Mary Ellen Schneider

In addition to the presidential candidates, other players in the health care arena are unveiling detailed plans to provide health care coverage for all or most Americans.

The Commonwealth Fund's proposal, called “Building Blocks,” seeks to cover 44 of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature private plans and a “Medicare Extra” option. The latter would offer monthly premiums of $259 for individuals and $702 for families, 30% lower than the average premium charged to employers today, said the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan to cover all adults and children below 150% of the federal poverty level and would include individual and employer mandates for health coverage.

Using modeling from the Lewin Group, the Commonwealth Fund estimated the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But it could save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health.

Meanwhile, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has offered its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” it calls for subsidies and tax breaks to help individuals afford coverage and would realign financial incentives in the health care system to pay for value.

The plan calls for the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums and for the same tax breaks to be applied to individually purchased health insurance as applied to employer-sponsored coverage. The group did not endorse individual mandates.

In addition to the presidential candidates, other players in the health care arena are unveiling detailed plans to provide health care coverage for all or most Americans.

The Commonwealth Fund's proposal, called “Building Blocks,” seeks to cover 44 of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature private plans and a “Medicare Extra” option. The latter would offer monthly premiums of $259 for individuals and $702 for families, 30% lower than the average premium charged to employers today, said the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan to cover all adults and children below 150% of the federal poverty level and would include individual and employer mandates for health coverage.

Using modeling from the Lewin Group, the Commonwealth Fund estimated the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But it could save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health.

Meanwhile, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has offered its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” it calls for subsidies and tax breaks to help individuals afford coverage and would realign financial incentives in the health care system to pay for value.

The plan calls for the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums and for the same tax breaks to be applied to individually purchased health insurance as applied to employer-sponsored coverage. The group did not endorse individual mandates.

In addition to the presidential candidates, other players in the health care arena are unveiling detailed plans to provide health care coverage for all or most Americans.

The Commonwealth Fund's proposal, called “Building Blocks,” seeks to cover 44 of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature private plans and a “Medicare Extra” option. The latter would offer monthly premiums of $259 for individuals and $702 for families, 30% lower than the average premium charged to employers today, said the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan to cover all adults and children below 150% of the federal poverty level and would include individual and employer mandates for health coverage.

Using modeling from the Lewin Group, the Commonwealth Fund estimated the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But it could save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health.

Meanwhile, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has offered its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” it calls for subsidies and tax breaks to help individuals afford coverage and would realign financial incentives in the health care system to pay for value.

The plan calls for the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums and for the same tax breaks to be applied to individually purchased health insurance as applied to employer-sponsored coverage. The group did not endorse individual mandates.

Editor's Note: Coverage of the health care proposals of presidential candidate Sen. John McCain (R-Ariz.) will appear in an upcoming issue of this newspaper.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program (SCHIP). Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

“I want to … know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.). Sen. Obama's approach is really a “back door” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short.” Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. While in the long term it might be a good idea to move away from that system, that should be a gradual process, he said.

“Employer coverage isn't really broken,” Dr. Lewin said. “But we can improve upon it.”

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said. “He clearly intends to engage and work with Congress and stakeholders.”

And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said. “There's a different environment,” Mr. Nichols said.

Sen. Barack Obama's plan would allow people to remain in their employer-sponsored health plans.

Editor's Note: Coverage of the health care proposals of presidential candidate Sen. John McCain (R-Ariz.) will appear in an upcoming issue of this newspaper.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program (SCHIP). Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

“I want to … know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.). Sen. Obama's approach is really a “back door” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short.” Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. While in the long term it might be a good idea to move away from that system, that should be a gradual process, he said.

“Employer coverage isn't really broken,” Dr. Lewin said. “But we can improve upon it.”

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said. “He clearly intends to engage and work with Congress and stakeholders.”

And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said. “There's a different environment,” Mr. Nichols said.

Sen. Barack Obama's plan would allow people to remain in their employer-sponsored health plans.

Editor's Note: Coverage of the health care proposals of presidential candidate Sen. John McCain (R-Ariz.) will appear in an upcoming issue of this newspaper.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program (SCHIP). Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

“I want to … know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.). Sen. Obama's approach is really a “back door” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short.” Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. While in the long term it might be a good idea to move away from that system, that should be a gradual process, he said.

“Employer coverage isn't really broken,” Dr. Lewin said. “But we can improve upon it.”

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said. “He clearly intends to engage and work with Congress and stakeholders.”

And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said. “There's a different environment,” Mr. Nichols said.

Sen. Barack Obama's plan would allow people to remain in their employer-sponsored health plans.

LBW Births in U.S. Rise Slightly

More infants continue to be born at low birth weight, according to findings from the federal government's annual statistical report on the well-being of American children. The report, from the Federal Interagency Forum on Child and Family Statistics, showed a small uptick in the percentage of infants born at low birth rate, from 8.2% in 2005 to 8.3% in 2006. Just 7% of infants were born at low birth weight in 1990. “This trend reflects an increase in the number of infants born prematurely, the largest category of low-birth-weight infants,” Dr. Duane Alexander, director of NIH's National Institute of Child Health and Human Development, said in a statement. Other possible factors include an increase in multiple births, delayed childbearing, and infertility therapies, according to the NIH.

Court Upholds Abortion Consent Clause

A South Dakota law that expands the requirements for informed consent prior to an abortion recently went into effect following a federal appeals court ruling. The 8th U.S. Circuit Court of Appeals voted 7-4 to overturn a lower court's injunction and allow the law to go into effect. The law requires that the patient be given a written statement prior to abortion that the procedure will terminate the “life of a whole, separate, unique, living human being.” The South Dakota legislature originally passed the law in 2005 but it has been tied up in the courts after being challenged by Planned Parenthood of Minnesota, North Dakota, South Dakota, and the Planned Parenthood Federation of America. The lawsuit challenged the law on constitutional grounds saying that it would violate the rights of physicians and patients by interfering with the doctor-patient relationship.

Planned Parenthood Endorses Obama

The Planned Parenthood Action Fund, the political arm of the Planned Parenthood Federation of America, recently endorsed Sen. Barack Obama (D-Ill.) for president. The group praised Sen. Obama as a “passionate advocate for women's rights.” The candidate has a 100% rating from the group both as a U.S. senator and as a state senator in Illinois. Sen. Obama is a cosponsor of the Freedom of Choice Act (H.R. 1964/S. 1173), which would codify abortion rights. He supports comprehensive sex education, expanding access to contraceptives, and expanding family planning efforts worldwide, according to Planned Parenthood. The group criticized Sen. John McCain (R-Ariz.), saying that he has a 0% rating with the organization and that he wants to overturn Roe v. Wade.

CMS Issues $36M in PQRI Bonuses

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month. Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of PQRI. Of the approximately, 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community. More information on the program is available at

www.cms.hhs.gov/PQRI

NIH Seeks to Cut Science Gender Gap

NIH officials plan to spend up to $3 million in an effort to advance the careers of women in biomedical and behavioral science and engineering. The agency plans to award eight grants in fiscal year 2009 for research that can better explain the career patterns of women in the science and engineering fields and test programs designed to encourage women to enter these areas. Researchers will be tasked with looking at family and economic circumstances, institutional environments, disciplinary culture and practices, and the broader social and cultural context. “Through rigorous research efforts, the NIH and others will continue to close the gender gap in science and engineering,” Dr. Elias A. Zerhouni, NIH director, said in a statement.

LBW Births in U.S. Rise Slightly

More infants continue to be born at low birth weight, according to findings from the federal government's annual statistical report on the well-being of American children. The report, from the Federal Interagency Forum on Child and Family Statistics, showed a small uptick in the percentage of infants born at low birth rate, from 8.2% in 2005 to 8.3% in 2006. Just 7% of infants were born at low birth weight in 1990. “This trend reflects an increase in the number of infants born prematurely, the largest category of low-birth-weight infants,” Dr. Duane Alexander, director of NIH's National Institute of Child Health and Human Development, said in a statement. Other possible factors include an increase in multiple births, delayed childbearing, and infertility therapies, according to the NIH.

Court Upholds Abortion Consent Clause

A South Dakota law that expands the requirements for informed consent prior to an abortion recently went into effect following a federal appeals court ruling. The 8th U.S. Circuit Court of Appeals voted 7-4 to overturn a lower court's injunction and allow the law to go into effect. The law requires that the patient be given a written statement prior to abortion that the procedure will terminate the “life of a whole, separate, unique, living human being.” The South Dakota legislature originally passed the law in 2005 but it has been tied up in the courts after being challenged by Planned Parenthood of Minnesota, North Dakota, South Dakota, and the Planned Parenthood Federation of America. The lawsuit challenged the law on constitutional grounds saying that it would violate the rights of physicians and patients by interfering with the doctor-patient relationship.

Planned Parenthood Endorses Obama

The Planned Parenthood Action Fund, the political arm of the Planned Parenthood Federation of America, recently endorsed Sen. Barack Obama (D-Ill.) for president. The group praised Sen. Obama as a “passionate advocate for women's rights.” The candidate has a 100% rating from the group both as a U.S. senator and as a state senator in Illinois. Sen. Obama is a cosponsor of the Freedom of Choice Act (H.R. 1964/S. 1173), which would codify abortion rights. He supports comprehensive sex education, expanding access to contraceptives, and expanding family planning efforts worldwide, according to Planned Parenthood. The group criticized Sen. John McCain (R-Ariz.), saying that he has a 0% rating with the organization and that he wants to overturn Roe v. Wade.

CMS Issues $36M in PQRI Bonuses

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month. Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of PQRI. Of the approximately, 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community. More information on the program is available at

www.cms.hhs.gov/PQRI

NIH Seeks to Cut Science Gender Gap

NIH officials plan to spend up to $3 million in an effort to advance the careers of women in biomedical and behavioral science and engineering. The agency plans to award eight grants in fiscal year 2009 for research that can better explain the career patterns of women in the science and engineering fields and test programs designed to encourage women to enter these areas. Researchers will be tasked with looking at family and economic circumstances, institutional environments, disciplinary culture and practices, and the broader social and cultural context. “Through rigorous research efforts, the NIH and others will continue to close the gender gap in science and engineering,” Dr. Elias A. Zerhouni, NIH director, said in a statement.

LBW Births in U.S. Rise Slightly

More infants continue to be born at low birth weight, according to findings from the federal government's annual statistical report on the well-being of American children. The report, from the Federal Interagency Forum on Child and Family Statistics, showed a small uptick in the percentage of infants born at low birth rate, from 8.2% in 2005 to 8.3% in 2006. Just 7% of infants were born at low birth weight in 1990. “This trend reflects an increase in the number of infants born prematurely, the largest category of low-birth-weight infants,” Dr. Duane Alexander, director of NIH's National Institute of Child Health and Human Development, said in a statement. Other possible factors include an increase in multiple births, delayed childbearing, and infertility therapies, according to the NIH.

