Mary Ellen Schneider

While the Democrats debated the need for individual mandates for health coverage, Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a recent Tampa speech to announce details of his health care proposal. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign. The idea is to reform the marketplace and thus drive down costs overall.

Grace-Marie Turner, a McCain campaign adviser and president of the Galen Institute, which favors free-market approaches to health care, said that Sen. McCain recognizes that the first step to expanding coverage is to make health care more affordable. The cornerstones of that approach include giving consumers more coverage options, paying for wellness and prevention, and getting rid of waste in the system.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States. “We are pretty amazed at how extreme a plan Mr. McCain has staked out,” said Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to purchase coverage in the individual market where coverage is expensive and difficult to obtain. “Our prediction is a race to the bottom,” he said.

And a $5,000 tax credit wouldn't be enough to cover the cost of family coverage, which the Kaiser Family Foundation estimates costs on average nearly $12,000, Mr. Hickey said.

It's hard to predict exactly what would happen with employer-based coverage under this proposal, said Sara R. Collins, Ph.D., assistant vice president for the Program on the Future of Health Insurance at the Commonwealth Fund. The question is whether individuals who currently have comprehensive coverage through their employer would end up underinsured after moving into the individual market.

The proposal is raising some concerns among physicians. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal, saying that taking away the employee tax exclusion would “undoubtedly” cause a shift to individual coverage and force many people into government health care programs. The focus should be on expanding coverage to the uninsured, not destabilizing the current system of coverage, he said.

But Dr. Lewin praised the direction of Sen. McCain's quality of care proposals, which include plans aimed at increasing the adoption of health information technology and paying physicians for prevention and chronic disease management.

In the areas of health information technology and medical research funding, Sen. McCain's proposal is actually similar to the plans put forth by the Democratic candidates, Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.), said Naomi Senkeeto, a health policy analyst at the American College of Physicians. For example, Sen. McCain plans to dedicate federal research dollars on the basis of “sound science” and put a greater emphasis on chronic disease care and management.

The ACP does not endorse candidates but has performed an analysis of how the presidential candidates compare with one another on guaranteeing access to affordable coverage, providing everyone with a primary care physician, investing in health information technology, reducing administrative expenses, and increasing funding for research. The side-by-side comparison is available online at www.acponline.org/advocacy/where_we_stand/election

Sen. McCain proposes to provide a tax credit while eliminating the tax exclusion that lets employees avoid paying income tax on the value of their health benefits. John McCain 2008/

While the Democrats debated the need for individual mandates for health coverage, Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a recent Tampa speech to announce details of his health care proposal. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign. The idea is to reform the marketplace and thus drive down costs overall.

Grace-Marie Turner, a McCain campaign adviser and president of the Galen Institute, which favors free-market approaches to health care, said that Sen. McCain recognizes that the first step to expanding coverage is to make health care more affordable. The cornerstones of that approach include giving consumers more coverage options, paying for wellness and prevention, and getting rid of waste in the system.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States. “We are pretty amazed at how extreme a plan Mr. McCain has staked out,” said Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to purchase coverage in the individual market where coverage is expensive and difficult to obtain. “Our prediction is a race to the bottom,” he said.

And a $5,000 tax credit wouldn't be enough to cover the cost of family coverage, which the Kaiser Family Foundation estimates costs on average nearly $12,000, Mr. Hickey said.

It's hard to predict exactly what would happen with employer-based coverage under this proposal, said Sara R. Collins, Ph.D., assistant vice president for the Program on the Future of Health Insurance at the Commonwealth Fund. The question is whether individuals who currently have comprehensive coverage through their employer would end up underinsured after moving into the individual market.

The proposal is raising some concerns among physicians. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal, saying that taking away the employee tax exclusion would “undoubtedly” cause a shift to individual coverage and force many people into government health care programs. The focus should be on expanding coverage to the uninsured, not destabilizing the current system of coverage, he said.

But Dr. Lewin praised the direction of Sen. McCain's quality of care proposals, which include plans aimed at increasing the adoption of health information technology and paying physicians for prevention and chronic disease management.

In the areas of health information technology and medical research funding, Sen. McCain's proposal is actually similar to the plans put forth by the Democratic candidates, Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.), said Naomi Senkeeto, a health policy analyst at the American College of Physicians. For example, Sen. McCain plans to dedicate federal research dollars on the basis of “sound science” and put a greater emphasis on chronic disease care and management.

The ACP does not endorse candidates but has performed an analysis of how the presidential candidates compare with one another on guaranteeing access to affordable coverage, providing everyone with a primary care physician, investing in health information technology, reducing administrative expenses, and increasing funding for research. The side-by-side comparison is available online at www.acponline.org/advocacy/where_we_stand/election

Sen. McCain proposes to provide a tax credit while eliminating the tax exclusion that lets employees avoid paying income tax on the value of their health benefits. John McCain 2008/

While the Democrats debated the need for individual mandates for health coverage, Sen. John McCain recently unveiled a starkly different plan for reforming the health care system.

At the heart of Sen. McCain's health proposal is a plan to eliminate the tax exclusion that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, is proposing to replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families.

For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage on the individual market, the tax credit would be used to pay their premiums, according to Sen. McCain's plan.

Sen. McCain also espouses creating a national market for health insurance by allowing Americans to buy coverage across state lines.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said during a recent Tampa speech to announce details of his health care proposal. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. Sen. McCain pledged to work with Congress, governors, and industry to ensure that the initiative was adequately funded and included disease management programs, individual case management, and health and wellness programs.

The tax changes would not occur in a vacuum, said Crystal Benton, a spokeswoman for the McCain campaign. The idea is to reform the marketplace and thus drive down costs overall.

Grace-Marie Turner, a McCain campaign adviser and president of the Galen Institute, which favors free-market approaches to health care, said that Sen. McCain recognizes that the first step to expanding coverage is to make health care more affordable. The cornerstones of that approach include giving consumers more coverage options, paying for wellness and prevention, and getting rid of waste in the system.

But critics say the McCain plan would essentially destroy the employer-based health insurance system in the United States. “We are pretty amazed at how extreme a plan Mr. McCain has staked out,” said Roger Hickey, codirector of the Campaign for America's Future, a progressive think tank.

The elimination of the employee health benefits tax exclusion would be an excuse for employers of all sizes to get out of providing health insurance, leaving many workers to purchase coverage in the individual market where coverage is expensive and difficult to obtain. “Our prediction is a race to the bottom,” he said.

And a $5,000 tax credit wouldn't be enough to cover the cost of family coverage, which the Kaiser Family Foundation estimates costs on average nearly $12,000, Mr. Hickey said.

It's hard to predict exactly what would happen with employer-based coverage under this proposal, said Sara R. Collins, Ph.D., assistant vice president for the Program on the Future of Health Insurance at the Commonwealth Fund. The question is whether individuals who currently have comprehensive coverage through their employer would end up underinsured after moving into the individual market.

The proposal is raising some concerns among physicians. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal, saying that taking away the employee tax exclusion would “undoubtedly” cause a shift to individual coverage and force many people into government health care programs. The focus should be on expanding coverage to the uninsured, not destabilizing the current system of coverage, he said.

But Dr. Lewin praised the direction of Sen. McCain's quality of care proposals, which include plans aimed at increasing the adoption of health information technology and paying physicians for prevention and chronic disease management.

In the areas of health information technology and medical research funding, Sen. McCain's proposal is actually similar to the plans put forth by the Democratic candidates, Sen. Hillary Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.), said Naomi Senkeeto, a health policy analyst at the American College of Physicians. For example, Sen. McCain plans to dedicate federal research dollars on the basis of “sound science” and put a greater emphasis on chronic disease care and management.

