Mary Ellen Schneider

As part of an agreement with New York Attorney General Andrew Cuomo, UnitedHealth Group has agreed to shut down a national billing database used by health plans to determine reimbursements to members who use out-of-network physician services.

The billing database, which is operated by the UnitedHealth Group (UHG) subsidiary Ingenix Inc., will be replaced with a new, independent database run by a qualified nonprofit organization. Under the terms of the agreement, UHG will pay $50 million to help establish the new database. In addition, the nonprofit organization will develop a public Web site where consumers can research—before seeking services—how much they may be reimbursed for common out-of-network medical services in their area.

Aetna, the nation's third largest insurer, also has entered into an agreement with the New York attorney general to abandon its use of the Ingenix database in favor of the new one. Aetna also will contribute $20 million over 5 years for the creation of the new database.

In February 2009, Aetna reached an agreement with the New York Attorney General's office to pay $5.1 million to reimburse patients and physicians for claims involving out-of-network care. The settlement addresses charges that Aetna underpaid college student health insurance claims between 1998 and 2008 by more than $5 million. Aetna will now pay back the students, and in some cases their physicians, for the underpayments plus interest and penalties as calculated under state law. The agreement reached with the New York Attorney General will affect underpayments made to students across the country.

The agreements follow an investigation by Mr. Cuomo's office into allegations that insurers were systematically underpaying consumers for their out-of-network medical expenses by saying that physician charges were higher than the “usual, customary, and reasonable” rates as calculated by the Ingenix database. As a result, insurers would only pay a percentage of the lower “usual, customary, and reasonable” rate, leaving consumers to pay their own portion plus the balance of the bill. The investigation found that insurers were underpaying consumers for out-of-network expenses by 10%-28% for medical services across the state.

According to the UHG officials, the agreement with the New York attorney general will help increase the transparency of information related to physician fees for out-of-network services.

“We are committed to increasing the amount of useful information available in the health care marketplace so that people can make informed decisions, and this agreement is consistent with that approach and philosophy,” Thomas L. Strickland, executive vice president and chief legal officer for UnitedHealth Group, said in a statement. “We are pleased that an independent not-for-profit entity will play this important role for the marketplace.”

Just days after reaching an agreement with Mr. Cuomo's office, UHG also settled a lawsuit with the American Medical Association and two state medical associations over the use of the Ingenix database. The $350 million settlement is the largest monetary settlement of a class action lawsuit against a single health insurer in the United States, according to the AMA.

The lawsuit, which has been pending since 2000, alleged that UHG had been understating the “usual, customary, and reasonable” charges in payments to physicians and in reimbursing patients for out-of-network expenses. Under the class action settlement, UHG subscribers who submitted a claim for out-of-network services and were not properly reimbursed are eligible to receive part of the settlement. Physicians also could be eligible to receive payment under the settlement if they were underpaid by UHG and did not receive the balance from the patient.

But the biggest gain for physicians under both the AMA settlement and the agreement with the New York attorney general won't be money, but the rebuilding of the trust lost between patients and physicians, said Dr. Nancy H. Nielsen, AMA president.

When UHG and other insurers refused to pay the physician's charge, they were telling patients that the charge was unreasonable, creating tension between the patient and physician, said Dr. Michael H. Rosenberg, president of the Medical Society of the State of New York, which was part of the AMA's class action lawsuit.

Robert Laszewski, president of Health Policy and Strategy Associates LLC, a Washington-based consulting firm, said he doesn't expect to see significant changes in the “usual, customary, and reasonable” rates based on the creation of an independent database. The fundamental problem for physicians is that, regardless of who calculates the usual rates, there is still a wide discrepancy between the in-network rates available to most patients and the out-of-network rates paid by some.

As part of an agreement with New York Attorney General Andrew Cuomo, UnitedHealth Group has agreed to shut down a national billing database used by health plans to determine reimbursements to members who use out-of-network physician services.

The billing database, which is operated by the UnitedHealth Group (UHG) subsidiary Ingenix Inc., will be replaced with a new, independent database run by a qualified nonprofit organization. Under the terms of the agreement, UHG will pay $50 million to help establish the new database. In addition, the nonprofit organization will develop a public Web site where consumers can research—before seeking services—how much they may be reimbursed for common out-of-network medical services in their area.

Aetna, the nation's third largest insurer, also has entered into an agreement with the New York attorney general to abandon its use of the Ingenix database in favor of the new one. Aetna also will contribute $20 million over 5 years for the creation of the new database.

In February 2009, Aetna reached an agreement with the New York Attorney General's office to pay $5.1 million to reimburse patients and physicians for claims involving out-of-network care. The settlement addresses charges that Aetna underpaid college student health insurance claims between 1998 and 2008 by more than $5 million. Aetna will now pay back the students, and in some cases their physicians, for the underpayments plus interest and penalties as calculated under state law. The agreement reached with the New York Attorney General will affect underpayments made to students across the country.

The agreements follow an investigation by Mr. Cuomo's office into allegations that insurers were systematically underpaying consumers for their out-of-network medical expenses by saying that physician charges were higher than the “usual, customary, and reasonable” rates as calculated by the Ingenix database. As a result, insurers would only pay a percentage of the lower “usual, customary, and reasonable” rate, leaving consumers to pay their own portion plus the balance of the bill. The investigation found that insurers were underpaying consumers for out-of-network expenses by 10%-28% for medical services across the state.

According to the UHG officials, the agreement with the New York attorney general will help increase the transparency of information related to physician fees for out-of-network services.

“We are committed to increasing the amount of useful information available in the health care marketplace so that people can make informed decisions, and this agreement is consistent with that approach and philosophy,” Thomas L. Strickland, executive vice president and chief legal officer for UnitedHealth Group, said in a statement. “We are pleased that an independent not-for-profit entity will play this important role for the marketplace.”

Just days after reaching an agreement with Mr. Cuomo's office, UHG also settled a lawsuit with the American Medical Association and two state medical associations over the use of the Ingenix database. The $350 million settlement is the largest monetary settlement of a class action lawsuit against a single health insurer in the United States, according to the AMA.

The lawsuit, which has been pending since 2000, alleged that UHG had been understating the “usual, customary, and reasonable” charges in payments to physicians and in reimbursing patients for out-of-network expenses. Under the class action settlement, UHG subscribers who submitted a claim for out-of-network services and were not properly reimbursed are eligible to receive part of the settlement. Physicians also could be eligible to receive payment under the settlement if they were underpaid by UHG and did not receive the balance from the patient.

But the biggest gain for physicians under both the AMA settlement and the agreement with the New York attorney general won't be money, but the rebuilding of the trust lost between patients and physicians, said Dr. Nancy H. Nielsen, AMA president.

When UHG and other insurers refused to pay the physician's charge, they were telling patients that the charge was unreasonable, creating tension between the patient and physician, said Dr. Michael H. Rosenberg, president of the Medical Society of the State of New York, which was part of the AMA's class action lawsuit.

Robert Laszewski, president of Health Policy and Strategy Associates LLC, a Washington-based consulting firm, said he doesn't expect to see significant changes in the “usual, customary, and reasonable” rates based on the creation of an independent database. The fundamental problem for physicians is that, regardless of who calculates the usual rates, there is still a wide discrepancy between the in-network rates available to most patients and the out-of-network rates paid by some.

As part of an agreement with New York Attorney General Andrew Cuomo, UnitedHealth Group has agreed to shut down a national billing database used by health plans to determine reimbursements to members who use out-of-network physician services.

The billing database, which is operated by the UnitedHealth Group (UHG) subsidiary Ingenix Inc., will be replaced with a new, independent database run by a qualified nonprofit organization. Under the terms of the agreement, UHG will pay $50 million to help establish the new database. In addition, the nonprofit organization will develop a public Web site where consumers can research—before seeking services—how much they may be reimbursed for common out-of-network medical services in their area.

Aetna, the nation's third largest insurer, also has entered into an agreement with the New York attorney general to abandon its use of the Ingenix database in favor of the new one. Aetna also will contribute $20 million over 5 years for the creation of the new database.

In February 2009, Aetna reached an agreement with the New York Attorney General's office to pay $5.1 million to reimburse patients and physicians for claims involving out-of-network care. The settlement addresses charges that Aetna underpaid college student health insurance claims between 1998 and 2008 by more than $5 million. Aetna will now pay back the students, and in some cases their physicians, for the underpayments plus interest and penalties as calculated under state law. The agreement reached with the New York Attorney General will affect underpayments made to students across the country.

The agreements follow an investigation by Mr. Cuomo's office into allegations that insurers were systematically underpaying consumers for their out-of-network medical expenses by saying that physician charges were higher than the “usual, customary, and reasonable” rates as calculated by the Ingenix database. As a result, insurers would only pay a percentage of the lower “usual, customary, and reasonable” rate, leaving consumers to pay their own portion plus the balance of the bill. The investigation found that insurers were underpaying consumers for out-of-network expenses by 10%-28% for medical services across the state.

According to the UHG officials, the agreement with the New York attorney general will help increase the transparency of information related to physician fees for out-of-network services.

“We are committed to increasing the amount of useful information available in the health care marketplace so that people can make informed decisions, and this agreement is consistent with that approach and philosophy,” Thomas L. Strickland, executive vice president and chief legal officer for UnitedHealth Group, said in a statement. “We are pleased that an independent not-for-profit entity will play this important role for the marketplace.”

Just days after reaching an agreement with Mr. Cuomo's office, UHG also settled a lawsuit with the American Medical Association and two state medical associations over the use of the Ingenix database. The $350 million settlement is the largest monetary settlement of a class action lawsuit against a single health insurer in the United States, according to the AMA.

