Mary Ellen Schneider

Physicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards.

Under the draft policy, relicensure would become more comprehensive and require that physicians demonstrate continuing skills and knowledge in their area of practice. As proposed, the maintenance of licensure process would closely mirror the requirements that the American Board of Medical Specialties has in place for maintenance of certification. The draft policy is a model that state medical boards could use, but individual states would determine whether or how it would be implemented.

Over the last 5 years, the Federation of State Medical Boards (FSMB) has been considering how state medical boards could change these policies to ensure that licensees are competent. The organization's House of Delegates approved guiding principles for developing maintenance of licensure and called for research on the impact that the requirements would have on state medical boards and physicians.

Once that research is complete, the draft maintenance of licensure policy would likely be considered by the FSMB House of Delegates at their meeting next May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB.

The idea is to take advantage of activities physicians already are doing to demonstrate their competence and use those to satisfy these requirements, she said.

If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it would be up to individual states and territories to decide if they wanted to adopt, revise, or ignore the model policy.

Since states would make these changes legislatively, it's unlikely to happen quickly, said Dr. James C. Puffer, president and chief executive officer for the American Board of Family Medicine (ABFM).

Family physicians who remain current and active with maintenance of certification will have nothing to worry about, he said, since the draft model policy would allow maintenance of certification to satisfy the requirements of maintenance of licensure.

Family physicians may be better prepared for these requirements than physicians in other specialties since family medicine does not grant lifetime board certification. And so far the participation rate in maintenance of certification has exceeded expectations. Historically, the ABFM recertification rates have been around 75%-80%, but data from the first two cohorts going through maintenance of certification shows rates above 80%.

Physicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards.

Under the draft policy, relicensure would become more comprehensive and require that physicians demonstrate continuing skills and knowledge in their area of practice. As proposed, the maintenance of licensure process would closely mirror the requirements that the American Board of Medical Specialties has in place for maintenance of certification. The draft policy is a model that state medical boards could use, but individual states would determine whether or how it would be implemented.

Over the last 5 years, the Federation of State Medical Boards (FSMB) has been considering how state medical boards could change these policies to ensure that licensees are competent. The organization's House of Delegates approved guiding principles for developing maintenance of licensure and called for research on the impact that the requirements would have on state medical boards and physicians.

Once that research is complete, the draft maintenance of licensure policy would likely be considered by the FSMB House of Delegates at their meeting next May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB.

The idea is to take advantage of activities physicians already are doing to demonstrate their competence and use those to satisfy these requirements, she said.

If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it would be up to individual states and territories to decide if they wanted to adopt, revise, or ignore the model policy.

Since states would make these changes legislatively, it's unlikely to happen quickly, said Dr. James C. Puffer, president and chief executive officer for the American Board of Family Medicine (ABFM).

Family physicians who remain current and active with maintenance of certification will have nothing to worry about, he said, since the draft model policy would allow maintenance of certification to satisfy the requirements of maintenance of licensure.

Family physicians may be better prepared for these requirements than physicians in other specialties since family medicine does not grant lifetime board certification. And so far the participation rate in maintenance of certification has exceeded expectations. Historically, the ABFM recertification rates have been around 75%-80%, but data from the first two cohorts going through maintenance of certification shows rates above 80%.

Physicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards.

Under the draft policy, relicensure would become more comprehensive and require that physicians demonstrate continuing skills and knowledge in their area of practice. As proposed, the maintenance of licensure process would closely mirror the requirements that the American Board of Medical Specialties has in place for maintenance of certification. The draft policy is a model that state medical boards could use, but individual states would determine whether or how it would be implemented.

Over the last 5 years, the Federation of State Medical Boards (FSMB) has been considering how state medical boards could change these policies to ensure that licensees are competent. The organization's House of Delegates approved guiding principles for developing maintenance of licensure and called for research on the impact that the requirements would have on state medical boards and physicians.

Once that research is complete, the draft maintenance of licensure policy would likely be considered by the FSMB House of Delegates at their meeting next May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB.

The idea is to take advantage of activities physicians already are doing to demonstrate their competence and use those to satisfy these requirements, she said.

If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it would be up to individual states and territories to decide if they wanted to adopt, revise, or ignore the model policy.

Since states would make these changes legislatively, it's unlikely to happen quickly, said Dr. James C. Puffer, president and chief executive officer for the American Board of Family Medicine (ABFM).

Family physicians who remain current and active with maintenance of certification will have nothing to worry about, he said, since the draft model policy would allow maintenance of certification to satisfy the requirements of maintenance of licensure.

Family physicians may be better prepared for these requirements than physicians in other specialties since family medicine does not grant lifetime board certification. And so far the participation rate in maintenance of certification has exceeded expectations. Historically, the ABFM recertification rates have been around 75%-80%, but data from the first two cohorts going through maintenance of certification shows rates above 80%.

In Texas, BlueCross BlueShield is using its pharmacy claims data to help improve adherence to statin therapy among individuals who have suffered a major adverse cardiac event.

As part of the pilot program with a national employer, BlueCross BlueShield of Texas used medical records and pharmacy claims data to identify patients who were at highest risk for a major adverse cardiac event but who were not taking cholesterol-lowering medication. Starting in 2007, the health plan sent letters to physicians advising them that their high-risk patients should be on statin therapy and sent another letter to patients about the benefits of cholesterol-lowering drugs. “The idea was to alert physicians that their patients weren't filling their statin prescriptions,” said Tom Tran, Pharm.D., who is divisional vice president of pharmacy programs for the insurer.

Physicians typically prescribe the right medications, but they lack information on whether those prescriptions are filled. “They're sort of practicing in the dark,” Dr. Tran said.

Both national data and experience within BlueCross BlueShield of Texas show that even among people at high risk for another adverse cardiac event, only about half are taking the medication a year after a myocardial infarction (JAMA 2002;288:455–61). Patients just feel that they don't need the medication, Dr. Tran said.

Health plan pharmacy data gives the physician more information to use in a meaningful discussion with the patient, Dr. Tran said. For example, if a patient hasn't been taking his medication and his cholesterol is up, the physician may assume he is not responding to the medication and increase his dosage or switch him to a new therapy. If the patient then fills and starts using the new prescription, he may be exposed to increased and potentially unnecessary side effects, Dr. Tran said.

Through the pilot program, health plan officials did see an uptick in adherence to statins. For every 17 members who received some type of physician intervention, 1 additional individual initiated and continued statin therapy, compared with a control group. The interventions were aimed at patients at highest risk for a recurrence of a major adverse cardiac event among more than 44,000 insured employees. Dr. Tran estimates that if the program were to be expanded to all individuals insured by BlueCross BlueShield of Texas, more than 100,000 high-risk members would be on cholesterol-lowering medications.

In addition to improving medication adherence, the pilot project also sought to save money by putting patients on generic drugs. As a result, the pilot included a step therapy program in which patients were asked to try a generic statin first; those on a brand-name statin could stay on that drug.

Generic use saved the employer group 5 cents per member per month, or about $26,000 per year. The cost savings does not include “medical avoidance” cost savings resulting from fewer hospitalizations from heart attacks and strokes.

Given the success of the statin project, officials at BlueCross BlueShield of Texas are considering trying the same approach with other chronic conditions including diabetes, high blood pressure, and asthma, Dr. Tran said.

The pilot program was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross Blue Shield Association as innovative approaches to improving health and wellness. The other “BlueWorks” winners include programs that coordinate care for children with special health care needs, address racial and ethnic disparities in health care, and encourage children to adopt healthy lifestyles.

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

In Texas, BlueCross BlueShield is using its pharmacy claims data to help improve adherence to statin therapy among individuals who have suffered a major adverse cardiac event.

As part of the pilot program with a national employer, BlueCross BlueShield of Texas used medical records and pharmacy claims data to identify patients who were at highest risk for a major adverse cardiac event but who were not taking cholesterol-lowering medication. Starting in 2007, the health plan sent letters to physicians advising them that their high-risk patients should be on statin therapy and sent another letter to patients about the benefits of cholesterol-lowering drugs. “The idea was to alert physicians that their patients weren't filling their statin prescriptions,” said Tom Tran, Pharm.D., who is divisional vice president of pharmacy programs for the insurer.

Physicians typically prescribe the right medications, but they lack information on whether those prescriptions are filled. “They're sort of practicing in the dark,” Dr. Tran said.

Both national data and experience within BlueCross BlueShield of Texas show that even among people at high risk for another adverse cardiac event, only about half are taking the medication a year after a myocardial infarction (JAMA 2002;288:455–61). Patients just feel that they don't need the medication, Dr. Tran said.

Health plan pharmacy data gives the physician more information to use in a meaningful discussion with the patient, Dr. Tran said. For example, if a patient hasn't been taking his medication and his cholesterol is up, the physician may assume he is not responding to the medication and increase his dosage or switch him to a new therapy. If the patient then fills and starts using the new prescription, he may be exposed to increased and potentially unnecessary side effects, Dr. Tran said.