The ACP does not endorse candidates but has performed an analysis of how the presidential candidates compare with one another on guaranteeing access to affordable coverage, providing everyone with a primary care physician, investing in health information technology, reducing administrative expenses, and increasing funding for research. The side-by-side comparison is available online at www.acponline.org/advocacy/where_we_stand/election

Sen. McCain proposes to provide a tax credit while eliminating the tax exclusion that lets employees avoid paying income tax on the value of their health benefits. John McCain 2008/

PHILADELPHIA — The jury is still out on whether aromatase inhibitors could offer an alternative to clomiphene in the treatment of infertility associated with polycystic ovary syndrome, according to Dr. Andrea D. Coviello, an endocrinologist who is at Boston University.

Aromatase inhibitors are on the horizon, Dr. Coviello said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS. Although they have been approved for use in breast cancer, they are still experimental for ovulation induction.

Instead of blocking the receptors centrally in the hypothalamus and the pituitary, aromatase inhibitors completely block estradiol production. Like clomiphene, aromatase inhibitor drugs are used during the follicular phase, she said.

The rationale for moving to aromatase inhibitors is that this class of drugs is thought to have fewer antiestrogenic side effects. But there are also significant concerns about fetal development problems in the babies conceived using aromatase inhibitors, Dr. Coviello said.

A definitive study that would help physicians assess how aromatase inhibitors stack up to clomiphene has yet to be done. The available data are derived from very small studies, said Dr. Coviello, who also said she has no commercial support to disclose.

In a prospective, randomized trial of 74 patients, researchers did not find a significant difference in pregnancy rates between women who received clomiphene and those who received the aromatase inhibitor, letrozole (Fertil. Steril. 2006;86:1447–51). However, the researchers found significantly lower estrogen levels in the letrozole group on the day of human chorionic gonadotropin administration, which indicated the potential for a better side-effect profile with letrozole, Dr. Coviello said.

Another study, published online, compared the efficacy of letrozole and clomiphene among women who had failed to ovulate when taking 100 mg/day of clomiphene citrate (Fertil. Steril. 2008 January [Epub doi:10.1016/j.fertnstert. 2007.08.044]). Sixty-four patients were randomized to receive either 7.5 mg/day of letrozole or 150 mg/day of clomiphene. The researchers found that letrozole had better ovulation and pregnancy rates compared with clomiphene.

However, in that study, the results came as no surprise because the women in the study were clomiphene resistant, Dr. Coviello said. So although it showed that letrozole is not inferior in terms of ovulation, it failed to make the case that aromatase inhibitors outperform clomiphene.

INTERNAL MEDICINE NEWS, FAMILY PRACTICE NEWS, and this newspaper are published by the International Medical News Group, a division of Elsevier.

PHILADELPHIA — The jury is still out on whether aromatase inhibitors could offer an alternative to clomiphene in the treatment of infertility associated with polycystic ovary syndrome, according to Dr. Andrea D. Coviello, an endocrinologist who is at Boston University.

Aromatase inhibitors are on the horizon, Dr. Coviello said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS. Although they have been approved for use in breast cancer, they are still experimental for ovulation induction.

Instead of blocking the receptors centrally in the hypothalamus and the pituitary, aromatase inhibitors completely block estradiol production. Like clomiphene, aromatase inhibitor drugs are used during the follicular phase, she said.

The rationale for moving to aromatase inhibitors is that this class of drugs is thought to have fewer antiestrogenic side effects. But there are also significant concerns about fetal development problems in the babies conceived using aromatase inhibitors, Dr. Coviello said.

A definitive study that would help physicians assess how aromatase inhibitors stack up to clomiphene has yet to be done. The available data are derived from very small studies, said Dr. Coviello, who also said she has no commercial support to disclose.

In a prospective, randomized trial of 74 patients, researchers did not find a significant difference in pregnancy rates between women who received clomiphene and those who received the aromatase inhibitor, letrozole (Fertil. Steril. 2006;86:1447–51). However, the researchers found significantly lower estrogen levels in the letrozole group on the day of human chorionic gonadotropin administration, which indicated the potential for a better side-effect profile with letrozole, Dr. Coviello said.

Another study, published online, compared the efficacy of letrozole and clomiphene among women who had failed to ovulate when taking 100 mg/day of clomiphene citrate (Fertil. Steril. 2008 January [Epub doi:10.1016/j.fertnstert. 2007.08.044]). Sixty-four patients were randomized to receive either 7.5 mg/day of letrozole or 150 mg/day of clomiphene. The researchers found that letrozole had better ovulation and pregnancy rates compared with clomiphene.

However, in that study, the results came as no surprise because the women in the study were clomiphene resistant, Dr. Coviello said. So although it showed that letrozole is not inferior in terms of ovulation, it failed to make the case that aromatase inhibitors outperform clomiphene.

INTERNAL MEDICINE NEWS, FAMILY PRACTICE NEWS, and this newspaper are published by the International Medical News Group, a division of Elsevier.

PHILADELPHIA — The jury is still out on whether aromatase inhibitors could offer an alternative to clomiphene in the treatment of infertility associated with polycystic ovary syndrome, according to Dr. Andrea D. Coviello, an endocrinologist who is at Boston University.

Aromatase inhibitors are on the horizon, Dr. Coviello said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS. Although they have been approved for use in breast cancer, they are still experimental for ovulation induction.

Instead of blocking the receptors centrally in the hypothalamus and the pituitary, aromatase inhibitors completely block estradiol production. Like clomiphene, aromatase inhibitor drugs are used during the follicular phase, she said.

The rationale for moving to aromatase inhibitors is that this class of drugs is thought to have fewer antiestrogenic side effects. But there are also significant concerns about fetal development problems in the babies conceived using aromatase inhibitors, Dr. Coviello said.

A definitive study that would help physicians assess how aromatase inhibitors stack up to clomiphene has yet to be done. The available data are derived from very small studies, said Dr. Coviello, who also said she has no commercial support to disclose.

In a prospective, randomized trial of 74 patients, researchers did not find a significant difference in pregnancy rates between women who received clomiphene and those who received the aromatase inhibitor, letrozole (Fertil. Steril. 2006;86:1447–51). However, the researchers found significantly lower estrogen levels in the letrozole group on the day of human chorionic gonadotropin administration, which indicated the potential for a better side-effect profile with letrozole, Dr. Coviello said.

Another study, published online, compared the efficacy of letrozole and clomiphene among women who had failed to ovulate when taking 100 mg/day of clomiphene citrate (Fertil. Steril. 2008 January [Epub doi:10.1016/j.fertnstert. 2007.08.044]). Sixty-four patients were randomized to receive either 7.5 mg/day of letrozole or 150 mg/day of clomiphene. The researchers found that letrozole had better ovulation and pregnancy rates compared with clomiphene.

However, in that study, the results came as no surprise because the women in the study were clomiphene resistant, Dr. Coviello said. So although it showed that letrozole is not inferior in terms of ovulation, it failed to make the case that aromatase inhibitors outperform clomiphene.

INTERNAL MEDICINE NEWS, FAMILY PRACTICE NEWS, and this newspaper are published by the International Medical News Group, a division of Elsevier.

