicare Payments

As members of Congress consider comprehensive health reform this year, the American Academy of Neurology is urging lawmakers to include a complete overhaul of the Medicare physician payment system. In testimony to the House Committee on Energy and Commerce Subcommittee on Health last month, Dr. Bruce Sigsbee, a member of the board of directors of the American Academy of Neurology, said the current Medicare payment system is so fundamentally flawed that it should be thrown out entirely. In its place, he suggested, Congress should consider a blended payment method that would include a base salary for physicians but put as much as 35% of the compensation at risk based on factors such as productivity, quality performance, and patient satisfaction. “For this type of system to work, it would have to provide incentives for coordinating the care of Medicare beneficiaries, especially those with chronic disease that incur a large percentage of Medicare resources,” Dr. Sigsbee said in testimony to Congress. “The result will be that physicians will be encouraged to provide high quality care that reduces the use of unnecessary care and improves the quality of life of the patient.”

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines, such as Google, as “sponsored links” when patients search for information on medical conditions. The ads cited by the Food and Drug Administration include promotions for the multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

Vt. Neurologists Make Pharma List

Neurologists were among the top recipients of pharmaceutical industry funding in the state of Vermont, according to an annual report compiled by the state's attorney general. The data are from drug manufacturers' public disclosures between July 2007 and June 2008. The disclosures include consulting and speaking fees, travel, gifts, and other payments to physicians, nurses, physician assistants, hospitals, and universities. In the report, neurologists received the third highest amount of industry funding, with about $185,000 going to eight neurologists. Psychiatry topped the list with about $479,000 in industry funds and internal medicine was second with about $333,000. The top five 2007-2008 spenders were Eli Lilly & Co.—the leaders for 3 years consecutively in the report—Pfizer Inc., Novartis Pharmaceuticals, Merck & Co., and Forest Pharmaceuticals.

Reloxin Approval Delayed

Ipsen and its marketing partner Medicis announced in mid-April that its botulinum type A (Reloxin, known as Dysport in Europe) would not be approved at that time, as had been expected. Instead, the companies reported in a statement that they were “in active labeling and risk evaluation and mitigation strategy discussions” with the FDA for both the therapeutic—cervical dystonia—and the aesthetic indications. Galderma owns European marketing rights for aesthetic uses and Medicis owns the U.S., Canadian, and Japanese rights. The companies did not say when they expect final approval.

Makeover for Medicare Payments

As members of Congress consider comprehensive health reform this year, the American Academy of Neurology is urging lawmakers to include a complete overhaul of the Medicare physician payment system. In testimony to the House Committee on Energy and Commerce Subcommittee on Health last month, Dr. Bruce Sigsbee, a member of the board of directors of the American Academy of Neurology, said the current Medicare payment system is so fundamentally flawed that it should be thrown out entirely. In its place, he suggested, Congress should consider a blended payment method that would include a base salary for physicians but put as much as 35% of the compensation at risk based on factors such as productivity, quality performance, and patient satisfaction. “For this type of system to work, it would have to provide incentives for coordinating the care of Medicare beneficiaries, especially those with chronic disease that incur a large percentage of Medicare resources,” Dr. Sigsbee said in testimony to Congress. “The result will be that physicians will be encouraged to provide high quality care that reduces the use of unnecessary care and improves the quality of life of the patient.”

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines, such as Google, as “sponsored links” when patients search for information on medical conditions. The ads cited by the Food and Drug Administration include promotions for the multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

Vt. Neurologists Make Pharma List

Neurologists were among the top recipients of pharmaceutical industry funding in the state of Vermont, according to an annual report compiled by the state's attorney general. The data are from drug manufacturers' public disclosures between July 2007 and June 2008. The disclosures include consulting and speaking fees, travel, gifts, and other payments to physicians, nurses, physician assistants, hospitals, and universities. In the report, neurologists received the third highest amount of industry funding, with about $185,000 going to eight neurologists. Psychiatry topped the list with about $479,000 in industry funds and internal medicine was second with about $333,000. The top five 2007-2008 spenders were Eli Lilly & Co.—the leaders for 3 years consecutively in the report—Pfizer Inc., Novartis Pharmaceuticals, Merck & Co., and Forest Pharmaceuticals.