Through the pilot program, health plan officials did see an uptick in adherence to statins. For every 17 members who received some type of physician intervention, 1 additional individual initiated and continued statin therapy, compared with a control group. The interventions were aimed at patients at highest risk for a recurrence of a major adverse cardiac event among more than 44,000 insured employees. Dr. Tran estimates that if the program were to be expanded to all individuals insured by BlueCross BlueShield of Texas, more than 100,000 high-risk members would be on cholesterol-lowering medications.

In addition to improving medication adherence, the pilot project also sought to save money by putting patients on generic drugs. As a result, the pilot included a step therapy program in which patients were asked to try a generic statin first; those on a brand-name statin could stay on that drug.

Generic use saved the employer group 5 cents per member per month, or about $26,000 per year. The cost savings does not include “medical avoidance” cost savings resulting from fewer hospitalizations from heart attacks and strokes.

Given the success of the statin project, officials at BlueCross BlueShield of Texas are considering trying the same approach with other chronic conditions including diabetes, high blood pressure, and asthma, Dr. Tran said.

The pilot program was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross Blue Shield Association as innovative approaches to improving health and wellness. The other “BlueWorks” winners include programs that coordinate care for children with special health care needs, address racial and ethnic disparities in health care, and encourage children to adopt healthy lifestyles.

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

In Texas, BlueCross BlueShield is using its pharmacy claims data to help improve adherence to statin therapy among individuals who have suffered a major adverse cardiac event.

As part of the pilot program with a national employer, BlueCross BlueShield of Texas used medical records and pharmacy claims data to identify patients who were at highest risk for a major adverse cardiac event but who were not taking cholesterol-lowering medication. Starting in 2007, the health plan sent letters to physicians advising them that their high-risk patients should be on statin therapy and sent another letter to patients about the benefits of cholesterol-lowering drugs. “The idea was to alert physicians that their patients weren't filling their statin prescriptions,” said Tom Tran, Pharm.D., who is divisional vice president of pharmacy programs for the insurer.

Physicians typically prescribe the right medications, but they lack information on whether those prescriptions are filled. “They're sort of practicing in the dark,” Dr. Tran said.

Both national data and experience within BlueCross BlueShield of Texas show that even among people at high risk for another adverse cardiac event, only about half are taking the medication a year after a myocardial infarction (JAMA 2002;288:455–61). Patients just feel that they don't need the medication, Dr. Tran said.

Health plan pharmacy data gives the physician more information to use in a meaningful discussion with the patient, Dr. Tran said. For example, if a patient hasn't been taking his medication and his cholesterol is up, the physician may assume he is not responding to the medication and increase his dosage or switch him to a new therapy. If the patient then fills and starts using the new prescription, he may be exposed to increased and potentially unnecessary side effects, Dr. Tran said.

Through the pilot program, health plan officials did see an uptick in adherence to statins. For every 17 members who received some type of physician intervention, 1 additional individual initiated and continued statin therapy, compared with a control group. The interventions were aimed at patients at highest risk for a recurrence of a major adverse cardiac event among more than 44,000 insured employees. Dr. Tran estimates that if the program were to be expanded to all individuals insured by BlueCross BlueShield of Texas, more than 100,000 high-risk members would be on cholesterol-lowering medications.

In addition to improving medication adherence, the pilot project also sought to save money by putting patients on generic drugs. As a result, the pilot included a step therapy program in which patients were asked to try a generic statin first; those on a brand-name statin could stay on that drug.

Generic use saved the employer group 5 cents per member per month, or about $26,000 per year. The cost savings does not include “medical avoidance” cost savings resulting from fewer hospitalizations from heart attacks and strokes.

Given the success of the statin project, officials at BlueCross BlueShield of Texas are considering trying the same approach with other chronic conditions including diabetes, high blood pressure, and asthma, Dr. Tran said.

The pilot program was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross Blue Shield Association as innovative approaches to improving health and wellness. The other “BlueWorks” winners include programs that coordinate care for children with special health care needs, address racial and ethnic disparities in health care, and encourage children to adopt healthy lifestyles.

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

The price tag for medical assistance under Medicaid is expected to reach nearly $674 billion over the next decade, with the federal government picking up more than $383 billion of the cost, according to projections from the Centers for Medicare and Medicaid Services.

Under this estimate, which was part of the first annual actuarial report on the financial outlook of Medicaid, the program's expenditures for medical assistance are projected to grow on average 7.9% per year for the next 10 years, outpacing the 4.8% growth in the U.S. gross domestic product.

“This report should serve as an urgent reminder that the current path of Medicaid spending is unsustainable for both federal and state governments,” Mike Leavitt, secretary of the Health and Human Services department, said in a statement. “If nothing is done to rein in these costs, access to health care for the nation's most vulnerable citizens could be threatened.”

Medicaid spending for fiscal 2007 was about $333 billion, with the federal government paying 57% of the cost and the states picking up 43%. The average per-person spending for medical services was $6,120 in fiscal year 2007, with more spent on older and disabled enrollees and less on children. The average per-person spending was $2,435 for nondisabled children and $3,586 for nondisabled adults, compared with $14,058 for older adults and $14,858 for disabled beneficiaries.

Average Medicaid enrollment also is expected to increase over the next decade, according to the report, from 49.1 million in FY 2007 to 55.1 million by FY 2017.

The projections are no surprise given the rising cost of health care overall, said Judith Solomon, senior fellow at the Center on Budget and Policy Priorities, a research organization that analyzes state and federal budget issues. For states, which pay a significant share of Medicaid costs, the 10-year projections are likely be mainly academic, she said, as they struggle to balance this year's budgets in a worsening economy.

The report offers an analysis of past trends in Medicaid and a 10-year projection of expenditures and enrollment. Future reports are expected to have longer-range projections and more extensive analysis, according to CMS.

The data and assumptions of the report are based largely on three sources: data submitted to CMS from the states; the boards of trustees of the Social Security and Medicare programs; and National Health Expenditure historical data and projections. The analysis is based on current law and does not make predictions of possible policy or legislative changes.

The full report is available online at http://cms.hhs.gov/ActuarialStudies/03_MedicaidReport.asp

The price tag for medical assistance under Medicaid is expected to reach nearly $674 billion over the next decade, with the federal government picking up more than $383 billion of the cost, according to projections from the Centers for Medicare and Medicaid Services.

Under this estimate, which was part of the first annual actuarial report on the financial outlook of Medicaid, the program's expenditures for medical assistance are projected to grow on average 7.9% per year for the next 10 years, outpacing the 4.8% growth in the U.S. gross domestic product.

“This report should serve as an urgent reminder that the current path of Medicaid spending is unsustainable for both federal and state governments,” Mike Leavitt, secretary of the Health and Human Services department, said in a statement. “If nothing is done to rein in these costs, access to health care for the nation's most vulnerable citizens could be threatened.”

Medicaid spending for fiscal 2007 was about $333 billion, with the federal government paying 57% of the cost and the states picking up 43%. The average per-person spending for medical services was $6,120 in fiscal year 2007, with more spent on older and disabled enrollees and less on children. The average per-person spending was $2,435 for nondisabled children and $3,586 for nondisabled adults, compared with $14,058 for older adults and $14,858 for disabled beneficiaries.

Average Medicaid enrollment also is expected to increase over the next decade, according to the report, from 49.1 million in FY 2007 to 55.1 million by FY 2017.

The projections are no surprise given the rising cost of health care overall, said Judith Solomon, senior fellow at the Center on Budget and Policy Priorities, a research organization that analyzes state and federal budget issues. For states, which pay a significant share of Medicaid costs, the 10-year projections are likely be mainly academic, she said, as they struggle to balance this year's budgets in a worsening economy.

The report offers an analysis of past trends in Medicaid and a 10-year projection of expenditures and enrollment. Future reports are expected to have longer-range projections and more extensive analysis, according to CMS.

The data and assumptions of the report are based largely on three sources: data submitted to CMS from the states; the boards of trustees of the Social Security and Medicare programs; and National Health Expenditure historical data and projections. The analysis is based on current law and does not make predictions of possible policy or legislative changes.

The full report is available online at http://cms.hhs.gov/ActuarialStudies/03_MedicaidReport.asp

The price tag for medical assistance under Medicaid is expected to reach nearly $674 billion over the next decade, with the federal government picking up more than $383 billion of the cost, according to projections from the Centers for Medicare and Medicaid Services.

Under this estimate, which was part of the first annual actuarial report on the financial outlook of Medicaid, the program's expenditures for medical assistance are projected to grow on average 7.9% per year for the next 10 years, outpacing the 4.8% growth in the U.S. gross domestic product.

“This report should serve as an urgent reminder that the current path of Medicaid spending is unsustainable for both federal and state governments,” Mike Leavitt, secretary of the Health and Human Services department, said in a statement. “If nothing is done to rein in these costs, access to health care for the nation's most vulnerable citizens could be threatened.”

