Mary Ellen Schneider

The full report is available online at http://sph.bu.edu/insider/racreport

It's been a long time coming for veterans whose health complaints have been met with skepticism, but a federal committee has determined that Gulf War syndrome is not only real, it is tied to two causes: exposure to pyridostigmine bromide and certain pesticides during the 1990-1991 Persian Gulf War.

Members of the federal Research Advisory Committee on Gulf War Veterans' Illnesses who wrote the 450-plus page report also called for research efforts aimed at shifting away from establishing the existence of a Gulf War syndrome to focus on treatment and diagnostic tests.

“There's no way to say that [Gulf War illness] is not real at this point,” said Lea Steele, Ph.D., an epidemiologist and faculty member at Kansas State University, Manhattan, and a member of the committee that prepared the report.

At least a quarter of the nearly 700,000 U.S. military members who served in the Gulf war have experienced some type of chronic, multisymptom illness since returning home. The symptoms are not explained by established medical diagnoses and typically include a combination of memory and concentration problems, chronic headaches, widespread pain, and unexplained fatigue, and can include chronic diarrhea, skin rashes, respiratory problems, and other abnormalities.

The symptoms may vary among individuals, but the overall profile has been consistent across hundreds of reports from Gulf War veterans in the United States and allied countries, the committee found.

Although the evidence is less consistent, the committee could not rule out a number of additional environmental factors as causes including exposure to smoke from the Kuwaiti oil well fires, the receipt of multiple vaccines over a short period of time, exposure to low levels of nerve agents, and combinations of neurotoxic exposures. Despite early assumptions that the symptoms reported by Gulf War veterans were caused by psychological stress, the existing evidence does not show a link, the committee found.

These conclusions are based on an analysis of available evidence on Gulf War illnesses. The committee consulted about 1,600 sources for its current report, said Roberta F. White, Ph.D., the scientific director of the committee and chair of the department of environmental health at the Boston University School of Public Health.

It's the large number of sources reviewed that allowed the committee to reach a conclusion on the existence and causes of Gulf War illness where others have not, Dr. White said. For example, a 2006 report from the Institute of Medicine did not find evidence of a definitive link between reports of multisymptom illness and Gulf War service. The IOM committee cited a lack of objective predeployment health information as one reason why they could not reach a more definitive conclusion about the issue.

But the series of reports from the IOM report were “skewed and limited,” the Research Advisory Committee on Gulf War Veterans' Illnesses concluded in its own report. The IOM failed to consider adequately the results of animal studies and did not consider undiagnosed illnesses that were affecting Gulf War veterans at excessive rates.

As a result, advisory committee is calling for the IOM to conduct a repeat investigation that would include animal studies, Dr. White said.

Now that the syndrome's existence has been confirmed, it's time to focus research efforts on the development of diagnostic tests and treatments, according to the committee members.

“We need to be solving the problem now, not debating the problem,” Dr. Steele said.

The committee also called on Congress to allocate at least $60 million annually for federal Gulf War research. Since 1994, the federal government has spent more than $440 million on Gulf War research, primarily at the Departments of Defense and Veterans Affairs, but in recent years the budgets in both agencies have been cut. In 2006, DOD spent just $5 million and the VA spent $4 million on research related to the Gulf War.

At press time, officials at the VA and members of the VA committees in Congress were reviewing the report.

The full report is available online at http://sph.bu.edu/insider/racreport

It's been a long time coming for veterans whose health complaints have been met with skepticism, but a federal committee has determined that Gulf War syndrome is not only real, it is tied to two causes: exposure to pyridostigmine bromide and certain pesticides during the 1990-1991 Persian Gulf War.

Members of the federal Research Advisory Committee on Gulf War Veterans' Illnesses who wrote the 450-plus page report also called for research efforts aimed at shifting away from establishing the existence of a Gulf War syndrome to focus on treatment and diagnostic tests.

“There's no way to say that [Gulf War illness] is not real at this point,” said Lea Steele, Ph.D., an epidemiologist and faculty member at Kansas State University, Manhattan, and a member of the committee that prepared the report.

At least a quarter of the nearly 700,000 U.S. military members who served in the Gulf war have experienced some type of chronic, multisymptom illness since returning home. The symptoms are not explained by established medical diagnoses and typically include a combination of memory and concentration problems, chronic headaches, widespread pain, and unexplained fatigue, and can include chronic diarrhea, skin rashes, respiratory problems, and other abnormalities.

The symptoms may vary among individuals, but the overall profile has been consistent across hundreds of reports from Gulf War veterans in the United States and allied countries, the committee found.

Although the evidence is less consistent, the committee could not rule out a number of additional environmental factors as causes including exposure to smoke from the Kuwaiti oil well fires, the receipt of multiple vaccines over a short period of time, exposure to low levels of nerve agents, and combinations of neurotoxic exposures. Despite early assumptions that the symptoms reported by Gulf War veterans were caused by psychological stress, the existing evidence does not show a link, the committee found.

These conclusions are based on an analysis of available evidence on Gulf War illnesses. The committee consulted about 1,600 sources for its current report, said Roberta F. White, Ph.D., the scientific director of the committee and chair of the department of environmental health at the Boston University School of Public Health.

It's the large number of sources reviewed that allowed the committee to reach a conclusion on the existence and causes of Gulf War illness where others have not, Dr. White said. For example, a 2006 report from the Institute of Medicine did not find evidence of a definitive link between reports of multisymptom illness and Gulf War service. The IOM committee cited a lack of objective predeployment health information as one reason why they could not reach a more definitive conclusion about the issue.

But the series of reports from the IOM report were “skewed and limited,” the Research Advisory Committee on Gulf War Veterans' Illnesses concluded in its own report. The IOM failed to consider adequately the results of animal studies and did not consider undiagnosed illnesses that were affecting Gulf War veterans at excessive rates.