The lawsuit, which has been pending since 2000, alleged that UHG had been understating the “usual, customary, and reasonable” charges in payments to physicians and in reimbursing patients for out-of-network expenses. Under the class action settlement, UHG subscribers who submitted a claim for out-of-network services and were not properly reimbursed are eligible to receive part of the settlement. Physicians also could be eligible to receive payment under the settlement if they were underpaid by UHG and did not receive the balance from the patient.

But the biggest gain for physicians under both the AMA settlement and the agreement with the New York attorney general won't be money, but the rebuilding of the trust lost between patients and physicians, said Dr. Nancy H. Nielsen, AMA president.

When UHG and other insurers refused to pay the physician's charge, they were telling patients that the charge was unreasonable, creating tension between the patient and physician, said Dr. Michael H. Rosenberg, president of the Medical Society of the State of New York, which was part of the AMA's class action lawsuit.

Robert Laszewski, president of Health Policy and Strategy Associates LLC, a Washington-based consulting firm, said he doesn't expect to see significant changes in the “usual, customary, and reasonable” rates based on the creation of an independent database. The fundamental problem for physicians is that, regardless of who calculates the usual rates, there is still a wide discrepancy between the in-network rates available to most patients and the out-of-network rates paid by some.

Care coordination could be a cost-effective strategy to help families of children with special health care needs navigate the health care and school systems, according to the results of a pilot program in Pennsylvania.

Highmark Blue Shield's Caring Foundation launched the program in late 2004 in an effort to ensure that children with chronic illnesses and multiple diagnoses could access health care services. The program matches eligible children who are enrolled in the Pennsylvania's Children's Health Insurance Program (CHIP) through Highmark Blue Shield with a community-based care coordinator.

For most families, the care coordinators offer education and referrals by telephone or e-mail. However, for families in need of a greater level of support, the care coordinators make home visits, accompany families to physician appointments, and even go to the child's school to educate the teachers about the child's condition. The care coordinators, most of whom are nurses, also design a personalized care plan, which lists the child's medications and physicians and can be easily shared among providers.

Officials at Highmark's Caring Foundation decided to develop the program after hearing from families that they had trouble focusing on finding the right health care provider because they were struggling with everyday essentials like housing, food, and heat, Caring Program director Mary Kay Holleran, R.N., said at a briefing sponsored by the Blue Cross and Blue Shield Association.

“Children with special health care needs very often have to navigate a very difficult maze of services,” she said. “This sometimes inefficient and uncoordinated system has an enormous financial and emotional implication for the families.”

Since its inception, more than 8,500 children and families have received services through the program and many are still with the program, Ms. Holleran said. Of those, about 500 received intensive services, including home visits by care coordinators.

In an analysis of the first year of the program, researchers at the University of Pittsburgh found that children who received intensive support from a care coordinator had fewer emergency department visits, fewer unplanned inpatient admissions, and lower costs for durable medical equipment. However, the researchers did notice an increase in prescription costs for these children.

The cost findings are encouraging, Ms. Holleran said. The rise in medication costs could signal that children are getting appropriate treatments that are helping them to stay out of the hospital.

Even with the increase in prescription costs, the researchers estimated that the care coordinator program saves an average of $334 per member per year.

The researchers also performed a psychosocial analysis of the families who enrolled in the program during the first year. They found decreased anxiety among the parents, decreased out-of-pocket expenses, decreased school absences, and fewer problems with grades.

One surprise that came out of the program was how unprepared schools are to care for children with chronic health conditions, Ms. Holleran said. They had expected to find that poor coordination among physicians would be the biggest problem, but instead found enormous gaps in knowledge at the school level.

In one case, the mother of a 5-year-old girl with type 1 diabetes was concerned about having her daughter start kindergarten because she didn't feel the school would be able to handle her daughter's medical needs. The school's initial plan was to call the mother out of work or call an ambulance if any problems developed. So the care coordinator worked with the state health department to bring a nurse educator into the school. They provided information to the teachers about how to manage the girl's diabetes without constantly calling her mother out of work, as well as when it would be appropriate to call an ambulance.

The Caring Program is continuing among children who are enrolled in CHIP through Highmark, and may be expanded to the commercially insured pediatric population in the future, Ms. Holleran said. It was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross and Blue Shield Association as an innovative approach to improving health and wellness. The other “BlueWorks” winners include programs that address racial and ethnic disparities in health care, and that encourage children to adopt healthy lifestyles.

The BlueWorks program is juried by the department of health care policy at Harvard Medical School, Boston, in consultation with physicians from the American Academy of Pediatrics, the American College of Physicians, and the American Cancer Society.

Care coordination could be a cost-effective strategy to help families of children with special health care needs navigate the health care and school systems, according to the results of a pilot program in Pennsylvania.

Highmark Blue Shield's Caring Foundation launched the program in late 2004 in an effort to ensure that children with chronic illnesses and multiple diagnoses could access health care services. The program matches eligible children who are enrolled in the Pennsylvania's Children's Health Insurance Program (CHIP) through Highmark Blue Shield with a community-based care coordinator.

For most families, the care coordinators offer education and referrals by telephone or e-mail. However, for families in need of a greater level of support, the care coordinators make home visits, accompany families to physician appointments, and even go to the child's school to educate the teachers about the child's condition. The care coordinators, most of whom are nurses, also design a personalized care plan, which lists the child's medications and physicians and can be easily shared among providers.

Officials at Highmark's Caring Foundation decided to develop the program after hearing from families that they had trouble focusing on finding the right health care provider because they were struggling with everyday essentials like housing, food, and heat, Caring Program director Mary Kay Holleran, R.N., said at a briefing sponsored by the Blue Cross and Blue Shield Association.

“Children with special health care needs very often have to navigate a very difficult maze of services,” she said. “This sometimes inefficient and uncoordinated system has an enormous financial and emotional implication for the families.”

Since its inception, more than 8,500 children and families have received services through the program and many are still with the program, Ms. Holleran said. Of those, about 500 received intensive services, including home visits by care coordinators.

In an analysis of the first year of the program, researchers at the University of Pittsburgh found that children who received intensive support from a care coordinator had fewer emergency department visits, fewer unplanned inpatient admissions, and lower costs for durable medical equipment. However, the researchers did notice an increase in prescription costs for these children.

The cost findings are encouraging, Ms. Holleran said. The rise in medication costs could signal that children are getting appropriate treatments that are helping them to stay out of the hospital.

Even with the increase in prescription costs, the researchers estimated that the care coordinator program saves an average of $334 per member per year.

The researchers also performed a psychosocial analysis of the families who enrolled in the program during the first year. They found decreased anxiety among the parents, decreased out-of-pocket expenses, decreased school absences, and fewer problems with grades.

One surprise that came out of the program was how unprepared schools are to care for children with chronic health conditions, Ms. Holleran said. They had expected to find that poor coordination among physicians would be the biggest problem, but instead found enormous gaps in knowledge at the school level.

In one case, the mother of a 5-year-old girl with type 1 diabetes was concerned about having her daughter start kindergarten because she didn't feel the school would be able to handle her daughter's medical needs. The school's initial plan was to call the mother out of work or call an ambulance if any problems developed. So the care coordinator worked with the state health department to bring a nurse educator into the school. They provided information to the teachers about how to manage the girl's diabetes without constantly calling her mother out of work, as well as when it would be appropriate to call an ambulance.

The Caring Program is continuing among children who are enrolled in CHIP through Highmark, and may be expanded to the commercially insured pediatric population in the future, Ms. Holleran said. It was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross and Blue Shield Association as an innovative approach to improving health and wellness. The other “BlueWorks” winners include programs that address racial and ethnic disparities in health care, and that encourage children to adopt healthy lifestyles.

The BlueWorks program is juried by the department of health care policy at Harvard Medical School, Boston, in consultation with physicians from the American Academy of Pediatrics, the American College of Physicians, and the American Cancer Society.

Care coordination could be a cost-effective strategy to help families of children with special health care needs navigate the health care and school systems, according to the results of a pilot program in Pennsylvania.

Highmark Blue Shield's Caring Foundation launched the program in late 2004 in an effort to ensure that children with chronic illnesses and multiple diagnoses could access health care services. The program matches eligible children who are enrolled in the Pennsylvania's Children's Health Insurance Program (CHIP) through Highmark Blue Shield with a community-based care coordinator.

For most families, the care coordinators offer education and referrals by telephone or e-mail. However, for families in need of a greater level of support, the care coordinators make home visits, accompany families to physician appointments, and even go to the child's school to educate the teachers about the child's condition. The care coordinators, most of whom are nurses, also design a personalized care plan, which lists the child's medications and physicians and can be easily shared among providers.

Officials at Highmark's Caring Foundation decided to develop the program after hearing from families that they had trouble focusing on finding the right health care provider because they were struggling with everyday essentials like housing, food, and heat, Caring Program director Mary Kay Holleran, R.N., said at a briefing sponsored by the Blue Cross and Blue Shield Association.

“Children with special health care needs very often have to navigate a very difficult maze of services,” she said. “This sometimes inefficient and uncoordinated system has an enormous financial and emotional implication for the families.”

Since its inception, more than 8,500 children and families have received services through the program and many are still with the program, Ms. Holleran said. Of those, about 500 received intensive services, including home visits by care coordinators.

In an analysis of the first year of the program, researchers at the University of Pittsburgh found that children who received intensive support from a care coordinator had fewer emergency department visits, fewer unplanned inpatient admissions, and lower costs for durable medical equipment. However, the researchers did notice an increase in prescription costs for these children.

The cost findings are encouraging, Ms. Holleran said. The rise in medication costs could signal that children are getting appropriate treatments that are helping them to stay out of the hospital.

Even with the increase in prescription costs, the researchers estimated that the care coordinator program saves an average of $334 per member per year.