Medicaid spending for fiscal 2007 was about $333 billion, with the federal government paying 57% of the cost and the states picking up 43%. The average per-person spending for medical services was $6,120 in fiscal year 2007, with more spent on older and disabled enrollees and less on children. The average per-person spending was $2,435 for nondisabled children and $3,586 for nondisabled adults, compared with $14,058 for older adults and $14,858 for disabled beneficiaries.

Average Medicaid enrollment also is expected to increase over the next decade, according to the report, from 49.1 million in FY 2007 to 55.1 million by FY 2017.

The projections are no surprise given the rising cost of health care overall, said Judith Solomon, senior fellow at the Center on Budget and Policy Priorities, a research organization that analyzes state and federal budget issues. For states, which pay a significant share of Medicaid costs, the 10-year projections are likely be mainly academic, she said, as they struggle to balance this year's budgets in a worsening economy.

The report offers an analysis of past trends in Medicaid and a 10-year projection of expenditures and enrollment. Future reports are expected to have longer-range projections and more extensive analysis, according to CMS.

The data and assumptions of the report are based largely on three sources: data submitted to CMS from the states; the boards of trustees of the Social Security and Medicare programs; and National Health Expenditure historical data and projections. The analysis is based on current law and does not make predictions of possible policy or legislative changes.

The full report is available online at http://cms.hhs.gov/ActuarialStudies/03_MedicaidReport.asp

New Cigarette to Target Women

The planned launch of a new pink cigarette pack has many health organizations seeing red. The American Medical Association, the American Heart Association, the American Cancer Society, the Cancer Action Network, the American Lung Association, and the Campaign for Tobacco-Free Kids recently condemned Philip Morris for its plan to repackage its Virginia Slims cigarettes in small, pink purse packs in early 2009. The planned marketing push shows that the company is aggressively marketing cigarettes to women and girls, the coalition said in a statement. “The Virginia Slims pink purse pack is yet another tobacco industry slap in the face to women,” the coalition said. “Far from making a fashion statement, the pink purse pack will encourage smoking by women and girls and expose them to its lethal effects.” The coalition called on Philip Morris to stop the marketing effort and urged Congress to pass legislation that would give the Food and Drug Administration authority over tobacco products.

U.S. Gets 'D' on Prematurity Rate

The United States received a “D” on the Premature Birth Report Card issued recently by the March of Dimes. The report card compares actual preterm birth rates in each state with the national Healthy People 2010 objectives set by the federal government. The Healthy People 2010 goal is to lower preterm birth to 7.6% of all live births, while data from 2005 show that the national preterm birth rate is 12.7%. No state earned an “A” and only one state—Vermont—earned a grade of “B.” Eight states received a “C,” 23 received a “D,” and 18 states, Puerto Rico, and the District of Columbia received failing grades. “It is unacceptable that our nation is failing so many preterm babies,” Jennifer L. Howse, Ph.D., president of the March of Dimes, said in a statement. “We are determined to find and implement solutions to prevent preterm birth, based on research, best clinical practices, and improved education for moms.” This is the first year that the March of Dimes has issued the prematurity report card, but it is expected to continue on an annual basis. In addition to rating state performance, the report card also calls on hospital officials to review all births by cesarean section and inductions of labor that occur before 39 weeks' gestation as a strategy to help curb preterm births.

Feds Finalize New Rules on FMLA

Last month, the U.S. Department of Labor issued a final regulation updating the Family and Medical Leave Act, including the establishment of new rights for miliary families. The final rule will allow family members caring for a military service member with a serious illness or injury incurred in the line of duty to take up to 26 work weeks of leave during a 12-month period. The rule also allows families of National Guard and Reserve personnel on active duty to take leave to manage their affairs without risking their jobs. The final rule also clarifies some definitions. For example, the rule defines “periodic visits to a health care provider” for a chronic serious health condition as at least two visits to a health care provider per year. But the rule has been criticized by some unions and women's organizations for making it harder for workers to access benefits under the FMLA. Specifically, the groups object to provisions of the final rule that give workers less time to give notice that they will take leave and give employers more time to approve the request, Debra L. Ness, president of the National Partnership for Women and Families, said in a statement.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. The CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require E-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

New Cigarette to Target Women

The planned launch of a new pink cigarette pack has many health organizations seeing red. The American Medical Association, the American Heart Association, the American Cancer Society, the Cancer Action Network, the American Lung Association, and the Campaign for Tobacco-Free Kids recently condemned Philip Morris for its plan to repackage its Virginia Slims cigarettes in small, pink purse packs in early 2009. The planned marketing push shows that the company is aggressively marketing cigarettes to women and girls, the coalition said in a statement. “The Virginia Slims pink purse pack is yet another tobacco industry slap in the face to women,” the coalition said. “Far from making a fashion statement, the pink purse pack will encourage smoking by women and girls and expose them to its lethal effects.” The coalition called on Philip Morris to stop the marketing effort and urged Congress to pass legislation that would give the Food and Drug Administration authority over tobacco products.

U.S. Gets 'D' on Prematurity Rate

The United States received a “D” on the Premature Birth Report Card issued recently by the March of Dimes. The report card compares actual preterm birth rates in each state with the national Healthy People 2010 objectives set by the federal government. The Healthy People 2010 goal is to lower preterm birth to 7.6% of all live births, while data from 2005 show that the national preterm birth rate is 12.7%. No state earned an “A” and only one state—Vermont—earned a grade of “B.” Eight states received a “C,” 23 received a “D,” and 18 states, Puerto Rico, and the District of Columbia received failing grades. “It is unacceptable that our nation is failing so many preterm babies,” Jennifer L. Howse, Ph.D., president of the March of Dimes, said in a statement. “We are determined to find and implement solutions to prevent preterm birth, based on research, best clinical practices, and improved education for moms.” This is the first year that the March of Dimes has issued the prematurity report card, but it is expected to continue on an annual basis. In addition to rating state performance, the report card also calls on hospital officials to review all births by cesarean section and inductions of labor that occur before 39 weeks' gestation as a strategy to help curb preterm births.

Feds Finalize New Rules on FMLA

Last month, the U.S. Department of Labor issued a final regulation updating the Family and Medical Leave Act, including the establishment of new rights for miliary families. The final rule will allow family members caring for a military service member with a serious illness or injury incurred in the line of duty to take up to 26 work weeks of leave during a 12-month period. The rule also allows families of National Guard and Reserve personnel on active duty to take leave to manage their affairs without risking their jobs. The final rule also clarifies some definitions. For example, the rule defines “periodic visits to a health care provider” for a chronic serious health condition as at least two visits to a health care provider per year. But the rule has been criticized by some unions and women's organizations for making it harder for workers to access benefits under the FMLA. Specifically, the groups object to provisions of the final rule that give workers less time to give notice that they will take leave and give employers more time to approve the request, Debra L. Ness, president of the National Partnership for Women and Families, said in a statement.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. The CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require E-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

New Cigarette to Target Women

The planned launch of a new pink cigarette pack has many health organizations seeing red. The American Medical Association, the American Heart Association, the American Cancer Society, the Cancer Action Network, the American Lung Association, and the Campaign for Tobacco-Free Kids recently condemned Philip Morris for its plan to repackage its Virginia Slims cigarettes in small, pink purse packs in early 2009. The planned marketing push shows that the company is aggressively marketing cigarettes to women and girls, the coalition said in a statement. “The Virginia Slims pink purse pack is yet another tobacco industry slap in the face to women,” the coalition said. “Far from making a fashion statement, the pink purse pack will encourage smoking by women and girls and expose them to its lethal effects.” The coalition called on Philip Morris to stop the marketing effort and urged Congress to pass legislation that would give the Food and Drug Administration authority over tobacco products.

U.S. Gets 'D' on Prematurity Rate

The United States received a “D” on the Premature Birth Report Card issued recently by the March of Dimes. The report card compares actual preterm birth rates in each state with the national Healthy People 2010 objectives set by the federal government. The Healthy People 2010 goal is to lower preterm birth to 7.6% of all live births, while data from 2005 show that the national preterm birth rate is 12.7%. No state earned an “A” and only one state—Vermont—earned a grade of “B.” Eight states received a “C,” 23 received a “D,” and 18 states, Puerto Rico, and the District of Columbia received failing grades. “It is unacceptable that our nation is failing so many preterm babies,” Jennifer L. Howse, Ph.D., president of the March of Dimes, said in a statement. “We are determined to find and implement solutions to prevent preterm birth, based on research, best clinical practices, and improved education for moms.” This is the first year that the March of Dimes has issued the prematurity report card, but it is expected to continue on an annual basis. In addition to rating state performance, the report card also calls on hospital officials to review all births by cesarean section and inductions of labor that occur before 39 weeks' gestation as a strategy to help curb preterm births.