As a result, advisory committee is calling for the IOM to conduct a repeat investigation that would include animal studies, Dr. White said.

Now that the syndrome's existence has been confirmed, it's time to focus research efforts on the development of diagnostic tests and treatments, according to the committee members.

“We need to be solving the problem now, not debating the problem,” Dr. Steele said.

The committee also called on Congress to allocate at least $60 million annually for federal Gulf War research. Since 1994, the federal government has spent more than $440 million on Gulf War research, primarily at the Departments of Defense and Veterans Affairs, but in recent years the budgets in both agencies have been cut. In 2006, DOD spent just $5 million and the VA spent $4 million on research related to the Gulf War.

At press time, officials at the VA and members of the VA committees in Congress were reviewing the report.

The full report is available online at http://sph.bu.edu/insider/racreport

It's been a long time coming for veterans whose health complaints have been met with skepticism, but a federal committee has determined that Gulf War syndrome is not only real, it is tied to two causes: exposure to pyridostigmine bromide and certain pesticides during the 1990-1991 Persian Gulf War.

Members of the federal Research Advisory Committee on Gulf War Veterans' Illnesses who wrote the 450-plus page report also called for research efforts aimed at shifting away from establishing the existence of a Gulf War syndrome to focus on treatment and diagnostic tests.

“There's no way to say that [Gulf War illness] is not real at this point,” said Lea Steele, Ph.D., an epidemiologist and faculty member at Kansas State University, Manhattan, and a member of the committee that prepared the report.

At least a quarter of the nearly 700,000 U.S. military members who served in the Gulf war have experienced some type of chronic, multisymptom illness since returning home. The symptoms are not explained by established medical diagnoses and typically include a combination of memory and concentration problems, chronic headaches, widespread pain, and unexplained fatigue, and can include chronic diarrhea, skin rashes, respiratory problems, and other abnormalities.

The symptoms may vary among individuals, but the overall profile has been consistent across hundreds of reports from Gulf War veterans in the United States and allied countries, the committee found.

Although the evidence is less consistent, the committee could not rule out a number of additional environmental factors as causes including exposure to smoke from the Kuwaiti oil well fires, the receipt of multiple vaccines over a short period of time, exposure to low levels of nerve agents, and combinations of neurotoxic exposures. Despite early assumptions that the symptoms reported by Gulf War veterans were caused by psychological stress, the existing evidence does not show a link, the committee found.

These conclusions are based on an analysis of available evidence on Gulf War illnesses. The committee consulted about 1,600 sources for its current report, said Roberta F. White, Ph.D., the scientific director of the committee and chair of the department of environmental health at the Boston University School of Public Health.

It's the large number of sources reviewed that allowed the committee to reach a conclusion on the existence and causes of Gulf War illness where others have not, Dr. White said. For example, a 2006 report from the Institute of Medicine did not find evidence of a definitive link between reports of multisymptom illness and Gulf War service. The IOM committee cited a lack of objective predeployment health information as one reason why they could not reach a more definitive conclusion about the issue.

But the series of reports from the IOM report were “skewed and limited,” the Research Advisory Committee on Gulf War Veterans' Illnesses concluded in its own report. The IOM failed to consider adequately the results of animal studies and did not consider undiagnosed illnesses that were affecting Gulf War veterans at excessive rates.

As a result, advisory committee is calling for the IOM to conduct a repeat investigation that would include animal studies, Dr. White said.

Now that the syndrome's existence has been confirmed, it's time to focus research efforts on the development of diagnostic tests and treatments, according to the committee members.

“We need to be solving the problem now, not debating the problem,” Dr. Steele said.

The committee also called on Congress to allocate at least $60 million annually for federal Gulf War research. Since 1994, the federal government has spent more than $440 million on Gulf War research, primarily at the Departments of Defense and Veterans Affairs, but in recent years the budgets in both agencies have been cut. In 2006, DOD spent just $5 million and the VA spent $4 million on research related to the Gulf War.

At press time, officials at the VA and members of the VA committees in Congress were reviewing the report.

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 budget in a worsening economy.

Future reports are expected to have longer-range projections and more extensive analysis, according to the CMS.

The data and assumptions of the report are based largely on three sources: data submitted to the CMS from the states; the boards of trustees of the Social Security and Medicare programs; and National Health Expenditure historical data and projections.

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 budget in a worsening economy.

Future reports are expected to have longer-range projections and more extensive analysis, according to the CMS.

The data and assumptions of the report are based largely on three sources: data submitted to the CMS from the states; the boards of trustees of the Social Security and Medicare programs; and National Health Expenditure historical data and projections.

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 budget in a worsening economy.

Future reports are expected to have longer-range projections and more extensive analysis, according to the CMS.

The data and assumptions of the report are based largely on three sources: data submitted to the CMS from the states; the boards of trustees of the Social Security and Medicare programs; and National Health Expenditure historical data and projections.

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

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, the 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 the 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.

The National Committee for Quality Assurance 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.

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

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, the 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 the 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.

The National Committee for Quality Assurance 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.

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

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, the 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 the 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.

The National Committee for Quality Assurance 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.

Within the next 5 years, researchers at the University of Miami's newly launched Cosmetic Medicine and Research Institute hope to make a major genetic breakthrough related to skin appearance.

Dr. Leslie Baumann, a cosmetic dermatologist who directs the Cosmetic Medicine and Research Institute (CMRI), said that she and her colleagues will team up with researchers at the university's Miami Institute for Human Genomics to conduct basic science to find the genetic factors that protect some individuals from the effects of skin aging. For example, Dr. Baumann has about 20 patients over age 60 whose skin is in excellent shape despite engaging in years of harmful behaviors such as tanning and smoking.