HIV/AIDS Stigma Continues

Individuals continue to harbor negative opinions about women with HIV/AIDS, according to a survey from the Foundation for AIDS Research. For example, 57% of the respondents said they would be somewhat or not at all comfortable having a female physician who is HIV positive and 68% said they would be somewhat or not at all comfortable with an HIV-positive woman as their dentist. Only 14% of survey respondents said that HIV-positive women should have children. “These results should serve as a wake-up call for action across all sectors of society,” Dr. Susan J. Blumenthal, senior policy and medical adviser to the Foundation for AIDS Research, said in a statement. “We need to intensify efforts for science-based education and policy, and shatter the stigma that has surrounded this disease for all too long.” The online survey conducted by Harris Interactive surveyed nearly 5,000 men and women ages 18–44 years about attitudes toward HIV-positive women.

Ban on Abortion Data Surfing Dropped

The dean of the Johns Hopkins Bloomberg School of Public Health recently reversed the practice of restricting abortion searches on the POPLINE family planning database. In a statement issued last month, the dean, Dr. Michael J. Klag, said he immediately stopped the practice of blocking searches of the term “abortion” as soon as it came to his attention. Database administrators had temporarily restricted such searches after they uncovered opinion-based articles among the search results. Advocacy articles on abortion are not included in POPLINE because it is funded by the U.S. Agency for International Development (USAID) and is subject to a federal law that restricts the use of federal funds for abortion activities or supplies. “In my judgment, the decision to block the search term was an overreaction on the part of the POPLINE staff,” Dr. Klag wrote. “Other measures are available to us for ensuring that items in the POPLINE database meet USAID guidelines.”

Women Lack Breast Cancer Tx Info

Many women with breast cancer lack important information about their treatment options, according to a study published online in April in the journal Health Services Research. African American and Latina women had the greatest gaps in knowledge, the researchers found. When asked about 5-year survival rates for mastectomy versus lumpectomy with radiation, 49% did not know that the two procedures had equivalent survival rates. Younger women and women with higher levels of education were significantly more likely than their counterparts to have knowledge about survival rates. The survival knowledge findings are based on a survey of 1,132 women with breast cancer diagnosed in Detroit and Los Angeles.

AIDS Rx Wait Lists Nearly Clear

Waiting lists for the AIDS Drug Assistance Programs have been virtually eliminated for the first time in more than a decade, according to the 2008 National ADAP Monitoring Project report. As of March, only Montana had a waiting list for services and only three patients were on the list. ADAPs are state-run, federally funded programs that provide HIV medications to low-income individuals with limited or no drug coverage. The near elimination of the waiting lists comes despite record caseload levels within the program, with 146,000 individuals enrolled in 2007. The improvements are likely due to a combination of factors, including increased funding from states and pharmaceutical drug rebate programs, a one-time infusion of funds from the federal government, and implementation of Medicare Part D. The National ADAP Monitoring Project report is released annually by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors.

ACOG Joins E-Prescribing Coalition

The American College of Obstetricians and Gynecologists, along with the Center for Improving Medication Management and several other medical societies, is launching a nationwide program to help physicians with electronic prescribing. The “Get Connected” program features a Web site (

www.GetRxConnected.com

HIV/AIDS Stigma Continues

Individuals continue to harbor negative opinions about women with HIV/AIDS, according to a survey from the Foundation for AIDS Research. For example, 57% of the respondents said they would be somewhat or not at all comfortable having a female physician who is HIV positive and 68% said they would be somewhat or not at all comfortable with an HIV-positive woman as their dentist. Only 14% of survey respondents said that HIV-positive women should have children. “These results should serve as a wake-up call for action across all sectors of society,” Dr. Susan J. Blumenthal, senior policy and medical adviser to the Foundation for AIDS Research, said in a statement. “We need to intensify efforts for science-based education and policy, and shatter the stigma that has surrounded this disease for all too long.” The online survey conducted by Harris Interactive surveyed nearly 5,000 men and women ages 18–44 years about attitudes toward HIV-positive women.

Ban on Abortion Data Surfing Dropped

The dean of the Johns Hopkins Bloomberg School of Public Health recently reversed the practice of restricting abortion searches on the POPLINE family planning database. In a statement issued last month, the dean, Dr. Michael J. Klag, said he immediately stopped the practice of blocking searches of the term “abortion” as soon as it came to his attention. Database administrators had temporarily restricted such searches after they uncovered opinion-based articles among the search results. Advocacy articles on abortion are not included in POPLINE because it is funded by the U.S. Agency for International Development (USAID) and is subject to a federal law that restricts the use of federal funds for abortion activities or supplies. “In my judgment, the decision to block the search term was an overreaction on the part of the POPLINE staff,” Dr. Klag wrote. “Other measures are available to us for ensuring that items in the POPLINE database meet USAID guidelines.”

Women Lack Breast Cancer Tx Info

Many women with breast cancer lack important information about their treatment options, according to a study published online in April in the journal Health Services Research. African American and Latina women had the greatest gaps in knowledge, the researchers found. When asked about 5-year survival rates for mastectomy versus lumpectomy with radiation, 49% did not know that the two procedures had equivalent survival rates. Younger women and women with higher levels of education were significantly more likely than their counterparts to have knowledge about survival rates. The survival knowledge findings are based on a survey of 1,132 women with breast cancer diagnosed in Detroit and Los Angeles.

AIDS Rx Wait Lists Nearly Clear

Waiting lists for the AIDS Drug Assistance Programs have been virtually eliminated for the first time in more than a decade, according to the 2008 National ADAP Monitoring Project report. As of March, only Montana had a waiting list for services and only three patients were on the list. ADAPs are state-run, federally funded programs that provide HIV medications to low-income individuals with limited or no drug coverage. The near elimination of the waiting lists comes despite record caseload levels within the program, with 146,000 individuals enrolled in 2007. The improvements are likely due to a combination of factors, including increased funding from states and pharmaceutical drug rebate programs, a one-time infusion of funds from the federal government, and implementation of Medicare Part D. The National ADAP Monitoring Project report is released annually by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors.

ACOG Joins E-Prescribing Coalition

The American College of Obstetricians and Gynecologists, along with the Center for Improving Medication Management and several other medical societies, is launching a nationwide program to help physicians with electronic prescribing. The “Get Connected” program features a Web site (

www.GetRxConnected.com

HIV/AIDS Stigma Continues

Individuals continue to harbor negative opinions about women with HIV/AIDS, according to a survey from the Foundation for AIDS Research. For example, 57% of the respondents said they would be somewhat or not at all comfortable having a female physician who is HIV positive and 68% said they would be somewhat or not at all comfortable with an HIV-positive woman as their dentist. Only 14% of survey respondents said that HIV-positive women should have children. “These results should serve as a wake-up call for action across all sectors of society,” Dr. Susan J. Blumenthal, senior policy and medical adviser to the Foundation for AIDS Research, said in a statement. “We need to intensify efforts for science-based education and policy, and shatter the stigma that has surrounded this disease for all too long.” The online survey conducted by Harris Interactive surveyed nearly 5,000 men and women ages 18–44 years about attitudes toward HIV-positive women.

Ban on Abortion Data Surfing Dropped

The dean of the Johns Hopkins Bloomberg School of Public Health recently reversed the practice of restricting abortion searches on the POPLINE family planning database. In a statement issued last month, the dean, Dr. Michael J. Klag, said he immediately stopped the practice of blocking searches of the term “abortion” as soon as it came to his attention. Database administrators had temporarily restricted such searches after they uncovered opinion-based articles among the search results. Advocacy articles on abortion are not included in POPLINE because it is funded by the U.S. Agency for International Development (USAID) and is subject to a federal law that restricts the use of federal funds for abortion activities or supplies. “In my judgment, the decision to block the search term was an overreaction on the part of the POPLINE staff,” Dr. Klag wrote. “Other measures are available to us for ensuring that items in the POPLINE database meet USAID guidelines.”