Feds Finalize New Rules on FMLA

Last month, the U.S. Department of Labor issued a final regulation updating the Family and Medical Leave Act, including the establishment of new rights for miliary families. The final rule will allow family members caring for a military service member with a serious illness or injury incurred in the line of duty to take up to 26 work weeks of leave during a 12-month period. The rule also allows families of National Guard and Reserve personnel on active duty to take leave to manage their affairs without risking their jobs. The final rule also clarifies some definitions. For example, the rule defines “periodic visits to a health care provider” for a chronic serious health condition as at least two visits to a health care provider per year. But the rule has been criticized by some unions and women's organizations for making it harder for workers to access benefits under the FMLA. Specifically, the groups object to provisions of the final rule that give workers less time to give notice that they will take leave and give employers more time to approve the request, Debra L. Ness, president of the National Partnership for Women and Families, said in a statement.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. The CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require E-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

NIH Examines Early-Onset Alzheimer's

As part of a study aimed at better understanding early-onset Alzheimer's disease, researchers are recruiting the adult children of individuals diagnosed with inherited AD. The volunteers will undergo genetic analysis, cognitive testing, and neuroimaging, as well as provide blood and cerebral spinal fluid samples, which to build an international database. The Dominantly Inherited Alzheimer's Network study, funded by the National Institutes of Health, is a 6-year, $16 million effort aimed at identifying the sequence of brain changes in the early-onset form of the disease before symptoms occur. The study involves researchers from sites in the United States, England, and Australia. “By sharing data within the network, we hope to advance our knowledge of the brain mechanisms involved in Alzheimer's, eventually leading to targets for therapies that can delay or even prevent progress of the disease,” Dr. Richard J. Hodes, director of the National Institute of Aging, part of the National Institutes of Health, said in a statement. More information about the study is at

www.dian-info.org

AAN Hails Successful Year on the Hill

Neurologists and their patients realized significant victories on Capitol Hill this year, according to the American Academy of Neurology. In October, President Bush signed the Veterans' Mental Health and Other Care Improvements Act (S. 2162), which included the establishment of between four and six epilepsy centers of excellence within the Department of Veterans Affairs. And over the summer, Congress overrode a presidential veto to cancel a 10.6% cut in Medicare physician payments. The legislation (H.R. 6331) also gave physicians a 1.1% pay increase for 2009. But more work will be needed over the next year, said the AAN. The pay fix passed by Congress this summer did not address the sustainable growth rate formula, which ties physician payments to the gross domestic product. As a result, physicians can expect to face a 21% payment cut in 2010. In addition, legislation to promote stroke prevention and early treatment passed the House but was stalled in the Senate. Congress also failed to approve increased funding for the National Institutes of Health in 2008.

Eligibility for Special Needs Plans

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisors as being medically complex, substantially disabling, or life threatening, and as having a high risk of hospitalization or other adverse outcome. The conditions are: certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes mellitus, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list is part of new guidelines for the special needs plans that will go into effect in 2010. By selecting the chronic conditions eligible for enrollment in the Medicare Advantage special needs plans, officials at the Centers for Medicare and Medicaid Services said they are trying to ensure that the plans stay focused on a specific population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory, which is available at the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. The inventory is at

www.qualitymeasures.ahrq.gov

American Patients Skip Care

U.S. chronic disease patients are far more likely than are patients in seven other countries to forgo care because of costs, according to a study from the Commonwealth Fund. More than half of chronically ill patients in the U.S. did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared with 7%–36% in the seven other countries studied. In addition, patients in the U.S. experience the highest rates of medical errors, care coordination problems, and high out-of-pocket costs, the study found. The eight-country survey also reported that U.S. patients are significantly more likely to call for fundamental change in their country's health care system, with one-third saying the system needs to be rebuilt completely. The Commonwealth Fund polled patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom along with patients in this country.

MedPAC Calls for Disclosure

The Medicare Payment Advisory Commission has called on Congress to adopt five recommendations that would require drug, device, and medical supply makers, and hospitals to disclose their financial ties to physicians and physician groups. They manufacturers would have to disclose financial relationships with pharmacies and pharmacists; health plans; pharmacy benefit managers and their employees; hospitals and medical schools; organizations that support continuing medical education; patient organizations; and professional organizations. MedPAC also urged Congress to require drug makers to post on a Web site all details about free drug samples. Lawmakers are not required to implement MedPAC recommendations.

NIH Examines Early-Onset Alzheimer's

As part of a study aimed at better understanding early-onset Alzheimer's disease, researchers are recruiting the adult children of individuals diagnosed with inherited AD. The volunteers will undergo genetic analysis, cognitive testing, and neuroimaging, as well as provide blood and cerebral spinal fluid samples, which to build an international database. The Dominantly Inherited Alzheimer's Network study, funded by the National Institutes of Health, is a 6-year, $16 million effort aimed at identifying the sequence of brain changes in the early-onset form of the disease before symptoms occur. The study involves researchers from sites in the United States, England, and Australia. “By sharing data within the network, we hope to advance our knowledge of the brain mechanisms involved in Alzheimer's, eventually leading to targets for therapies that can delay or even prevent progress of the disease,” Dr. Richard J. Hodes, director of the National Institute of Aging, part of the National Institutes of Health, said in a statement. More information about the study is at

www.dian-info.org

AAN Hails Successful Year on the Hill

Neurologists and their patients realized significant victories on Capitol Hill this year, according to the American Academy of Neurology. In October, President Bush signed the Veterans' Mental Health and Other Care Improvements Act (S. 2162), which included the establishment of between four and six epilepsy centers of excellence within the Department of Veterans Affairs. And over the summer, Congress overrode a presidential veto to cancel a 10.6% cut in Medicare physician payments. The legislation (H.R. 6331) also gave physicians a 1.1% pay increase for 2009. But more work will be needed over the next year, said the AAN. The pay fix passed by Congress this summer did not address the sustainable growth rate formula, which ties physician payments to the gross domestic product. As a result, physicians can expect to face a 21% payment cut in 2010. In addition, legislation to promote stroke prevention and early treatment passed the House but was stalled in the Senate. Congress also failed to approve increased funding for the National Institutes of Health in 2008.

Eligibility for Special Needs Plans

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisors as being medically complex, substantially disabling, or life threatening, and as having a high risk of hospitalization or other adverse outcome. The conditions are: certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes mellitus, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list is part of new guidelines for the special needs plans that will go into effect in 2010. By selecting the chronic conditions eligible for enrollment in the Medicare Advantage special needs plans, officials at the Centers for Medicare and Medicaid Services said they are trying to ensure that the plans stay focused on a specific population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory, which is available at the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. The inventory is at

www.qualitymeasures.ahrq.gov

American Patients Skip Care

U.S. chronic disease patients are far more likely than are patients in seven other countries to forgo care because of costs, according to a study from the Commonwealth Fund. More than half of chronically ill patients in the U.S. did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared with 7%–36% in the seven other countries studied. In addition, patients in the U.S. experience the highest rates of medical errors, care coordination problems, and high out-of-pocket costs, the study found. The eight-country survey also reported that U.S. patients are significantly more likely to call for fundamental change in their country's health care system, with one-third saying the system needs to be rebuilt completely. The Commonwealth Fund polled patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom along with patients in this country.

MedPAC Calls for Disclosure

The Medicare Payment Advisory Commission has called on Congress to adopt five recommendations that would require drug, device, and medical supply makers, and hospitals to disclose their financial ties to physicians and physician groups. They manufacturers would have to disclose financial relationships with pharmacies and pharmacists; health plans; pharmacy benefit managers and their employees; hospitals and medical schools; organizations that support continuing medical education; patient organizations; and professional organizations. MedPAC also urged Congress to require drug makers to post on a Web site all details about free drug samples. Lawmakers are not required to implement MedPAC recommendations.

NIH Examines Early-Onset Alzheimer's

As part of a study aimed at better understanding early-onset Alzheimer's disease, researchers are recruiting the adult children of individuals diagnosed with inherited AD. The volunteers will undergo genetic analysis, cognitive testing, and neuroimaging, as well as provide blood and cerebral spinal fluid samples, which to build an international database. The Dominantly Inherited Alzheimer's Network study, funded by the National Institutes of Health, is a 6-year, $16 million effort aimed at identifying the sequence of brain changes in the early-onset form of the disease before symptoms occur. The study involves researchers from sites in the United States, England, and Australia. “By sharing data within the network, we hope to advance our knowledge of the brain mechanisms involved in Alzheimer's, eventually leading to targets for therapies that can delay or even prevent progress of the disease,” Dr. Richard J. Hodes, director of the National Institute of Aging, part of the National Institutes of Health, said in a statement. More information about the study is at

www.dian-info.org

AAN Hails Successful Year on the Hill

Neurologists and their patients realized significant victories on Capitol Hill this year, according to the American Academy of Neurology. In October, President Bush signed the Veterans' Mental Health and Other Care Improvements Act (S. 2162), which included the establishment of between four and six epilepsy centers of excellence within the Department of Veterans Affairs. And over the summer, Congress overrode a presidential veto to cancel a 10.6% cut in Medicare physician payments. The legislation (H.R. 6331) also gave physicians a 1.1% pay increase for 2009. But more work will be needed over the next year, said the AAN. The pay fix passed by Congress this summer did not address the sustainable growth rate formula, which ties physician payments to the gross domestic product. As a result, physicians can expect to face a 21% payment cut in 2010. In addition, legislation to promote stroke prevention and early treatment passed the House but was stalled in the Senate. Congress also failed to approve increased funding for the National Institutes of Health in 2008.