Court Upholds Abortion Consent Clause

A South Dakota law that expands the requirements for informed consent prior to an abortion recently went into effect following a federal appeals court ruling. The 8th U.S. Circuit Court of Appeals voted 7-4 to overturn a lower court's injunction and allow the law to go into effect. The law requires that the patient be given a written statement prior to abortion that the procedure will terminate the “life of a whole, separate, unique, living human being.” The South Dakota legislature originally passed the law in 2005 but it has been tied up in the courts after being challenged by Planned Parenthood of Minnesota, North Dakota, South Dakota, and the Planned Parenthood Federation of America. The lawsuit challenged the law on constitutional grounds saying that it would violate the rights of physicians and patients by interfering with the doctor-patient relationship.

Planned Parenthood Endorses Obama

The Planned Parenthood Action Fund, the political arm of the Planned Parenthood Federation of America, recently endorsed Sen. Barack Obama (D-Ill.) for president. The group praised Sen. Obama as a “passionate advocate for women's rights.” The candidate has a 100% rating from the group both as a U.S. senator and as a state senator in Illinois. Sen. Obama is a cosponsor of the Freedom of Choice Act (H.R. 1964/S. 1173), which would codify abortion rights. He supports comprehensive sex education, expanding access to contraceptives, and expanding family planning efforts worldwide, according to Planned Parenthood. The group criticized Sen. John McCain (R-Ariz.), saying that he has a 0% rating with the organization and that he wants to overturn Roe v. Wade.

CMS Issues $36M in PQRI Bonuses

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month. Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of PQRI. Of the approximately, 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. To access the feedback reports, providers must register with the Individuals Authorized Access to CMS Computer Services-Provider Community. More information on the program is available at

www.cms.hhs.gov/PQRI

NIH Seeks to Cut Science Gender Gap

NIH officials plan to spend up to $3 million in an effort to advance the careers of women in biomedical and behavioral science and engineering. The agency plans to award eight grants in fiscal year 2009 for research that can better explain the career patterns of women in the science and engineering fields and test programs designed to encourage women to enter these areas. Researchers will be tasked with looking at family and economic circumstances, institutional environments, disciplinary culture and practices, and the broader social and cultural context. “Through rigorous research efforts, the NIH and others will continue to close the gender gap in science and engineering,” Dr. Elias A. Zerhouni, NIH director, said in a statement.

Principles for Physician Ranking

As more insurers begin using physician rankings, the American Academy of Neurology Professional Association (AANPA), which coordinates all advocacy and medical economics activities for members of the American Academy of Neurology, recently issued a set of principles to ensure “clarity and fairness” in the design of physician ranking programs. For starters, AANPA would like a seat at the table to provide input into the development, implementation, and evaluation of any physician profiling or ranking arrangements that involve neurologists. The group is also seeking disclosure of the methods used to collect and analyze performance data and details about pilot studies to validate physician rankings prior to their use. In addition, AANPA is calling on insurers to create a process through which physicians could dispute their ranking before it is made public. The principles also urge insurers to use established national standards in evaluating physicians, such as measures endorsed by the National Quality Forum. “The AANPA recognizes that there can be benefit in physician profiling programs when they are transparent to those profiled; use only measures, data, and procedures of proven validity; and are overseen by an independent national oversight organization,” the group said in its position statement.

Fox Foundation Awards $1.1 Million

In the first half of this year, the Michael J. Fox Foundation awarded $1.1 million in grants for Parkinson's disease research projects as part of its “rapid response” program. The organization expects to award nearly another $1 million before the end of 2008. The Rapid Response Innovation Awards program, launched in 2007, accepts proposals on a rolling basis and makes funding decisions within 6 weeks of receiving an application. Researchers can get up to $75,000 for a 1-year basic, preclinical, or clinical research project for any work that is relevant to Parkinson's disease. “Rapid Response infuses capital quickly into exciting new ideas that could open up important new avenues of inquiry for Parkinson's disease,” Katie Hood, CEO of the Michael J. Fox Foundation, said in a statement. “Our goal is to provide the funding needed to further 'build the case' for these new concepts, developing the data required before other traditional funding sources can step in.” This year, the organization has funded research into the use of gene silencing techniques and pluripotent stem cell technology. Other grantees are working on better treatments for digestive problems in Parkinson's and studying epidemiological findings that have shown that smoking may protect against Parkinson's disease.

NIH Funds Chronic Disease Training

The National Institutes of Health is launching a $1.5 million-a-year grant program to fund the training of researchers who will combat chronic diseases in developing countries. NIH officials are seeking to build a cadre of researchers who can find better ways to treat stroke, cancer, lung disease, obesity, and other conditions in low- to middle-income countries where deaths from chronic diseases are common. As part of the program, grantees would receive funding of up to $220,000 a year for up to 5 years to train researchers. Among the objectives of the project is to train researchers who can identify the economic factors that influence chronic disease risk and take research findings and translate them into policies and programs of care.

Principles for Physician Ranking

As more insurers begin using physician rankings, the American Academy of Neurology Professional Association (AANPA), which coordinates all advocacy and medical economics activities for members of the American Academy of Neurology, recently issued a set of principles to ensure “clarity and fairness” in the design of physician ranking programs. For starters, AANPA would like a seat at the table to provide input into the development, implementation, and evaluation of any physician profiling or ranking arrangements that involve neurologists. The group is also seeking disclosure of the methods used to collect and analyze performance data and details about pilot studies to validate physician rankings prior to their use. In addition, AANPA is calling on insurers to create a process through which physicians could dispute their ranking before it is made public. The principles also urge insurers to use established national standards in evaluating physicians, such as measures endorsed by the National Quality Forum. “The AANPA recognizes that there can be benefit in physician profiling programs when they are transparent to those profiled; use only measures, data, and procedures of proven validity; and are overseen by an independent national oversight organization,” the group said in its position statement.

Fox Foundation Awards $1.1 Million

In the first half of this year, the Michael J. Fox Foundation awarded $1.1 million in grants for Parkinson's disease research projects as part of its “rapid response” program. The organization expects to award nearly another $1 million before the end of 2008. The Rapid Response Innovation Awards program, launched in 2007, accepts proposals on a rolling basis and makes funding decisions within 6 weeks of receiving an application. Researchers can get up to $75,000 for a 1-year basic, preclinical, or clinical research project for any work that is relevant to Parkinson's disease. “Rapid Response infuses capital quickly into exciting new ideas that could open up important new avenues of inquiry for Parkinson's disease,” Katie Hood, CEO of the Michael J. Fox Foundation, said in a statement. “Our goal is to provide the funding needed to further 'build the case' for these new concepts, developing the data required before other traditional funding sources can step in.” This year, the organization has funded research into the use of gene silencing techniques and pluripotent stem cell technology. Other grantees are working on better treatments for digestive problems in Parkinson's and studying epidemiological findings that have shown that smoking may protect against Parkinson's disease.

NIH Funds Chronic Disease Training

The National Institutes of Health is launching a $1.5 million-a-year grant program to fund the training of researchers who will combat chronic diseases in developing countries. NIH officials are seeking to build a cadre of researchers who can find better ways to treat stroke, cancer, lung disease, obesity, and other conditions in low- to middle-income countries where deaths from chronic diseases are common. As part of the program, grantees would receive funding of up to $220,000 a year for up to 5 years to train researchers. Among the objectives of the project is to train researchers who can identify the economic factors that influence chronic disease risk and take research findings and translate them into policies and programs of care.

Principles for Physician Ranking

As more insurers begin using physician rankings, the American Academy of Neurology Professional Association (AANPA), which coordinates all advocacy and medical economics activities for members of the American Academy of Neurology, recently issued a set of principles to ensure “clarity and fairness” in the design of physician ranking programs. For starters, AANPA would like a seat at the table to provide input into the development, implementation, and evaluation of any physician profiling or ranking arrangements that involve neurologists. The group is also seeking disclosure of the methods used to collect and analyze performance data and details about pilot studies to validate physician rankings prior to their use. In addition, AANPA is calling on insurers to create a process through which physicians could dispute their ranking before it is made public. The principles also urge insurers to use established national standards in evaluating physicians, such as measures endorsed by the National Quality Forum. “The AANPA recognizes that there can be benefit in physician profiling programs when they are transparent to those profiled; use only measures, data, and procedures of proven validity; and are overseen by an independent national oversight organization,” the group said in its position statement.

Fox Foundation Awards $1.1 Million

In the first half of this year, the Michael J. Fox Foundation awarded $1.1 million in grants for Parkinson's disease research projects as part of its “rapid response” program. The organization expects to award nearly another $1 million before the end of 2008. The Rapid Response Innovation Awards program, launched in 2007, accepts proposals on a rolling basis and makes funding decisions within 6 weeks of receiving an application. Researchers can get up to $75,000 for a 1-year basic, preclinical, or clinical research project for any work that is relevant to Parkinson's disease. “Rapid Response infuses capital quickly into exciting new ideas that could open up important new avenues of inquiry for Parkinson's disease,” Katie Hood, CEO of the Michael J. Fox Foundation, said in a statement. “Our goal is to provide the funding needed to further 'build the case' for these new concepts, developing the data required before other traditional funding sources can step in.” This year, the organization has funded research into the use of gene silencing techniques and pluripotent stem cell technology. Other grantees are working on better treatments for digestive problems in Parkinson's and studying epidemiological findings that have shown that smoking may protect against Parkinson's disease.

NIH Funds Chronic Disease Training

The National Institutes of Health is launching a $1.5 million-a-year grant program to fund the training of researchers who will combat chronic diseases in developing countries. NIH officials are seeking to build a cadre of researchers who can find better ways to treat stroke, cancer, lung disease, obesity, and other conditions in low- to middle-income countries where deaths from chronic diseases are common. As part of the program, grantees would receive funding of up to $220,000 a year for up to 5 years to train researchers. Among the objectives of the project is to train researchers who can identify the economic factors that influence chronic disease risk and take research findings and translate them into policies and programs of care.

Patients will soon be able to undergo genetic testing without fear of discrimination from either their health insurers or their employers, thanks to a new law signed by President Bush.

The Genetic Information Nondiscrimination Act (H.R. 493), which passed both houses of Congress by wide margins, prohibits health insurers from using genetic information in determining eligibility or setting premiums and forbids employers from using that information for decisions about hiring, firing, job assignments, or promotions. The law also prohibits health insurers and employers from requesting or requiring that individuals take a genetic test. The health insurance provisions in the law will go into effect in 12 months, and the employment provisions will take effect in 18 months.