"Hopefully we'll come out with discoveries of new medications and new treatments that will help dermatologists have more in their armamentarium," she said.

In an effort to make a significant genetic discovery, researchers at CMRI have created a skin repository. Instead of discarding extra skin after surgery, patients can choose to donate it. The skin, and information on its phenotype, are being stored for future research. The phenotype information can be especially helpful in identifying genes, Dr. Baumann said.

The repository could help reduce both the cost of cosmetic research and the need for animal testing, she said. For example, a pharmaceutical company testing a new acne drug could use skin collected from individuals with acne. The CMRI researchers will also collect extra fat from liposuction procedures and use it for stem cell research.

CMRI was launched in August, and is believed to be the first multispecialty, university-based research center to explore the role of genetics in skin appearance.

The CMRI staff includes experts in cosmetic dermatology, facial plastic surgery, oculoplastic surgery, and nutrition. The dermatology faculty includes experts in skin care and fillers, cosmetic surgery, lasers and light devices, and ethnic skin care.

"Most of the time these specialties compete against each other," Dr. Baumann said. "We're teaming up." The multispecialty team approach is helpful across the board in research, education, and day-to-day activities in the clinic.

About 65 residents a year are being trained at the CMRI clinic, of whom 22- 25 on average are coming from dermatology. Since it is a multispecialty clinic, residents rotate not only with faculty in their specialty but with other experts, Dr. Baumann said.

The multispecialty nature of CMRI also lends itself to easy consults, said Dr. Heather Woolery-Lloyd, director of ethnic skin care. She performs a lot of skin tightening, but a patient who is a better candidate for a face lift can be sent to a colleague and never has to leave the practice.

"I love practicing in this environment," Dr. Woolery-Lloyd said. "It really does give you the opportunity to provide patients with the best care."

She predicts that more private practices will use the multidisciplinary team approach as a way to expand. Instead of hiring another cosmetic dermatologist or a nurse practitioner, practices can recruit someone who does facial plastic surgery or an ophthalmologist who does oculoplastic and reconstructive surgery, Dr. Woolery-Lloyd said.

CMRI's faculty includes Dr. Leslie Baumann (third from left) and Dr. Heather Woolery-Lloyd (third from right). Cosmetic Medicine and Research Institute

Within the next 5 years, researchers at the University of Miami's newly launched Cosmetic Medicine and Research Institute hope to make a major genetic breakthrough related to skin appearance.

Dr. Leslie Baumann, a cosmetic dermatologist who directs the Cosmetic Medicine and Research Institute (CMRI), said that she and her colleagues will team up with researchers at the university's Miami Institute for Human Genomics to conduct basic science to find the genetic factors that protect some individuals from the effects of skin aging. For example, Dr. Baumann has about 20 patients over age 60 whose skin is in excellent shape despite engaging in years of harmful behaviors such as tanning and smoking.

"Hopefully we'll come out with discoveries of new medications and new treatments that will help dermatologists have more in their armamentarium," she said.

In an effort to make a significant genetic discovery, researchers at CMRI have created a skin repository. Instead of discarding extra skin after surgery, patients can choose to donate it. The skin, and information on its phenotype, are being stored for future research. The phenotype information can be especially helpful in identifying genes, Dr. Baumann said.

The repository could help reduce both the cost of cosmetic research and the need for animal testing, she said. For example, a pharmaceutical company testing a new acne drug could use skin collected from individuals with acne. The CMRI researchers will also collect extra fat from liposuction procedures and use it for stem cell research.

CMRI was launched in August, and is believed to be the first multispecialty, university-based research center to explore the role of genetics in skin appearance.

The CMRI staff includes experts in cosmetic dermatology, facial plastic surgery, oculoplastic surgery, and nutrition. The dermatology faculty includes experts in skin care and fillers, cosmetic surgery, lasers and light devices, and ethnic skin care.

"Most of the time these specialties compete against each other," Dr. Baumann said. "We're teaming up." The multispecialty team approach is helpful across the board in research, education, and day-to-day activities in the clinic.

About 65 residents a year are being trained at the CMRI clinic, of whom 22- 25 on average are coming from dermatology. Since it is a multispecialty clinic, residents rotate not only with faculty in their specialty but with other experts, Dr. Baumann said.

The multispecialty nature of CMRI also lends itself to easy consults, said Dr. Heather Woolery-Lloyd, director of ethnic skin care. She performs a lot of skin tightening, but a patient who is a better candidate for a face lift can be sent to a colleague and never has to leave the practice.

"I love practicing in this environment," Dr. Woolery-Lloyd said. "It really does give you the opportunity to provide patients with the best care."

She predicts that more private practices will use the multidisciplinary team approach as a way to expand. Instead of hiring another cosmetic dermatologist or a nurse practitioner, practices can recruit someone who does facial plastic surgery or an ophthalmologist who does oculoplastic and reconstructive surgery, Dr. Woolery-Lloyd said.

CMRI's faculty includes Dr. Leslie Baumann (third from left) and Dr. Heather Woolery-Lloyd (third from right). Cosmetic Medicine and Research Institute

Within the next 5 years, researchers at the University of Miami's newly launched Cosmetic Medicine and Research Institute hope to make a major genetic breakthrough related to skin appearance.

Dr. Leslie Baumann, a cosmetic dermatologist who directs the Cosmetic Medicine and Research Institute (CMRI), said that she and her colleagues will team up with researchers at the university's Miami Institute for Human Genomics to conduct basic science to find the genetic factors that protect some individuals from the effects of skin aging. For example, Dr. Baumann has about 20 patients over age 60 whose skin is in excellent shape despite engaging in years of harmful behaviors such as tanning and smoking.