Reloxin Approval Delayed

Ipsen and its marketing partner Medicis announced in mid-April that its botulinum type A (Reloxin, known as Dysport in Europe) would not be approved at that time, as had been expected. Instead, the companies reported in a statement that they were “in active labeling and risk evaluation and mitigation strategy discussions” with the FDA for both the therapeutic—cervical dystonia—and the aesthetic indications. Galderma owns European marketing rights for aesthetic uses and Medicis owns the U.S., Canadian, and Japanese rights. The companies did not say when they expect final approval.

Makeover for Medicare Payments

As members of Congress consider comprehensive health reform this year, the American Academy of Neurology is urging lawmakers to include a complete overhaul of the Medicare physician payment system. In testimony to the House Committee on Energy and Commerce Subcommittee on Health last month, Dr. Bruce Sigsbee, a member of the board of directors of the American Academy of Neurology, said the current Medicare payment system is so fundamentally flawed that it should be thrown out entirely. In its place, he suggested, Congress should consider a blended payment method that would include a base salary for physicians but put as much as 35% of the compensation at risk based on factors such as productivity, quality performance, and patient satisfaction. “For this type of system to work, it would have to provide incentives for coordinating the care of Medicare beneficiaries, especially those with chronic disease that incur a large percentage of Medicare resources,” Dr. Sigsbee said in testimony to Congress. “The result will be that physicians will be encouraged to provide high quality care that reduces the use of unnecessary care and improves the quality of life of the patient.”

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines, such as Google, as “sponsored links” when patients search for information on medical conditions. The ads cited by the Food and Drug Administration include promotions for the multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

Vt. Neurologists Make Pharma List

Neurologists were among the top recipients of pharmaceutical industry funding in the state of Vermont, according to an annual report compiled by the state's attorney general. The data are from drug manufacturers' public disclosures between July 2007 and June 2008. The disclosures include consulting and speaking fees, travel, gifts, and other payments to physicians, nurses, physician assistants, hospitals, and universities. In the report, neurologists received the third highest amount of industry funding, with about $185,000 going to eight neurologists. Psychiatry topped the list with about $479,000 in industry funds and internal medicine was second with about $333,000. The top five 2007-2008 spenders were Eli Lilly & Co.—the leaders for 3 years consecutively in the report—Pfizer Inc., Novartis Pharmaceuticals, Merck & Co., and Forest Pharmaceuticals.

Reloxin Approval Delayed

Ipsen and its marketing partner Medicis announced in mid-April that its botulinum type A (Reloxin, known as Dysport in Europe) would not be approved at that time, as had been expected. Instead, the companies reported in a statement that they were “in active labeling and risk evaluation and mitigation strategy discussions” with the FDA for both the therapeutic—cervical dystonia—and the aesthetic indications. Galderma owns European marketing rights for aesthetic uses and Medicis owns the U.S., Canadian, and Japanese rights. The companies did not say when they expect final approval.

Fewer than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, according to data from a survey of nearly 3,000 nonfederal acute care general hospitals in the United States.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey, conducted in 2008, 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.

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. It 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 UpToDate 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.”

Some hospitals may not have access to sufficient capital to purchase and implement a system, whereas 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 said.

Fewer than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, according to data from a survey of nearly 3,000 nonfederal acute care general hospitals in the United States.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey, conducted in 2008, 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.

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. It 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 UpToDate 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.”

Some hospitals may not have access to sufficient capital to purchase and implement a system, whereas 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 said.

Fewer than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, according to data from a survey of nearly 3,000 nonfederal acute care general hospitals in the United States.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey, conducted in 2008, 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.

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. It 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 UpToDate 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.”

Some hospitals may not have access to sufficient capital to purchase and implement a system, whereas 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 said.

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

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

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

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

But the survey's findings prompted a skeptical response from some emergency medicine experts.

This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.

“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.” For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.

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

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

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

Dr. Michael Carius, a past president of the American College of Emergency Physicians, questioned the MGMA survey findings. While ACEP has not commissioned a survey of its own on the on-call payment issue, anecdotal evidence indicates that the number of physicians receiving compensation to provide on-call coverage is much lower than is indicated by the survey, he said in an interview.

Hospitals increasingly are willing to consider creative arrangements, such as sharing on-call physician panels between hospitals, Dr. Carius said. However, in this tough economic environment, most hospitals are likely to be reluctant to pay for on-call coverage, he said.

“It really is a hospital-by-hospital and region-by-region problem,” Dr. Carius said.

ACEP and the emergency medicine community as a whole have been concerned about on-call coverage for a number of years. The ACEP On-Call Task Force, chaired by Dr. Carius, issued policy recommendations on the topic last year.