Supporters of the law are hailing it as the first civil rights legislation of the new millennium. The law will have a positive impact on neurologists and their patients as soon as it goes into effect, said Dr. Bruce Sigsbee, a member of the legislative affairs committee of the American Academy of Neurology. Most neurologists already do at least some genetic testing and counseling for diseases such as Huntington's, he said, and that is likely to increase over time.

For many patients, the first barrier to genetic testing is whether they want to know their risk, but the potential for discrimination is one of the important factors in their decision, Dr. Sigsbee said. “It complicates their own medical decision making substantially,” he said.

“Genetic testing holds great promise for improving public health, and patients must be able to trust that their genetic information will be protected from inappropriate and discriminatory uses,” said Dr. Edward Langston, board chair of the American Medical Association. It “will allow patients to take advantage of scientific advances in genetics, such as screenings and therapies, without worrying that their personal health information could be used against them.”

Some patients who would be good candidates for genetic testing have been refusing the tests, or in some cases taking them under an assumed name, said Sharon Terry, president of the Coalition for Genetic Fairness, and CEO of the Genetic Alliance.

The frequency of genetic discrimination has been difficult to document, but it's clear that fear of discrimination has been a barrier to genetic services for some patients, said Dr. Matthew Taylor, director of adult clinical genetics at the University of Colorado in Denver. For example, last year the Genetics and Public Policy Center at Johns Hopkins University, Baltimore, conducted a survey of 1,199 U.S. adults on genetic testing and discrimination. The researchers found that 92% of respondents expressed concern that the results of a genetic test for disease risk could be used against them in some way.

One of the biggest impacts of the law may be its potential to alleviate concerns about genetic discrimination among both patients and physicians, Dr. Taylor said.

Another area where the law is likely to have a significant impact is in research. Many informed consent forms for clinical trials include statements warning participants that they could be discriminated against on the basis of their genetic information, according to Ms. Terry. The Coalition for Genetic Fairness plans to mount an educational campaign to make patients and physicians aware of the new protections in the law in the hopes of increasing participation in research, she said.

The new federal law is essential to help to “close the gaps in protection” among the various state laws, according to Naomi Senkeeto, a health policy analyst for the American College of Physicians. The new law is similar to policy positions outlined in an ACP monograph issued earlier this year. In fact, the law includes all of the provisions that the ACP monograph recommended. The law also adds a specific prohibition against issuers of Medigap policies using genetic information to adjust price or condition eligibility.

The law was a long time coming, according to supporters. Legislation on genetic nondiscrimination was first introduced in 1995. The bill has had broad support in Congress for many years but couldn't get to the House floor under the Republican leadership, according to Susannah Baruch, associate director of the Genetics and Public Policy Center at Johns Hopkins University. The other change that propelled the legislation forward was the explosion in the number of genetic tests available, she said.

About 1,200 genetic tests can be used to identify thousands of health conditions, according to the Coalition for Genetic Fairness. Only about 100 genetic tests were available a decade ago.

Over time, the legislation has garnered support from a broad coalition of groups, including the health insurance industry. “With this landmark bipartisan legislation, Congress and the president have taken strong action to prohibit discrimination based on a person's genetic makeup and to protect patients' privacy as they pursue genetic evaluations,” Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement. “This legislation also ensures that patients can continue to benefit from health plans' innovative early detection and care coordination programs that improve the safety and quality of care.”

But more work needs to be done, Ms. Terry said. The Coalition for Genetic Fairness has been working with Sen. Edward Kennedy (D-Mass.) and Sen. Barack Obama (D-Ill.) on better oversight for genetic testing in general. And the Agency for Healthcare Research and Quality recently called for improvements to public health surveillance databases and health information technology used to monitor the tests.

Potential discrimination in life insurance and disability insurance also must be addressed in the future, Ms. Terry said. “This is a first-step bill for sure.”

Patients will soon be able to undergo genetic testing without fear of discrimination from either their health insurers or their employers, thanks to a new law signed by President Bush.

The Genetic Information Nondiscrimination Act (H.R. 493), which passed both houses of Congress by wide margins, prohibits health insurers from using genetic information in determining eligibility or setting premiums and forbids employers from using that information for decisions about hiring, firing, job assignments, or promotions. The law also prohibits health insurers and employers from requesting or requiring that individuals take a genetic test. The health insurance provisions in the law will go into effect in 12 months, and the employment provisions will take effect in 18 months.

Supporters of the law are hailing it as the first civil rights legislation of the new millennium. The law will have a positive impact on neurologists and their patients as soon as it goes into effect, said Dr. Bruce Sigsbee, a member of the legislative affairs committee of the American Academy of Neurology. Most neurologists already do at least some genetic testing and counseling for diseases such as Huntington's, he said, and that is likely to increase over time.

For many patients, the first barrier to genetic testing is whether they want to know their risk, but the potential for discrimination is one of the important factors in their decision, Dr. Sigsbee said. “It complicates their own medical decision making substantially,” he said.

“Genetic testing holds great promise for improving public health, and patients must be able to trust that their genetic information will be protected from inappropriate and discriminatory uses,” said Dr. Edward Langston, board chair of the American Medical Association. It “will allow patients to take advantage of scientific advances in genetics, such as screenings and therapies, without worrying that their personal health information could be used against them.”

Some patients who would be good candidates for genetic testing have been refusing the tests, or in some cases taking them under an assumed name, said Sharon Terry, president of the Coalition for Genetic Fairness, and CEO of the Genetic Alliance.

The frequency of genetic discrimination has been difficult to document, but it's clear that fear of discrimination has been a barrier to genetic services for some patients, said Dr. Matthew Taylor, director of adult clinical genetics at the University of Colorado in Denver. For example, last year the Genetics and Public Policy Center at Johns Hopkins University, Baltimore, conducted a survey of 1,199 U.S. adults on genetic testing and discrimination. The researchers found that 92% of respondents expressed concern that the results of a genetic test for disease risk could be used against them in some way.

One of the biggest impacts of the law may be its potential to alleviate concerns about genetic discrimination among both patients and physicians, Dr. Taylor said.

Another area where the law is likely to have a significant impact is in research. Many informed consent forms for clinical trials include statements warning participants that they could be discriminated against on the basis of their genetic information, according to Ms. Terry. The Coalition for Genetic Fairness plans to mount an educational campaign to make patients and physicians aware of the new protections in the law in the hopes of increasing participation in research, she said.

The new federal law is essential to help to “close the gaps in protection” among the various state laws, according to Naomi Senkeeto, a health policy analyst for the American College of Physicians. The new law is similar to policy positions outlined in an ACP monograph issued earlier this year. In fact, the law includes all of the provisions that the ACP monograph recommended. The law also adds a specific prohibition against issuers of Medigap policies using genetic information to adjust price or condition eligibility.

The law was a long time coming, according to supporters. Legislation on genetic nondiscrimination was first introduced in 1995. The bill has had broad support in Congress for many years but couldn't get to the House floor under the Republican leadership, according to Susannah Baruch, associate director of the Genetics and Public Policy Center at Johns Hopkins University. The other change that propelled the legislation forward was the explosion in the number of genetic tests available, she said.

About 1,200 genetic tests can be used to identify thousands of health conditions, according to the Coalition for Genetic Fairness. Only about 100 genetic tests were available a decade ago.

Over time, the legislation has garnered support from a broad coalition of groups, including the health insurance industry. “With this landmark bipartisan legislation, Congress and the president have taken strong action to prohibit discrimination based on a person's genetic makeup and to protect patients' privacy as they pursue genetic evaluations,” Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement. “This legislation also ensures that patients can continue to benefit from health plans' innovative early detection and care coordination programs that improve the safety and quality of care.”

But more work needs to be done, Ms. Terry said. The Coalition for Genetic Fairness has been working with Sen. Edward Kennedy (D-Mass.) and Sen. Barack Obama (D-Ill.) on better oversight for genetic testing in general. And the Agency for Healthcare Research and Quality recently called for improvements to public health surveillance databases and health information technology used to monitor the tests.

Potential discrimination in life insurance and disability insurance also must be addressed in the future, Ms. Terry said. “This is a first-step bill for sure.”

Patients will soon be able to undergo genetic testing without fear of discrimination from either their health insurers or their employers, thanks to a new law signed by President Bush.

The Genetic Information Nondiscrimination Act (H.R. 493), which passed both houses of Congress by wide margins, prohibits health insurers from using genetic information in determining eligibility or setting premiums and forbids employers from using that information for decisions about hiring, firing, job assignments, or promotions. The law also prohibits health insurers and employers from requesting or requiring that individuals take a genetic test. The health insurance provisions in the law will go into effect in 12 months, and the employment provisions will take effect in 18 months.

Supporters of the law are hailing it as the first civil rights legislation of the new millennium. The law will have a positive impact on neurologists and their patients as soon as it goes into effect, said Dr. Bruce Sigsbee, a member of the legislative affairs committee of the American Academy of Neurology. Most neurologists already do at least some genetic testing and counseling for diseases such as Huntington's, he said, and that is likely to increase over time.

For many patients, the first barrier to genetic testing is whether they want to know their risk, but the potential for discrimination is one of the important factors in their decision, Dr. Sigsbee said. “It complicates their own medical decision making substantially,” he said.

“Genetic testing holds great promise for improving public health, and patients must be able to trust that their genetic information will be protected from inappropriate and discriminatory uses,” said Dr. Edward Langston, board chair of the American Medical Association. It “will allow patients to take advantage of scientific advances in genetics, such as screenings and therapies, without worrying that their personal health information could be used against them.”

Some patients who would be good candidates for genetic testing have been refusing the tests, or in some cases taking them under an assumed name, said Sharon Terry, president of the Coalition for Genetic Fairness, and CEO of the Genetic Alliance.

The frequency of genetic discrimination has been difficult to document, but it's clear that fear of discrimination has been a barrier to genetic services for some patients, said Dr. Matthew Taylor, director of adult clinical genetics at the University of Colorado in Denver. For example, last year the Genetics and Public Policy Center at Johns Hopkins University, Baltimore, conducted a survey of 1,199 U.S. adults on genetic testing and discrimination. The researchers found that 92% of respondents expressed concern that the results of a genetic test for disease risk could be used against them in some way.

One of the biggest impacts of the law may be its potential to alleviate concerns about genetic discrimination among both patients and physicians, Dr. Taylor said.

Another area where the law is likely to have a significant impact is in research. Many informed consent forms for clinical trials include statements warning participants that they could be discriminated against on the basis of their genetic information, according to Ms. Terry. The Coalition for Genetic Fairness plans to mount an educational campaign to make patients and physicians aware of the new protections in the law in the hopes of increasing participation in research, she said.