"Hopefully we'll come out with discoveries of new medications and new treatments that will help dermatologists have more in their armamentarium," she said.

In an effort to make a significant genetic discovery, researchers at CMRI have created a skin repository. Instead of discarding extra skin after surgery, patients can choose to donate it. The skin, and information on its phenotype, are being stored for future research. The phenotype information can be especially helpful in identifying genes, Dr. Baumann said.

The repository could help reduce both the cost of cosmetic research and the need for animal testing, she said. For example, a pharmaceutical company testing a new acne drug could use skin collected from individuals with acne. The CMRI researchers will also collect extra fat from liposuction procedures and use it for stem cell research.

CMRI was launched in August, and is believed to be the first multispecialty, university-based research center to explore the role of genetics in skin appearance.

The CMRI staff includes experts in cosmetic dermatology, facial plastic surgery, oculoplastic surgery, and nutrition. The dermatology faculty includes experts in skin care and fillers, cosmetic surgery, lasers and light devices, and ethnic skin care.

"Most of the time these specialties compete against each other," Dr. Baumann said. "We're teaming up." The multispecialty team approach is helpful across the board in research, education, and day-to-day activities in the clinic.

About 65 residents a year are being trained at the CMRI clinic, of whom 22- 25 on average are coming from dermatology. Since it is a multispecialty clinic, residents rotate not only with faculty in their specialty but with other experts, Dr. Baumann said.

The multispecialty nature of CMRI also lends itself to easy consults, said Dr. Heather Woolery-Lloyd, director of ethnic skin care. She performs a lot of skin tightening, but a patient who is a better candidate for a face lift can be sent to a colleague and never has to leave the practice.

"I love practicing in this environment," Dr. Woolery-Lloyd said. "It really does give you the opportunity to provide patients with the best care."

She predicts that more private practices will use the multidisciplinary team approach as a way to expand. Instead of hiring another cosmetic dermatologist or a nurse practitioner, practices can recruit someone who does facial plastic surgery or an ophthalmologist who does oculoplastic and reconstructive surgery, Dr. Woolery-Lloyd said.

CMRI's faculty includes Dr. Leslie Baumann (third from left) and Dr. Heather Woolery-Lloyd (third from right). Cosmetic Medicine and Research Institute

On Election Day, voters in South Dakota, Colorado, and California rejected ballot initiatives to restrict abortion access while those in Michigan endorsed stem cell research.

By a margin of 55% to 45%, South Dakotans defeated Measure 11, which would have banned abortions except in the case of rape, incest, or a serious threat to the mother's health or life. This is the second time in 2 years that antiabortion advocates have tried to enact a ban. In 2006, an abortion ban was signed into law but never went into effect because it was overturned by voters later that year.

In California, voters defeated an attempt to require parental notification before a minor could receive an abortion. Proposition 4 would have changed the California constitution to prohibit abortions for minors until 48 hours after a parent or legal guardian had been notified. The proposition would have made exceptions in the case of a medical emergency, and it contained a pathway for minors to seek a waiver from the courts.

Supporters of the proposition argued that it would prevent sexual predators from using secret abortions to cover up their exploitation of minors. Opponents argued that parental notification is ineffective and potentially dangerous for young women. Voters defeated the proposition by a margin of 52% to 48%. Similar ballot initiatives were defeated in the state in 2005 and 2006.

In Colorado, voters rejected by a margin of 73% to 27% a constitutional amendment that would have defined a “person” as any human being from the moment of fertilization.

Stem cell research was on the ballot in Michigan, where voters approved an amendment to the state's constitution to remove previous restrictions on human embryonic stem cell research. Under the proposal, which was approved 53% to 47%, human embryos created for fertility treatment can now be used for research.

The proposal also places some limits on deriving stem cells and obtaining embryos for research. For example, stem cells cannot be taken from human embryos more than 14 days after cell division begins and individuals are prohibited from selling or purchasing human embryos for stem cell research.

On Election Day, voters in South Dakota, Colorado, and California rejected ballot initiatives to restrict abortion access while those in Michigan endorsed stem cell research.

By a margin of 55% to 45%, South Dakotans defeated Measure 11, which would have banned abortions except in the case of rape, incest, or a serious threat to the mother's health or life. This is the second time in 2 years that antiabortion advocates have tried to enact a ban. In 2006, an abortion ban was signed into law but never went into effect because it was overturned by voters later that year.

In California, voters defeated an attempt to require parental notification before a minor could receive an abortion. Proposition 4 would have changed the California constitution to prohibit abortions for minors until 48 hours after a parent or legal guardian had been notified. The proposition would have made exceptions in the case of a medical emergency, and it contained a pathway for minors to seek a waiver from the courts.

Supporters of the proposition argued that it would prevent sexual predators from using secret abortions to cover up their exploitation of minors. Opponents argued that parental notification is ineffective and potentially dangerous for young women. Voters defeated the proposition by a margin of 52% to 48%. Similar ballot initiatives were defeated in the state in 2005 and 2006.

In Colorado, voters rejected by a margin of 73% to 27% a constitutional amendment that would have defined a “person” as any human being from the moment of fertilization.

Stem cell research was on the ballot in Michigan, where voters approved an amendment to the state's constitution to remove previous restrictions on human embryonic stem cell research. Under the proposal, which was approved 53% to 47%, human embryos created for fertility treatment can now be used for research.

The proposal also places some limits on deriving stem cells and obtaining embryos for research. For example, stem cells cannot be taken from human embryos more than 14 days after cell division begins and individuals are prohibited from selling or purchasing human embryos for stem cell research.

On Election Day, voters in South Dakota, Colorado, and California rejected ballot initiatives to restrict abortion access while those in Michigan endorsed stem cell research.