Eligibility for Special Needs Plans

Medicare officials have identified 15 chronic conditions that would make individuals eligible for enrollment in a Chronic Care Medicare Advantage Special Needs Plan. The conditions were selected by a panel of advisors as being medically complex, substantially disabling, or life threatening, and as having a high risk of hospitalization or other adverse outcome. The conditions are: certain neurologic disorders, stroke, chronic alcohol and other drug dependence, certain autoimmune disorders, cancer excluding precancer conditions, certain cardiovascular disorders, chronic heart failure, dementia, diabetes mellitus, end-stage liver disease, end-stage renal disease requiring dialysis, certain severe hematologic disorders, HIV/AIDS, certain chronic lung disorders, and certain chronic and disabling mental health conditions. The list is part of new guidelines for the special needs plans that will go into effect in 2010. By selecting the chronic conditions eligible for enrollment in the Medicare Advantage special needs plans, officials at the Centers for Medicare and Medicaid Services said they are trying to ensure that the plans stay focused on a specific population.

HHS Releases Quality Measures

The Department of Health and Human Services has released its first-ever inventory of the quality measures its agencies use for reporting, payment, and quality improvement. The HHS measure inventory, which is available at the National Quality Measures Clearinghouse, a Web site run by the Agency for Healthcare Research and Quality, is designed to advance collaboration within the quality measurement community and to synchronize measurement, according to the HHS. The inventory is at

www.qualitymeasures.ahrq.gov

American Patients Skip Care

U.S. chronic disease patients are far more likely than are patients in seven other countries to forgo care because of costs, according to a study from the Commonwealth Fund. More than half of chronically ill patients in the U.S. did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared with 7%–36% in the seven other countries studied. In addition, patients in the U.S. experience the highest rates of medical errors, care coordination problems, and high out-of-pocket costs, the study found. The eight-country survey also reported that U.S. patients are significantly more likely to call for fundamental change in their country's health care system, with one-third saying the system needs to be rebuilt completely. The Commonwealth Fund polled patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom along with patients in this country.

MedPAC Calls for Disclosure

The Medicare Payment Advisory Commission has called on Congress to adopt five recommendations that would require drug, device, and medical supply makers, and hospitals to disclose their financial ties to physicians and physician groups. They manufacturers would have to disclose financial relationships with pharmacies and pharmacists; health plans; pharmacy benefit managers and their employees; hospitals and medical schools; organizations that support continuing medical education; patient organizations; and professional organizations. MedPAC also urged Congress to require drug makers to post on a Web site all details about free drug samples. Lawmakers are not required to implement MedPAC recommendations.

Arthritis Spending Reaches $32B

Nearly 10% of adults in the United States sought treatment for arthritis in 2005, according to figures from the Agency for Healthcare Research and Quality. More women than men reported experiencing arthritis—12% versus 7%. The disease was also more common among non-Hispanic white adults (11%) and black non-Hispanic adults (10%), compared with Hispanics (6%) and non-Hispanic Asian adults (4%). The cost of treating arthritis was $32 billion in 2005, with most of the dollars being spent in ambulatory care (36%). About 31% was spent on inpatient care and 21% was spent on prescriptions. Home health costs made up 12% of the costs and less than 1% was spent on visits to the emergency room.

Prior Authorization for DMARDs

Most state Medicaid programs require prior authorization for at least one biologic disease-modifying antirheumatic drug (DMARD), according to an analysis published in the November issue of Arthritis Care & Research. In 2006, 32 states had implemented or were planning to implement policies for prior authorization, but the drugs included and the specific criteria varied widely. For example, 20 states asked for detailed clinical criteria such as the number of swollen or painful joints, rheumatoid factor levels, and radiologic findings. Six states required that a rheumatologist prescribe the biologic DMARD and two states required that a purified protein derivative be checked before starting treatment. After a later further analysis of the utilization of adalimumab and etanercept, the researchers found that prior authorization seems to control growth in utilization at first but utilization appears to rise again over time.

Pfizer Settles Bextra Claims

Pfizer Inc. has struck a multimillion-dollar agreement to resolve most of the pending claims involving its drug Bextra (valdecoxib), which was withdrawn from the market in 2005. The company agreed to pay $60 million to attorneys general in 33 states as well as in the District of Columbia and also to adopt certain compliance practices in response to suits alleging that the company violated state laws in its promotion and marketing of Bextra. Pfizer also annnounced that it was setting aside $745 million in anticipation of a final settlement of pending personal injury claims involving the company's other cyclooxygenase-2 inhibitor, Celebrex (celecoxib). That amount should resolve more than 90% of the suits alleging that Celebrex caused heart attack, stroke, or other injury in those who took the drug. Several courts have ruled that the plaintiffs had failed to prove that the drug led to these effects. Pfizer settled to remove the cloud over the drug, the pharmaceutical company said in a statement.

Lupus Foundation Awards $1.1 Million

The Lupus Foundation of America spent more than $1.1 million in 2008 to fund research grants and fellowships. The grants will support research in pediatric and adolescent lupus, lupus in men, the use of adult stem cells in lupus, and mid- to late-stage translational studies. Other areas of research funded this year include studies of cutaneous lupus, kidney disease and lupus, and the cognitive effects of lupus. But the grants awarded were far short of the requests received by the organization, according to the Lupus Foundation. The organization received more than 77 grant applications totaling about $7.8 billion in requests for lupus research funding.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require E-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

Arthritis Spending Reaches $32B

Nearly 10% of adults in the United States sought treatment for arthritis in 2005, according to figures from the Agency for Healthcare Research and Quality. More women than men reported experiencing arthritis—12% versus 7%. The disease was also more common among non-Hispanic white adults (11%) and black non-Hispanic adults (10%), compared with Hispanics (6%) and non-Hispanic Asian adults (4%). The cost of treating arthritis was $32 billion in 2005, with most of the dollars being spent in ambulatory care (36%). About 31% was spent on inpatient care and 21% was spent on prescriptions. Home health costs made up 12% of the costs and less than 1% was spent on visits to the emergency room.

Prior Authorization for DMARDs

Most state Medicaid programs require prior authorization for at least one biologic disease-modifying antirheumatic drug (DMARD), according to an analysis published in the November issue of Arthritis Care & Research. In 2006, 32 states had implemented or were planning to implement policies for prior authorization, but the drugs included and the specific criteria varied widely. For example, 20 states asked for detailed clinical criteria such as the number of swollen or painful joints, rheumatoid factor levels, and radiologic findings. Six states required that a rheumatologist prescribe the biologic DMARD and two states required that a purified protein derivative be checked before starting treatment. After a later further analysis of the utilization of adalimumab and etanercept, the researchers found that prior authorization seems to control growth in utilization at first but utilization appears to rise again over time.

Pfizer Settles Bextra Claims

Pfizer Inc. has struck a multimillion-dollar agreement to resolve most of the pending claims involving its drug Bextra (valdecoxib), which was withdrawn from the market in 2005. The company agreed to pay $60 million to attorneys general in 33 states as well as in the District of Columbia and also to adopt certain compliance practices in response to suits alleging that the company violated state laws in its promotion and marketing of Bextra. Pfizer also annnounced that it was setting aside $745 million in anticipation of a final settlement of pending personal injury claims involving the company's other cyclooxygenase-2 inhibitor, Celebrex (celecoxib). That amount should resolve more than 90% of the suits alleging that Celebrex caused heart attack, stroke, or other injury in those who took the drug. Several courts have ruled that the plaintiffs had failed to prove that the drug led to these effects. Pfizer settled to remove the cloud over the drug, the pharmaceutical company said in a statement.

Lupus Foundation Awards $1.1 Million

The Lupus Foundation of America spent more than $1.1 million in 2008 to fund research grants and fellowships. The grants will support research in pediatric and adolescent lupus, lupus in men, the use of adult stem cells in lupus, and mid- to late-stage translational studies. Other areas of research funded this year include studies of cutaneous lupus, kidney disease and lupus, and the cognitive effects of lupus. But the grants awarded were far short of the requests received by the organization, according to the Lupus Foundation. The organization received more than 77 grant applications totaling about $7.8 billion in requests for lupus research funding.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require E-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

Arthritis Spending Reaches $32B

Nearly 10% of adults in the United States sought treatment for arthritis in 2005, according to figures from the Agency for Healthcare Research and Quality. More women than men reported experiencing arthritis—12% versus 7%. The disease was also more common among non-Hispanic white adults (11%) and black non-Hispanic adults (10%), compared with Hispanics (6%) and non-Hispanic Asian adults (4%). The cost of treating arthritis was $32 billion in 2005, with most of the dollars being spent in ambulatory care (36%). About 31% was spent on inpatient care and 21% was spent on prescriptions. Home health costs made up 12% of the costs and less than 1% was spent on visits to the emergency room.