The researchers also performed a psychosocial analysis of the families who enrolled in the program during the first year. They found decreased anxiety among the parents, decreased out-of-pocket expenses, decreased school absences, and fewer problems with grades.

One surprise that came out of the program was how unprepared schools are to care for children with chronic health conditions, Ms. Holleran said. They had expected to find that poor coordination among physicians would be the biggest problem, but instead found enormous gaps in knowledge at the school level.

In one case, the mother of a 5-year-old girl with type 1 diabetes was concerned about having her daughter start kindergarten because she didn't feel the school would be able to handle her daughter's medical needs. The school's initial plan was to call the mother out of work or call an ambulance if any problems developed. So the care coordinator worked with the state health department to bring a nurse educator into the school. They provided information to the teachers about how to manage the girl's diabetes without constantly calling her mother out of work, as well as when it would be appropriate to call an ambulance.

The Caring Program is continuing among children who are enrolled in CHIP through Highmark, and may be expanded to the commercially insured pediatric population in the future, Ms. Holleran said. It was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross and Blue Shield Association as an innovative approach to improving health and wellness. The other “BlueWorks” winners include programs that address racial and ethnic disparities in health care, and that encourage children to adopt healthy lifestyles.

The BlueWorks program is juried by the department of health care policy at Harvard Medical School, Boston, in consultation with physicians from the American Academy of Pediatrics, the American College of Physicians, and the American Cancer Society.

Detailed descriptions of the quality measures and measures groups that can be used as part of the 2009 Medicare Physician Quality Reporting Initiative are now available online.

Officials at the Centers for Medicare and Medicaid Services also have posted an implementation guide for claims-based reporting in 2009 and instructions for reporting using measures groups.

Among the 153 measures eligible for reporting in 2009, there are 52 new measures including elder maltreatment screening and follow-up planning, glucocorticoid management in rheumatoid arthritis, and influenza immunization in pediatric end-stage renal disease.

The measures and related guidance documents are available at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp

Late last year, CMS officials began listing the names of physicians and other health care professionals who reported on at least 1 of the 74 PQRI measures in 2007 at www.medicare.gov/physician

Along with the listing of physicians, CMS officials included general information about the PQRI program. They noted that physicians may have had good reasons not to report measures and that a failure to report through PQRI doesn't reflect a lack of commitment to high quality care.

For example, CMS officials wrote that reporting quality data may have been too costly for some physicians or that physicians may have been engaged in other quality improvement reporting activities.

Detailed descriptions of the quality measures and measures groups that can be used as part of the 2009 Medicare Physician Quality Reporting Initiative are now available online.

Officials at the Centers for Medicare and Medicaid Services also have posted an implementation guide for claims-based reporting in 2009 and instructions for reporting using measures groups.

Among the 153 measures eligible for reporting in 2009, there are 52 new measures including elder maltreatment screening and follow-up planning, glucocorticoid management in rheumatoid arthritis, and influenza immunization in pediatric end-stage renal disease.

The measures and related guidance documents are available at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp

Late last year, CMS officials began listing the names of physicians and other health care professionals who reported on at least 1 of the 74 PQRI measures in 2007 at www.medicare.gov/physician

Along with the listing of physicians, CMS officials included general information about the PQRI program. They noted that physicians may have had good reasons not to report measures and that a failure to report through PQRI doesn't reflect a lack of commitment to high quality care.

For example, CMS officials wrote that reporting quality data may have been too costly for some physicians or that physicians may have been engaged in other quality improvement reporting activities.

Detailed descriptions of the quality measures and measures groups that can be used as part of the 2009 Medicare Physician Quality Reporting Initiative are now available online.

Officials at the Centers for Medicare and Medicaid Services also have posted an implementation guide for claims-based reporting in 2009 and instructions for reporting using measures groups.

Among the 153 measures eligible for reporting in 2009, there are 52 new measures including elder maltreatment screening and follow-up planning, glucocorticoid management in rheumatoid arthritis, and influenza immunization in pediatric end-stage renal disease.

The measures and related guidance documents are available at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp

Late last year, CMS officials began listing the names of physicians and other health care professionals who reported on at least 1 of the 74 PQRI measures in 2007 at www.medicare.gov/physician

Along with the listing of physicians, CMS officials included general information about the PQRI program. They noted that physicians may have had good reasons not to report measures and that a failure to report through PQRI doesn't reflect a lack of commitment to high quality care.

For example, CMS officials wrote that reporting quality data may have been too costly for some physicians or that physicians may have been engaged in other quality improvement reporting activities.

Privacy should be the top priority when developing certification criteria for personal health records, a task force created by the Certification Commission for Healthcare Information Technology has recommended.

Adequate security and interoperability also must be included in certification efforts, according to the task force.

The Certification Commission for Healthcare Information Technology (CCHIT) will use these recommendations as it prepares to begin certifying personal health records (PHRs) this summer.

Since the PHR field is still “rapidly evolving,” the task force said that certification requirements should not be so prescriptive that they interfere with the progress of the technology.

The task force recommended that the voluntary certification process should apply to any products or services that collect, receive, store, or use health information provided by consumers. Certification should also apply to products or services that transmit or disclose to a third party any personal health information. This would allow the CCHIT to offer certification to a range of products and applications, from those that offer a PHR application and connectivity as an accessory to an electronic health record (EHR) to stand-alone PHRs.

CCHIT hopes that, just as it did in the EHR field, certification will create a floor of functionality, security, and interoperability, said Dr. Paul Tang, cochair of the PHR Advisory Task Force and vice president and chief medical information officer for the Palo Alto (Calif.) Medical Foundation.

The task force called for requirements to maintain privacy in monitoring and enforcement, and for consumer protection that would allow patients to remove their data if certification is revoked. The group also recommended that standards-based criteria be developed that would require PHRs to send and receive data from as many potential data sources as possible.

If done right, certification would have significant benefits for both physicians and patients, Dr. Tang said. A PHR could provide physicians with better access to secure, authenticated data that could help them make decisions, while patients would have more control over their own care, he said.

In July, the task force made its recommendations and handed over responsibility for PHR certification to a CCHIT work group. That work group will develop the actual certification criteria that will be used to test PHR products starting next July, according to Dr. Jody Pettit, strategic leader for CCHIT's PHR work group.

Offering certification for PHR platforms and applications could help spur consumer acceptance and adoption of PHRs, Dr. Pettit said. “The consumer wouldn't feel so far out on a limb in terms of putting in their data.”

Privacy should be the top priority when developing certification criteria for personal health records, a task force created by the Certification Commission for Healthcare Information Technology has recommended.

Adequate security and interoperability also must be included in certification efforts, according to the task force.

The Certification Commission for Healthcare Information Technology (CCHIT) will use these recommendations as it prepares to begin certifying personal health records (PHRs) this summer.

Since the PHR field is still “rapidly evolving,” the task force said that certification requirements should not be so prescriptive that they interfere with the progress of the technology.

The task force recommended that the voluntary certification process should apply to any products or services that collect, receive, store, or use health information provided by consumers. Certification should also apply to products or services that transmit or disclose to a third party any personal health information. This would allow the CCHIT to offer certification to a range of products and applications, from those that offer a PHR application and connectivity as an accessory to an electronic health record (EHR) to stand-alone PHRs.

CCHIT hopes that, just as it did in the EHR field, certification will create a floor of functionality, security, and interoperability, said Dr. Paul Tang, cochair of the PHR Advisory Task Force and vice president and chief medical information officer for the Palo Alto (Calif.) Medical Foundation.

The task force called for requirements to maintain privacy in monitoring and enforcement, and for consumer protection that would allow patients to remove their data if certification is revoked. The group also recommended that standards-based criteria be developed that would require PHRs to send and receive data from as many potential data sources as possible.

If done right, certification would have significant benefits for both physicians and patients, Dr. Tang said. A PHR could provide physicians with better access to secure, authenticated data that could help them make decisions, while patients would have more control over their own care, he said.

In July, the task force made its recommendations and handed over responsibility for PHR certification to a CCHIT work group. That work group will develop the actual certification criteria that will be used to test PHR products starting next July, according to Dr. Jody Pettit, strategic leader for CCHIT's PHR work group.

Offering certification for PHR platforms and applications could help spur consumer acceptance and adoption of PHRs, Dr. Pettit said. “The consumer wouldn't feel so far out on a limb in terms of putting in their data.”

Privacy should be the top priority when developing certification criteria for personal health records, a task force created by the Certification Commission for Healthcare Information Technology has recommended.

Adequate security and interoperability also must be included in certification efforts, according to the task force.

The Certification Commission for Healthcare Information Technology (CCHIT) will use these recommendations as it prepares to begin certifying personal health records (PHRs) this summer.

Since the PHR field is still “rapidly evolving,” the task force said that certification requirements should not be so prescriptive that they interfere with the progress of the technology.

The task force recommended that the voluntary certification process should apply to any products or services that collect, receive, store, or use health information provided by consumers. Certification should also apply to products or services that transmit or disclose to a third party any personal health information. This would allow the CCHIT to offer certification to a range of products and applications, from those that offer a PHR application and connectivity as an accessory to an electronic health record (EHR) to stand-alone PHRs.

CCHIT hopes that, just as it did in the EHR field, certification will create a floor of functionality, security, and interoperability, said Dr. Paul Tang, cochair of the PHR Advisory Task Force and vice president and chief medical information officer for the Palo Alto (Calif.) Medical Foundation.

The task force called for requirements to maintain privacy in monitoring and enforcement, and for consumer protection that would allow patients to remove their data if certification is revoked. The group also recommended that standards-based criteria be developed that would require PHRs to send and receive data from as many potential data sources as possible.