The task force recommended that policymakers provide liability protections to emergency and on-call specialty physicians to try to remove barriers to taking call. For example, one strategy proposed would be to change the threshold for a civil malpractice suit so that the plaintiff would have to show “recklessness” by the on-call specialist rather than “simple negligence.”

The task force also recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. A system that pays physicians a per-patient fee rather than a flat stipend would make the most sense, Dr. Carius said.

The task force also supported various ways that hospitals in the same region could work together to provide on-call coverage.

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

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

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

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

But the survey's findings prompted a skeptical response from some emergency medicine experts.

This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.

“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.” For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.

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

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

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

Dr. Michael Carius, a past president of the American College of Emergency Physicians, questioned the MGMA survey findings. While ACEP has not commissioned a survey of its own on the on-call payment issue, anecdotal evidence indicates that the number of physicians receiving compensation to provide on-call coverage is much lower than is indicated by the survey, he said in an interview.

Hospitals increasingly are willing to consider creative arrangements, such as sharing on-call physician panels between hospitals, Dr. Carius said. However, in this tough economic environment, most hospitals are likely to be reluctant to pay for on-call coverage, he said.

“It really is a hospital-by-hospital and region-by-region problem,” Dr. Carius said.

ACEP and the emergency medicine community as a whole have been concerned about on-call coverage for a number of years. The ACEP On-Call Task Force, chaired by Dr. Carius, issued policy recommendations on the topic last year.

The task force recommended that policymakers provide liability protections to emergency and on-call specialty physicians to try to remove barriers to taking call. For example, one strategy proposed would be to change the threshold for a civil malpractice suit so that the plaintiff would have to show “recklessness” by the on-call specialist rather than “simple negligence.”

The task force also recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. A system that pays physicians a per-patient fee rather than a flat stipend would make the most sense, Dr. Carius said.

The task force also supported various ways that hospitals in the same region could work together to provide on-call coverage.

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

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

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

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

But the survey's findings prompted a skeptical response from some emergency medicine experts.

This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.

“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.” For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.

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

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

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

Dr. Michael Carius, a past president of the American College of Emergency Physicians, questioned the MGMA survey findings. While ACEP has not commissioned a survey of its own on the on-call payment issue, anecdotal evidence indicates that the number of physicians receiving compensation to provide on-call coverage is much lower than is indicated by the survey, he said in an interview.

Hospitals increasingly are willing to consider creative arrangements, such as sharing on-call physician panels between hospitals, Dr. Carius said. However, in this tough economic environment, most hospitals are likely to be reluctant to pay for on-call coverage, he said.

“It really is a hospital-by-hospital and region-by-region problem,” Dr. Carius said.

ACEP and the emergency medicine community as a whole have been concerned about on-call coverage for a number of years. The ACEP On-Call Task Force, chaired by Dr. Carius, issued policy recommendations on the topic last year.

The task force recommended that policymakers provide liability protections to emergency and on-call specialty physicians to try to remove barriers to taking call. For example, one strategy proposed would be to change the threshold for a civil malpractice suit so that the plaintiff would have to show “recklessness” by the on-call specialist rather than “simple negligence.”

The task force also recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. A system that pays physicians a per-patient fee rather than a flat stipend would make the most sense, Dr. Carius said.

The task force also supported various ways that hospitals in the same region could work together to provide on-call coverage.

The federal government has released free software that will enable health care organizations to exchange information over the Nationwide Health Information Network at some point 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, so that health information can follow patients around the country.

The new software is designed to be an “on-ramp,” allowing different health care organization patients' electronic health record 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 software is available under an open source license that allows users to make changes to fit their own needs.

Although the software is free, organizations that use it are responsible for the costs of implementation and maintenance, according to the Department of Health and Human Services.

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.

The federal government has released free software that will enable health care organizations to exchange information over the Nationwide Health Information Network at some point 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, so that health information can follow patients around the country.

The new software is designed to be an “on-ramp,” allowing different health care organization patients' electronic health record 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 software is available under an open source license that allows users to make changes to fit their own needs.

Although the software is free, organizations that use it are responsible for the costs of implementation and maintenance, according to the Department of Health and Human Services.

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.

The federal government has released free software that will enable health care organizations to exchange information over the Nationwide Health Information Network at some point 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, so that health information can follow patients around the country.