Prior Authorization for DMARDs

Most state Medicaid programs require prior authorization for at least one biologic disease-modifying antirheumatic drug (DMARD), according to an analysis published in the November issue of Arthritis Care & Research. In 2006, 32 states had implemented or were planning to implement policies for prior authorization, but the drugs included and the specific criteria varied widely. For example, 20 states asked for detailed clinical criteria such as the number of swollen or painful joints, rheumatoid factor levels, and radiologic findings. Six states required that a rheumatologist prescribe the biologic DMARD and two states required that a purified protein derivative be checked before starting treatment. After a later further analysis of the utilization of adalimumab and etanercept, the researchers found that prior authorization seems to control growth in utilization at first but utilization appears to rise again over time.

Pfizer Settles Bextra Claims

Pfizer Inc. has struck a multimillion-dollar agreement to resolve most of the pending claims involving its drug Bextra (valdecoxib), which was withdrawn from the market in 2005. The company agreed to pay $60 million to attorneys general in 33 states as well as in the District of Columbia and also to adopt certain compliance practices in response to suits alleging that the company violated state laws in its promotion and marketing of Bextra. Pfizer also annnounced that it was setting aside $745 million in anticipation of a final settlement of pending personal injury claims involving the company's other cyclooxygenase-2 inhibitor, Celebrex (celecoxib). That amount should resolve more than 90% of the suits alleging that Celebrex caused heart attack, stroke, or other injury in those who took the drug. Several courts have ruled that the plaintiffs had failed to prove that the drug led to these effects. Pfizer settled to remove the cloud over the drug, the pharmaceutical company said in a statement.

Lupus Foundation Awards $1.1 Million

The Lupus Foundation of America spent more than $1.1 million in 2008 to fund research grants and fellowships. The grants will support research in pediatric and adolescent lupus, lupus in men, the use of adult stem cells in lupus, and mid- to late-stage translational studies. Other areas of research funded this year include studies of cutaneous lupus, kidney disease and lupus, and the cognitive effects of lupus. But the grants awarded were far short of the requests received by the organization, according to the Lupus Foundation. The organization received more than 77 grant applications totaling about $7.8 billion in requests for lupus research funding.

HIPAA Enforcement 'Limited'

The Centers for Medicare and Medicaid Services has not provided effective oversight and has taken only “limited actions” to ensure that covered entities adequately implement patient privacy regulations contained in the Health Insurance Portability and Accountability Act of 1996, according to a report from the Health and Human Services Department's Office of Inspector General. The OIG found that the CMS had not conducted any compliance reviews of covered entities, and instead relied on complaints to target investigations. However, the CMS has received very few complaints about violations, the report said. “As a result, the CMS had no effective mechanism to ensure that covered entities were complying with the HIPAA security rule” or that electronic health information was being adequately protected, the report concluded. CMS has taken steps to begin conducting compliance reviews in an effort to identify security problems and vulnerabilities under HIPAA, the OIG said.

Mass. Blues Require E-Prescribing

Blue Cross Blue Shield of Massachusetts said it will require all physicians to prescribe electronically beginning in 2011 in order to qualify for any of the health plan's physician incentive programs. Currently, 99% of primary care physicians and 78% of specialists participate in the insurer's incentive programs, which reward physicians for meeting nationally recognized quality standards and patient safety goals. Currently, e-prescribing is an optional measure in the plan's incentive programs. The insurer said it realized that start-up costs involved with implementing an e-prescribing system continue to be a barrier to adoption for physicians, and said it would provide some financial assistance for doctors in 2009 to offset those start-up costs. A 2006 study by the plan showed that physicians who used an e-prescribing device were able to choose more cost-efficient drugs, and therefore saved 5% on their drug costs relative to physicians who did not use the technology.

Physicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards.

Under the draft policy, relicensure would become more comprehensive and require that physicians demonstrate continuing skills and knowledge in their area of practice.

The maintenance of licensure process would closely mirror the requirements that the American Board of Medical Specialties has in place for maintenance of certification.

The draft policy is a model that individual state medical boards could use, but the states would determine whether or how it would be implemented.

Over the last 5 years, the Federation of State Medical Boards (FSMB) has been considering just how state medical boards could change these policies to ensure that physician licensees are competent.

“There is general agreement that current licensing requirements involve mainly activities associated with passive learning,” said Dr. Audrey Uknis, professor of medicine at Temple University, Philadelphia, and chair of the continuous professional development committee for the American College of Rheumatology.

But while current relicensure requirements may fall short of demonstrating physician competence to the public, they can still be onerous in terms of their demands on physician time, she said. As a result, if states were to move ahead with increased requirements for relicensure there could be some initial pushback from rheumatologists.

The proposed plan to allow physicians involved in maintenance of certification to use that process to satisfy any new state licensing requirements would help some rheumatologists, Dr. Uknis said. However, there are many rheumatologists who are not engaged in maintenance of certification because of the time and expense involved, or because they hold a lifetime certification from the American Board of Internal Medicine. Roughly half of the 5,000 rheumatologists who are board certified have lifetime certification, she said.

If even a fraction of those physicians who have lifetime certification chose to retire because of increased licensing requirements, it would have a significant impact on the rheumatology workforce, Dr. Uknis said.

But Dr. Uknis said officials at the ACR will continue to work to ensure that even rheumatologists who aren't participating in maintenance of certification have a reasonable pathway to relicensure and tools that can help them meet those requirements.

Earlier this year, the organization's House of Delegates approved guiding principles for developing maintenance of licensure and called for additional research on the impact that the new requirements would have on state medical boards and licensed physicians.

Once that research is complete, the draft maintenance of licensure policy would likely be considered by the FSMB House of Delegates at their meeting next May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB.

“Nobody wants to create more work for physicians,” she said.

The idea is to try to take advantage of activities physicians already are doing to and use those to satisfy state licensure requirements, she said.

For their part, state medical boards are feeling pressure from the public in light of rapidly changing science and technology.

And the current requirements, which vary but generally include some continuing medical education, don't match up with public expectations, she said.

If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it still would be a model policy only, Ms. Clothier said.

It would be up to individual states and territories to decide if they wanted to adopt, revise, or ignore the model policy. And that decision and its timing is likely to vary widely based on the politics involved in each state, she added.

This Month's Talk Back Question

If this maintenance of certification issue affects you, will you recertify? Why or why not?

Physicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards.

Under the draft policy, relicensure would become more comprehensive and require that physicians demonstrate continuing skills and knowledge in their area of practice.

The maintenance of licensure process would closely mirror the requirements that the American Board of Medical Specialties has in place for maintenance of certification.

The draft policy is a model that individual state medical boards could use, but the states would determine whether or how it would be implemented.

Over the last 5 years, the Federation of State Medical Boards (FSMB) has been considering just how state medical boards could change these policies to ensure that physician licensees are competent.

“There is general agreement that current licensing requirements involve mainly activities associated with passive learning,” said Dr. Audrey Uknis, professor of medicine at Temple University, Philadelphia, and chair of the continuous professional development committee for the American College of Rheumatology.

But while current relicensure requirements may fall short of demonstrating physician competence to the public, they can still be onerous in terms of their demands on physician time, she said. As a result, if states were to move ahead with increased requirements for relicensure there could be some initial pushback from rheumatologists.

The proposed plan to allow physicians involved in maintenance of certification to use that process to satisfy any new state licensing requirements would help some rheumatologists, Dr. Uknis said. However, there are many rheumatologists who are not engaged in maintenance of certification because of the time and expense involved, or because they hold a lifetime certification from the American Board of Internal Medicine. Roughly half of the 5,000 rheumatologists who are board certified have lifetime certification, she said.

If even a fraction of those physicians who have lifetime certification chose to retire because of increased licensing requirements, it would have a significant impact on the rheumatology workforce, Dr. Uknis said.

But Dr. Uknis said officials at the ACR will continue to work to ensure that even rheumatologists who aren't participating in maintenance of certification have a reasonable pathway to relicensure and tools that can help them meet those requirements.

Earlier this year, the organization's House of Delegates approved guiding principles for developing maintenance of licensure and called for additional research on the impact that the new requirements would have on state medical boards and licensed physicians.

Once that research is complete, the draft maintenance of licensure policy would likely be considered by the FSMB House of Delegates at their meeting next May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB.

“Nobody wants to create more work for physicians,” she said.