If done right, certification would have significant benefits for both physicians and patients, Dr. Tang said. A PHR could provide physicians with better access to secure, authenticated data that could help them make decisions, while patients would have more control over their own care, he said.

In July, the task force made its recommendations and handed over responsibility for PHR certification to a CCHIT work group. That work group will develop the actual certification criteria that will be used to test PHR products starting next July, according to Dr. Jody Pettit, strategic leader for CCHIT's PHR work group.

Offering certification for PHR platforms and applications could help spur consumer acceptance and adoption of PHRs, Dr. Pettit said. “The consumer wouldn't feel so far out on a limb in terms of putting in their data.”

Federal officials are seeking significant reductions in some of the most common health care-associated infections over the next 5 years.

In a new “action plan,” the Department of Health and Human Services outlined goals related to six categories of health care-associated infections: central line-associated bloodstream infections, Clostridium difficile infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) infections, surgical-site infections, and ventilator-associated pneumonia.

The seven national prevention targets identified in the HHS action plan call for the following:

▸Reducing the number of central line-associated bloodstream infections per 1,000 device days to below the current 25th percentile set by the National Healthcare Safety Network by location type.

▸Achieving full compliance with the central line bundle in nonemergent insertions.

▸Reducing by 30% the case rate per patient days and administrative/discharge data for ICD-9-CM-coded C. difficile infections.

▸Reducing by 25% the number of symptomatic urinary tract infections per 1,000 urinary catheter days.

▸Reducing by half the incidence rate of all health care-associated invasive MRSA infections.

▸Reducing the median deep-incision and organ-space infection rate for each procedure/risk group to at or below the current National Healthcare Safety Network 25th percentile.

▸Achieving 95% adherence rates for each Surgical Care Improvement Project/National Quality Forum infection process measure for surgical-site infections.

The national goals do not include targets for ventilator-associated pneumonia because HHS officials could not identify any valid outcome or process metrics for the condition. “This plan will serve as our road map on how the department addresses this important public health and patient safety issue,” said Mike Leavitt, former HHS secretary.

The goals outlined by the HHS are “reasonable,” said Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology. The action plan targets the most costly infections, both in terms of dollars and harm to patients, she said. The 5-year timeline also gives hospitals time to achieve reductions. At first, many hospitals may see increases in these infections, because the more you look, the more you find, Ms. Warye said.

The action plan may also play an important role by giving infection-control specialists more clout when they lobby their hospital administrators for resources for infection prevention, she said. “When the federal government gets into the act, it raises the stakes.”

The action plan also addresses concerns that there has been a lack of coordination among the various federal agencies and departments that have some responsibility for health care-associated infections, said Dr. Patrick J. Brennan, chairman of the Healthcare Infection Control Practices Advisory Committee. Dr. Brennan, who served on the steering committee that prepared the report, said that improved coordination is especially important at a time when federal budget dollars are tight.

For example, the HHS plan addresses the role of information technology as a way to improve coordination of federal departments with databases of infection information.

The action plan also outlines a research agenda related to the prevention of health care-associated infections. At the top of the agenda are research into the barriers to adherence of recommended infection-control practices, and strategies to overcome those barriers. For example, the report calls for demonstration projects that are focused on the prevention of surgical-site infection, C. difficile infection, and MRSA.

The HHS also called for more basic, epidemiologic, and translational research into how health care-associated pathogens are acquired. Many of the current infection-control practices are based on empirical observation, according to the HHS.

The plan is available at www.hhs.gov/ophs/initiatives/hai

Federal officials are seeking significant reductions in some of the most common health care-associated infections over the next 5 years.

In a new “action plan,” the Department of Health and Human Services outlined goals related to six categories of health care-associated infections: central line-associated bloodstream infections, Clostridium difficile infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) infections, surgical-site infections, and ventilator-associated pneumonia.

The seven national prevention targets identified in the HHS action plan call for the following:

▸Reducing the number of central line-associated bloodstream infections per 1,000 device days to below the current 25th percentile set by the National Healthcare Safety Network by location type.

▸Achieving full compliance with the central line bundle in nonemergent insertions.

▸Reducing by 30% the case rate per patient days and administrative/discharge data for ICD-9-CM-coded C. difficile infections.

▸Reducing by 25% the number of symptomatic urinary tract infections per 1,000 urinary catheter days.

▸Reducing by half the incidence rate of all health care-associated invasive MRSA infections.

▸Reducing the median deep-incision and organ-space infection rate for each procedure/risk group to at or below the current National Healthcare Safety Network 25th percentile.

▸Achieving 95% adherence rates for each Surgical Care Improvement Project/National Quality Forum infection process measure for surgical-site infections.

The national goals do not include targets for ventilator-associated pneumonia because HHS officials could not identify any valid outcome or process metrics for the condition. “This plan will serve as our road map on how the department addresses this important public health and patient safety issue,” said Mike Leavitt, former HHS secretary.

The goals outlined by the HHS are “reasonable,” said Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology. The action plan targets the most costly infections, both in terms of dollars and harm to patients, she said. The 5-year timeline also gives hospitals time to achieve reductions. At first, many hospitals may see increases in these infections, because the more you look, the more you find, Ms. Warye said.

The action plan may also play an important role by giving infection-control specialists more clout when they lobby their hospital administrators for resources for infection prevention, she said. “When the federal government gets into the act, it raises the stakes.”

The action plan also addresses concerns that there has been a lack of coordination among the various federal agencies and departments that have some responsibility for health care-associated infections, said Dr. Patrick J. Brennan, chairman of the Healthcare Infection Control Practices Advisory Committee. Dr. Brennan, who served on the steering committee that prepared the report, said that improved coordination is especially important at a time when federal budget dollars are tight.

For example, the HHS plan addresses the role of information technology as a way to improve coordination of federal departments with databases of infection information.

The action plan also outlines a research agenda related to the prevention of health care-associated infections. At the top of the agenda are research into the barriers to adherence of recommended infection-control practices, and strategies to overcome those barriers. For example, the report calls for demonstration projects that are focused on the prevention of surgical-site infection, C. difficile infection, and MRSA.

The HHS also called for more basic, epidemiologic, and translational research into how health care-associated pathogens are acquired. Many of the current infection-control practices are based on empirical observation, according to the HHS.

The plan is available at www.hhs.gov/ophs/initiatives/hai

Federal officials are seeking significant reductions in some of the most common health care-associated infections over the next 5 years.

In a new “action plan,” the Department of Health and Human Services outlined goals related to six categories of health care-associated infections: central line-associated bloodstream infections, Clostridium difficile infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) infections, surgical-site infections, and ventilator-associated pneumonia.

The seven national prevention targets identified in the HHS action plan call for the following:

▸Reducing the number of central line-associated bloodstream infections per 1,000 device days to below the current 25th percentile set by the National Healthcare Safety Network by location type.

▸Achieving full compliance with the central line bundle in nonemergent insertions.

▸Reducing by 30% the case rate per patient days and administrative/discharge data for ICD-9-CM-coded C. difficile infections.

▸Reducing by 25% the number of symptomatic urinary tract infections per 1,000 urinary catheter days.

▸Reducing by half the incidence rate of all health care-associated invasive MRSA infections.

▸Reducing the median deep-incision and organ-space infection rate for each procedure/risk group to at or below the current National Healthcare Safety Network 25th percentile.

▸Achieving 95% adherence rates for each Surgical Care Improvement Project/National Quality Forum infection process measure for surgical-site infections.

The national goals do not include targets for ventilator-associated pneumonia because HHS officials could not identify any valid outcome or process metrics for the condition. “This plan will serve as our road map on how the department addresses this important public health and patient safety issue,” said Mike Leavitt, former HHS secretary.

The goals outlined by the HHS are “reasonable,” said Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology. The action plan targets the most costly infections, both in terms of dollars and harm to patients, she said. The 5-year timeline also gives hospitals time to achieve reductions. At first, many hospitals may see increases in these infections, because the more you look, the more you find, Ms. Warye said.

The action plan may also play an important role by giving infection-control specialists more clout when they lobby their hospital administrators for resources for infection prevention, she said. “When the federal government gets into the act, it raises the stakes.”

The action plan also addresses concerns that there has been a lack of coordination among the various federal agencies and departments that have some responsibility for health care-associated infections, said Dr. Patrick J. Brennan, chairman of the Healthcare Infection Control Practices Advisory Committee. Dr. Brennan, who served on the steering committee that prepared the report, said that improved coordination is especially important at a time when federal budget dollars are tight.

For example, the HHS plan addresses the role of information technology as a way to improve coordination of federal departments with databases of infection information.

The action plan also outlines a research agenda related to the prevention of health care-associated infections. At the top of the agenda are research into the barriers to adherence of recommended infection-control practices, and strategies to overcome those barriers. For example, the report calls for demonstration projects that are focused on the prevention of surgical-site infection, C. difficile infection, and MRSA.

The HHS also called for more basic, epidemiologic, and translational research into how health care-associated pathogens are acquired. Many of the current infection-control practices are based on empirical observation, according to the HHS.

The plan is available at www.hhs.gov/ophs/initiatives/hai

Medicare officials are preparing to expand the coverage of positron emission tomography for initial diagnostic testing in individuals with suspected solid tumors.

Under a proposed national coverage determination issued by the Centers for Medicare and Medicaid Services, Medicare beneficiaries would be eligible for one PET scan to guide the initial treatment strategy for most cancer indications not previously covered for PET. The proposal also allows for coverage of treatment response monitoring of several cancers.

Beneficiaries would be eligible for an assessment with PET if they had a solid tumor that was biopsy proven or strongly suspected based on other diagnostic testing, according to the CMS. However, Medicare officials will not provide coverage for initial PET assessments of patients with adenocarcinoma of the prostate because the available evidence does not show that these would improve physician decision making.