The new software is designed to be an “on-ramp,” allowing different health care organization patients' electronic health record 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 software is available under an open source license that allows users to make changes to fit their own needs.

Although the software is free, organizations that use it are responsible for the costs of implementation and maintenance, according to the Department of Health and Human Services.

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.

Bill Seeks Payment Floor for Tests

Rheumatologists, endocrinologists, ob.gyns., 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 of 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 services that began in 2007. The new bill is supported by the DXA Task Force, which includes the American College of Rheumatology, the National Osteoporosis Foundation, and the American Association of Clinical Endocrinologists.

Feds Subpoena Study Documents

Federal investigators are showing an interest in a medical scandal involving the alleged fabrication of data in more than 20 anesthesia studies. The U.S. Attorney's Office in Boston recently subpoenaed documents from Bay-state Medical Center, located in Springfield, Mass., that are related to studies conducted by the anesthesiology researcher Dr. Scott S. Reuben. Jane Albert, a spokeswoman for Baystate Medical Center, said that the hospital is complying with the subpoena. Dr. Reuben performed anesthesiology services at the hospital but was employed by an outside medical group. Both the hospital and the anesthesiology group he worked for terminated their relationship with Dr. Reuben in March after an investigation by Baystate Medical Center concluded that Dr. Reuben fabricated data reported in more than 20 published articles, including the use of pain medications like celecoxib following surgery.

HHS Launches Lupus Campaign

The Health and Human Services Department, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. “Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country,” said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18-44 in the United States have little or no knowledge of lupus.

EMR Applications Rise

As of the March 31 deadline, 64 companies had applied for certification of their electronic medical record (EMR) products, one-third more than had 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 EMR products, rather than renewals, according to the federally recognized commission. So far, 25 of the products have been certified.

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines, such as Google, as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for the multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA.

Massachusetts Clinics Are Busy

Community health centers in Massachusetts saw a significant increase in their patient loads from 2005 to 2007, as the state implemented its health reform law, according to a study from the Kaiser Family Foundation. The 34 federally qualified clinics, which provide comprehensive primary care for low-income and uninsured patients, served 482,503 patients in 2007, up more than 51,000 from 2 years earlier, the foundation reported. The state's reform aims at universal coverage, but many people remain uninsured. Although the number of health center patients who lack insurance declined, the clinics in 2007 cared for a much larger proportion (36%) of the state's uninsured population than before. The experience in Massachusetts shows that community health centers play a critical role in caring for newly insured patients, the report concluded.

Issues of Drug Class Pending

Logistical and cost issues must be addressed before a behind-the-counter class of nonprescription drugs can be established officially in the United States, the Government Accountability Office said in a report on so-called BTC drugs. The GAO stressed that pharmacists must be ready to provide BTC counseling and that pharmacies must protect consumer privacy. In addition, policy makers should address cost issues, such as the availability of third-party coverage for BTC drugs and pharmacists' compensation for providing associated services. GAO researchers studied the experiences of five countries, including Italy and the Netherlands, that have a behind-the-counter or similarly restricted drug class.

Bill Seeks Payment Floor for Tests

Rheumatologists, endocrinologists, ob.gyns., 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 of 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 services that began in 2007. The new bill is supported by the DXA Task Force, which includes the American College of Rheumatology, the National Osteoporosis Foundation, and the American Association of Clinical Endocrinologists.

Feds Subpoena Study Documents

Federal investigators are showing an interest in a medical scandal involving the alleged fabrication of data in more than 20 anesthesia studies. The U.S. Attorney's Office in Boston recently subpoenaed documents from Bay-state Medical Center, located in Springfield, Mass., that are related to studies conducted by the anesthesiology researcher Dr. Scott S. Reuben. Jane Albert, a spokeswoman for Baystate Medical Center, said that the hospital is complying with the subpoena. Dr. Reuben performed anesthesiology services at the hospital but was employed by an outside medical group. Both the hospital and the anesthesiology group he worked for terminated their relationship with Dr. Reuben in March after an investigation by Baystate Medical Center concluded that Dr. Reuben fabricated data reported in more than 20 published articles, including the use of pain medications like celecoxib following surgery.

HHS Launches Lupus Campaign

The Health and Human Services Department, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. “Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country,” said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18-44 in the United States have little or no knowledge of lupus.

EMR Applications Rise

As of the March 31 deadline, 64 companies had applied for certification of their electronic medical record (EMR) products, one-third more than had 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 EMR products, rather than renewals, according to the federally recognized commission. So far, 25 of the products have been certified.