Women Lack Breast Cancer Tx Info

Many women with breast cancer lack important information about their treatment options, according to a study published online in April in the journal Health Services Research. African American and Latina women had the greatest gaps in knowledge, the researchers found. When asked about 5-year survival rates for mastectomy versus lumpectomy with radiation, 49% did not know that the two procedures had equivalent survival rates. Younger women and women with higher levels of education were significantly more likely than their counterparts to have knowledge about survival rates. The survival knowledge findings are based on a survey of 1,132 women with breast cancer diagnosed in Detroit and Los Angeles.

AIDS Rx Wait Lists Nearly Clear

Waiting lists for the AIDS Drug Assistance Programs have been virtually eliminated for the first time in more than a decade, according to the 2008 National ADAP Monitoring Project report. As of March, only Montana had a waiting list for services and only three patients were on the list. ADAPs are state-run, federally funded programs that provide HIV medications to low-income individuals with limited or no drug coverage. The near elimination of the waiting lists comes despite record caseload levels within the program, with 146,000 individuals enrolled in 2007. The improvements are likely due to a combination of factors, including increased funding from states and pharmaceutical drug rebate programs, a one-time infusion of funds from the federal government, and implementation of Medicare Part D. The National ADAP Monitoring Project report is released annually by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors.

ACOG Joins E-Prescribing Coalition

The American College of Obstetricians and Gynecologists, along with the Center for Improving Medication Management and several other medical societies, is launching a nationwide program to help physicians with electronic prescribing. The “Get Connected” program features a Web site (

www.GetRxConnected.com

President Signs TBI Legislation

President Bush recently signed legislation to expand funding for traumatic brain injury rehabilitation programs. The reauthorization of the Traumatic Brain Injury Act (S. 793) also provides funding to study the incidence of traumatic brain injury and disability associated with it. Each year, about 1.4 million people sustain a traumatic brain injury, resulting in long-term disability, according to Sen. Orrin Hatch (R-Utah), a bill sponsor. In addition, TBI accounted for $60 billion in both direct medical costs and indirect costs, such as lost productivity. “The reauthorized TBI Act promises to build on its tremendously successful first 10 years by extending services and establishing new studies to register brain injured veterans of Iraq and Afghanistan,” Rep. Bill Pascrell (D-N.J.), another sponsor, said.

Inpatient Rehab Proposal Issued

Officials at the Centers for Medicare and Medicaid Services issued a proposal to change payment rates for services provided at inpatient rehabilitation facilities, including rehabilitation for stroke and spinal cord injuries. CMS estimates the proposed changes will result in a decrease in aggregate payments of $20 million in fiscal year 2009. The CMS proposed rule also calls for changing the case mix group relative weights and the average length of stay values based on updated data. The payment changes would go into effect on Oct. 1 and would apply to more than 200 freestanding facilities and inpatient rehabilitation facilities, and more than 1,000 units in acute care hospitals. Comments will be accepted until July 20.A final rule is expected Aug. 1.

2008 Potamkin Prize Awarded

The American Academy of Neurology has awarded three researchers the Potamkin Prize in Alzheimer's disease research. The three researchers will split the $100,000 prize, designated for continuing their research efforts. This year's prize went to Dr. Clifford R. Jack Jr. of the Mayo Clinic in Rochester, Minn., and to Dr. William E. Klunk and Chester A. Mathis, Ph.D., both of the University of Pittsburgh. Dr. Jack's research involves the use of MRI measurements to assess the neurodegenerative stages of Alzheimer's disease. Dr. Klunk and Dr. Mathis developed a novel tracer for positron emission tomography that can identify the amyloid protein deposits characteristically present with Alzheimer's disease to help identify Alzheimer's earlier.

Half of Health Spending Wasted

Wasteful spending in the U.S. health system could amount to as much as $1.2 trillion of the $2.2 trillion spent annually, according to a report from the PriceWaterhouseCoopers' Health Research Institute. Defensive medicine was identified as the biggest excess, followed by inefficient administration and the cost of care necessitated by preventable conditions, such as obesity, according to the report. The impact of issues such as nonadherence to medical advice and prescriptions, alcohol abuse, smoking, and obesity “are exponential,” the report said.

Demand Strong for New MDs

The job market for new physicians in New York is characterized by strong demand, according to a recent study from the Center for Health Workforce Studies at the University of Albany School of Public Health. The need for primary care physicians was comparable with the demand for specialists, with new primary care doctors reporting an increasing number of job offers and increasing median starting income. In addition, the median starting income for new physicians grew by 13% from 2005 to 2007. Median starting income was $142,100 for primary care physicians.

Disciplinary Actions Decline

The number and rate of serious disciplinary actions against physicians has decreased for the third consecutive year, according to Public Citizen's annual ranking of state medical boards. Since 2004, the number of serious disciplinary actions against doctors has decreased 17%, resulting in 553 fewer serious actions in 2007 than in 2004. Taking into account the increasing number of U.S. physicians since 2004, the rate of serious actions has fallen 22% since then, when calculated per 1,000 physicians, according to Public Citizen. The annual rankings are based on data from the Federation of State Medical Boards.

President Signs TBI Legislation

President Bush recently signed legislation to expand funding for traumatic brain injury rehabilitation programs. The reauthorization of the Traumatic Brain Injury Act (S. 793) also provides funding to study the incidence of traumatic brain injury and disability associated with it. Each year, about 1.4 million people sustain a traumatic brain injury, resulting in long-term disability, according to Sen. Orrin Hatch (R-Utah), a bill sponsor. In addition, TBI accounted for $60 billion in both direct medical costs and indirect costs, such as lost productivity. “The reauthorized TBI Act promises to build on its tremendously successful first 10 years by extending services and establishing new studies to register brain injured veterans of Iraq and Afghanistan,” Rep. Bill Pascrell (D-N.J.), another sponsor, said.

Inpatient Rehab Proposal Issued

Officials at the Centers for Medicare and Medicaid Services issued a proposal to change payment rates for services provided at inpatient rehabilitation facilities, including rehabilitation for stroke and spinal cord injuries. CMS estimates the proposed changes will result in a decrease in aggregate payments of $20 million in fiscal year 2009. The CMS proposed rule also calls for changing the case mix group relative weights and the average length of stay values based on updated data. The payment changes would go into effect on Oct. 1 and would apply to more than 200 freestanding facilities and inpatient rehabilitation facilities, and more than 1,000 units in acute care hospitals. Comments will be accepted until July 20.A final rule is expected Aug. 1.

2008 Potamkin Prize Awarded

The American Academy of Neurology has awarded three researchers the Potamkin Prize in Alzheimer's disease research. The three researchers will split the $100,000 prize, designated for continuing their research efforts. This year's prize went to Dr. Clifford R. Jack Jr. of the Mayo Clinic in Rochester, Minn., and to Dr. William E. Klunk and Chester A. Mathis, Ph.D., both of the University of Pittsburgh. Dr. Jack's research involves the use of MRI measurements to assess the neurodegenerative stages of Alzheimer's disease. Dr. Klunk and Dr. Mathis developed a novel tracer for positron emission tomography that can identify the amyloid protein deposits characteristically present with Alzheimer's disease to help identify Alzheimer's earlier.

Half of Health Spending Wasted

Wasteful spending in the U.S. health system could amount to as much as $1.2 trillion of the $2.2 trillion spent annually, according to a report from the PriceWaterhouseCoopers' Health Research Institute. Defensive medicine was identified as the biggest excess, followed by inefficient administration and the cost of care necessitated by preventable conditions, such as obesity, according to the report. The impact of issues such as nonadherence to medical advice and prescriptions, alcohol abuse, smoking, and obesity “are exponential,” the report said.