By a margin of 55% to 45%, South Dakotans defeated Measure 11, which would have banned abortions except in the case of rape, incest, or a serious threat to the mother's health or life. This is the second time in 2 years that antiabortion advocates have tried to enact a ban. In 2006, an abortion ban was signed into law but never went into effect because it was overturned by voters later that year.

In California, voters defeated an attempt to require parental notification before a minor could receive an abortion. Proposition 4 would have changed the California constitution to prohibit abortions for minors until 48 hours after a parent or legal guardian had been notified. The proposition would have made exceptions in the case of a medical emergency, and it contained a pathway for minors to seek a waiver from the courts.

Supporters of the proposition argued that it would prevent sexual predators from using secret abortions to cover up their exploitation of minors. Opponents argued that parental notification is ineffective and potentially dangerous for young women. Voters defeated the proposition by a margin of 52% to 48%. Similar ballot initiatives were defeated in the state in 2005 and 2006.

In Colorado, voters rejected by a margin of 73% to 27% a constitutional amendment that would have defined a “person” as any human being from the moment of fertilization.

Stem cell research was on the ballot in Michigan, where voters approved an amendment to the state's constitution to remove previous restrictions on human embryonic stem cell research. Under the proposal, which was approved 53% to 47%, human embryos created for fertility treatment can now be used for research.

The proposal also places some limits on deriving stem cells and obtaining embryos for research. For example, stem cells cannot be taken from human embryos more than 14 days after cell division begins and individuals are prohibited from selling or purchasing human embryos for stem cell research.

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., 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 shows that even among individuals 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 simply 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.

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. 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.

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., 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 shows that even among individuals 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 simply 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.

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. 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.

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., 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 shows that even among individuals 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 simply 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.

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. 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.

Physicians will have the potential to gain as much as a 5.1% increase in their Medicare payments next year, according to a final rule issued by the Centers for Medicare and Medicaid Services.

The projected pay raise is a combination of the 1.1% payment increase mandated by Congress this summer, as well as a 2% incentive payment available for physicians who successfully participate in Medicare's voluntary pay-for-reporting program, and another 2% for those who implement electronic prescribing in their practices next year.

While the 1.1% positive payment update is good news, few physicians are likely to take advantage of the bonuses available for pay-for-reporting through the Physician Quality Reporting Initiative or e-prescribing, said Dr. Jonathan Leffert, chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists. “It's going to be those who already have electronic medical records, [a number that] is relatively small to begin with, and those who think 2% is enough of an incentive, and those who are interested in safety and quality in general,” he said. “If you add those groups up, it's probably still a fairly small number.”

The 2009 Medicare Physician Fee Schedule final rule was released Oct. 30 and will be published in the Federal Register on Nov. 19. In the final rule, the CMS estimates that total Medicare spending on the physician fee schedule for 2009 will reach $61.9 billion, up about 4% over 2008 projections.

Without the intervention by Congress over the summer, physicians would be facing a deep payment cut come January. As part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was enacted in July, Congress eliminated a 10.6% pay cut scheduled to go into effect in July and another 5.4% cut scheduled for January.

By law, CMS officials are required to adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. Over the past several years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, since the SGR formula has not been altered, over time physicians will face even more significant pay cuts unless Congress acts to change or replace the SGR.

In addition to the payment update and incentives provided in the final rule, the CMS is also making a technical change to how it calculates the statutorily required budget neutrality adjustment. Previously, the CMS has applied budget neutrality to work relative value units (RVUs), but under a mandate in the MIPPA, the agency now will make the adjustment to the conversion factor.

This change is expected to benefit primary care providers and others who provide cognitive services since increases to work RVUs were implemented in 2007 and 2008. However, the change is expected to result in lower payments for services with a significant practice expense element such as imaging and in-office procedures.

The final rule did not include an earlier proposal that would have required physicians who perform certain diagnostic testing services to meet most of the quality and performance standards established for independent diagnostic testing facilities, including requiring a supervising physician to prove proficiency in the performance and interpretation of each diagnostic procedure and maintaining an inventory of diagnostic testing equipment.

If the proposal had been implemented, it would have been devastating for endocrinologists who provide in-office imaging, said Dr. Leffert of the University of Texas Southwestern Medical Center in Dallas. For example, an endocrinologist who offered either ultrasound or bone density screening in the office would have to hire a radiologist in a supervisory role. “That would have made it impossible for physicians to do any important diagnostic tests in the office,” he said.

To realize the incentive payments outlined in the physician fee schedule final rule, physicians will need to successfully participate in the Physician Quality Reporting Initiative (PQRI) and meet requirements for being a successful electronic prescriber.

Physicians will have the potential to gain as much as a 5.1% increase in their Medicare payments next year, according to a final rule issued by the Centers for Medicare and Medicaid Services.

The projected pay raise is a combination of the 1.1% payment increase mandated by Congress this summer, as well as a 2% incentive payment available for physicians who successfully participate in Medicare's voluntary pay-for-reporting program, and another 2% for those who implement electronic prescribing in their practices next year.

While the 1.1% positive payment update is good news, few physicians are likely to take advantage of the bonuses available for pay-for-reporting through the Physician Quality Reporting Initiative or e-prescribing, said Dr. Jonathan Leffert, chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists. “It's going to be those who already have electronic medical records, [a number that] is relatively small to begin with, and those who think 2% is enough of an incentive, and those who are interested in safety and quality in general,” he said. “If you add those groups up, it's probably still a fairly small number.”

The 2009 Medicare Physician Fee Schedule final rule was released Oct. 30 and will be published in the Federal Register on Nov. 19. In the final rule, the CMS estimates that total Medicare spending on the physician fee schedule for 2009 will reach $61.9 billion, up about 4% over 2008 projections.