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines, such as Google, as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for the multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA.

Massachusetts Clinics Are Busy

Community health centers in Massachusetts saw a significant increase in their patient loads from 2005 to 2007, as the state implemented its health reform law, according to a study from the Kaiser Family Foundation. The 34 federally qualified clinics, which provide comprehensive primary care for low-income and uninsured patients, served 482,503 patients in 2007, up more than 51,000 from 2 years earlier, the foundation reported. The state's reform aims at universal coverage, but many people remain uninsured. Although the number of health center patients who lack insurance declined, the clinics in 2007 cared for a much larger proportion (36%) of the state's uninsured population than before. The experience in Massachusetts shows that community health centers play a critical role in caring for newly insured patients, the report concluded.

Issues of Drug Class Pending

Logistical and cost issues must be addressed before a behind-the-counter class of nonprescription drugs can be established officially in the United States, the Government Accountability Office said in a report on so-called BTC drugs. The GAO stressed that pharmacists must be ready to provide BTC counseling and that pharmacies must protect consumer privacy. In addition, policy makers should address cost issues, such as the availability of third-party coverage for BTC drugs and pharmacists' compensation for providing associated services. GAO researchers studied the experiences of five countries, including Italy and the Netherlands, that have a behind-the-counter or similarly restricted drug class.

Bill Seeks Payment Floor for Tests

Rheumatologists, endocrinologists, ob.gyns., 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 of 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 services that began in 2007. The new bill is supported by the DXA Task Force, which includes the American College of Rheumatology, the National Osteoporosis Foundation, and the American Association of Clinical Endocrinologists.

Feds Subpoena Study Documents

Federal investigators are showing an interest in a medical scandal involving the alleged fabrication of data in more than 20 anesthesia studies. The U.S. Attorney's Office in Boston recently subpoenaed documents from Bay-state Medical Center, located in Springfield, Mass., that are related to studies conducted by the anesthesiology researcher Dr. Scott S. Reuben. Jane Albert, a spokeswoman for Baystate Medical Center, said that the hospital is complying with the subpoena. Dr. Reuben performed anesthesiology services at the hospital but was employed by an outside medical group. Both the hospital and the anesthesiology group he worked for terminated their relationship with Dr. Reuben in March after an investigation by Baystate Medical Center concluded that Dr. Reuben fabricated data reported in more than 20 published articles, including the use of pain medications like celecoxib following surgery.

HHS Launches Lupus Campaign

The Health and Human Services Department, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. “Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country,” said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18-44 in the United States have little or no knowledge of lupus.

EMR Applications Rise

As of the March 31 deadline, 64 companies had applied for certification of their electronic medical record (EMR) products, one-third more than had 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 EMR products, rather than renewals, according to the federally recognized commission. So far, 25 of the products have been certified.

FDA Warns on Internet Ads

The Food and Drug Administration has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines, such as Google, as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for the multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA.

Massachusetts Clinics Are Busy

Community health centers in Massachusetts saw a significant increase in their patient loads from 2005 to 2007, as the state implemented its health reform law, according to a study from the Kaiser Family Foundation. The 34 federally qualified clinics, which provide comprehensive primary care for low-income and uninsured patients, served 482,503 patients in 2007, up more than 51,000 from 2 years earlier, the foundation reported. The state's reform aims at universal coverage, but many people remain uninsured. Although the number of health center patients who lack insurance declined, the clinics in 2007 cared for a much larger proportion (36%) of the state's uninsured population than before. The experience in Massachusetts shows that community health centers play a critical role in caring for newly insured patients, the report concluded.

Issues of Drug Class Pending

Logistical and cost issues must be addressed before a behind-the-counter class of nonprescription drugs can be established officially in the United States, the Government Accountability Office said in a report on so-called BTC drugs. The GAO stressed that pharmacists must be ready to provide BTC counseling and that pharmacies must protect consumer privacy. In addition, policy makers should address cost issues, such as the availability of third-party coverage for BTC drugs and pharmacists' compensation for providing associated services. GAO researchers studied the experiences of five countries, including Italy and the Netherlands, that have a behind-the-counter or similarly restricted drug class.

Physicians and health care organizations will have to 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 in August, 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 were required to come into compliance with the rule as of Aug. 1.

The rule requires health care professionals to develop and implement a written identity-theft prevention and detection program to protect consumers. Specifically, 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.

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 identify theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians 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 ID 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.”