Demand Strong for New MDs

The job market for new physicians in New York is characterized by strong demand, according to a recent study from the Center for Health Workforce Studies at the University of Albany School of Public Health. The need for primary care physicians was comparable with the demand for specialists, with new primary care doctors reporting an increasing number of job offers and increasing median starting income. In addition, the median starting income for new physicians grew by 13% from 2005 to 2007. Median starting income was $142,100 for primary care physicians.

Disciplinary Actions Decline

The number and rate of serious disciplinary actions against physicians has decreased for the third consecutive year, according to Public Citizen's annual ranking of state medical boards. Since 2004, the number of serious disciplinary actions against doctors has decreased 17%, resulting in 553 fewer serious actions in 2007 than in 2004. Taking into account the increasing number of U.S. physicians since 2004, the rate of serious actions has fallen 22% since then, when calculated per 1,000 physicians, according to Public Citizen. The annual rankings are based on data from the Federation of State Medical Boards.

President Signs TBI Legislation

President Bush recently signed legislation to expand funding for traumatic brain injury rehabilitation programs. The reauthorization of the Traumatic Brain Injury Act (S. 793) also provides funding to study the incidence of traumatic brain injury and disability associated with it. Each year, about 1.4 million people sustain a traumatic brain injury, resulting in long-term disability, according to Sen. Orrin Hatch (R-Utah), a bill sponsor. In addition, TBI accounted for $60 billion in both direct medical costs and indirect costs, such as lost productivity. “The reauthorized TBI Act promises to build on its tremendously successful first 10 years by extending services and establishing new studies to register brain injured veterans of Iraq and Afghanistan,” Rep. Bill Pascrell (D-N.J.), another sponsor, said.

Inpatient Rehab Proposal Issued

Officials at the Centers for Medicare and Medicaid Services issued a proposal to change payment rates for services provided at inpatient rehabilitation facilities, including rehabilitation for stroke and spinal cord injuries. CMS estimates the proposed changes will result in a decrease in aggregate payments of $20 million in fiscal year 2009. The CMS proposed rule also calls for changing the case mix group relative weights and the average length of stay values based on updated data. The payment changes would go into effect on Oct. 1 and would apply to more than 200 freestanding facilities and inpatient rehabilitation facilities, and more than 1,000 units in acute care hospitals. Comments will be accepted until July 20.A final rule is expected Aug. 1.

2008 Potamkin Prize Awarded

The American Academy of Neurology has awarded three researchers the Potamkin Prize in Alzheimer's disease research. The three researchers will split the $100,000 prize, designated for continuing their research efforts. This year's prize went to Dr. Clifford R. Jack Jr. of the Mayo Clinic in Rochester, Minn., and to Dr. William E. Klunk and Chester A. Mathis, Ph.D., both of the University of Pittsburgh. Dr. Jack's research involves the use of MRI measurements to assess the neurodegenerative stages of Alzheimer's disease. Dr. Klunk and Dr. Mathis developed a novel tracer for positron emission tomography that can identify the amyloid protein deposits characteristically present with Alzheimer's disease to help identify Alzheimer's earlier.

Half of Health Spending Wasted

Wasteful spending in the U.S. health system could amount to as much as $1.2 trillion of the $2.2 trillion spent annually, according to a report from the PriceWaterhouseCoopers' Health Research Institute. Defensive medicine was identified as the biggest excess, followed by inefficient administration and the cost of care necessitated by preventable conditions, such as obesity, according to the report. The impact of issues such as nonadherence to medical advice and prescriptions, alcohol abuse, smoking, and obesity “are exponential,” the report said.

Demand Strong for New MDs

The job market for new physicians in New York is characterized by strong demand, according to a recent study from the Center for Health Workforce Studies at the University of Albany School of Public Health. The need for primary care physicians was comparable with the demand for specialists, with new primary care doctors reporting an increasing number of job offers and increasing median starting income. In addition, the median starting income for new physicians grew by 13% from 2005 to 2007. Median starting income was $142,100 for primary care physicians.

Disciplinary Actions Decline

The number and rate of serious disciplinary actions against physicians has decreased for the third consecutive year, according to Public Citizen's annual ranking of state medical boards. Since 2004, the number of serious disciplinary actions against doctors has decreased 17%, resulting in 553 fewer serious actions in 2007 than in 2004. Taking into account the increasing number of U.S. physicians since 2004, the rate of serious actions has fallen 22% since then, when calculated per 1,000 physicians, according to Public Citizen. The annual rankings are based on data from the Federation of State Medical Boards.

Physicians now have nine different options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.

The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half year. Officials at the Centers for Medicare and Medicaid Services announced the changes last month.

Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.

“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” CMS Acting Administrator Kerry Weems said in a statement.

In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.

Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.

In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.

This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.

CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.

CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.

For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to qualify for payment using measures groups, physicians have to submit data for each of the measures in the group. Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS.

Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.

Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.

However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. Another unanswered question is how CMS will ensure that the data being submitted by registries is accurate, Mr. Whitman said.

More information about the different reporting options is available online at www.cms.hhs.gov/pqri

Here are Nine Physician Quality Reporting Options

The Centers for Medicare and Medicaid Services outlined nine options for reporting data to PQRI in 2008.

Three options allow claims-based reporting:

▸ Physicians can choose to report on individual measures for the full year of 2008. Under this option, physicians with three or more applicable measures would report on at least three measures for at least 80% of their patients. Those with fewer than three applicable measures would report on all of those measures for at least 80% of their eligible patients.

▸ Physicians can also choose from two reporting approaches for the half-year reporting period from July 1 to Dec. 31. Physicians could report on all measures in a measures group for 15 consecutive patients with the relevant condition or 80% of eligible patients.

Six options are registry-based:

▸ CMS will allow three reporting options for a full-year reporting period. Those who chose to report on individual measures must report on 80% of applicable cases for a minimum of three measures. Physicians can also report on a measures group for 30 consecutive patients with the applicable condition or 80% of the applicable cases.

▸ CMS has also established three reporting options for reporting to a registry for a half-year from July 1 to Dec. 31. For example, physicians and other eligible professionals could report on individual measures for 80% of applicable cases for a minimum of three measures. Physicians could also report for a half-year using measures groups. For example, physicians can report on a measures group for 15 consecutive patients with the applicable condition or 80% of applicable cases.

Physicians now have nine different options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.

The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half year. Officials at the Centers for Medicare and Medicaid Services announced the changes last month.

Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.

“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” CMS Acting Administrator Kerry Weems said in a statement.

In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.

Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.

In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.

This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.

CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.

CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.

For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to qualify for payment using measures groups, physicians have to submit data for each of the measures in the group. Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS.

Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.

Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.

However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. Another unanswered question is how CMS will ensure that the data being submitted by registries is accurate, Mr. Whitman said.

More information about the different reporting options is available online at www.cms.hhs.gov/pqri

Here are Nine Physician Quality Reporting Options

The Centers for Medicare and Medicaid Services outlined nine options for reporting data to PQRI in 2008.

Three options allow claims-based reporting:

▸ Physicians can choose to report on individual measures for the full year of 2008. Under this option, physicians with three or more applicable measures would report on at least three measures for at least 80% of their patients. Those with fewer than three applicable measures would report on all of those measures for at least 80% of their eligible patients.