Under the CMS proposal, coverage of subsequent PET scans for currently noncovered cancers would continue to fall under requirements of the CMS's Coverage with Evidence Development (CED) program, meaning that patients must be involved in an approved clinical study to gain coverage. CMS officials cited a lack of evidence to support coverage of additional scans.

The CMS is expected to issue a final coverage determination in April.

Currently, Medicare beneficiaries are covered for PET scans at various stages for nine common cancers: breast, cervical, colorectal, esophageal, head and neck, non-small cell lung, and thyroid cancers, as well as lymphoma and melanoma.

Since 2005, Medicare beneficiaries have also been covered for the use of PET scans in all other cancers under the CED program, an initiative that is designed to collect information on the utilization and impact of medical technologies. As a condition of CED, beneficiaries must be enrolled in an approved clinical study. For PET, the approved study has been the National Oncologic PET Registry (NOPR), which collects prospective data from referring physicians and participating PET facilities on PET scans that are used for diagnosis, staging, restaging, and monitoring response.

Based on data collected through the registry, researchers at the NOPR requested in March 2008 that Medicare expand coverage for PET more broadly and end the required data collection except in monitoring response to treatment.

If the coverage determination were finalized as is, it would be an improvement over the current policy, said Dr. Barry A. Siegel, cochair of the NOPR Working Group and director of nuclear medicine at Washington University in St. Louis.

However, the proposal falls short by failing to provide coverage for subsequent PET scans for many cancers, Dr. Siegel added. “In some ways, it runs counter to the evidence,” he said.

Looking either at cancers globally or at changes in intended management provides a clear picture of the benefit of PET scans for restaging and for detection of suspected recurrence, he said.

For example, a study from researchers at NOPR found a change in intended management (from treatment to nontreatment, or the reverse) in 38% of cancer cases. The study looked at more than 40,000 PET scans across 18 types of cancer. The researchers found similar overall results for initial staging, restaging, and recurrence. In initial staging, there was a change in intended management in 39.8% of cases, compared with 35.9% for restaging and 38.5% for detecting suspected recurrence (J. Nucl. Med. 2008;49:1928–35).

In addition, Dr. Siegel disagreed with the CMS's decision to allow only a single PET scan before the initiation of treatment. In practice, more than one PET scan is often used during the pretreatment phase, especially for radiation therapy planning, said Dr. Siegel, who serves on the medical advisory board and has a small equity interest in Radiology Corporation of America, which is a national provider of mobile PET/CT services.

Medicare officials are preparing to expand the coverage of positron emission tomography for initial diagnostic testing in individuals with suspected solid tumors.

Under a proposed national coverage determination issued by the Centers for Medicare and Medicaid Services, Medicare beneficiaries would be eligible for one PET scan to guide the initial treatment strategy for most cancer indications not previously covered for PET. The proposal also allows for coverage of treatment response monitoring of several cancers.

Beneficiaries would be eligible for an assessment with PET if they had a solid tumor that was biopsy proven or strongly suspected based on other diagnostic testing, according to the CMS. However, Medicare officials will not provide coverage for initial PET assessments of patients with adenocarcinoma of the prostate because the available evidence does not show that these would improve physician decision making.

Under the CMS proposal, coverage of subsequent PET scans for currently noncovered cancers would continue to fall under requirements of the CMS's Coverage with Evidence Development (CED) program, meaning that patients must be involved in an approved clinical study to gain coverage. CMS officials cited a lack of evidence to support coverage of additional scans.

The CMS is expected to issue a final coverage determination in April.

Currently, Medicare beneficiaries are covered for PET scans at various stages for nine common cancers: breast, cervical, colorectal, esophageal, head and neck, non-small cell lung, and thyroid cancers, as well as lymphoma and melanoma.

Since 2005, Medicare beneficiaries have also been covered for the use of PET scans in all other cancers under the CED program, an initiative that is designed to collect information on the utilization and impact of medical technologies. As a condition of CED, beneficiaries must be enrolled in an approved clinical study. For PET, the approved study has been the National Oncologic PET Registry (NOPR), which collects prospective data from referring physicians and participating PET facilities on PET scans that are used for diagnosis, staging, restaging, and monitoring response.

Based on data collected through the registry, researchers at the NOPR requested in March 2008 that Medicare expand coverage for PET more broadly and end the required data collection except in monitoring response to treatment.

If the coverage determination were finalized as is, it would be an improvement over the current policy, said Dr. Barry A. Siegel, cochair of the NOPR Working Group and director of nuclear medicine at Washington University in St. Louis.

However, the proposal falls short by failing to provide coverage for subsequent PET scans for many cancers, Dr. Siegel added. “In some ways, it runs counter to the evidence,” he said.

Looking either at cancers globally or at changes in intended management provides a clear picture of the benefit of PET scans for restaging and for detection of suspected recurrence, he said.

For example, a study from researchers at NOPR found a change in intended management (from treatment to nontreatment, or the reverse) in 38% of cancer cases. The study looked at more than 40,000 PET scans across 18 types of cancer. The researchers found similar overall results for initial staging, restaging, and recurrence. In initial staging, there was a change in intended management in 39.8% of cases, compared with 35.9% for restaging and 38.5% for detecting suspected recurrence (J. Nucl. Med. 2008;49:1928–35).

In addition, Dr. Siegel disagreed with the CMS's decision to allow only a single PET scan before the initiation of treatment. In practice, more than one PET scan is often used during the pretreatment phase, especially for radiation therapy planning, said Dr. Siegel, who serves on the medical advisory board and has a small equity interest in Radiology Corporation of America, which is a national provider of mobile PET/CT services.

Medicare officials are preparing to expand the coverage of positron emission tomography for initial diagnostic testing in individuals with suspected solid tumors.

Under a proposed national coverage determination issued by the Centers for Medicare and Medicaid Services, Medicare beneficiaries would be eligible for one PET scan to guide the initial treatment strategy for most cancer indications not previously covered for PET. The proposal also allows for coverage of treatment response monitoring of several cancers.

Beneficiaries would be eligible for an assessment with PET if they had a solid tumor that was biopsy proven or strongly suspected based on other diagnostic testing, according to the CMS. However, Medicare officials will not provide coverage for initial PET assessments of patients with adenocarcinoma of the prostate because the available evidence does not show that these would improve physician decision making.

Under the CMS proposal, coverage of subsequent PET scans for currently noncovered cancers would continue to fall under requirements of the CMS's Coverage with Evidence Development (CED) program, meaning that patients must be involved in an approved clinical study to gain coverage. CMS officials cited a lack of evidence to support coverage of additional scans.

The CMS is expected to issue a final coverage determination in April.

Currently, Medicare beneficiaries are covered for PET scans at various stages for nine common cancers: breast, cervical, colorectal, esophageal, head and neck, non-small cell lung, and thyroid cancers, as well as lymphoma and melanoma.

Since 2005, Medicare beneficiaries have also been covered for the use of PET scans in all other cancers under the CED program, an initiative that is designed to collect information on the utilization and impact of medical technologies. As a condition of CED, beneficiaries must be enrolled in an approved clinical study. For PET, the approved study has been the National Oncologic PET Registry (NOPR), which collects prospective data from referring physicians and participating PET facilities on PET scans that are used for diagnosis, staging, restaging, and monitoring response.

Based on data collected through the registry, researchers at the NOPR requested in March 2008 that Medicare expand coverage for PET more broadly and end the required data collection except in monitoring response to treatment.

If the coverage determination were finalized as is, it would be an improvement over the current policy, said Dr. Barry A. Siegel, cochair of the NOPR Working Group and director of nuclear medicine at Washington University in St. Louis.

However, the proposal falls short by failing to provide coverage for subsequent PET scans for many cancers, Dr. Siegel added. “In some ways, it runs counter to the evidence,” he said.

Looking either at cancers globally or at changes in intended management provides a clear picture of the benefit of PET scans for restaging and for detection of suspected recurrence, he said.

For example, a study from researchers at NOPR found a change in intended management (from treatment to nontreatment, or the reverse) in 38% of cancer cases. The study looked at more than 40,000 PET scans across 18 types of cancer. The researchers found similar overall results for initial staging, restaging, and recurrence. In initial staging, there was a change in intended management in 39.8% of cases, compared with 35.9% for restaging and 38.5% for detecting suspected recurrence (J. Nucl. Med. 2008;49:1928–35).

In addition, Dr. Siegel disagreed with the CMS's decision to allow only a single PET scan before the initiation of treatment. In practice, more than one PET scan is often used during the pretreatment phase, especially for radiation therapy planning, said Dr. Siegel, who serves on the medical advisory board and has a small equity interest in Radiology Corporation of America, which is a national provider of mobile PET/CT services.

Coalition Urges Quick Pick for FDA

The next Food and Drug Administration commissioner should be a proven manager who can rise above politics, according to a coalition of a patient advocacy groups. The group of more than 30 organizations, including the Society for Women's Health Research and Susan G. Komen for the Cure, wrote a letter to then-Health and Human Services secretary-designate Tom Daschle, calling on the Obama administration to fill the FDA post quickly. Candidates for the job shouldn't be excluded because of ties to the pharmaceutical or device industries, the coalition advised. “Diverse experience, including that with an FDA-regulated industry, should be viewed as a positive qualification,” the letter said.

ACOG Supports Abortion Access

The American College of Obstetricians and Gynecologists is calling on medical schools and ob.gyn. residency programs to integrate family planning and abortion education into physician training as a way to ensure that women have access to a full range of reproductive health services. Despite the continued demand for abortion services, training in these services is limited, according to a policy statement from ACOG's Committee on Health Care for Underserved Women, published this month in Obstetrics & Gynecology. For example, a 1998 survey by the National Abortion Federation found that only 46% of the 261 accredited U.S. obstetrics and gynecology residency programs offer first-trimester abortion training, despite requirements from the Accreditation Council for Graduate Medical Education to make experience with induced abortion part of residency training.