But the interpretation of physicians as creditors has raised the hackles of the American Medical Association, the American College of Cardiology, the Heart Rhythm Society, the Society for Cardiovascular Angiography and Interventions, the American College of Physicians, 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.

In addition, the physician groups point out that they didn't have an opportunity to comment on the rule's impact before it was issued. Since the 2007 rule didn't explicitly mention physicians, the groups contend that the FTC must publish a new rule and put that new rule out for public comment.

Tips for Red Flags Rule Compliance

Physician practices seeking to comply with the “Red Flags Rule” can begin by appointing someone who will be the 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 the medical services that are covered by the rule, said Mr. Huda, chairman and CEO of Compliance Coach Inc., a provider of regulatory compliance software. 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.

Mr. Huda recommended tightening up hiring and retention practices as part of the effort to reduce fraud. It's worth spending the money for a background and credit check on potential new hires, he said.

Compliance Coach sells an online tool to help in the formulation of an identity theft prevention plan, but there are also free resources that physicians can use to help set up a program. Mr. Huda advised that physicians check out the Red Flags Rule at

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

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

www.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdf

Physicians and health care organizations will have to 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 in August, 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 were required to come into compliance with the rule as of Aug. 1.

The rule requires health care professionals to develop and implement a written identity-theft prevention and detection program to protect consumers. Specifically, 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.

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 identify theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians 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 ID 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.”

But the interpretation of physicians as creditors has raised the hackles of the American Medical Association, the American College of Cardiology, the Heart Rhythm Society, the Society for Cardiovascular Angiography and Interventions, the American College of Physicians, 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.

In addition, the physician groups point out that they didn't have an opportunity to comment on the rule's impact before it was issued. Since the 2007 rule didn't explicitly mention physicians, the groups contend that the FTC must publish a new rule and put that new rule out for public comment.

Tips for Red Flags Rule Compliance

Physician practices seeking to comply with the “Red Flags Rule” can begin by appointing someone who will be the 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 the medical services that are covered by the rule, said Mr. Huda, chairman and CEO of Compliance Coach Inc., a provider of regulatory compliance software. 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.

Mr. Huda recommended tightening up hiring and retention practices as part of the effort to reduce fraud. It's worth spending the money for a background and credit check on potential new hires, he said.

Compliance Coach sells an online tool to help in the formulation of an identity theft prevention plan, but there are also free resources that physicians can use to help set up a program. Mr. Huda advised that physicians check out the Red Flags Rule at

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

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

www.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdf

Physicians and health care organizations will have to 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 in August, 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 were required to come into compliance with the rule as of Aug. 1.

The rule requires health care professionals to develop and implement a written identity-theft prevention and detection program to protect consumers. Specifically, 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.

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 identify theft can occur when a patient seeks care using the name or insurance information of another person.

For most physicians 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 ID 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.”

But the interpretation of physicians as creditors has raised the hackles of the American Medical Association, the American College of Cardiology, the Heart Rhythm Society, the Society for Cardiovascular Angiography and Interventions, the American College of Physicians, 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.

In addition, the physician groups point out that they didn't have an opportunity to comment on the rule's impact before it was issued. Since the 2007 rule didn't explicitly mention physicians, the groups contend that the FTC must publish a new rule and put that new rule out for public comment.

Tips for Red Flags Rule Compliance

Physician practices seeking to comply with the “Red Flags Rule” can begin by appointing someone who will be the 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 the medical services that are covered by the rule, said Mr. Huda, chairman and CEO of Compliance Coach Inc., a provider of regulatory compliance software. 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.

Mr. Huda recommended tightening up hiring and retention practices as part of the effort to reduce fraud. It's worth spending the money for a background and credit check on potential new hires, he said.

Compliance Coach sells an online tool to help in the formulation of an identity theft prevention plan, but there are also free resources that physicians can use to help set up a program. Mr. Huda advised that physicians check out the Red Flags Rule at

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

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

www.worldprivacyforum.org/pdf/WPF_RedFlagReport_09242008fs.pdf

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

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 was sworn in later that day at the White House and was immediately briefed on the swine flu situation by Homeland Security officials.

Gov. Sebelius, a two-term governor and former state insurance commissioner, has been praised for her bipartisan approach to governing in Kansas. However, 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 she vetoed 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, as well as for the role she played in blocking a major insurance merger in her state.

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

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 was sworn in later that day at the White House and was immediately briefed on the swine flu situation by Homeland Security officials.