Without the intervention by Congress over the summer, physicians would be facing a deep payment cut come January. As part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was enacted in July, Congress eliminated a 10.6% pay cut scheduled to go into effect in July and another 5.4% cut scheduled for January.

By law, CMS officials are required to adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. Over the past several years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, since the SGR formula has not been altered, over time physicians will face even more significant pay cuts unless Congress acts to change or replace the SGR.

In addition to the payment update and incentives provided in the final rule, the CMS is also making a technical change to how it calculates the statutorily required budget neutrality adjustment. Previously, the CMS has applied budget neutrality to work relative value units (RVUs), but under a mandate in the MIPPA, the agency now will make the adjustment to the conversion factor.

This change is expected to benefit primary care providers and others who provide cognitive services since increases to work RVUs were implemented in 2007 and 2008. However, the change is expected to result in lower payments for services with a significant practice expense element such as imaging and in-office procedures.

The final rule did not include an earlier proposal that would have required physicians who perform certain diagnostic testing services to meet most of the quality and performance standards established for independent diagnostic testing facilities, including requiring a supervising physician to prove proficiency in the performance and interpretation of each diagnostic procedure and maintaining an inventory of diagnostic testing equipment.

If the proposal had been implemented, it would have been devastating for endocrinologists who provide in-office imaging, said Dr. Leffert of the University of Texas Southwestern Medical Center in Dallas. For example, an endocrinologist who offered either ultrasound or bone density screening in the office would have to hire a radiologist in a supervisory role. “That would have made it impossible for physicians to do any important diagnostic tests in the office,” he said.

To realize the incentive payments outlined in the physician fee schedule final rule, physicians will need to successfully participate in the Physician Quality Reporting Initiative (PQRI) and meet requirements for being a successful electronic prescriber.

Physicians will have the potential to gain as much as a 5.1% increase in their Medicare payments next year, according to a final rule issued by the Centers for Medicare and Medicaid Services.

The projected pay raise is a combination of the 1.1% payment increase mandated by Congress this summer, as well as a 2% incentive payment available for physicians who successfully participate in Medicare's voluntary pay-for-reporting program, and another 2% for those who implement electronic prescribing in their practices next year.

While the 1.1% positive payment update is good news, few physicians are likely to take advantage of the bonuses available for pay-for-reporting through the Physician Quality Reporting Initiative or e-prescribing, said Dr. Jonathan Leffert, chairman of the legislative and regulatory committee for the American Association of Clinical Endocrinologists. “It's going to be those who already have electronic medical records, [a number that] is relatively small to begin with, and those who think 2% is enough of an incentive, and those who are interested in safety and quality in general,” he said. “If you add those groups up, it's probably still a fairly small number.”

The 2009 Medicare Physician Fee Schedule final rule was released Oct. 30 and will be published in the Federal Register on Nov. 19. In the final rule, the CMS estimates that total Medicare spending on the physician fee schedule for 2009 will reach $61.9 billion, up about 4% over 2008 projections.

Without the intervention by Congress over the summer, physicians would be facing a deep payment cut come January. As part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was enacted in July, Congress eliminated a 10.6% pay cut scheduled to go into effect in July and another 5.4% cut scheduled for January.

By law, CMS officials are required to adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. Over the past several years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, since the SGR formula has not been altered, over time physicians will face even more significant pay cuts unless Congress acts to change or replace the SGR.

In addition to the payment update and incentives provided in the final rule, the CMS is also making a technical change to how it calculates the statutorily required budget neutrality adjustment. Previously, the CMS has applied budget neutrality to work relative value units (RVUs), but under a mandate in the MIPPA, the agency now will make the adjustment to the conversion factor.

This change is expected to benefit primary care providers and others who provide cognitive services since increases to work RVUs were implemented in 2007 and 2008. However, the change is expected to result in lower payments for services with a significant practice expense element such as imaging and in-office procedures.

The final rule did not include an earlier proposal that would have required physicians who perform certain diagnostic testing services to meet most of the quality and performance standards established for independent diagnostic testing facilities, including requiring a supervising physician to prove proficiency in the performance and interpretation of each diagnostic procedure and maintaining an inventory of diagnostic testing equipment.

If the proposal had been implemented, it would have been devastating for endocrinologists who provide in-office imaging, said Dr. Leffert of the University of Texas Southwestern Medical Center in Dallas. For example, an endocrinologist who offered either ultrasound or bone density screening in the office would have to hire a radiologist in a supervisory role. “That would have made it impossible for physicians to do any important diagnostic tests in the office,” he said.

To realize the incentive payments outlined in the physician fee schedule final rule, physicians will need to successfully participate in the Physician Quality Reporting Initiative (PQRI) and meet requirements for being a successful electronic prescriber.

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

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

The evaluation 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 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.

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

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

The evaluation 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 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.

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

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

The evaluation 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 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.

U.S. Infant Mortality Fails to Improve

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from the rate of 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

FDA Issues Warning on Yaz Ads

The Food and Drug Administration has warned Bayer HealthCare Pharmaceuticals Inc. to tone down its advertising for Yaz (drospirenone and ethinyl estradiol tablets). Two television ads for the oral contraceptive overstate the drug's benefits and minimize its risks, according to an FDA letter to the company. “These violations are concerning from a public health perspective because they encourage use of Yaz in circumstances other than those in which the drug has been approved,” the FDA wrote in a letter. For example, the ads suggest that Yaz can treat the symptoms of premenstrual syndrome, but the drug is approved only for the treatment of premenstrual dysphoric disorder. The agency also complained that the ads did not effectively communicate the drug's risks because of distracting visuals and music.