The idea is to try to take advantage of activities physicians already are doing to and use those to satisfy state licensure requirements, she said.

For their part, state medical boards are feeling pressure from the public in light of rapidly changing science and technology.

And the current requirements, which vary but generally include some continuing medical education, don't match up with public expectations, she said.

If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it still would be a model policy only, Ms. Clothier said.

It would be up to individual states and territories to decide if they wanted to adopt, revise, or ignore the model policy. And that decision and its timing is likely to vary widely based on the politics involved in each state, she added.

This Month's Talk Back Question

If this maintenance of certification issue affects you, will you recertify? Why or why not?

Physicians could face increased requirements when renewing their state medical licenses under a draft model policy currently being evaluated by the Federation of State Medical Boards.

Under the draft policy, relicensure would become more comprehensive and require that physicians demonstrate continuing skills and knowledge in their area of practice.

The maintenance of licensure process would closely mirror the requirements that the American Board of Medical Specialties has in place for maintenance of certification.

The draft policy is a model that individual state medical boards could use, but the states would determine whether or how it would be implemented.

Over the last 5 years, the Federation of State Medical Boards (FSMB) has been considering just how state medical boards could change these policies to ensure that physician licensees are competent.

“There is general agreement that current licensing requirements involve mainly activities associated with passive learning,” said Dr. Audrey Uknis, professor of medicine at Temple University, Philadelphia, and chair of the continuous professional development committee for the American College of Rheumatology.

But while current relicensure requirements may fall short of demonstrating physician competence to the public, they can still be onerous in terms of their demands on physician time, she said. As a result, if states were to move ahead with increased requirements for relicensure there could be some initial pushback from rheumatologists.

The proposed plan to allow physicians involved in maintenance of certification to use that process to satisfy any new state licensing requirements would help some rheumatologists, Dr. Uknis said. However, there are many rheumatologists who are not engaged in maintenance of certification because of the time and expense involved, or because they hold a lifetime certification from the American Board of Internal Medicine. Roughly half of the 5,000 rheumatologists who are board certified have lifetime certification, she said.

If even a fraction of those physicians who have lifetime certification chose to retire because of increased licensing requirements, it would have a significant impact on the rheumatology workforce, Dr. Uknis said.

But Dr. Uknis said officials at the ACR will continue to work to ensure that even rheumatologists who aren't participating in maintenance of certification have a reasonable pathway to relicensure and tools that can help them meet those requirements.

Earlier this year, the organization's House of Delegates approved guiding principles for developing maintenance of licensure and called for additional research on the impact that the new requirements would have on state medical boards and licensed physicians.

Once that research is complete, the draft maintenance of licensure policy would likely be considered by the FSMB House of Delegates at their meeting next May, said Carol Clothier, vice president of strategic planning and physician competency initiatives for the FSMB.

“Nobody wants to create more work for physicians,” she said.

The idea is to try to take advantage of activities physicians already are doing to and use those to satisfy state licensure requirements, she said.

For their part, state medical boards are feeling pressure from the public in light of rapidly changing science and technology.

And the current requirements, which vary but generally include some continuing medical education, don't match up with public expectations, she said.

If the maintenance of licensure policy is accepted by the FSMB House of Delegates, it still would be a model policy only, Ms. Clothier said.

It would be up to individual states and territories to decide if they wanted to adopt, revise, or ignore the model policy. And that decision and its timing is likely to vary widely based on the politics involved in each state, she added.

This Month's Talk Back Question

If this maintenance of certification issue affects you, will you recertify? Why or why not?

The federal government's plan to transition from the ICD-9-CM diagnosis and procedure code set to the ICD-10 by 2011 could cost physicians big bucks, according to a cost analysis commissioned by the Medical Group Management Association and other provider groups.

The cost analysis, which was conducted by Nachimson Advisors, puts the total cost of implementation for a typical small practice with three physicians at $83,290. A typical medium practice with 10 providers would end up spending $285,195, and a typical large practice with 100 providers would spend about $2.7 million, according to the estimate. The estimate includes costs associated with education, process analysis, changes to superbills, information technology changes, increased documentation costs, and cash flow disruption.

For example, because of the greatly expanded number of codes, a one-page superbill would no longer be sufficient to capture all the necessary codes and a longer superbill would likely be impractical. Instead, practices may need to consider using automated tools to help with coding, according to the analysis.

In a letter to the Health and Human Services Department, groups including the MGMA, the American Medical Association, and more than 100 other provider organizations and state medical societies urged the agency to provide more time to implement both the ICD-10 coding sets and the X12 Version 5010 technical standard for electronic transactions that is also being required by HHS.

The department should provide at least 36 months to adopt and implement the 5010 standard in order to accommodate testing at all levels. And physicians and other health care providers will need at least another 60 months after the industry has demonstrated readiness with the 5010 standard before adopting ICD-10, the letter said.

“Physicians are deeply concerned that a hasty transition to a new, complex coding system will result in chaos for all involved, especially if the transition is done in tandem with the implementation of HIPAA's new electronic claim standard (5010),” Dr. Joseph M. Heyman, AMA board chair, said in a statement. “Costs, training, and impact of the new rule have been underestimated by HHS, and must be readdressed before going forward.”

The move to a National Provider Identifier was one of the simplest changes called for under HIPAA, said Robert Tennant, senior policy adviser at MGMA, and it still took 4 years to complete. The idea that physicians, hospitals, laboratories, and health plans will be able to implement a much more complex transition to ICD-10 in the next 3 years is unrealistic, he said.

“History tells us that time frame simply won't work,” he said.

While MGMA supports the move to ICD-10, a rushed transition to the new system could affect patient care and financially squeeze already struggling physicians, Mr. Tennant said. There's no question that even if the time frame for adoption is extended by HHS, physicians will face significant implementation costs, Mr. Tennant said. However, if physicians and the rest of the industry don't have adequate time to prepare, the price tag could be even higher, forcing some physicians to put off needed investments such as the adoption of electronic health records, he said.

The cost estimate is available online at http://nachimsonadvisors.com/products.asp

The federal government's plan to transition from the ICD-9-CM diagnosis and procedure code set to the ICD-10 by 2011 could cost physicians big bucks, according to a cost analysis commissioned by the Medical Group Management Association and other provider groups.

The cost analysis, which was conducted by Nachimson Advisors, puts the total cost of implementation for a typical small practice with three physicians at $83,290. A typical medium practice with 10 providers would end up spending $285,195, and a typical large practice with 100 providers would spend about $2.7 million, according to the estimate. The estimate includes costs associated with education, process analysis, changes to superbills, information technology changes, increased documentation costs, and cash flow disruption.

For example, because of the greatly expanded number of codes, a one-page superbill would no longer be sufficient to capture all the necessary codes and a longer superbill would likely be impractical. Instead, practices may need to consider using automated tools to help with coding, according to the analysis.

In a letter to the Health and Human Services Department, groups including the MGMA, the American Medical Association, and more than 100 other provider organizations and state medical societies urged the agency to provide more time to implement both the ICD-10 coding sets and the X12 Version 5010 technical standard for electronic transactions that is also being required by HHS.

The department should provide at least 36 months to adopt and implement the 5010 standard in order to accommodate testing at all levels. And physicians and other health care providers will need at least another 60 months after the industry has demonstrated readiness with the 5010 standard before adopting ICD-10, the letter said.

“Physicians are deeply concerned that a hasty transition to a new, complex coding system will result in chaos for all involved, especially if the transition is done in tandem with the implementation of HIPAA's new electronic claim standard (5010),” Dr. Joseph M. Heyman, AMA board chair, said in a statement. “Costs, training, and impact of the new rule have been underestimated by HHS, and must be readdressed before going forward.”

The move to a National Provider Identifier was one of the simplest changes called for under HIPAA, said Robert Tennant, senior policy adviser at MGMA, and it still took 4 years to complete. The idea that physicians, hospitals, laboratories, and health plans will be able to implement a much more complex transition to ICD-10 in the next 3 years is unrealistic, he said.

“History tells us that time frame simply won't work,” he said.

While MGMA supports the move to ICD-10, a rushed transition to the new system could affect patient care and financially squeeze already struggling physicians, Mr. Tennant said. There's no question that even if the time frame for adoption is extended by HHS, physicians will face significant implementation costs, Mr. Tennant said. However, if physicians and the rest of the industry don't have adequate time to prepare, the price tag could be even higher, forcing some physicians to put off needed investments such as the adoption of electronic health records, he said.

The cost estimate is available online at http://nachimsonadvisors.com/products.asp

The federal government's plan to transition from the ICD-9-CM diagnosis and procedure code set to the ICD-10 by 2011 could cost physicians big bucks, according to a cost analysis commissioned by the Medical Group Management Association and other provider groups.