▸ Physicians can also choose from two reporting approaches for the half-year reporting period from July 1 to Dec. 31. Physicians could report on all measures in a measures group for 15 consecutive patients with the relevant condition or 80% of eligible patients.

Six options are registry-based:

▸ CMS will allow three reporting options for a full-year reporting period. Those who chose to report on individual measures must report on 80% of applicable cases for a minimum of three measures. Physicians can also report on a measures group for 30 consecutive patients with the applicable condition or 80% of the applicable cases.

▸ CMS has also established three reporting options for reporting to a registry for a half-year from July 1 to Dec. 31. For example, physicians and other eligible professionals could report on individual measures for 80% of applicable cases for a minimum of three measures. Physicians could also report for a half-year using measures groups. For example, physicians can report on a measures group for 15 consecutive patients with the applicable condition or 80% of applicable cases.

Physicians now have nine different options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.

The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half year. Officials at the Centers for Medicare and Medicaid Services announced the changes last month.

Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.

“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” CMS Acting Administrator Kerry Weems said in a statement.

In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.

Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.

In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.

This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.

CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.

CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.

For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to qualify for payment using measures groups, physicians have to submit data for each of the measures in the group. Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS.

Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.

Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.

However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. Another unanswered question is how CMS will ensure that the data being submitted by registries is accurate, Mr. Whitman said.

More information about the different reporting options is available online at www.cms.hhs.gov/pqri

Here are Nine Physician Quality Reporting Options

The Centers for Medicare and Medicaid Services outlined nine options for reporting data to PQRI in 2008.

Three options allow claims-based reporting:

▸ Physicians can choose to report on individual measures for the full year of 2008. Under this option, physicians with three or more applicable measures would report on at least three measures for at least 80% of their patients. Those with fewer than three applicable measures would report on all of those measures for at least 80% of their eligible patients.

▸ Physicians can also choose from two reporting approaches for the half-year reporting period from July 1 to Dec. 31. Physicians could report on all measures in a measures group for 15 consecutive patients with the relevant condition or 80% of eligible patients.

Six options are registry-based:

▸ CMS will allow three reporting options for a full-year reporting period. Those who chose to report on individual measures must report on 80% of applicable cases for a minimum of three measures. Physicians can also report on a measures group for 30 consecutive patients with the applicable condition or 80% of the applicable cases.

▸ CMS has also established three reporting options for reporting to a registry for a half-year from July 1 to Dec. 31. For example, physicians and other eligible professionals could report on individual measures for 80% of applicable cases for a minimum of three measures. Physicians could also report for a half-year using measures groups. For example, physicians can report on a measures group for 15 consecutive patients with the applicable condition or 80% of applicable cases.

Under an arrangement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts, according to numerous sources interviewed by this newspaper.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge them prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs.

Giving physicians a chance to ensure that the data are accurate makes the process fair, he said. It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter. Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

And some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint. Other health plans are likely to follow suit, said Susan Pisano, AHIP spokeswoman. Third-party review of rating systems and allowing physicians to review and challenge data before they become public will likely become the industry standard.

“We believe strongly that consumers both want and need good information on health care quality,” Ms. Pisano said.

Now that the Patient Charter has laid down the ground rules for how clinical performance measures should be used, the next step is to ensure that physician ratings accurately reflect all the care given, because patients are generally scattered across multiple health plans.

Ms. Pisano said the AHIP Foundation is studying how to aggregate data from across different plans to provide a full picture of physician quality.

Under an arrangement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts, according to numerous sources interviewed by this newspaper.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge them prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs.

Giving physicians a chance to ensure that the data are accurate makes the process fair, he said. It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter. Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

And some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint. Other health plans are likely to follow suit, said Susan Pisano, AHIP spokeswoman. Third-party review of rating systems and allowing physicians to review and challenge data before they become public will likely become the industry standard.

“We believe strongly that consumers both want and need good information on health care quality,” Ms. Pisano said.

Now that the Patient Charter has laid down the ground rules for how clinical performance measures should be used, the next step is to ensure that physician ratings accurately reflect all the care given, because patients are generally scattered across multiple health plans.

Ms. Pisano said the AHIP Foundation is studying how to aggregate data from across different plans to provide a full picture of physician quality.

Under an arrangement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts, according to numerous sources interviewed by this newspaper.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge them prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs.

Giving physicians a chance to ensure that the data are accurate makes the process fair, he said. It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter. Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

And some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint. Other health plans are likely to follow suit, said Susan Pisano, AHIP spokeswoman. Third-party review of rating systems and allowing physicians to review and challenge data before they become public will likely become the industry standard.

“We believe strongly that consumers both want and need good information on health care quality,” Ms. Pisano said.

Now that the Patient Charter has laid down the ground rules for how clinical performance measures should be used, the next step is to ensure that physician ratings accurately reflect all the care given, because patients are generally scattered across multiple health plans.

Ms. Pisano said the AHIP Foundation is studying how to aggregate data from across different plans to provide a full picture of physician quality.

Rheumatology Honors Awarded

Members of Congress were honored for their advocacy efforts on behalf of patients with rheumatology-related conditions. Earlier this month, the Lupus Foundation of America presented its Leadership in Lupus Research Award to Sen. Tom Harkin (D-Iowa) for his support of research on lupus and women's health issues at the National Institutes of Health. Also recently, the Arthritis Foundation presented Sen. Edward Kennedy (D-Mass.) with its first Arthritis Foundation Advocacy Leadership Award in recognition of his work on the Arthritis Prevention, Control, and Cure Act (S. 626). Sen. Kennedy introduced the legislation, which would establish and strengthen arthritis research and public health initiatives.

International OA Study Launched

Researchers recently launched a multinational osteoporosis trial of nearly 60,000 postmenopausal women that aims to provide a real-world look at how patients at risk for osteoporotic fractures are treated. The Global Longitudinal Registry of Osteoporosis in Women (GLOW) is an observational study that has enrolled women over age 55 years who visited their primary care physician during the 2 years prior to study enrollment; enrollment is not linked to an osteoporosis diagnosis. Participants were recruited through primary care physicians at 17 sites in North America, Europe, and Australia. Researchers will collect information on osteoporosis risk factors, treatments, patient and physician behavior, and fracture outcomes over a 5-year period. “We want to understand regional differences in physician and patient behavior and how [they affect] patient outcomes,” Dr. Pierre Delmas, cochair of the study's executive committee, said in a statement. The study is being conducted by researchers at the Center for Outcomes Research at the University of Massachusetts, Worcester, and is supported by an unrestricted research grant from the Alliance for Better Bone Health, funded by Sanofi Aventis U.S. and Procter & Gamble Pharmaceuticals. More information is available at

www.outcomes.org/glow

Arthritis in Top 20 Online Searches

Arthritis and fibromyalgia were among the top 20 most-searched health conditions on the Internet, according to a ranking released by the research firm ComScore Inc. The firm reported that arthritis ranked 17th out of the top 20 searches and fibromyalgia came in at 20th. The results are based on searches conducted by a panel of approximately 1 million individuals in the United States during February. Pregnancy, cancer, and flu topped the list.

Health Sector Biggest Lobby

The health care industry was the biggest spender when it came to lobbying Congress in 2007. Pharmaceutical, medical device, physician, and hospital groups spent $227 million, a larger tally than for any other sector, according to the Center for Responsive Politics, a Washington-based watchdog group. Of individual lobbying concerns, the U.S. Chamber of Commerce was No. 1, spending $53 million on in-house and external personnel, the center reported. Close behind was General Electric Co. ($24 million), followed by the Pharmaceutical Research and Manufacturers of America ($23 million), the American Medical Association ($22 million), and the American Hospital Association ($20 million). Broken out by industries, the pharmaceutical sector has spent more than any other industry in the last decade, laying out an accumulated $1.3 billion since 1997, said the center. The data are taken from official lobbying reports that are submitted to the Senate Office of Public Records. The figures do not include other spending that is still aimed at influencing policy, according to the center.