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate last month. S. Res. 616 also recognized that access to quality and affordable health care is critical to making improvements in maternal health. The resolution, which was introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “This is not a problem we can or should ignore. A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on the FDA's scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a recent report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Flat Rx Pricing Satisfies Consumers

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers aged 44 years and older, the study said. Satisfaction among customers who participate in flat-rate programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Medicare Imaging Costs Fall 13%

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office. Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect Jan. 1, 2007, and Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computed tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated payment cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of personnel in physician offices and developing appropriateness criteria would be better ways to curb high imaging expenses, suggested AdvaMed.

U.S. Infant Mortality Fails to Improve

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from the rate of 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

FDA Issues Warning on Yaz Ads

The Food and Drug Administration has warned Bayer HealthCare Pharmaceuticals Inc. to tone down its advertising for Yaz (drospirenone and ethinyl estradiol tablets). Two television ads for the oral contraceptive overstate the drug's benefits and minimize its risks, according to an FDA letter to the company. “These violations are concerning from a public health perspective because they encourage use of Yaz in circumstances other than those in which the drug has been approved,” the FDA wrote in a letter. For example, the ads suggest that Yaz can treat the symptoms of premenstrual syndrome, but the drug is approved only for the treatment of premenstrual dysphoric disorder. The agency also complained that the ads did not effectively communicate the drug's risks because of distracting visuals and music.

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate last month. S. Res. 616 also recognized that access to quality and affordable health care is critical to making improvements in maternal health. The resolution, which was introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “This is not a problem we can or should ignore. A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on the FDA's scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a recent report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Flat Rx Pricing Satisfies Consumers

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers aged 44 years and older, the study said. Satisfaction among customers who participate in flat-rate programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Medicare Imaging Costs Fall 13%

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office. Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect Jan. 1, 2007, and Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computed tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated payment cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of personnel in physician offices and developing appropriateness criteria would be better ways to curb high imaging expenses, suggested AdvaMed.

U.S. Infant Mortality Fails to Improve

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from the rate of 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

FDA Issues Warning on Yaz Ads

The Food and Drug Administration has warned Bayer HealthCare Pharmaceuticals Inc. to tone down its advertising for Yaz (drospirenone and ethinyl estradiol tablets). Two television ads for the oral contraceptive overstate the drug's benefits and minimize its risks, according to an FDA letter to the company. “These violations are concerning from a public health perspective because they encourage use of Yaz in circumstances other than those in which the drug has been approved,” the FDA wrote in a letter. For example, the ads suggest that Yaz can treat the symptoms of premenstrual syndrome, but the drug is approved only for the treatment of premenstrual dysphoric disorder. The agency also complained that the ads did not effectively communicate the drug's risks because of distracting visuals and music.

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate last month. S. Res. 616 also recognized that access to quality and affordable health care is critical to making improvements in maternal health. The resolution, which was introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “This is not a problem we can or should ignore. A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on the FDA's scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a recent report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Flat Rx Pricing Satisfies Consumers

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers aged 44 years and older, the study said. Satisfaction among customers who participate in flat-rate programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Medicare Imaging Costs Fall 13%

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office. Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect Jan. 1, 2007, and Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computed tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated payment cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of personnel in physician offices and developing appropriateness criteria would be better ways to curb high imaging expenses, suggested AdvaMed.

Fentanyl a Top Cause for Injuries

Fentanyl accounted for the third highest number of serious drug reactions in the first quarter of 2008, according to an analysis of Food and Drug Administration data by the Institute for Safe Medicine Practices. The FDA received reports of 631 cases of serious adverse reactions and 131 deaths possibly related to fentanyl during the first 3 months of this year. The product associated with the most reports was varenicline (Chantix); there were 1,001 cases and 50 deaths potentially related to use of the smoking cessation therapy. Overall, there was a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Most drugs are relatively safe; a small number of drugs accounted for a large volume of reports, the institute reported. For injuries, that list included heparin, interferon-β, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Cognitive Research Gets a Boost

A new cooperative approach to research on cognitive aging is expected to bring with it an infusion of $20 million in grant funding over the next 5 years. A newly launched public-private partnership—the Research Partnership in Cognitive Aging—is funded by the National Institutes of Health and the McKnight Brain Research Foundation. The partnership will support an initiative to define healthy cognitive aging at the molecular, cellular, physiologic, and behavioral levels. It will also fund pilot studies with an aim toward setting the stage for larger clinical trials.

Nondrug Approaches to PTSD Tested

Researchers at the Southeast Louisiana Veterans Health Care System will test a series of interventions, from yoga to guided imagery, to treat posttraumatic stress disorder and major depression in veterans returning from Iraq and Afghanistan, and their families. The randomized controlled study was funded by a grant from the Department of Defense's new Center of Excellence for Psychological Health and Traumatic Brain Injury. The $411,000, 2-year grant will study the effectiveness of a technique developed by the Washington- based Center for Mind-Body Medicine. The technique, which includes meditation, biofeedback, and small-sized support groups, has been used successfully in treating PTSD in children in Kosovo.

U.S. Pharmaceutical Sales Outlook

The U.S. pharmaceutical market is expected to grow 1%-2% in 2009, resulting in sales of about $292-$302 billion, according to analysis from the health care market research firm IMS Health. This latest projection is down from the 2%-3% increase projected by IMS earlier this year, and reflects the expected impact of patent expirations, fewer launches of new products, and the slowing U.S. economy. Worldwide pharmaceutical sales are expected to grow 4.5%-5.5% in 2009, similar to growth this year. “The market will continue to contend with a number of forces—among them, the shift in growth from developed countries to emerging ones, specialist-driven products playing a larger role, blockbuster drugs losing patent protection, and the rising influence of regulators and payers on health care decisions,” Murray Aitken, senior vice president of Healthcare Insight at IMS, said in a statement. “Layered on top is the uncertainty in the global economic environment and its effect on demand.”