The new federal law is essential to help to “close the gaps in protection” among the various state laws, according to Naomi Senkeeto, a health policy analyst for the American College of Physicians. The new law is similar to policy positions outlined in an ACP monograph issued earlier this year. In fact, the law includes all of the provisions that the ACP monograph recommended. The law also adds a specific prohibition against issuers of Medigap policies using genetic information to adjust price or condition eligibility.

The law was a long time coming, according to supporters. Legislation on genetic nondiscrimination was first introduced in 1995. The bill has had broad support in Congress for many years but couldn't get to the House floor under the Republican leadership, according to Susannah Baruch, associate director of the Genetics and Public Policy Center at Johns Hopkins University. The other change that propelled the legislation forward was the explosion in the number of genetic tests available, she said.

About 1,200 genetic tests can be used to identify thousands of health conditions, according to the Coalition for Genetic Fairness. Only about 100 genetic tests were available a decade ago.

Over time, the legislation has garnered support from a broad coalition of groups, including the health insurance industry. “With this landmark bipartisan legislation, Congress and the president have taken strong action to prohibit discrimination based on a person's genetic makeup and to protect patients' privacy as they pursue genetic evaluations,” Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement. “This legislation also ensures that patients can continue to benefit from health plans' innovative early detection and care coordination programs that improve the safety and quality of care.”

But more work needs to be done, Ms. Terry said. The Coalition for Genetic Fairness has been working with Sen. Edward Kennedy (D-Mass.) and Sen. Barack Obama (D-Ill.) on better oversight for genetic testing in general. And the Agency for Healthcare Research and Quality recently called for improvements to public health surveillance databases and health information technology used to monitor the tests.

Potential discrimination in life insurance and disability insurance also must be addressed in the future, Ms. Terry said. “This is a first-step bill for sure.”

Federal officials are urging physicians to begin electronic prescribing as soon as possible now that Congress has authorized bonus payments for use of the technology.

Under the recently enacted Medicare Improvements for Patients and Providers Act (H.R. 6331)—the same law that eliminated the 10.6% Medicare physician pay cut—Congress also outlined plans to ramp up e-prescribing beginning next year. Under the law, bonus payments will gradually decrease and eventually physicians will be penalized if they don't transmit prescriptions electronically.

“We expect this will have a profound effect on the adoption and use of e-prescribing,” Health and Human Services Secretary Mike Leavitt said during a press conference to explain the details of the new initiative.

The widespread use of e-prescribing will create benefits for patients and the health system as a whole by allowing for real-time cross-checking for drug-drug interactions and providing automatic error screening of prescriptions, Mr. Leavitt said.

Medicare could also save up to $156 million over a 5-year period by avoiding adverse drug events, according to the Centers for Medicare and Medicaid Services.

The incentive payments will be awarded through the Physician Quality Reporting Initiative, Medicare's voluntary program that provides incentives to physicians who successfully report on certain quality measures. CMS officials have developed measures specific to e-prescribing and will be releasing guidance on how they define the routine use of e-prescribing. They also plan to host a conference on the technical details of the plan this fall.

The e-prescribing bonuses will be in addition to the current bonuses.

During 2009 and 2010, physicians who successfully report on e-prescribing measures will be eligible to earn 2% of total allowed Medicare charges. In 2011 and 2012, the incentive payment will drop to 1% and then to 0.5% in 2013.

Beginning in 2012, eligible physicians who do not e-prescribe will see their total allowed Medicare charges cut by 1% with that amount increasing to 2% by 2014, according to the provisions of H.R. 6331.

The law grants an exemption for those providers for whom the requirement would be a “significant hardship,” such as a physician practicing in a rural area without sufficient Internet access.

CMS officials already have laid the groundwork for the increased use of e-prescribing by issuing standards around the transmission of electronic prescriptions, Mr. Leavitt said. With the authorization of bonus payments, the government will be able ease some of the costs of adopting e-prescribing technology.

According to CMS estimates, the average the cost of acquiring and setting up an e-prescribing system is about $3,000 per prescriber, with ongoing maintenance costs of $80-$400 per month.

Dr. James King, a family physician in Selmer, Tenn., and president of the American Academy of Family Physicians, estimated that he spent about $10,000 to implement an e-prescribing system in his practice. But, even with the technology in place, he is able to e-prescribe only some of the time. For example, not all pharmacies in his area are able to receive electronic prescriptions, he can't prescribe some narcotic drugs electronically, and he cannot prescribe medications electronically across state lines for his patients who live in Mississippi.

That's why Dr. King said he is pleased that Congress chose to proceed first with payment incentives, so policy makers have time to remove some of these barriers.

He urged physicians to adopt the technology. In addition to improving quality and safety for patients, it allows the physicians to engage in more “two-way communication,” he said. For example, e-prescriptions generally allow physicians access to information about whether the patient has filled the prescription. And e-prescribing should improve efficiency, allowing physicians to devote more time to patient care, he said.

A significant number of family physicians are likely to be ready to begin e-prescribing in January, Dr. King said. The AAFP estimates that about half of their members either have electronic health records (EHRs) with e-prescribing capabilities or plan to implement them by the end of the year.

By 2012, eligible physicians who do not e-prescribe will see their total allowed Medicare charges reduced by 1%. MR. LEAVITT

Federal officials are urging physicians to begin electronic prescribing as soon as possible now that Congress has authorized bonus payments for use of the technology.

Under the recently enacted Medicare Improvements for Patients and Providers Act (H.R. 6331)—the same law that eliminated the 10.6% Medicare physician pay cut—Congress also outlined plans to ramp up e-prescribing beginning next year. Under the law, bonus payments will gradually decrease and eventually physicians will be penalized if they don't transmit prescriptions electronically.

“We expect this will have a profound effect on the adoption and use of e-prescribing,” Health and Human Services Secretary Mike Leavitt said during a press conference to explain the details of the new initiative.

The widespread use of e-prescribing will create benefits for patients and the health system as a whole by allowing for real-time cross-checking for drug-drug interactions and providing automatic error screening of prescriptions, Mr. Leavitt said.

Medicare could also save up to $156 million over a 5-year period by avoiding adverse drug events, according to the Centers for Medicare and Medicaid Services.

The incentive payments will be awarded through the Physician Quality Reporting Initiative, Medicare's voluntary program that provides incentives to physicians who successfully report on certain quality measures. CMS officials have developed measures specific to e-prescribing and will be releasing guidance on how they define the routine use of e-prescribing. They also plan to host a conference on the technical details of the plan this fall.

The e-prescribing bonuses will be in addition to the current bonuses.

During 2009 and 2010, physicians who successfully report on e-prescribing measures will be eligible to earn 2% of total allowed Medicare charges. In 2011 and 2012, the incentive payment will drop to 1% and then to 0.5% in 2013.

Beginning in 2012, eligible physicians who do not e-prescribe will see their total allowed Medicare charges cut by 1% with that amount increasing to 2% by 2014, according to the provisions of H.R. 6331.

The law grants an exemption for those providers for whom the requirement would be a “significant hardship,” such as a physician practicing in a rural area without sufficient Internet access.

CMS officials already have laid the groundwork for the increased use of e-prescribing by issuing standards around the transmission of electronic prescriptions, Mr. Leavitt said. With the authorization of bonus payments, the government will be able ease some of the costs of adopting e-prescribing technology.

According to CMS estimates, the average the cost of acquiring and setting up an e-prescribing system is about $3,000 per prescriber, with ongoing maintenance costs of $80-$400 per month.

Dr. James King, a family physician in Selmer, Tenn., and president of the American Academy of Family Physicians, estimated that he spent about $10,000 to implement an e-prescribing system in his practice. But, even with the technology in place, he is able to e-prescribe only some of the time. For example, not all pharmacies in his area are able to receive electronic prescriptions, he can't prescribe some narcotic drugs electronically, and he cannot prescribe medications electronically across state lines for his patients who live in Mississippi.

That's why Dr. King said he is pleased that Congress chose to proceed first with payment incentives, so policy makers have time to remove some of these barriers.

He urged physicians to adopt the technology. In addition to improving quality and safety for patients, it allows the physicians to engage in more “two-way communication,” he said. For example, e-prescriptions generally allow physicians access to information about whether the patient has filled the prescription. And e-prescribing should improve efficiency, allowing physicians to devote more time to patient care, he said.

A significant number of family physicians are likely to be ready to begin e-prescribing in January, Dr. King said. The AAFP estimates that about half of their members either have electronic health records (EHRs) with e-prescribing capabilities or plan to implement them by the end of the year.

By 2012, eligible physicians who do not e-prescribe will see their total allowed Medicare charges reduced by 1%. MR. LEAVITT

Federal officials are urging physicians to begin electronic prescribing as soon as possible now that Congress has authorized bonus payments for use of the technology.

Under the recently enacted Medicare Improvements for Patients and Providers Act (H.R. 6331)—the same law that eliminated the 10.6% Medicare physician pay cut—Congress also outlined plans to ramp up e-prescribing beginning next year. Under the law, bonus payments will gradually decrease and eventually physicians will be penalized if they don't transmit prescriptions electronically.

“We expect this will have a profound effect on the adoption and use of e-prescribing,” Health and Human Services Secretary Mike Leavitt said during a press conference to explain the details of the new initiative.

The widespread use of e-prescribing will create benefits for patients and the health system as a whole by allowing for real-time cross-checking for drug-drug interactions and providing automatic error screening of prescriptions, Mr. Leavitt said.

Medicare could also save up to $156 million over a 5-year period by avoiding adverse drug events, according to the Centers for Medicare and Medicaid Services.

The incentive payments will be awarded through the Physician Quality Reporting Initiative, Medicare's voluntary program that provides incentives to physicians who successfully report on certain quality measures. CMS officials have developed measures specific to e-prescribing and will be releasing guidance on how they define the routine use of e-prescribing. They also plan to host a conference on the technical details of the plan this fall.

The e-prescribing bonuses will be in addition to the current bonuses.

During 2009 and 2010, physicians who successfully report on e-prescribing measures will be eligible to earn 2% of total allowed Medicare charges. In 2011 and 2012, the incentive payment will drop to 1% and then to 0.5% in 2013.

Beginning in 2012, eligible physicians who do not e-prescribe will see their total allowed Medicare charges cut by 1% with that amount increasing to 2% by 2014, according to the provisions of H.R. 6331.

The law grants an exemption for those providers for whom the requirement would be a “significant hardship,” such as a physician practicing in a rural area without sufficient Internet access.