Gov. Sebelius, a two-term governor and former state insurance commissioner, has been praised for her bipartisan approach to governing in Kansas. However, 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 she vetoed 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, as well as for the role she played in blocking a major insurance merger in her state.

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

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 was sworn in later that day at the White House and was immediately briefed on the swine flu situation by Homeland Security officials.

Gov. Sebelius, a two-term governor and former state insurance commissioner, has been praised for her bipartisan approach to governing in Kansas. However, 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 she vetoed 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, as well as for the role she played in blocking a major insurance merger in her state.

NEW YORK — Most mental health disorders begin in childhood and adolescence, but the early onset of these disorders makes it less likely that individuals will promptly seek treatment, initial findings of the World Health Organization's World Mental Health Survey Initiative show.

“Mental disorders worldwide are basically disorders of the young,” said Dr. Philip Wang, director of the Division of Services and Interventional Research at the National Institute of Mental Health, who presented the survey findings at the annual meeting of the American Psychopathological Association.

For example, worldwide about 50% of cases of anxiety disorders have an onset before age 15. For mood disorders, 50% of survey respondents reported onset by age 25. Among respondents who reported substance abuse disorders, 50% said the condition appeared by age 20.

The survey also found that most professionally diagnosed cases of chronic mental disorders eventually get some kind of treatment, although not necessarily administered in a professional setting. But treatment delays are pervasive, and treatment quality is often inadequate. The treatment, which is very broadly defined, can be anything from buying a self-help book to formal mental health care, may not be intensive enough or simply ineffective, Dr. Wang said.

Worldwide, 70%–90% of respondents diagnosed with panic disorder said they had received some form of treatment, but the median time to receiving treatment was 1–4 years. In generalized anxiety disorder (GAD), about 60%–82% of respondents reported receiving care, but it took about 4–6 years to receive treatment.

The treatment delays are longer for major depression and addictive disorders. In major depression, 63%–92% of respondents said they received treatment, but not until 5–8 years after their diagnosis. For addictive disorders, 35%–51% reported receiving treatment, but the median delay was about 10–14 years.

In panic and GAD, help seeking is the fastest, Dr. Wang said, which accounts for those disorders having the shortest delays to treatment. But even those among those patients, they are waiting years from the onset of the “full blown” disorder, he said.

The initial results of the survey also indicate that the speed with which someone seeks treatment is modified by the age of onset of the disorder. In phobias, for example, if the disorder begins at age 30 or older, it takes about 5 years before 50% of individuals have sought some form of care. But if the onset of the phobia comes when the patients are in their 20s, it takes about 20 years before half of patients have sought any kind of treatment.

The World Mental Health Survey Initiative is aimed at assessing psychopathology and service use worldwide. It involves 28 countries, and a total of 200,000 face-to-face interviews have either been conducted or are being planned.

NEW YORK — Most mental health disorders begin in childhood and adolescence, but the early onset of these disorders makes it less likely that individuals will promptly seek treatment, initial findings of the World Health Organization's World Mental Health Survey Initiative show.

“Mental disorders worldwide are basically disorders of the young,” said Dr. Philip Wang, director of the Division of Services and Interventional Research at the National Institute of Mental Health, who presented the survey findings at the annual meeting of the American Psychopathological Association.

For example, worldwide about 50% of cases of anxiety disorders have an onset before age 15. For mood disorders, 50% of survey respondents reported onset by age 25. Among respondents who reported substance abuse disorders, 50% said the condition appeared by age 20.

The survey also found that most professionally diagnosed cases of chronic mental disorders eventually get some kind of treatment, although not necessarily administered in a professional setting. But treatment delays are pervasive, and treatment quality is often inadequate. The treatment, which is very broadly defined, can be anything from buying a self-help book to formal mental health care, may not be intensive enough or simply ineffective, Dr. Wang said.

Worldwide, 70%–90% of respondents diagnosed with panic disorder said they had received some form of treatment, but the median time to receiving treatment was 1–4 years. In generalized anxiety disorder (GAD), about 60%–82% of respondents reported receiving care, but it took about 4–6 years to receive treatment.

The treatment delays are longer for major depression and addictive disorders. In major depression, 63%–92% of respondents said they received treatment, but not until 5–8 years after their diagnosis. For addictive disorders, 35%–51% reported receiving treatment, but the median delay was about 10–14 years.