Poor Marks for PQRI

Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback report. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey from the Medical Group Management Association reported similar problems in accessing feedback reports.

Fentanyl a Top Cause for Injuries

Fentanyl accounted for the third highest number of serious drug reactions in the first quarter of 2008, according to an analysis of Food and Drug Administration data by the Institute for Safe Medicine Practices. The FDA received reports of 631 cases of serious adverse reactions and 131 deaths possibly related to fentanyl during the first 3 months of this year. The product associated with the most reports was varenicline (Chantix); there were 1,001 cases and 50 deaths potentially related to use of the smoking cessation therapy. Overall, there was a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Most drugs are relatively safe; a small number of drugs accounted for a large volume of reports, the institute reported. For injuries, that list included heparin, interferon-β, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Cognitive Research Gets a Boost

A new cooperative approach to research on cognitive aging is expected to bring with it an infusion of $20 million in grant funding over the next 5 years. A newly launched public-private partnership—the Research Partnership in Cognitive Aging—is funded by the National Institutes of Health and the McKnight Brain Research Foundation. The partnership will support an initiative to define healthy cognitive aging at the molecular, cellular, physiologic, and behavioral levels. It will also fund pilot studies with an aim toward setting the stage for larger clinical trials.

Nondrug Approaches to PTSD Tested

Researchers at the Southeast Louisiana Veterans Health Care System will test a series of interventions, from yoga to guided imagery, to treat posttraumatic stress disorder and major depression in veterans returning from Iraq and Afghanistan, and their families. The randomized controlled study was funded by a grant from the Department of Defense's new Center of Excellence for Psychological Health and Traumatic Brain Injury. The $411,000, 2-year grant will study the effectiveness of a technique developed by the Washington- based Center for Mind-Body Medicine. The technique, which includes meditation, biofeedback, and small-sized support groups, has been used successfully in treating PTSD in children in Kosovo.

U.S. Pharmaceutical Sales Outlook

The U.S. pharmaceutical market is expected to grow 1%-2% in 2009, resulting in sales of about $292-$302 billion, according to analysis from the health care market research firm IMS Health. This latest projection is down from the 2%-3% increase projected by IMS earlier this year, and reflects the expected impact of patent expirations, fewer launches of new products, and the slowing U.S. economy. Worldwide pharmaceutical sales are expected to grow 4.5%-5.5% in 2009, similar to growth this year. “The market will continue to contend with a number of forces—among them, the shift in growth from developed countries to emerging ones, specialist-driven products playing a larger role, blockbuster drugs losing patent protection, and the rising influence of regulators and payers on health care decisions,” Murray Aitken, senior vice president of Healthcare Insight at IMS, said in a statement. “Layered on top is the uncertainty in the global economic environment and its effect on demand.”

Poor Marks for PQRI

Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback report. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey from the Medical Group Management Association reported similar problems in accessing feedback reports.

Fentanyl a Top Cause for Injuries

Fentanyl accounted for the third highest number of serious drug reactions in the first quarter of 2008, according to an analysis of Food and Drug Administration data by the Institute for Safe Medicine Practices. The FDA received reports of 631 cases of serious adverse reactions and 131 deaths possibly related to fentanyl during the first 3 months of this year. The product associated with the most reports was varenicline (Chantix); there were 1,001 cases and 50 deaths potentially related to use of the smoking cessation therapy. Overall, there was a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Most drugs are relatively safe; a small number of drugs accounted for a large volume of reports, the institute reported. For injuries, that list included heparin, interferon-β, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Cognitive Research Gets a Boost

A new cooperative approach to research on cognitive aging is expected to bring with it an infusion of $20 million in grant funding over the next 5 years. A newly launched public-private partnership—the Research Partnership in Cognitive Aging—is funded by the National Institutes of Health and the McKnight Brain Research Foundation. The partnership will support an initiative to define healthy cognitive aging at the molecular, cellular, physiologic, and behavioral levels. It will also fund pilot studies with an aim toward setting the stage for larger clinical trials.

Nondrug Approaches to PTSD Tested

Researchers at the Southeast Louisiana Veterans Health Care System will test a series of interventions, from yoga to guided imagery, to treat posttraumatic stress disorder and major depression in veterans returning from Iraq and Afghanistan, and their families. The randomized controlled study was funded by a grant from the Department of Defense's new Center of Excellence for Psychological Health and Traumatic Brain Injury. The $411,000, 2-year grant will study the effectiveness of a technique developed by the Washington- based Center for Mind-Body Medicine. The technique, which includes meditation, biofeedback, and small-sized support groups, has been used successfully in treating PTSD in children in Kosovo.

U.S. Pharmaceutical Sales Outlook

The U.S. pharmaceutical market is expected to grow 1%-2% in 2009, resulting in sales of about $292-$302 billion, according to analysis from the health care market research firm IMS Health. This latest projection is down from the 2%-3% increase projected by IMS earlier this year, and reflects the expected impact of patent expirations, fewer launches of new products, and the slowing U.S. economy. Worldwide pharmaceutical sales are expected to grow 4.5%-5.5% in 2009, similar to growth this year. “The market will continue to contend with a number of forces—among them, the shift in growth from developed countries to emerging ones, specialist-driven products playing a larger role, blockbuster drugs losing patent protection, and the rising influence of regulators and payers on health care decisions,” Murray Aitken, senior vice president of Healthcare Insight at IMS, said in a statement. “Layered on top is the uncertainty in the global economic environment and its effect on demand.”

Poor Marks for PQRI

Most physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback report. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey from the Medical Group Management Association reported similar problems in accessing feedback reports.