Consequences of EC Access

Some women with unrestricted access to emergency contraception (EC) will substitute it for their usual methods of birth control, according to data from a randomized, controlled trial. Women who had EC on hand were about three times as likely as were women who had to obtain EC to report that they had ever substituted emergency contraception for condoms or other methods of contraception, the researchers found. This effect was most pronounced among women who did not use a hormonal method at baseline and were not consistent condom users at baseline. The researchers analyzed data from more than 1,000 women aged 14–24 years who had been part of an earlier randomized trial on EC (Obstet.Gynecol. 2009;113:107–16). The study was funded by Family Health International, the National Institutes of Health, and the William and Flora Hewlett Foundation. The EC was provided by Barr Pharmaceuticals, which manufactures Plan B. One of the study authors has worked on studies funded by Barr Pharmaceuticals. The researchers did not report any other potential conflicts of interest.

FTC Alleges Price Gouging

The Federal Trade Commission has alleged that a pharmaceutical company acted illegally in buying the only two medicines approved to treat a deadly congenital heart defect in premature babies and then raising the prices for the drugs by nearly 1,300%. Ovation Pharmaceuticals Inc. bought the drug NeoProfen (ibuprofen lysine) in early 2006, when it already held the rights to Indocin IV (indomethacin). Both drugs are used to treat patent ductus arteriosus in lieu of surgical repair. After acquiring NeoProfen, Ovation raised the price of Indocin from $36 to nearly $500 per vial, and set a similar price when it launched NeoProfen in July 2006, according to the FTC, which has filed a civil lawsuit to force Ovation to divest itself of one of the drugs and forfeit some of the profits. Ovation said in a statement that NeoProfen and Indocin are not interchangeable and that it would fight the allegations.

Teen Health Care Reform Urged

Current health services for adolescents are fragmented and poorly designed to meet the needs of the nation's adolescents, according to a report from the National Research Council and the Institute of Medicine. Although most U.S. adolescents are healthy, many engage in risky behavior, develop unhealthy habits, and have physical and mental conditions that can jeopardize their immediate and future health, the report said. The U.S. health care system should foster better coordination between primary and specialty care and should include opportunities for adolescents to receive primary care services in “safety-net settings” such as schools, hospitals, and community health centers, the report said.

Coalition Urges Quick Pick for FDA

The next Food and Drug Administration commissioner should be a proven manager who can rise above politics, according to a coalition of a patient advocacy groups. The group of more than 30 organizations, including the Society for Women's Health Research and Susan G. Komen for the Cure, wrote a letter to then-Health and Human Services secretary-designate Tom Daschle, calling on the Obama administration to fill the FDA post quickly. Candidates for the job shouldn't be excluded because of ties to the pharmaceutical or device industries, the coalition advised. “Diverse experience, including that with an FDA-regulated industry, should be viewed as a positive qualification,” the letter said.

ACOG Supports Abortion Access

The American College of Obstetricians and Gynecologists is calling on medical schools and ob.gyn. residency programs to integrate family planning and abortion education into physician training as a way to ensure that women have access to a full range of reproductive health services. Despite the continued demand for abortion services, training in these services is limited, according to a policy statement from ACOG's Committee on Health Care for Underserved Women, published this month in Obstetrics & Gynecology. For example, a 1998 survey by the National Abortion Federation found that only 46% of the 261 accredited U.S. obstetrics and gynecology residency programs offer first-trimester abortion training, despite requirements from the Accreditation Council for Graduate Medical Education to make experience with induced abortion part of residency training.

Consequences of EC Access

Some women with unrestricted access to emergency contraception (EC) will substitute it for their usual methods of birth control, according to data from a randomized, controlled trial. Women who had EC on hand were about three times as likely as were women who had to obtain EC to report that they had ever substituted emergency contraception for condoms or other methods of contraception, the researchers found. This effect was most pronounced among women who did not use a hormonal method at baseline and were not consistent condom users at baseline. The researchers analyzed data from more than 1,000 women aged 14–24 years who had been part of an earlier randomized trial on EC (Obstet.Gynecol. 2009;113:107–16). The study was funded by Family Health International, the National Institutes of Health, and the William and Flora Hewlett Foundation. The EC was provided by Barr Pharmaceuticals, which manufactures Plan B. One of the study authors has worked on studies funded by Barr Pharmaceuticals. The researchers did not report any other potential conflicts of interest.

FTC Alleges Price Gouging

The Federal Trade Commission has alleged that a pharmaceutical company acted illegally in buying the only two medicines approved to treat a deadly congenital heart defect in premature babies and then raising the prices for the drugs by nearly 1,300%. Ovation Pharmaceuticals Inc. bought the drug NeoProfen (ibuprofen lysine) in early 2006, when it already held the rights to Indocin IV (indomethacin). Both drugs are used to treat patent ductus arteriosus in lieu of surgical repair. After acquiring NeoProfen, Ovation raised the price of Indocin from $36 to nearly $500 per vial, and set a similar price when it launched NeoProfen in July 2006, according to the FTC, which has filed a civil lawsuit to force Ovation to divest itself of one of the drugs and forfeit some of the profits. Ovation said in a statement that NeoProfen and Indocin are not interchangeable and that it would fight the allegations.

Teen Health Care Reform Urged

Current health services for adolescents are fragmented and poorly designed to meet the needs of the nation's adolescents, according to a report from the National Research Council and the Institute of Medicine. Although most U.S. adolescents are healthy, many engage in risky behavior, develop unhealthy habits, and have physical and mental conditions that can jeopardize their immediate and future health, the report said. The U.S. health care system should foster better coordination between primary and specialty care and should include opportunities for adolescents to receive primary care services in “safety-net settings” such as schools, hospitals, and community health centers, the report said.

Coalition Urges Quick Pick for FDA

The next Food and Drug Administration commissioner should be a proven manager who can rise above politics, according to a coalition of a patient advocacy groups. The group of more than 30 organizations, including the Society for Women's Health Research and Susan G. Komen for the Cure, wrote a letter to then-Health and Human Services secretary-designate Tom Daschle, calling on the Obama administration to fill the FDA post quickly. Candidates for the job shouldn't be excluded because of ties to the pharmaceutical or device industries, the coalition advised. “Diverse experience, including that with an FDA-regulated industry, should be viewed as a positive qualification,” the letter said.

ACOG Supports Abortion Access

The American College of Obstetricians and Gynecologists is calling on medical schools and ob.gyn. residency programs to integrate family planning and abortion education into physician training as a way to ensure that women have access to a full range of reproductive health services. Despite the continued demand for abortion services, training in these services is limited, according to a policy statement from ACOG's Committee on Health Care for Underserved Women, published this month in Obstetrics & Gynecology. For example, a 1998 survey by the National Abortion Federation found that only 46% of the 261 accredited U.S. obstetrics and gynecology residency programs offer first-trimester abortion training, despite requirements from the Accreditation Council for Graduate Medical Education to make experience with induced abortion part of residency training.

Consequences of EC Access

Some women with unrestricted access to emergency contraception (EC) will substitute it for their usual methods of birth control, according to data from a randomized, controlled trial. Women who had EC on hand were about three times as likely as were women who had to obtain EC to report that they had ever substituted emergency contraception for condoms or other methods of contraception, the researchers found. This effect was most pronounced among women who did not use a hormonal method at baseline and were not consistent condom users at baseline. The researchers analyzed data from more than 1,000 women aged 14–24 years who had been part of an earlier randomized trial on EC (Obstet.Gynecol. 2009;113:107–16). The study was funded by Family Health International, the National Institutes of Health, and the William and Flora Hewlett Foundation. The EC was provided by Barr Pharmaceuticals, which manufactures Plan B. One of the study authors has worked on studies funded by Barr Pharmaceuticals. The researchers did not report any other potential conflicts of interest.

FTC Alleges Price Gouging

The Federal Trade Commission has alleged that a pharmaceutical company acted illegally in buying the only two medicines approved to treat a deadly congenital heart defect in premature babies and then raising the prices for the drugs by nearly 1,300%. Ovation Pharmaceuticals Inc. bought the drug NeoProfen (ibuprofen lysine) in early 2006, when it already held the rights to Indocin IV (indomethacin). Both drugs are used to treat patent ductus arteriosus in lieu of surgical repair. After acquiring NeoProfen, Ovation raised the price of Indocin from $36 to nearly $500 per vial, and set a similar price when it launched NeoProfen in July 2006, according to the FTC, which has filed a civil lawsuit to force Ovation to divest itself of one of the drugs and forfeit some of the profits. Ovation said in a statement that NeoProfen and Indocin are not interchangeable and that it would fight the allegations.

Teen Health Care Reform Urged

Current health services for adolescents are fragmented and poorly designed to meet the needs of the nation's adolescents, according to a report from the National Research Council and the Institute of Medicine. Although most U.S. adolescents are healthy, many engage in risky behavior, develop unhealthy habits, and have physical and mental conditions that can jeopardize their immediate and future health, the report said. The U.S. health care system should foster better coordination between primary and specialty care and should include opportunities for adolescents to receive primary care services in “safety-net settings” such as schools, hospitals, and community health centers, the report said.

The CBO reports are available online at www.cbo.gov

A health reform plan that calls for either subsidies of health insurance premiums or mandates alone would not result in universal coverage, according to an analysis from the Congressional Budget Office.

Lawmakers, however, could achieve near-universal coverage by combining those policies or implementing them with strategies that simplify the enrollment process, the CBO analysts wrote in one of two reports on health care released last month.