CMS officials already have laid the groundwork for the increased use of e-prescribing by issuing standards around the transmission of electronic prescriptions, Mr. Leavitt said. With the authorization of bonus payments, the government will be able ease some of the costs of adopting e-prescribing technology.

According to CMS estimates, the average the cost of acquiring and setting up an e-prescribing system is about $3,000 per prescriber, with ongoing maintenance costs of $80-$400 per month.

Dr. James King, a family physician in Selmer, Tenn., and president of the American Academy of Family Physicians, estimated that he spent about $10,000 to implement an e-prescribing system in his practice. But, even with the technology in place, he is able to e-prescribe only some of the time. For example, not all pharmacies in his area are able to receive electronic prescriptions, he can't prescribe some narcotic drugs electronically, and he cannot prescribe medications electronically across state lines for his patients who live in Mississippi.

That's why Dr. King said he is pleased that Congress chose to proceed first with payment incentives, so policy makers have time to remove some of these barriers.

He urged physicians to adopt the technology. In addition to improving quality and safety for patients, it allows the physicians to engage in more “two-way communication,” he said. For example, e-prescriptions generally allow physicians access to information about whether the patient has filled the prescription. And e-prescribing should improve efficiency, allowing physicians to devote more time to patient care, he said.

A significant number of family physicians are likely to be ready to begin e-prescribing in January, Dr. King said. The AAFP estimates that about half of their members either have electronic health records (EHRs) with e-prescribing capabilities or plan to implement them by the end of the year.

By 2012, eligible physicians who do not e-prescribe will see their total allowed Medicare charges reduced by 1%. MR. LEAVITT

Starting Oct. 1, Medicare won't pay for a total of 11 preventable conditions acquired during a hospital stay, up from the current 8 such conditions.

Added to the list of noncovered preventable conditions are surgical site infections following certain elective procedures, such as orthopedic surgeries and bariatric surgery for obesity; manifestations of poor glycemic control; deep vein thrombosis or pulmonary embolism following certain orthopedic surgeries, such as total knee replacement and hip replacement. (See box for current list of preventable conditions.)

The new conditions were included in the Acute Care Hospital Inpatient Prospective Payment final rule, which is slated to be published in the Federal Register on Aug. 19 and released earlier on the Centers for Medicare and Medicaid Services' Web site.

The expansion of the preventable conditions list was criticized by the American Medical Association for putting patient care at risk. The AMA said that Medicare officials are lumping together true “never” events such as wrong-site surgery with “often unavoidable” conditions such as surgical site infections.

“Focusing on determining whether or not medical conditions exist when the patient enters the hospital will increase Medicare spending on tests and screenings with questionable benefit to patients,” Dr. J. James Rohack, AMA president-elect, said in a statement. “A more effective patient safety approach would be to encourage compliance with evidence-based guidelines by health care professionals.”

Officials at CMS estimate that the nonpayment for preventable errors policy will save Medicare about $20 million a year. However, the policy is not about saving money, Kerry Weems, CMS acting administrator, said during a press conference.

“I would be perfectly happy if we never came to a point where we didn't have to pay because somebody got a hospital-acquired condition,” Mr. Weems said. “This is about changing hospitals and making them safer places.”

CMS had proposed adding nine new conditions to the preventable conditions nonpayment list. Agency officials pared down the list after public comments raised questioned about including the other conditions. Some conditions that were not included in the final rule are delirium, ventilator-associated pneumonia, Staphylococcus aureus septicemia, Clostridium difficile-associated disease, legionnaires' disease, and iatrogenic pneumothorax.

However, those conditions may appear in future proposals once the agency has refined them, according to Mr. Weems.

The CMS also is in talks with the National Quality Forum, the Agency for Healthcare Research and Quality, the Leapfrog Group for Patient Safety, and others about expanding the list of never events and considering how to expand the nonpayment policy to nonhospital settings such as nursing homes and home health agencies.

In addition to the expansion of the conditions on the preventable hospital-acquired conditions list, CMS is also beginning to develop three National Coverage Determinations to deny Medicare coverage for three never events—surgery on the wrong body part, surgery on the wrong patient, and wrong surgery performed on a patient. “These national coverage decisions will mandate what seems obvious—never events should never occur,” Mr. Weems said. “They should not be reimbursed by the Medicare trust fund.”

A proposed decision memorandum on these surgical errors is scheduled to be issued by next February and is expected to be made final by the end of next April.

Including these events in Medicare's coverage policy also would apply to Medicare Advantage plans. Medicare Advantage plans are required to follow all Medicare fee-for-service coverage policies, even when those policies differ from their commercial practices, according to the CMS.

The CMS also sent a letter to state Medicaid directors to encourage states to adopt similar policies on payment for preventable hospital-acquired conditions. The letter also provides information on how states can adopt the policies outlined in the final Medicare inpatient prospective payment system regulation. Nearly 20 states are considering methods to eliminate payment for certain never events, or already have them in place, according to the CMS.

Finally, as part of the Acute Care Inpatient Prospective Payment System final rule, the CMS is adding 13 new measures to the Reporting Hospital Quality Data for Annual Payment Update program. Under the program, hospitals are required to report quality data publicly on the Medicare Hospital Compare Web site in order to receive their full payment update.

Never Events' Number 8 for Now

Medicare currently lists eight preventable health care-acquired conditions under its nonpayment policy and will not reimburse hospitals for secondary diagnoses associated with the following eight conditions if acquired after hospital admission:

▸ Foreign object retained after surgery.

▸ Air embolism.

▸ Blood incompatibility.

▸ Pressure ulcer at stages III and IV.

▸ Falls and trauma.

▸ Catheter-associated urinary tract infection.

▸ Vascular catheter-associated infection.

▸ Mediastinitis after coronary artery bypass graft.

Starting Oct. 1, Medicare won't pay for a total of 11 preventable conditions acquired during a hospital stay, up from the current 8 such conditions.

Added to the list of noncovered preventable conditions are surgical site infections following certain elective procedures, such as orthopedic surgeries and bariatric surgery for obesity; manifestations of poor glycemic control; deep vein thrombosis or pulmonary embolism following certain orthopedic surgeries, such as total knee replacement and hip replacement. (See box for current list of preventable conditions.)

The new conditions were included in the Acute Care Hospital Inpatient Prospective Payment final rule, which is slated to be published in the Federal Register on Aug. 19 and released earlier on the Centers for Medicare and Medicaid Services' Web site.

The expansion of the preventable conditions list was criticized by the American Medical Association for putting patient care at risk. The AMA said that Medicare officials are lumping together true “never” events such as wrong-site surgery with “often unavoidable” conditions such as surgical site infections.

“Focusing on determining whether or not medical conditions exist when the patient enters the hospital will increase Medicare spending on tests and screenings with questionable benefit to patients,” Dr. J. James Rohack, AMA president-elect, said in a statement. “A more effective patient safety approach would be to encourage compliance with evidence-based guidelines by health care professionals.”

Officials at CMS estimate that the nonpayment for preventable errors policy will save Medicare about $20 million a year. However, the policy is not about saving money, Kerry Weems, CMS acting administrator, said during a press conference.

“I would be perfectly happy if we never came to a point where we didn't have to pay because somebody got a hospital-acquired condition,” Mr. Weems said. “This is about changing hospitals and making them safer places.”

CMS had proposed adding nine new conditions to the preventable conditions nonpayment list. Agency officials pared down the list after public comments raised questioned about including the other conditions. Some conditions that were not included in the final rule are delirium, ventilator-associated pneumonia, Staphylococcus aureus septicemia, Clostridium difficile-associated disease, legionnaires' disease, and iatrogenic pneumothorax.

However, those conditions may appear in future proposals once the agency has refined them, according to Mr. Weems.

The CMS also is in talks with the National Quality Forum, the Agency for Healthcare Research and Quality, the Leapfrog Group for Patient Safety, and others about expanding the list of never events and considering how to expand the nonpayment policy to nonhospital settings such as nursing homes and home health agencies.

In addition to the expansion of the conditions on the preventable hospital-acquired conditions list, CMS is also beginning to develop three National Coverage Determinations to deny Medicare coverage for three never events—surgery on the wrong body part, surgery on the wrong patient, and wrong surgery performed on a patient. “These national coverage decisions will mandate what seems obvious—never events should never occur,” Mr. Weems said. “They should not be reimbursed by the Medicare trust fund.”

A proposed decision memorandum on these surgical errors is scheduled to be issued by next February and is expected to be made final by the end of next April.

Including these events in Medicare's coverage policy also would apply to Medicare Advantage plans. Medicare Advantage plans are required to follow all Medicare fee-for-service coverage policies, even when those policies differ from their commercial practices, according to the CMS.

The CMS also sent a letter to state Medicaid directors to encourage states to adopt similar policies on payment for preventable hospital-acquired conditions. The letter also provides information on how states can adopt the policies outlined in the final Medicare inpatient prospective payment system regulation. Nearly 20 states are considering methods to eliminate payment for certain never events, or already have them in place, according to the CMS.

Finally, as part of the Acute Care Inpatient Prospective Payment System final rule, the CMS is adding 13 new measures to the Reporting Hospital Quality Data for Annual Payment Update program. Under the program, hospitals are required to report quality data publicly on the Medicare Hospital Compare Web site in order to receive their full payment update.

Never Events' Number 8 for Now

Medicare currently lists eight preventable health care-acquired conditions under its nonpayment policy and will not reimburse hospitals for secondary diagnoses associated with the following eight conditions if acquired after hospital admission:

▸ Foreign object retained after surgery.

▸ Air embolism.

▸ Blood incompatibility.

▸ Pressure ulcer at stages III and IV.

▸ Falls and trauma.

▸ Catheter-associated urinary tract infection.

▸ Vascular catheter-associated infection.

▸ Mediastinitis after coronary artery bypass graft.

Starting Oct. 1, Medicare won't pay for a total of 11 preventable conditions acquired during a hospital stay, up from the current 8 such conditions.

Added to the list of noncovered preventable conditions are surgical site infections following certain elective procedures, such as orthopedic surgeries and bariatric surgery for obesity; manifestations of poor glycemic control; deep vein thrombosis or pulmonary embolism following certain orthopedic surgeries, such as total knee replacement and hip replacement. (See box for current list of preventable conditions.)

The new conditions were included in the Acute Care Hospital Inpatient Prospective Payment final rule, which is slated to be published in the Federal Register on Aug. 19 and released earlier on the Centers for Medicare and Medicaid Services' Web site.

The expansion of the preventable conditions list was criticized by the American Medical Association for putting patient care at risk. The AMA said that Medicare officials are lumping together true “never” events such as wrong-site surgery with “often unavoidable” conditions such as surgical site infections.