The cost analysis, which was conducted by Nachimson Advisors, puts the total cost of implementation for a typical small practice with three physicians at $83,290. A typical medium practice with 10 providers would end up spending $285,195, and a typical large practice with 100 providers would spend about $2.7 million, according to the estimate. The estimate includes costs associated with education, process analysis, changes to superbills, information technology changes, increased documentation costs, and cash flow disruption.

For example, because of the greatly expanded number of codes, a one-page superbill would no longer be sufficient to capture all the necessary codes and a longer superbill would likely be impractical. Instead, practices may need to consider using automated tools to help with coding, according to the analysis.

In a letter to the Health and Human Services Department, groups including the MGMA, the American Medical Association, and more than 100 other provider organizations and state medical societies urged the agency to provide more time to implement both the ICD-10 coding sets and the X12 Version 5010 technical standard for electronic transactions that is also being required by HHS.

The department should provide at least 36 months to adopt and implement the 5010 standard in order to accommodate testing at all levels. And physicians and other health care providers will need at least another 60 months after the industry has demonstrated readiness with the 5010 standard before adopting ICD-10, the letter said.

“Physicians are deeply concerned that a hasty transition to a new, complex coding system will result in chaos for all involved, especially if the transition is done in tandem with the implementation of HIPAA's new electronic claim standard (5010),” Dr. Joseph M. Heyman, AMA board chair, said in a statement. “Costs, training, and impact of the new rule have been underestimated by HHS, and must be readdressed before going forward.”

The move to a National Provider Identifier was one of the simplest changes called for under HIPAA, said Robert Tennant, senior policy adviser at MGMA, and it still took 4 years to complete. The idea that physicians, hospitals, laboratories, and health plans will be able to implement a much more complex transition to ICD-10 in the next 3 years is unrealistic, he said.

“History tells us that time frame simply won't work,” he said.

While MGMA supports the move to ICD-10, a rushed transition to the new system could affect patient care and financially squeeze already struggling physicians, Mr. Tennant said. There's no question that even if the time frame for adoption is extended by HHS, physicians will face significant implementation costs, Mr. Tennant said. However, if physicians and the rest of the industry don't have adequate time to prepare, the price tag could be even higher, forcing some physicians to put off needed investments such as the adoption of electronic health records, he said.

The cost estimate is available online at http://nachimsonadvisors.com/products.asp

The national roll out of Medicare's Recovery Audit Contractor program is on hold because of protests filed by two contractors who bid unsuccessfully to be part of the program.

The dispute will be reviewed by the Government Accountability Office (GAO) and a decision is expected in early February. In the meantime, officials at the Centers for Medicare and Medicaid Services have imposed an automatic stay on any work by the four regional recovery audit contractors (RACs) recently selected by the agency.

The stay means that the agency has postponed most of its provider outreach efforts. However, the delay is temporary and not expected to result in any substantive changes to the program, according to CMS.

The RAC program is aimed at identifying and correcting improper payments—both over and under—made through the Medicare fee-for-service program. But the program has been unpopular with physicians, who say it adds administrative hassles and puts the burden on physicians to prove that payments they received were correct.

The RAC program was mandated by Congress as part of the Medicare Modernization Act; it began as a 3-year demonstration project in New York, Massachusetts, Florida, South Carolina, and California.

The demonstration project was completed earlier this year and the national roll out of the program was scheduled to be completed by 2010.

The national roll out of Medicare's Recovery Audit Contractor program is on hold because of protests filed by two contractors who bid unsuccessfully to be part of the program.

The dispute will be reviewed by the Government Accountability Office (GAO) and a decision is expected in early February. In the meantime, officials at the Centers for Medicare and Medicaid Services have imposed an automatic stay on any work by the four regional recovery audit contractors (RACs) recently selected by the agency.

The stay means that the agency has postponed most of its provider outreach efforts. However, the delay is temporary and not expected to result in any substantive changes to the program, according to CMS.

The RAC program is aimed at identifying and correcting improper payments—both over and under—made through the Medicare fee-for-service program. But the program has been unpopular with physicians, who say it adds administrative hassles and puts the burden on physicians to prove that payments they received were correct.

The RAC program was mandated by Congress as part of the Medicare Modernization Act; it began as a 3-year demonstration project in New York, Massachusetts, Florida, South Carolina, and California.

The demonstration project was completed earlier this year and the national roll out of the program was scheduled to be completed by 2010.

The national roll out of Medicare's Recovery Audit Contractor program is on hold because of protests filed by two contractors who bid unsuccessfully to be part of the program.

The dispute will be reviewed by the Government Accountability Office (GAO) and a decision is expected in early February. In the meantime, officials at the Centers for Medicare and Medicaid Services have imposed an automatic stay on any work by the four regional recovery audit contractors (RACs) recently selected by the agency.

The stay means that the agency has postponed most of its provider outreach efforts. However, the delay is temporary and not expected to result in any substantive changes to the program, according to CMS.

The RAC program is aimed at identifying and correcting improper payments—both over and under—made through the Medicare fee-for-service program. But the program has been unpopular with physicians, who say it adds administrative hassles and puts the burden on physicians to prove that payments they received were correct.

The RAC program was mandated by Congress as part of the Medicare Modernization Act; it began as a 3-year demonstration project in New York, Massachusetts, Florida, South Carolina, and California.

The demonstration project was completed earlier this year and the national roll out of the program was scheduled to be completed by 2010.

Aetna Inc.'s physician-rating program recently received a passing grade from the National Committee for Quality Assurance.

The evaluation was conducted under a 2007 agreement between Aetna and New York Attorney General Andrew Cuomo, and was aimed at addressing allegations that health plans were using physician-rating programs to steer members to less expensive providers.

To date, seven state, regional, and national insurers have signed on to the agreement and pledged not to base their physician rankings entirely on cost. The health plans have also agreed to involve physicians in measure development and to allow physicians to review their performance data and request changes.

In the most recent evaluation, NCQA reviewed the compliance efforts of Aetna Health Inc., an HMO-point of service plan, and Aetna Life Insurance Co., a preferred-provider organization, both operating in New York. The plans were found to be in full compliance with the eight requirements reviewed by NCQA.

Aetna officials said they were pleased with the results and committed to continuing to offer physician-rating information to members. “We will continue to base our programs on available evidence-based and externally validated measures to help ensure our programs are credible and useful to consumers,” Dr. James Coates, senior medical director for Aetna Informatics, said in a statement.

NCQA published reviews of CIGNA Healthcare of New York, an HMO, and Connecticut General Life Insurance Company, a PPO, in July. The organization is currently reviewing United Healthcare's physician-rating program.

Aetna Inc.'s physician-rating program recently received a passing grade from the National Committee for Quality Assurance.

The evaluation was conducted under a 2007 agreement between Aetna and New York Attorney General Andrew Cuomo, and was aimed at addressing allegations that health plans were using physician-rating programs to steer members to less expensive providers.

To date, seven state, regional, and national insurers have signed on to the agreement and pledged not to base their physician rankings entirely on cost. The health plans have also agreed to involve physicians in measure development and to allow physicians to review their performance data and request changes.

In the most recent evaluation, NCQA reviewed the compliance efforts of Aetna Health Inc., an HMO-point of service plan, and Aetna Life Insurance Co., a preferred-provider organization, both operating in New York. The plans were found to be in full compliance with the eight requirements reviewed by NCQA.

Aetna officials said they were pleased with the results and committed to continuing to offer physician-rating information to members. “We will continue to base our programs on available evidence-based and externally validated measures to help ensure our programs are credible and useful to consumers,” Dr. James Coates, senior medical director for Aetna Informatics, said in a statement.

NCQA published reviews of CIGNA Healthcare of New York, an HMO, and Connecticut General Life Insurance Company, a PPO, in July. The organization is currently reviewing United Healthcare's physician-rating program.

Aetna Inc.'s physician-rating program recently received a passing grade from the National Committee for Quality Assurance.

The evaluation was conducted under a 2007 agreement between Aetna and New York Attorney General Andrew Cuomo, and was aimed at addressing allegations that health plans were using physician-rating programs to steer members to less expensive providers.

To date, seven state, regional, and national insurers have signed on to the agreement and pledged not to base their physician rankings entirely on cost. The health plans have also agreed to involve physicians in measure development and to allow physicians to review their performance data and request changes.

In the most recent evaluation, NCQA reviewed the compliance efforts of Aetna Health Inc., an HMO-point of service plan, and Aetna Life Insurance Co., a preferred-provider organization, both operating in New York. The plans were found to be in full compliance with the eight requirements reviewed by NCQA.

Aetna officials said they were pleased with the results and committed to continuing to offer physician-rating information to members. “We will continue to base our programs on available evidence-based and externally validated measures to help ensure our programs are credible and useful to consumers,” Dr. James Coates, senior medical director for Aetna Informatics, said in a statement.

NCQA published reviews of CIGNA Healthcare of New York, an HMO, and Connecticut General Life Insurance Company, a PPO, in July. The organization is currently reviewing United Healthcare's physician-rating program.