Side Effects Underreported

One in six Americans who have taken a prescription drug experienced a side effect serious enough to send them to the doctor or hospital, but only 35% of consumers said they know they can report these side effects to the Food and Drug Administration, according to a Consumer Reports poll. Additionally, 81% of respondents said they had seen or heard an ad for prescription drugs within the last 30 days, almost all on television. Consumers Union, the nonprofit publisher of the magazine, gave the FDA a petition signed by nearly 56,000 consumers asking that a toll-free number and Web site be included in all television drug ads so people can easily report their serious side effects. “What better way for the FDA to let consumers know how to report serious problems with their medications than putting a toll-free number and Web site in all those drug ads we're bombarded by each day?” asked Liz Foley, campaign coordinator with Consumers Union, in a statement.

AAMC Adopts Medical Home

The Association of American Medical Colleges has adopted a formal position stating that every person should have access to a medical home. “We believe the medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional,” said Dr. Darrell G. Kirch, AAMC president and CEO, in a statement. The AAMC position also said that further research and evaluation of the medical home model is needed and more evidence must be gathered on how the model is best implemented. In addition, payment for the model should appropriately recognize and reward providers for prevention, care delivery, and coordination, and health care providers should be trained to understand and implement the medical home model within a team environment, the AAMC said.

Rheumatology Honors Awarded

Members of Congress were honored for their advocacy efforts on behalf of patients with rheumatology-related conditions. Earlier this month, the Lupus Foundation of America presented its Leadership in Lupus Research Award to Sen. Tom Harkin (D-Iowa) for his support of research on lupus and women's health issues at the National Institutes of Health. Also recently, the Arthritis Foundation presented Sen. Edward Kennedy (D-Mass.) with its first Arthritis Foundation Advocacy Leadership Award in recognition of his work on the Arthritis Prevention, Control, and Cure Act (S. 626). Sen. Kennedy introduced the legislation, which would establish and strengthen arthritis research and public health initiatives.

International OA Study Launched

Researchers recently launched a multinational osteoporosis trial of nearly 60,000 postmenopausal women that aims to provide a real-world look at how patients at risk for osteoporotic fractures are treated. The Global Longitudinal Registry of Osteoporosis in Women (GLOW) is an observational study that has enrolled women over age 55 years who visited their primary care physician during the 2 years prior to study enrollment; enrollment is not linked to an osteoporosis diagnosis. Participants were recruited through primary care physicians at 17 sites in North America, Europe, and Australia. Researchers will collect information on osteoporosis risk factors, treatments, patient and physician behavior, and fracture outcomes over a 5-year period. “We want to understand regional differences in physician and patient behavior and how [they affect] patient outcomes,” Dr. Pierre Delmas, cochair of the study's executive committee, said in a statement. The study is being conducted by researchers at the Center for Outcomes Research at the University of Massachusetts, Worcester, and is supported by an unrestricted research grant from the Alliance for Better Bone Health, funded by Sanofi Aventis U.S. and Procter & Gamble Pharmaceuticals. More information is available at

www.outcomes.org/glow

Arthritis in Top 20 Online Searches

Arthritis and fibromyalgia were among the top 20 most-searched health conditions on the Internet, according to a ranking released by the research firm ComScore Inc. The firm reported that arthritis ranked 17th out of the top 20 searches and fibromyalgia came in at 20th. The results are based on searches conducted by a panel of approximately 1 million individuals in the United States during February. Pregnancy, cancer, and flu topped the list.

Health Sector Biggest Lobby

The health care industry was the biggest spender when it came to lobbying Congress in 2007. Pharmaceutical, medical device, physician, and hospital groups spent $227 million, a larger tally than for any other sector, according to the Center for Responsive Politics, a Washington-based watchdog group. Of individual lobbying concerns, the U.S. Chamber of Commerce was No. 1, spending $53 million on in-house and external personnel, the center reported. Close behind was General Electric Co. ($24 million), followed by the Pharmaceutical Research and Manufacturers of America ($23 million), the American Medical Association ($22 million), and the American Hospital Association ($20 million). Broken out by industries, the pharmaceutical sector has spent more than any other industry in the last decade, laying out an accumulated $1.3 billion since 1997, said the center. The data are taken from official lobbying reports that are submitted to the Senate Office of Public Records. The figures do not include other spending that is still aimed at influencing policy, according to the center.

Side Effects Underreported

One in six Americans who have taken a prescription drug experienced a side effect serious enough to send them to the doctor or hospital, but only 35% of consumers said they know they can report these side effects to the Food and Drug Administration, according to a Consumer Reports poll. Additionally, 81% of respondents said they had seen or heard an ad for prescription drugs within the last 30 days, almost all on television. Consumers Union, the nonprofit publisher of the magazine, gave the FDA a petition signed by nearly 56,000 consumers asking that a toll-free number and Web site be included in all television drug ads so people can easily report their serious side effects. “What better way for the FDA to let consumers know how to report serious problems with their medications than putting a toll-free number and Web site in all those drug ads we're bombarded by each day?” asked Liz Foley, campaign coordinator with Consumers Union, in a statement.

AAMC Adopts Medical Home

The Association of American Medical Colleges has adopted a formal position stating that every person should have access to a medical home. “We believe the medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional,” said Dr. Darrell G. Kirch, AAMC president and CEO, in a statement. The AAMC position also said that further research and evaluation of the medical home model is needed and more evidence must be gathered on how the model is best implemented. In addition, payment for the model should appropriately recognize and reward providers for prevention, care delivery, and coordination, and health care providers should be trained to understand and implement the medical home model within a team environment, the AAMC said.

Rheumatology Honors Awarded

Members of Congress were honored for their advocacy efforts on behalf of patients with rheumatology-related conditions. Earlier this month, the Lupus Foundation of America presented its Leadership in Lupus Research Award to Sen. Tom Harkin (D-Iowa) for his support of research on lupus and women's health issues at the National Institutes of Health. Also recently, the Arthritis Foundation presented Sen. Edward Kennedy (D-Mass.) with its first Arthritis Foundation Advocacy Leadership Award in recognition of his work on the Arthritis Prevention, Control, and Cure Act (S. 626). Sen. Kennedy introduced the legislation, which would establish and strengthen arthritis research and public health initiatives.

International OA Study Launched

Researchers recently launched a multinational osteoporosis trial of nearly 60,000 postmenopausal women that aims to provide a real-world look at how patients at risk for osteoporotic fractures are treated. The Global Longitudinal Registry of Osteoporosis in Women (GLOW) is an observational study that has enrolled women over age 55 years who visited their primary care physician during the 2 years prior to study enrollment; enrollment is not linked to an osteoporosis diagnosis. Participants were recruited through primary care physicians at 17 sites in North America, Europe, and Australia. Researchers will collect information on osteoporosis risk factors, treatments, patient and physician behavior, and fracture outcomes over a 5-year period. “We want to understand regional differences in physician and patient behavior and how [they affect] patient outcomes,” Dr. Pierre Delmas, cochair of the study's executive committee, said in a statement. The study is being conducted by researchers at the Center for Outcomes Research at the University of Massachusetts, Worcester, and is supported by an unrestricted research grant from the Alliance for Better Bone Health, funded by Sanofi Aventis U.S. and Procter & Gamble Pharmaceuticals. More information is available at

www.outcomes.org/glow

Arthritis in Top 20 Online Searches

Arthritis and fibromyalgia were among the top 20 most-searched health conditions on the Internet, according to a ranking released by the research firm ComScore Inc. The firm reported that arthritis ranked 17th out of the top 20 searches and fibromyalgia came in at 20th. The results are based on searches conducted by a panel of approximately 1 million individuals in the United States during February. Pregnancy, cancer, and flu topped the list.