The CBO, created by Congress in the 1970s, provides legislators with objective, nonpartisan analyses to assist with economic and budgetary decisions regarding federal programs, according to the agency's Web site.

One option outlined by the CBO would be to enact an enforceable individual mandate accompanied by subsidies for low-income people. Another possibility would be to have a voluntary health insurance system with significant government subsidies and a system that facilitates enrollment, similar to how seniors are enrolled in Medicare.

In “Key Issues in Analyzing Major Health Insurance Proposals,” the CBO analysts provide an overview of the major issues they will consider in analyzing health reform proposals. A second report, “Budget Options, Volume I: Health Care,” outlines 115 specific health policy options and their costs or potential for savings. The options examined range from the establishment of association health plans to the limitation of awards from medical malpractice lawsuits.

The reports address some of the common elements from the major health reform proposals, but do not analyze any particular package. The CBO's projections are being closely watched as members of Congress prepare to consider significant changes to the U.S. health care system.

As part of this effort, the CBO also analyzed some commonly proposed approaches to reduce costs and improve the quality of health care. These include reducing rates of obesity and smoking, expanding the use of preventive medical care, adopting disease management programs, funding comparative effectiveness research, expanding the use of health information technology, and establishing a medical home for health plan enrollees. While these ideas could improve quality and health, the evidence is unclear about their impact on overall federal spending, the CBO wrote.

For example, in the case of health information technology, as more physicians and hospitals adopt electronic medical records under current law, it becomes less cost effective to offer subsidy payments for adoption. The impact of the medical home on health care spending is also unclear, according to the CBO.

The CBO reports are available online at www.cbo.gov

A health reform plan that calls for either subsidies of health insurance premiums or mandates alone would not result in universal coverage, according to an analysis from the Congressional Budget Office.

Lawmakers, however, could achieve near-universal coverage by combining those policies or implementing them with strategies that simplify the enrollment process, the CBO analysts wrote in one of two reports on health care released last month.

The CBO, created by Congress in the 1970s, provides legislators with objective, nonpartisan analyses to assist with economic and budgetary decisions regarding federal programs, according to the agency's Web site.

One option outlined by the CBO would be to enact an enforceable individual mandate accompanied by subsidies for low-income people. Another possibility would be to have a voluntary health insurance system with significant government subsidies and a system that facilitates enrollment, similar to how seniors are enrolled in Medicare.

In “Key Issues in Analyzing Major Health Insurance Proposals,” the CBO analysts provide an overview of the major issues they will consider in analyzing health reform proposals. A second report, “Budget Options, Volume I: Health Care,” outlines 115 specific health policy options and their costs or potential for savings. The options examined range from the establishment of association health plans to the limitation of awards from medical malpractice lawsuits.

The reports address some of the common elements from the major health reform proposals, but do not analyze any particular package. The CBO's projections are being closely watched as members of Congress prepare to consider significant changes to the U.S. health care system.

As part of this effort, the CBO also analyzed some commonly proposed approaches to reduce costs and improve the quality of health care. These include reducing rates of obesity and smoking, expanding the use of preventive medical care, adopting disease management programs, funding comparative effectiveness research, expanding the use of health information technology, and establishing a medical home for health plan enrollees. While these ideas could improve quality and health, the evidence is unclear about their impact on overall federal spending, the CBO wrote.

For example, in the case of health information technology, as more physicians and hospitals adopt electronic medical records under current law, it becomes less cost effective to offer subsidy payments for adoption. The impact of the medical home on health care spending is also unclear, according to the CBO.

The CBO reports are available online at www.cbo.gov

A health reform plan that calls for either subsidies of health insurance premiums or mandates alone would not result in universal coverage, according to an analysis from the Congressional Budget Office.

Lawmakers, however, could achieve near-universal coverage by combining those policies or implementing them with strategies that simplify the enrollment process, the CBO analysts wrote in one of two reports on health care released last month.

The CBO, created by Congress in the 1970s, provides legislators with objective, nonpartisan analyses to assist with economic and budgetary decisions regarding federal programs, according to the agency's Web site.

One option outlined by the CBO would be to enact an enforceable individual mandate accompanied by subsidies for low-income people. Another possibility would be to have a voluntary health insurance system with significant government subsidies and a system that facilitates enrollment, similar to how seniors are enrolled in Medicare.

In “Key Issues in Analyzing Major Health Insurance Proposals,” the CBO analysts provide an overview of the major issues they will consider in analyzing health reform proposals. A second report, “Budget Options, Volume I: Health Care,” outlines 115 specific health policy options and their costs or potential for savings. The options examined range from the establishment of association health plans to the limitation of awards from medical malpractice lawsuits.

The reports address some of the common elements from the major health reform proposals, but do not analyze any particular package. The CBO's projections are being closely watched as members of Congress prepare to consider significant changes to the U.S. health care system.

As part of this effort, the CBO also analyzed some commonly proposed approaches to reduce costs and improve the quality of health care. These include reducing rates of obesity and smoking, expanding the use of preventive medical care, adopting disease management programs, funding comparative effectiveness research, expanding the use of health information technology, and establishing a medical home for health plan enrollees. While these ideas could improve quality and health, the evidence is unclear about their impact on overall federal spending, the CBO wrote.

For example, in the case of health information technology, as more physicians and hospitals adopt electronic medical records under current law, it becomes less cost effective to offer subsidy payments for adoption. The impact of the medical home on health care spending is also unclear, according to the CBO.

One of the early moves of President Barack Obama may be to stop action on a controversial federal abortion regulation issued during the final weeks of the Bush administration, observers say.

The regulation withholds federal payment and funding from providers who do not certify that they do not discriminate against physicians and midlevel providers who refuse to perform abortion or sterilization procedures.

The regulation has been stirring controversy among abortion rights advocates since it was first proposed in August 2008. They contend that the regulation is overly broad and as a result would decrease access to reproductive health services, including contraception. Meanwhile, supporters, such as the Christian Medical Association, say the Bush administration's approach is balanced and helps clear up misconceptions about the conscience protections already in place under existing law.

If President Obama chooses to stop the regulation he has a few options, said Janet Crepps, deputy director of the U.S. Legal Program at the Center for Reproductive Rights. He could formally rescind the regulation by going through the federal rule-making process, which would involve giving notice and allowing for public comment. Mr. Obama also could immediately suspend enforcement of the regulation. Or he could choose to work with Congress on a way to block the regulation through legislation, Ms. Crepps said.

Democrats in Congress have indicated their willingness to act to reverse the regulation. At the end of the last session of Congress, Sen. Patty Murray (D-Wash.) and then-Sen. Hillary Clinton (D-N.Y.) introduced a bill that would stop all action on the regulation.

Aside from addressing the conscience refusal issue, reproductive health advocates expect that the Obama administration's health care agenda may include changes to expand access to emergency contraception, increase funding for family planning, and take a more comprehensive approach to sex education.

“We certainly have a pent-up agenda,” said Susan Cohen, director of government affairs at the Guttmacher Institute, a nonprofit research and education organization focused on sexual and reproductive health.

One area in which Ms. Cohen and her colleagues hope to see some action early in the Obama administration is increasing funding for Title X, which provides federal funds for family planning and preventive screening services. The National Family Planning and Reproductive Health Association estimates that if Title X funding had kept pace with medical inflation since 1980, it would be funded at $759 million today, instead of its current $283 million budget.

Sex education is another area ripe for a change in course under a Democratic president and Congress. During the Bush administration, the federal government invested millions in abstinence-only education. Many reproductive rights advocates say policy makers should look at evidence favoring a comprehensive sex education approach, which includes teaching teens about contraception as well as abstinence. President Obama should eliminate funding for abstinence-only sex education and shift those funds to comprehensive sex education, said Dr. Suzanne T. Poppema, chairwoman of the board of Physicians for Reproductive Choice and Health.

Reproductive rights advocates also are hopeful that the new president will eliminate the Mexico City policy or “global gag rule,” which bars nongovernmental organizations that receive U.S. funds from performing abortions or providing referrals for abortion overseas.

Dr. Poppema also said that the Obama administration should take action to expand access to emergency contraception. Mr. Obama could expand the number of women who could obtain emergency contraception by directing the Department of Defense to add the medication to its formulary and instructing the Justice Department to mandate that emergency contraception be made available to all victims of sexual assault. The Food and Drug Administration also should reopen its consideration of over-the-counter access for emergency contraception, which is currently available without a prescription only to women aged 18 years and older.

Though the new Congress will be controlled by Democrats, the majority are not uniformly in favor of abortion rights, Ms. Crepps said. However, a solid majority favor family planning, and she predicted that they can make some headway in expanding access to contraceptives as one way to prevent abortions.

But those who oppose abortion rights are concerned that with Democrats in control of both Congress and the executive branch, there will be a greater chance of passing legislation that would codify abortion rights. Dr. Gene Rudd, senior vice president of the Christian Medical Association, said that one of his major concerns is that Democrats will move forward with the Freedom of Choice Act, which has previously failed to gain traction. “It's a watershed event,” he said.

One of the early moves of President Barack Obama may be to stop action on a controversial federal abortion regulation issued during the final weeks of the Bush administration, observers say.

The regulation withholds federal payment and funding from providers who do not certify that they do not discriminate against physicians and midlevel providers who refuse to perform abortion or sterilization procedures.

The regulation has been stirring controversy among abortion rights advocates since it was first proposed in August 2008. They contend that the regulation is overly broad and as a result would decrease access to reproductive health services, including contraception. Meanwhile, supporters, such as the Christian Medical Association, say the Bush administration's approach is balanced and helps clear up misconceptions about the conscience protections already in place under existing law.