“Focusing on determining whether or not medical conditions exist when the patient enters the hospital will increase Medicare spending on tests and screenings with questionable benefit to patients,” Dr. J. James Rohack, AMA president-elect, said in a statement. “A more effective patient safety approach would be to encourage compliance with evidence-based guidelines by health care professionals.”

Officials at CMS estimate that the nonpayment for preventable errors policy will save Medicare about $20 million a year. However, the policy is not about saving money, Kerry Weems, CMS acting administrator, said during a press conference.

“I would be perfectly happy if we never came to a point where we didn't have to pay because somebody got a hospital-acquired condition,” Mr. Weems said. “This is about changing hospitals and making them safer places.”

CMS had proposed adding nine new conditions to the preventable conditions nonpayment list. Agency officials pared down the list after public comments raised questioned about including the other conditions. Some conditions that were not included in the final rule are delirium, ventilator-associated pneumonia, Staphylococcus aureus septicemia, Clostridium difficile-associated disease, legionnaires' disease, and iatrogenic pneumothorax.

However, those conditions may appear in future proposals once the agency has refined them, according to Mr. Weems.

The CMS also is in talks with the National Quality Forum, the Agency for Healthcare Research and Quality, the Leapfrog Group for Patient Safety, and others about expanding the list of never events and considering how to expand the nonpayment policy to nonhospital settings such as nursing homes and home health agencies.

In addition to the expansion of the conditions on the preventable hospital-acquired conditions list, CMS is also beginning to develop three National Coverage Determinations to deny Medicare coverage for three never events—surgery on the wrong body part, surgery on the wrong patient, and wrong surgery performed on a patient. “These national coverage decisions will mandate what seems obvious—never events should never occur,” Mr. Weems said. “They should not be reimbursed by the Medicare trust fund.”

A proposed decision memorandum on these surgical errors is scheduled to be issued by next February and is expected to be made final by the end of next April.

Including these events in Medicare's coverage policy also would apply to Medicare Advantage plans. Medicare Advantage plans are required to follow all Medicare fee-for-service coverage policies, even when those policies differ from their commercial practices, according to the CMS.

The CMS also sent a letter to state Medicaid directors to encourage states to adopt similar policies on payment for preventable hospital-acquired conditions. The letter also provides information on how states can adopt the policies outlined in the final Medicare inpatient prospective payment system regulation. Nearly 20 states are considering methods to eliminate payment for certain never events, or already have them in place, according to the CMS.

Finally, as part of the Acute Care Inpatient Prospective Payment System final rule, the CMS is adding 13 new measures to the Reporting Hospital Quality Data for Annual Payment Update program. Under the program, hospitals are required to report quality data publicly on the Medicare Hospital Compare Web site in order to receive their full payment update.

Never Events' Number 8 for Now

Medicare currently lists eight preventable health care-acquired conditions under its nonpayment policy and will not reimburse hospitals for secondary diagnoses associated with the following eight conditions if acquired after hospital admission:

▸ Foreign object retained after surgery.

▸ Air embolism.

▸ Blood incompatibility.

▸ Pressure ulcer at stages III and IV.

▸ Falls and trauma.

▸ Catheter-associated urinary tract infection.

▸ Vascular catheter-associated infection.

▸ Mediastinitis after coronary artery bypass graft.

African American physicians are looking for action to back up the words of apology recently tendered by the American Medical Association for more than a century of racial inequity and bias.

In accepting the AMA's apology, the National Medical Association (NMA), which represents minority physicians, urged the AMA leadership to work with them on three initiatives: recruiting more African American physicians, reducing health disparities among minorities, and requiring medical schools and licensing boards to make cultural competency mandatory for medical students, residents, and practicing physicians.

“We really want to use this apology as a springboard,” said Dr. Nedra H. Joyner, chair of the NMA board of trustees and an otolaryngologist in Chicago. “Talk is cheap,” said Dr. Carl Bell, professor of public health and psychiatry at the University of Illinois at Chicago. He said that while he is hopeful that the AMA will take some meaningful action to reduce health disparities, he is unimpressed by the apology alone. Instead, he would like the AMA take a stand on issues that would advance minority health in the United States. For example, he said that he wants to see the AMA push for single-payer national health insurance, be stronger in challenging the pharmaceutical industry, do a better job of promoting public health, and support research into minority health and mental health issues.

Dr. Warren A. Jones, the first African American president of the American Academy of Family Physicians, agreed that further action will be needed but called the AMA's apology “appropriate” and “timely.” This is not an apology of convenience, he said, but a signal of a change in the mind-set of the AMA leadership.

The AMA has an opportunity to ensure that cultural competency is a tool in the medical armamentarium in the same way as the stethoscope, he said. “Now is the time for the AMA to put its resources where its mouth is,” said Dr. Jones, executive director of the Mississippi Institute for Improvement of Geographic Minority Health.

The AMA offered the apology to coincide with the release of a historic paper in its flagship journal that examined race relations in organized medicine (JAMA 2008;300:306-13). The paper, which chronicles the origins of the racial divide in AMA history, was prepared by an independent panel of experts convened by the AMA in 2005. The panel reviewed archives of the AMA, the NMA, and newspapers from the time to provide a history from the founding of the AMA through the civil rights movement.

The paper notes a number of instances where the AMA leadership fostered racial segregation and bias. For example, in 1874 the AMA began restricting delegations to the organization's national convention to state and local medical societies. This move effectively excluded most African American physicians because many medical societies, especially those in the South, openly refused membership to them. Later, in the 1960s, the AMA rejected the idea of excluding medical societies with discriminatory practices.

During the civil rights era, the AMA was seen as obstructing the civil rights agenda, the paper noted. In 1961, the AMA refused to defend eight African American physicians who were arrested after asking to be served at a medical society luncheon in Atlanta.

In its review, the independent panel applauded AMA for its willingness to explore its history. But the researchers also noted that the legacy of inequality continues to negatively affect African American physicians and patients. For example, in 2006, African Americans made up 2.2% of physicians and medical students, less than in 1910, when 2.5% were African American.

In a commentary to accompany the history, Dr. Ronald M. Davis, immediate past president of the AMA, acknowledged the “stain left by a legacy of discrimination” and outlined what AMA is doing to eliminate prejudice within the organization and improve the health of minority patients (JAMA 2008;300:323-5).

Dr. Davis said that the AMA leadership felt it was important to offer the apology because it demonstrates the “current moral orientation of the organization” and lays down a marker to compare current and future actions.

Within the organization, AMA has in place a number of policies that explicitly prohibit discrimination in membership and support funding for “pipeline” programs to engage minority individuals to enter medical school. In addition, in 2004, the AMA joined the NMA and the National Hispanic Medical Association to form the Commission to End Health Care Disparities. That group has been working to expand the “Doctors Back to School” program, which brings minority physicians into schools to encourage students to consider careers in medicine.

The ultimate goal is to have as much diversity among physicians as in the general population, where African Americans make up about 12% of the U.S. population, Dr. Davis said. “Obviously, we have a long way to go.”

The AMA's apology is not an act of convenience but rather the signal of a change in attitude. DR. JONES

African American physicians are looking for action to back up the words of apology recently tendered by the American Medical Association for more than a century of racial inequity and bias.

In accepting the AMA's apology, the National Medical Association (NMA), which represents minority physicians, urged the AMA leadership to work with them on three initiatives: recruiting more African American physicians, reducing health disparities among minorities, and requiring medical schools and licensing boards to make cultural competency mandatory for medical students, residents, and practicing physicians.

“We really want to use this apology as a springboard,” said Dr. Nedra H. Joyner, chair of the NMA board of trustees and an otolaryngologist in Chicago. “Talk is cheap,” said Dr. Carl Bell, professor of public health and psychiatry at the University of Illinois at Chicago. He said that while he is hopeful that the AMA will take some meaningful action to reduce health disparities, he is unimpressed by the apology alone. Instead, he would like the AMA take a stand on issues that would advance minority health in the United States. For example, he said that he wants to see the AMA push for single-payer national health insurance, be stronger in challenging the pharmaceutical industry, do a better job of promoting public health, and support research into minority health and mental health issues.

Dr. Warren A. Jones, the first African American president of the American Academy of Family Physicians, agreed that further action will be needed but called the AMA's apology “appropriate” and “timely.” This is not an apology of convenience, he said, but a signal of a change in the mind-set of the AMA leadership.

The AMA has an opportunity to ensure that cultural competency is a tool in the medical armamentarium in the same way as the stethoscope, he said. “Now is the time for the AMA to put its resources where its mouth is,” said Dr. Jones, executive director of the Mississippi Institute for Improvement of Geographic Minority Health.

The AMA offered the apology to coincide with the release of a historic paper in its flagship journal that examined race relations in organized medicine (JAMA 2008;300:306-13). The paper, which chronicles the origins of the racial divide in AMA history, was prepared by an independent panel of experts convened by the AMA in 2005. The panel reviewed archives of the AMA, the NMA, and newspapers from the time to provide a history from the founding of the AMA through the civil rights movement.

The paper notes a number of instances where the AMA leadership fostered racial segregation and bias. For example, in 1874 the AMA began restricting delegations to the organization's national convention to state and local medical societies. This move effectively excluded most African American physicians because many medical societies, especially those in the South, openly refused membership to them. Later, in the 1960s, the AMA rejected the idea of excluding medical societies with discriminatory practices.

During the civil rights era, the AMA was seen as obstructing the civil rights agenda, the paper noted. In 1961, the AMA refused to defend eight African American physicians who were arrested after asking to be served at a medical society luncheon in Atlanta.

In its review, the independent panel applauded AMA for its willingness to explore its history. But the researchers also noted that the legacy of inequality continues to negatively affect African American physicians and patients. For example, in 2006, African Americans made up 2.2% of physicians and medical students, less than in 1910, when 2.5% were African American.

In a commentary to accompany the history, Dr. Ronald M. Davis, immediate past president of the AMA, acknowledged the “stain left by a legacy of discrimination” and outlined what AMA is doing to eliminate prejudice within the organization and improve the health of minority patients (JAMA 2008;300:323-5).

Dr. Davis said that the AMA leadership felt it was important to offer the apology because it demonstrates the “current moral orientation of the organization” and lays down a marker to compare current and future actions.

Within the organization, AMA has in place a number of policies that explicitly prohibit discrimination in membership and support funding for “pipeline” programs to engage minority individuals to enter medical school. In addition, in 2004, the AMA joined the NMA and the National Hispanic Medical Association to form the Commission to End Health Care Disparities. That group has been working to expand the “Doctors Back to School” program, which brings minority physicians into schools to encourage students to consider careers in medicine.