In panic and GAD, help seeking is the fastest, Dr. Wang said, which accounts for those disorders having the shortest delays to treatment. But even those among those patients, they are waiting years from the onset of the “full blown” disorder, he said.

The initial results of the survey also indicate that the speed with which someone seeks treatment is modified by the age of onset of the disorder. In phobias, for example, if the disorder begins at age 30 or older, it takes about 5 years before 50% of individuals have sought some form of care. But if the onset of the phobia comes when the patients are in their 20s, it takes about 20 years before half of patients have sought any kind of treatment.

The World Mental Health Survey Initiative is aimed at assessing psychopathology and service use worldwide. It involves 28 countries, and a total of 200,000 face-to-face interviews have either been conducted or are being planned.

NEW YORK — Most mental health disorders begin in childhood and adolescence, but the early onset of these disorders makes it less likely that individuals will promptly seek treatment, initial findings of the World Health Organization's World Mental Health Survey Initiative show.

“Mental disorders worldwide are basically disorders of the young,” said Dr. Philip Wang, director of the Division of Services and Interventional Research at the National Institute of Mental Health, who presented the survey findings at the annual meeting of the American Psychopathological Association.

For example, worldwide about 50% of cases of anxiety disorders have an onset before age 15. For mood disorders, 50% of survey respondents reported onset by age 25. Among respondents who reported substance abuse disorders, 50% said the condition appeared by age 20.

The survey also found that most professionally diagnosed cases of chronic mental disorders eventually get some kind of treatment, although not necessarily administered in a professional setting. But treatment delays are pervasive, and treatment quality is often inadequate. The treatment, which is very broadly defined, can be anything from buying a self-help book to formal mental health care, may not be intensive enough or simply ineffective, Dr. Wang said.

Worldwide, 70%–90% of respondents diagnosed with panic disorder said they had received some form of treatment, but the median time to receiving treatment was 1–4 years. In generalized anxiety disorder (GAD), about 60%–82% of respondents reported receiving care, but it took about 4–6 years to receive treatment.

The treatment delays are longer for major depression and addictive disorders. In major depression, 63%–92% of respondents said they received treatment, but not until 5–8 years after their diagnosis. For addictive disorders, 35%–51% reported receiving treatment, but the median delay was about 10–14 years.

In panic and GAD, help seeking is the fastest, Dr. Wang said, which accounts for those disorders having the shortest delays to treatment. But even those among those patients, they are waiting years from the onset of the “full blown” disorder, he said.

The initial results of the survey also indicate that the speed with which someone seeks treatment is modified by the age of onset of the disorder. In phobias, for example, if the disorder begins at age 30 or older, it takes about 5 years before 50% of individuals have sought some form of care. But if the onset of the phobia comes when the patients are in their 20s, it takes about 20 years before half of patients have sought any kind of treatment.

The World Mental Health Survey Initiative is aimed at assessing psychopathology and service use worldwide. It involves 28 countries, and a total of 200,000 face-to-face interviews have either been conducted or are being planned.

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

A smaller percentage of 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 nonfederal acute care general hospitals in the United States.

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. It 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 UpToDate 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 millions, and involve difficult workflow and behavior changes for the staff, Dr. Glaser said.

Some hospitals might not have access to sufficient capital to buy and implement a system; others might 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 said.

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

A smaller percentage of 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 nonfederal acute care general hospitals in the United States.

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. It 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 UpToDate 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 millions, and involve difficult workflow and behavior changes for the staff, Dr. Glaser said.

Some hospitals might not have access to sufficient capital to buy and implement a system; others might 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 said.

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

A smaller percentage of 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 nonfederal acute care general hospitals in the United States.

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. It 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 UpToDate 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 millions, and involve difficult workflow and behavior changes for the staff, Dr. Glaser said.

Some hospitals might not have access to sufficient capital to buy and implement a system; others might 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 said.

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

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

But the survey's findings prompted a skeptical response from some emergency medicine experts.

This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.

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

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

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

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

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

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

The task force recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. It also supported various ways that hospitals in the same region could work together to provide on-call coverage.

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

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

But the survey's findings prompted a skeptical response from some emergency medicine experts.

This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.

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

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

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

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

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

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

The task force recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. It also supported various ways that hospitals in the same region could work together to provide on-call coverage.

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

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

But the survey's findings prompted a skeptical response from some emergency medicine experts.

This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.

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

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

Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).

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

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

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

The task force recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. It also supported various ways that hospitals in the same region could work together to provide on-call coverage.