If President Obama chooses to stop the regulation he has a few options, said Janet Crepps, deputy director of the U.S. Legal Program at the Center for Reproductive Rights. He could formally rescind the regulation by going through the federal rule-making process, which would involve giving notice and allowing for public comment. Mr. Obama also could immediately suspend enforcement of the regulation. Or he could choose to work with Congress on a way to block the regulation through legislation, Ms. Crepps said.

Democrats in Congress have indicated their willingness to act to reverse the regulation. At the end of the last session of Congress, Sen. Patty Murray (D-Wash.) and then-Sen. Hillary Clinton (D-N.Y.) introduced a bill that would stop all action on the regulation.

Aside from addressing the conscience refusal issue, reproductive health advocates expect that the Obama administration's health care agenda may include changes to expand access to emergency contraception, increase funding for family planning, and take a more comprehensive approach to sex education.

“We certainly have a pent-up agenda,” said Susan Cohen, director of government affairs at the Guttmacher Institute, a nonprofit research and education organization focused on sexual and reproductive health.

One area in which Ms. Cohen and her colleagues hope to see some action early in the Obama administration is increasing funding for Title X, which provides federal funds for family planning and preventive screening services. The National Family Planning and Reproductive Health Association estimates that if Title X funding had kept pace with medical inflation since 1980, it would be funded at $759 million today, instead of its current $283 million budget.

Sex education is another area ripe for a change in course under a Democratic president and Congress. During the Bush administration, the federal government invested millions in abstinence-only education. Many reproductive rights advocates say policy makers should look at evidence favoring a comprehensive sex education approach, which includes teaching teens about contraception as well as abstinence. President Obama should eliminate funding for abstinence-only sex education and shift those funds to comprehensive sex education, said Dr. Suzanne T. Poppema, chairwoman of the board of Physicians for Reproductive Choice and Health.

Reproductive rights advocates also are hopeful that the new president will eliminate the Mexico City policy or “global gag rule,” which bars nongovernmental organizations that receive U.S. funds from performing abortions or providing referrals for abortion overseas.

Dr. Poppema also said that the Obama administration should take action to expand access to emergency contraception. Mr. Obama could expand the number of women who could obtain emergency contraception by directing the Department of Defense to add the medication to its formulary and instructing the Justice Department to mandate that emergency contraception be made available to all victims of sexual assault. The Food and Drug Administration also should reopen its consideration of over-the-counter access for emergency contraception, which is currently available without a prescription only to women aged 18 years and older.

Though the new Congress will be controlled by Democrats, the majority are not uniformly in favor of abortion rights, Ms. Crepps said. However, a solid majority favor family planning, and she predicted that they can make some headway in expanding access to contraceptives as one way to prevent abortions.

But those who oppose abortion rights are concerned that with Democrats in control of both Congress and the executive branch, there will be a greater chance of passing legislation that would codify abortion rights. Dr. Gene Rudd, senior vice president of the Christian Medical Association, said that one of his major concerns is that Democrats will move forward with the Freedom of Choice Act, which has previously failed to gain traction. “It's a watershed event,” he said.

One of the early moves of President Barack Obama may be to stop action on a controversial federal abortion regulation issued during the final weeks of the Bush administration, observers say.

The regulation withholds federal payment and funding from providers who do not certify that they do not discriminate against physicians and midlevel providers who refuse to perform abortion or sterilization procedures.

The regulation has been stirring controversy among abortion rights advocates since it was first proposed in August 2008. They contend that the regulation is overly broad and as a result would decrease access to reproductive health services, including contraception. Meanwhile, supporters, such as the Christian Medical Association, say the Bush administration's approach is balanced and helps clear up misconceptions about the conscience protections already in place under existing law.

If President Obama chooses to stop the regulation he has a few options, said Janet Crepps, deputy director of the U.S. Legal Program at the Center for Reproductive Rights. He could formally rescind the regulation by going through the federal rule-making process, which would involve giving notice and allowing for public comment. Mr. Obama also could immediately suspend enforcement of the regulation. Or he could choose to work with Congress on a way to block the regulation through legislation, Ms. Crepps said.

Democrats in Congress have indicated their willingness to act to reverse the regulation. At the end of the last session of Congress, Sen. Patty Murray (D-Wash.) and then-Sen. Hillary Clinton (D-N.Y.) introduced a bill that would stop all action on the regulation.

Aside from addressing the conscience refusal issue, reproductive health advocates expect that the Obama administration's health care agenda may include changes to expand access to emergency contraception, increase funding for family planning, and take a more comprehensive approach to sex education.

“We certainly have a pent-up agenda,” said Susan Cohen, director of government affairs at the Guttmacher Institute, a nonprofit research and education organization focused on sexual and reproductive health.

One area in which Ms. Cohen and her colleagues hope to see some action early in the Obama administration is increasing funding for Title X, which provides federal funds for family planning and preventive screening services. The National Family Planning and Reproductive Health Association estimates that if Title X funding had kept pace with medical inflation since 1980, it would be funded at $759 million today, instead of its current $283 million budget.

Sex education is another area ripe for a change in course under a Democratic president and Congress. During the Bush administration, the federal government invested millions in abstinence-only education. Many reproductive rights advocates say policy makers should look at evidence favoring a comprehensive sex education approach, which includes teaching teens about contraception as well as abstinence. President Obama should eliminate funding for abstinence-only sex education and shift those funds to comprehensive sex education, said Dr. Suzanne T. Poppema, chairwoman of the board of Physicians for Reproductive Choice and Health.

Reproductive rights advocates also are hopeful that the new president will eliminate the Mexico City policy or “global gag rule,” which bars nongovernmental organizations that receive U.S. funds from performing abortions or providing referrals for abortion overseas.

Dr. Poppema also said that the Obama administration should take action to expand access to emergency contraception. Mr. Obama could expand the number of women who could obtain emergency contraception by directing the Department of Defense to add the medication to its formulary and instructing the Justice Department to mandate that emergency contraception be made available to all victims of sexual assault. The Food and Drug Administration also should reopen its consideration of over-the-counter access for emergency contraception, which is currently available without a prescription only to women aged 18 years and older.

Though the new Congress will be controlled by Democrats, the majority are not uniformly in favor of abortion rights, Ms. Crepps said. However, a solid majority favor family planning, and she predicted that they can make some headway in expanding access to contraceptives as one way to prevent abortions.

But those who oppose abortion rights are concerned that with Democrats in control of both Congress and the executive branch, there will be a greater chance of passing legislation that would codify abortion rights. Dr. Gene Rudd, senior vice president of the Christian Medical Association, said that one of his major concerns is that Democrats will move forward with the Freedom of Choice Act, which has previously failed to gain traction. “It's a watershed event,” he said.

Detailed descriptions of the quality measures and measures groups that can be used as part of the 2009 Medicare Physician Quality Reporting Initiative are now available online.

Officials at the Centers for Medicare and Medicaid Services also have posted an implementation guide for claims-based reporting in 2009 and instructions for reporting using measures groups.

Among the 153 measures eligible for reporting in 2009, there are 52 new measures including elder maltreatment screening and follow-up planning, glucocorticoid management in rheumatoid arthritis, and influenza immunization in pediatric end-stage renal disease.

The measures and related guidance documents are available at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp

Late last year, CMS officials began listing the names of physicians and other health care professionals who reported on at least 1 of the 74 PQRI measures in 2007 at www.medicare.gov/physician

Along with the listing of physicians, CMS officials included general information about the PQRI program. They noted that physicians may have had good reasons not to report measures and that a failure to report through PQRI doesn't reflect a lack of commitment to high-quality care.

For example, CMS officials wrote that reporting quality data may have been too costly for some physicians or that physicians may have been engaged in other quality improvement reporting activities.

Detailed descriptions of the quality measures and measures groups that can be used as part of the 2009 Medicare Physician Quality Reporting Initiative are now available online.

Officials at the Centers for Medicare and Medicaid Services also have posted an implementation guide for claims-based reporting in 2009 and instructions for reporting using measures groups.

Among the 153 measures eligible for reporting in 2009, there are 52 new measures including elder maltreatment screening and follow-up planning, glucocorticoid management in rheumatoid arthritis, and influenza immunization in pediatric end-stage renal disease.

The measures and related guidance documents are available at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp

Late last year, CMS officials began listing the names of physicians and other health care professionals who reported on at least 1 of the 74 PQRI measures in 2007 at www.medicare.gov/physician

Along with the listing of physicians, CMS officials included general information about the PQRI program. They noted that physicians may have had good reasons not to report measures and that a failure to report through PQRI doesn't reflect a lack of commitment to high-quality care.

For example, CMS officials wrote that reporting quality data may have been too costly for some physicians or that physicians may have been engaged in other quality improvement reporting activities.

Detailed descriptions of the quality measures and measures groups that can be used as part of the 2009 Medicare Physician Quality Reporting Initiative are now available online.

Officials at the Centers for Medicare and Medicaid Services also have posted an implementation guide for claims-based reporting in 2009 and instructions for reporting using measures groups.

Among the 153 measures eligible for reporting in 2009, there are 52 new measures including elder maltreatment screening and follow-up planning, glucocorticoid management in rheumatoid arthritis, and influenza immunization in pediatric end-stage renal disease.

The measures and related guidance documents are available at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp

Late last year, CMS officials began listing the names of physicians and other health care professionals who reported on at least 1 of the 74 PQRI measures in 2007 at www.medicare.gov/physician

Along with the listing of physicians, CMS officials included general information about the PQRI program. They noted that physicians may have had good reasons not to report measures and that a failure to report through PQRI doesn't reflect a lack of commitment to high-quality care.

For example, CMS officials wrote that reporting quality data may have been too costly for some physicians or that physicians may have been engaged in other quality improvement reporting activities.