The ultimate goal is to have as much diversity among physicians as in the general population, where African Americans make up about 12% of the U.S. population, Dr. Davis said. “Obviously, we have a long way to go.”

The AMA's apology is not an act of convenience but rather the signal of a change in attitude. DR. JONES

African American physicians are looking for action to back up the words of apology recently tendered by the American Medical Association for more than a century of racial inequity and bias.

In accepting the AMA's apology, the National Medical Association (NMA), which represents minority physicians, urged the AMA leadership to work with them on three initiatives: recruiting more African American physicians, reducing health disparities among minorities, and requiring medical schools and licensing boards to make cultural competency mandatory for medical students, residents, and practicing physicians.

“We really want to use this apology as a springboard,” said Dr. Nedra H. Joyner, chair of the NMA board of trustees and an otolaryngologist in Chicago. “Talk is cheap,” said Dr. Carl Bell, professor of public health and psychiatry at the University of Illinois at Chicago. He said that while he is hopeful that the AMA will take some meaningful action to reduce health disparities, he is unimpressed by the apology alone. Instead, he would like the AMA take a stand on issues that would advance minority health in the United States. For example, he said that he wants to see the AMA push for single-payer national health insurance, be stronger in challenging the pharmaceutical industry, do a better job of promoting public health, and support research into minority health and mental health issues.

Dr. Warren A. Jones, the first African American president of the American Academy of Family Physicians, agreed that further action will be needed but called the AMA's apology “appropriate” and “timely.” This is not an apology of convenience, he said, but a signal of a change in the mind-set of the AMA leadership.

The AMA has an opportunity to ensure that cultural competency is a tool in the medical armamentarium in the same way as the stethoscope, he said. “Now is the time for the AMA to put its resources where its mouth is,” said Dr. Jones, executive director of the Mississippi Institute for Improvement of Geographic Minority Health.

The AMA offered the apology to coincide with the release of a historic paper in its flagship journal that examined race relations in organized medicine (JAMA 2008;300:306-13). The paper, which chronicles the origins of the racial divide in AMA history, was prepared by an independent panel of experts convened by the AMA in 2005. The panel reviewed archives of the AMA, the NMA, and newspapers from the time to provide a history from the founding of the AMA through the civil rights movement.

The paper notes a number of instances where the AMA leadership fostered racial segregation and bias. For example, in 1874 the AMA began restricting delegations to the organization's national convention to state and local medical societies. This move effectively excluded most African American physicians because many medical societies, especially those in the South, openly refused membership to them. Later, in the 1960s, the AMA rejected the idea of excluding medical societies with discriminatory practices.

During the civil rights era, the AMA was seen as obstructing the civil rights agenda, the paper noted. In 1961, the AMA refused to defend eight African American physicians who were arrested after asking to be served at a medical society luncheon in Atlanta.

In its review, the independent panel applauded AMA for its willingness to explore its history. But the researchers also noted that the legacy of inequality continues to negatively affect African American physicians and patients. For example, in 2006, African Americans made up 2.2% of physicians and medical students, less than in 1910, when 2.5% were African American.

In a commentary to accompany the history, Dr. Ronald M. Davis, immediate past president of the AMA, acknowledged the “stain left by a legacy of discrimination” and outlined what AMA is doing to eliminate prejudice within the organization and improve the health of minority patients (JAMA 2008;300:323-5).

Dr. Davis said that the AMA leadership felt it was important to offer the apology because it demonstrates the “current moral orientation of the organization” and lays down a marker to compare current and future actions.

Within the organization, AMA has in place a number of policies that explicitly prohibit discrimination in membership and support funding for “pipeline” programs to engage minority individuals to enter medical school. In addition, in 2004, the AMA joined the NMA and the National Hispanic Medical Association to form the Commission to End Health Care Disparities. That group has been working to expand the “Doctors Back to School” program, which brings minority physicians into schools to encourage students to consider careers in medicine.

The ultimate goal is to have as much diversity among physicians as in the general population, where African Americans make up about 12% of the U.S. population, Dr. Davis said. “Obviously, we have a long way to go.”

The AMA's apology is not an act of convenience but rather the signal of a change in attitude. DR. JONES

About 17% of U.S. physicians have electronic health records in their offices, but only 4% of those doctors have comprehensive systems, according to a survey of more than 2,700 physicians nationwide.

More physicians plan to purchase or implement the technology soon. For example, of the 83% of physicians without an EHR, 16% reported that their practice had purchased a system that had yet to be implemented. And 26% said that their practice was planning to purchase an EHR system in the next 2 years, according to a survey (N. Engl. J. Med. 2008;359:50-60).

“If these intentions are realized, we could see a good-sized increase in the number of physicians with an EHR over the next 3-5 years,” Catherine DesRoches, Ph.D., the lead author of the study, said during a briefing to release the survey results. Dr. DesRoches is an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston.

The nationally representative survey was conducted between September 2007 and March 2008 by researchers at the Massachusetts General Hospital, Cornell University, and the George Washington University. The study was funded by the Office of the National Coordinator for Health Information Technology, part of the Health and Human Services department, and the Robert Wood Johnson Foundation. Some of the researchers reported receiving grant support from GE Healthcare, which markets EHRs.

The Office of the National Coordinator for Health Information Technology commissioned the survey to provide a definitive national estimate of EHR adoption by physicians in the United States.

The researchers randomly selected 4,484 eligible physicians from the American Medical Association's 2007 Physician Masterfile, of which 2,758 completed the survey. The survey found that 4% of physicians have a fully functional EHR. The researchers defined a fully functional EHR as one that includes the ability to write and send orders electronically, the ability to view lab results and images, and the ability to provide clinical decision support and reminders. In addition, about 13% of physicians reported having a basic EHR, which has electronic prescribing but lacks clinical decision support and certain order entry capabilities.

Physicians were more likely to report having a fully functional system if it was integrated with their hospital system, the survey found. In addition, adoption was more likely among physicians who practiced in large groups (at least 50 physicians) than among those who practiced in groups of 3 physicians or fewer.

About 93% of physicians who have implemented fully functional EHRs reported being satisfied with their systems, along with 88% of physicians with basic systems.

Capital costs were cited as barriers by 66% of physicians without an EHR. Other barriers noted by physicians without an EHR include finding a system that meets their needs (54%), concerns about the return on investment (50%), and worries that the system will become obsolete (44%).

But adoption could be improved by helping physicians purchase EHRs with loans or direct payments, and offering additional payment for the use of a system, according to the survey. “We're not surprised by that, given their worries about the cost of the system,” Dr. DesRoches said, noting: “This suggests that we might be able to significantly increase the rate of adoption by easing the financial burden on office-based providers. I think this is particularly true for providers in smaller one- and two-physician practices.”

These types of incentives will be critical to increasing adoption, said Dr. Richard J. Baron, an internist in a five-physician community-based practice in Philadelphia that implemented an EHR in July 2004. While the use of the EHR has changed his practice for the better, Dr. Baron said the process of implementing the system was both disruptive and costly.

Not only did the practice spend more than $40,000 per physician to purchase their EHR system but they are also spending $60,000 annually for technical support. The practice also experienced a 2.5% absolute decrease in revenue in the year they implemented the system, said Dr. Baron, who recently became chair of the American Board of Internal Medicine.

About 17% of U.S. physicians have electronic health records in their offices, but only 4% of those doctors have comprehensive systems, according to a survey of more than 2,700 physicians nationwide.

More physicians plan to purchase or implement the technology soon. For example, of the 83% of physicians without an EHR, 16% reported that their practice had purchased a system that had yet to be implemented. And 26% said that their practice was planning to purchase an EHR system in the next 2 years, according to a survey (N. Engl. J. Med. 2008;359:50-60).

“If these intentions are realized, we could see a good-sized increase in the number of physicians with an EHR over the next 3-5 years,” Catherine DesRoches, Ph.D., the lead author of the study, said during a briefing to release the survey results. Dr. DesRoches is an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston.

The nationally representative survey was conducted between September 2007 and March 2008 by researchers at the Massachusetts General Hospital, Cornell University, and the George Washington University. The study was funded by the Office of the National Coordinator for Health Information Technology, part of the Health and Human Services department, and the Robert Wood Johnson Foundation. Some of the researchers reported receiving grant support from GE Healthcare, which markets EHRs.

The Office of the National Coordinator for Health Information Technology commissioned the survey to provide a definitive national estimate of EHR adoption by physicians in the United States.

The researchers randomly selected 4,484 eligible physicians from the American Medical Association's 2007 Physician Masterfile, of which 2,758 completed the survey. The survey found that 4% of physicians have a fully functional EHR. The researchers defined a fully functional EHR as one that includes the ability to write and send orders electronically, the ability to view lab results and images, and the ability to provide clinical decision support and reminders. In addition, about 13% of physicians reported having a basic EHR, which has electronic prescribing but lacks clinical decision support and certain order entry capabilities.

Physicians were more likely to report having a fully functional system if it was integrated with their hospital system, the survey found. In addition, adoption was more likely among physicians who practiced in large groups (at least 50 physicians) than among those who practiced in groups of 3 physicians or fewer.

About 93% of physicians who have implemented fully functional EHRs reported being satisfied with their systems, along with 88% of physicians with basic systems.

Capital costs were cited as barriers by 66% of physicians without an EHR. Other barriers noted by physicians without an EHR include finding a system that meets their needs (54%), concerns about the return on investment (50%), and worries that the system will become obsolete (44%).

But adoption could be improved by helping physicians purchase EHRs with loans or direct payments, and offering additional payment for the use of a system, according to the survey. “We're not surprised by that, given their worries about the cost of the system,” Dr. DesRoches said, noting: “This suggests that we might be able to significantly increase the rate of adoption by easing the financial burden on office-based providers. I think this is particularly true for providers in smaller one- and two-physician practices.”

These types of incentives will be critical to increasing adoption, said Dr. Richard J. Baron, an internist in a five-physician community-based practice in Philadelphia that implemented an EHR in July 2004. While the use of the EHR has changed his practice for the better, Dr. Baron said the process of implementing the system was both disruptive and costly.

Not only did the practice spend more than $40,000 per physician to purchase their EHR system but they are also spending $60,000 annually for technical support. The practice also experienced a 2.5% absolute decrease in revenue in the year they implemented the system, said Dr. Baron, who recently became chair of the American Board of Internal Medicine.

About 17% of U.S. physicians have electronic health records in their offices, but only 4% of those doctors have comprehensive systems, according to a survey of more than 2,700 physicians nationwide.

More physicians plan to purchase or implement the technology soon. For example, of the 83% of physicians without an EHR, 16% reported that their practice had purchased a system that had yet to be implemented. And 26% said that their practice was planning to purchase an EHR system in the next 2 years, according to a survey (N. Engl. J. Med. 2008;359:50-60).

“If these intentions are realized, we could see a good-sized increase in the number of physicians with an EHR over the next 3-5 years,” Catherine DesRoches, Ph.D., the lead author of the study, said during a briefing to release the survey results. Dr. DesRoches is an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston.

The nationally representative survey was conducted between September 2007 and March 2008 by researchers at the Massachusetts General Hospital, Cornell University, and the George Washington University. The study was funded by the Office of the National Coordinator for Health Information Technology, part of the Health and Human Services department, and the Robert Wood Johnson Foundation. Some of the researchers reported receiving grant support from GE Healthcare, which markets EHRs.

The Office of the National Coordinator for Health Information Technology commissioned the survey to provide a definitive national estimate of EHR adoption by physicians in the United States.

The researchers randomly selected 4,484 eligible physicians from the American Medical Association's 2007 Physician Masterfile, of which 2,758 completed the survey. The survey found that 4% of physicians have a fully functional EHR. The researchers defined a fully functional EHR as one that includes the ability to write and send orders electronically, the ability to view lab results and images, and the ability to provide clinical decision support and reminders. In addition, about 13% of physicians reported having a basic EHR, which has electronic prescribing but lacks clinical decision support and certain order entry capabilities.

Physicians were more likely to report having a fully functional system if it was integrated with their hospital system, the survey found. In addition, adoption was more likely among physicians who practiced in large groups (at least 50 physicians) than among those who practiced in groups of 3 physicians or fewer.

About 93% of physicians who have implemented fully functional EHRs reported being satisfied with their systems, along with 88% of physicians with basic systems.

Capital costs were cited as barriers by 66% of physicians without an EHR. Other barriers noted by physicians without an EHR include finding a system that meets their needs (54%), concerns about the return on investment (50%), and worries that the system will become obsolete (44%).

But adoption could be improved by helping physicians purchase EHRs with loans or direct payments, and offering additional payment for the use of a system, according to the survey. “We're not surprised by that, given their worries about the cost of the system,” Dr. DesRoches said, noting: “This suggests that we might be able to significantly increase the rate of adoption by easing the financial burden on office-based providers. I think this is particularly true for providers in smaller one- and two-physician practices.”

These types of incentives will be critical to increasing adoption, said Dr. Richard J. Baron, an internist in a five-physician community-based practice in Philadelphia that implemented an EHR in July 2004. While the use of the EHR has changed his practice for the better, Dr. Baron said the process of implementing the system was both disruptive and costly.

Not only did the practice spend more than $40,000 per physician to purchase their EHR system but they are also spending $60,000 annually for technical support. The practice also experienced a 2.5% absolute decrease in revenue in the year they implemented the system, said Dr. Baron, who recently became chair of the American Board of Internal Medicine.

Musculoskeletal Disease Legislation

With an eye to the aging population, members of Congress are seeking to raise awareness of musculoskeletal diseases. Rep. Hilda L. Solis (D-Calif.) and Rep. Michael C. Burgess (R-Tex.), both members of the House Energy and Commerce Committee's subcommittee on health, recently introduced the “Access to America's Orthopedic Services Act of 2008.” The bill (H.R. 6478) would direct the U.S. Department of Health and Human Services to conduct public education campaigns on musculoskeletal health and require data collection on the level of musculoskeletal research funding and the number of new investigators entering the musculoskeletal research field. The bill also would direct the Agency for Healthcare Research and Quality to issue recommendations for a cost-effective method to measure bone density. “The burden of musculoskeletal diseases and conditions has a much deeper impact on the nation's health care system than many realize,” Dr. David A. Halsey, chair of the council on advocacy for the American Association of Orthopaedic Surgeons, said in a statement. “In order to fully address this impact and ensure America's access to orthopedic services, we must first identify and address gaps in musculoskeletal health services and raise awareness about the importance of educating the public on these debilitating diseases.”

Follow-On Biologics May Be a Deal

Establishing an abbreviated regulatory pathway for approval of follow-on biologic drugs could reduce total national spending on biologics by $25 billion or 0.5% over the next 10 years, according to a Congressional Budget Office (CBO) estimate based on provisions proposed as part of the “Biologics Price Competition and Innovation Act of 2007” (S. 1695), which is currently pending in Congress. The legislation would authorize the Food and Drug Administration to create a special process for approval of biologic drugs that are highly similar to or interchangeable with already licensed products. Under the bill, a follow-on biologic would be awarded 1 year of market exclusivity and 12 years of exclusivity for the original biologic product. While the estimate shows savings from the establishment of a follow-on biologic approval process, it is essential to ensure incentives for continued biomedical innovation, according to the Biotechnology Industry Organization. Without incentives for innovation, the follow-on initiative could produce relatively minor savings as a percentage of overall health care spending.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should have received their bonus payments in August. Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, according to the CMS. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry N. Weems, acting administrator, said in a statement. Under PQRI, physicians can earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. More information on the program is available at

www.cms.hhs.gov/PQRI

Pharmacies, PBMs Merge Networks

RxHub, founded in 2001 by the nation's three largest pharmacy benefit managers, and SureScripts, formed the same year by the National Association of Chain Drug Stores and the National Community Pharmacists Association, announced that they will consolidate their operations, forming a single, secure, nationwide network for e-prescriptions and the exchange of health information.

Musculoskeletal Disease Legislation

With an eye to the aging population, members of Congress are seeking to raise awareness of musculoskeletal diseases. Rep. Hilda L. Solis (D-Calif.) and Rep. Michael C. Burgess (R-Tex.), both members of the House Energy and Commerce Committee's subcommittee on health, recently introduced the “Access to America's Orthopedic Services Act of 2008.” The bill (H.R. 6478) would direct the U.S. Department of Health and Human Services to conduct public education campaigns on musculoskeletal health and require data collection on the level of musculoskeletal research funding and the number of new investigators entering the musculoskeletal research field. The bill also would direct the Agency for Healthcare Research and Quality to issue recommendations for a cost-effective method to measure bone density. “The burden of musculoskeletal diseases and conditions has a much deeper impact on the nation's health care system than many realize,” Dr. David A. Halsey, chair of the council on advocacy for the American Association of Orthopaedic Surgeons, said in a statement. “In order to fully address this impact and ensure America's access to orthopedic services, we must first identify and address gaps in musculoskeletal health services and raise awareness about the importance of educating the public on these debilitating diseases.”

Follow-On Biologics May Be a Deal

Establishing an abbreviated regulatory pathway for approval of follow-on biologic drugs could reduce total national spending on biologics by $25 billion or 0.5% over the next 10 years, according to a Congressional Budget Office (CBO) estimate based on provisions proposed as part of the “Biologics Price Competition and Innovation Act of 2007” (S. 1695), which is currently pending in Congress. The legislation would authorize the Food and Drug Administration to create a special process for approval of biologic drugs that are highly similar to or interchangeable with already licensed products. Under the bill, a follow-on biologic would be awarded 1 year of market exclusivity and 12 years of exclusivity for the original biologic product. While the estimate shows savings from the establishment of a follow-on biologic approval process, it is essential to ensure incentives for continued biomedical innovation, according to the Biotechnology Industry Organization. Without incentives for innovation, the follow-on initiative could produce relatively minor savings as a percentage of overall health care spending.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should have received their bonus payments in August. Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, according to the CMS. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry N. Weems, acting administrator, said in a statement. Under PQRI, physicians can earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. More information on the program is available at

www.cms.hhs.gov/PQRI

Pharmacies, PBMs Merge Networks

RxHub, founded in 2001 by the nation's three largest pharmacy benefit managers, and SureScripts, formed the same year by the National Association of Chain Drug Stores and the National Community Pharmacists Association, announced that they will consolidate their operations, forming a single, secure, nationwide network for e-prescriptions and the exchange of health information.

Musculoskeletal Disease Legislation

With an eye to the aging population, members of Congress are seeking to raise awareness of musculoskeletal diseases. Rep. Hilda L. Solis (D-Calif.) and Rep. Michael C. Burgess (R-Tex.), both members of the House Energy and Commerce Committee's subcommittee on health, recently introduced the “Access to America's Orthopedic Services Act of 2008.” The bill (H.R. 6478) would direct the U.S. Department of Health and Human Services to conduct public education campaigns on musculoskeletal health and require data collection on the level of musculoskeletal research funding and the number of new investigators entering the musculoskeletal research field. The bill also would direct the Agency for Healthcare Research and Quality to issue recommendations for a cost-effective method to measure bone density. “The burden of musculoskeletal diseases and conditions has a much deeper impact on the nation's health care system than many realize,” Dr. David A. Halsey, chair of the council on advocacy for the American Association of Orthopaedic Surgeons, said in a statement. “In order to fully address this impact and ensure America's access to orthopedic services, we must first identify and address gaps in musculoskeletal health services and raise awareness about the importance of educating the public on these debilitating diseases.”

Follow-On Biologics May Be a Deal

Establishing an abbreviated regulatory pathway for approval of follow-on biologic drugs could reduce total national spending on biologics by $25 billion or 0.5% over the next 10 years, according to a Congressional Budget Office (CBO) estimate based on provisions proposed as part of the “Biologics Price Competition and Innovation Act of 2007” (S. 1695), which is currently pending in Congress. The legislation would authorize the Food and Drug Administration to create a special process for approval of biologic drugs that are highly similar to or interchangeable with already licensed products. Under the bill, a follow-on biologic would be awarded 1 year of market exclusivity and 12 years of exclusivity for the original biologic product. While the estimate shows savings from the establishment of a follow-on biologic approval process, it is essential to ensure incentives for continued biomedical innovation, according to the Biotechnology Industry Organization. Without incentives for innovation, the follow-on initiative could produce relatively minor savings as a percentage of overall health care spending.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should have received their bonus payments in August. Officials at the Centers for Medicare and Medicaid Services recently announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a physician group practice was more than $4,700. The largest payment to a physician group practice was more than $205,700, according to the CMS. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry N. Weems, acting administrator, said in a statement. Under PQRI, physicians can earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services provided from July to December 2007. In addition to the bonus payments, physicians and other health professionals can also start accessing confidential feedback reports on their performance. More information on the program is available at

www.cms.hhs.gov/PQRI

Pharmacies, PBMs Merge Networks

RxHub, founded in 2001 by the nation's three largest pharmacy benefit managers, and SureScripts, formed the same year by the National Association of Chain Drug Stores and the National Community Pharmacists Association, announced that they will consolidate their operations, forming a single, secure, nationwide network for e-prescriptions and the exchange of health information.