Health Sector Biggest Lobby

The health care industry was the biggest spender when it came to lobbying Congress in 2007. Pharmaceutical, medical device, physician, and hospital groups spent $227 million, a larger tally than for any other sector, according to the Center for Responsive Politics, a Washington-based watchdog group. Of individual lobbying concerns, the U.S. Chamber of Commerce was No. 1, spending $53 million on in-house and external personnel, the center reported. Close behind was General Electric Co. ($24 million), followed by the Pharmaceutical Research and Manufacturers of America ($23 million), the American Medical Association ($22 million), and the American Hospital Association ($20 million). Broken out by industries, the pharmaceutical sector has spent more than any other industry in the last decade, laying out an accumulated $1.3 billion since 1997, said the center. The data are taken from official lobbying reports that are submitted to the Senate Office of Public Records. The figures do not include other spending that is still aimed at influencing policy, according to the center.

Side Effects Underreported

One in six Americans who have taken a prescription drug experienced a side effect serious enough to send them to the doctor or hospital, but only 35% of consumers said they know they can report these side effects to the Food and Drug Administration, according to a Consumer Reports poll. Additionally, 81% of respondents said they had seen or heard an ad for prescription drugs within the last 30 days, almost all on television. Consumers Union, the nonprofit publisher of the magazine, gave the FDA a petition signed by nearly 56,000 consumers asking that a toll-free number and Web site be included in all television drug ads so people can easily report their serious side effects. “What better way for the FDA to let consumers know how to report serious problems with their medications than putting a toll-free number and Web site in all those drug ads we're bombarded by each day?” asked Liz Foley, campaign coordinator with Consumers Union, in a statement.

AAMC Adopts Medical Home

The Association of American Medical Colleges has adopted a formal position stating that every person should have access to a medical home. “We believe the medical home model holds great promise for improving Americans' health by ensuring that they have an ongoing relationship with a trusted medical professional,” said Dr. Darrell G. Kirch, AAMC president and CEO, in a statement. The AAMC position also said that further research and evaluation of the medical home model is needed and more evidence must be gathered on how the model is best implemented. In addition, payment for the model should appropriately recognize and reward providers for prevention, care delivery, and coordination, and health care providers should be trained to understand and implement the medical home model within a team environment, the AAMC said.

A Medicare demonstration project testing pay for performance among large multispecialty physician groups is yielding good data on care coordination programs, but expanding the program to small practices could present challenges, according to an analysis by the Government Accountability Office.

Small practices would have difficulty absorbing the high start-up costs associated with care coordination programs and the hefty price tag for electronic health record adoption and implementation, the GAO found.

The GAO report to Congress analyzed the Physician Group Practice Demonstration project. The demonstration tests an alternative payment approach that combines Medicare fee-for-service payments with incentive payments for achieving cost savings and hitting quality targets.

The demonstration, which began in April 2005, includes 10 multispecialty practices, each with 200 or more physicians. Officials at the Centers for Medicare and Medicaid Services recently added a fourth year to the project, which now is scheduled to end on March 31, 2009.

CMS reported the first-year results in July 2007. In the first year, two group practices earned bonus payments of about $7.4 million in total.

But it may be difficult to broaden this approach to other physician practices because of the large size and high revenues of the participating practices, GAO said. All of the demonstration practices had 200 or more physicians, while less than 1% of physician practices in the United States have more than 150 physicians.

In fact, about 83% of all physician practices are solo or two-person groups, according to GAO.

The practices weren't just bigger in terms of the number of physicians but also had more support staff and larger annual medical revenues. On average, the demonstration practices had annual medical revenues of $413 million in 2005. By comparison, only about 1% of single-specialty practices in the country have revenues exceeding $50 million a year.

GAO identified three advantages that the participating practices had because of their size, institutional affiliations with an integrated delivery system that gave them greater access to financial capital; past experience with pay-for-performance (P4P) programs, and experience using an electronic health records system.

Since most of the participating practices had affiliations with large, integrated delivery systems, they had access to the funds to start or expand quality programs. GAO estimated that on average, each participating practice invested about $489,000 to start or expand its demonstration-related programs and spent about $1.2 million on operating expenses for these programs in the first year.

The practices that participated in the demonstration also had a leg up in terms of electronic health record systems. Eight of the 10 participants had an electronic health record before the project began. By comparison, in 2005, only 24% of physician practices in the United States had a full or partial electronic health record, GAO said.

The majority of the participants in the demonstration also had past experience with pay-for-performance programs either through a private or public sector organization.

CMS officials told GAO investigators that they chose to focus on large practices because they affect a significant amount of Medicare expenditures and have sufficient Medicare beneficiary volume to calculate savings.

A Medicare demonstration project testing pay for performance among large multispecialty physician groups is yielding good data on care coordination programs, but expanding the program to small practices could present challenges, according to an analysis by the Government Accountability Office.

Small practices would have difficulty absorbing the high start-up costs associated with care coordination programs and the hefty price tag for electronic health record adoption and implementation, the GAO found.

The GAO report to Congress analyzed the Physician Group Practice Demonstration project. The demonstration tests an alternative payment approach that combines Medicare fee-for-service payments with incentive payments for achieving cost savings and hitting quality targets.

The demonstration, which began in April 2005, includes 10 multispecialty practices, each with 200 or more physicians. Officials at the Centers for Medicare and Medicaid Services recently added a fourth year to the project, which now is scheduled to end on March 31, 2009.

CMS reported the first-year results in July 2007. In the first year, two group practices earned bonus payments of about $7.4 million in total.

But it may be difficult to broaden this approach to other physician practices because of the large size and high revenues of the participating practices, GAO said. All of the demonstration practices had 200 or more physicians, while less than 1% of physician practices in the United States have more than 150 physicians.

In fact, about 83% of all physician practices are solo or two-person groups, according to GAO.

The practices weren't just bigger in terms of the number of physicians but also had more support staff and larger annual medical revenues. On average, the demonstration practices had annual medical revenues of $413 million in 2005. By comparison, only about 1% of single-specialty practices in the country have revenues exceeding $50 million a year.

GAO identified three advantages that the participating practices had because of their size, institutional affiliations with an integrated delivery system that gave them greater access to financial capital; past experience with pay-for-performance (P4P) programs, and experience using an electronic health records system.

Since most of the participating practices had affiliations with large, integrated delivery systems, they had access to the funds to start or expand quality programs. GAO estimated that on average, each participating practice invested about $489,000 to start or expand its demonstration-related programs and spent about $1.2 million on operating expenses for these programs in the first year.

The practices that participated in the demonstration also had a leg up in terms of electronic health record systems. Eight of the 10 participants had an electronic health record before the project began. By comparison, in 2005, only 24% of physician practices in the United States had a full or partial electronic health record, GAO said.

The majority of the participants in the demonstration also had past experience with pay-for-performance programs either through a private or public sector organization.

CMS officials told GAO investigators that they chose to focus on large practices because they affect a significant amount of Medicare expenditures and have sufficient Medicare beneficiary volume to calculate savings.

A Medicare demonstration project testing pay for performance among large multispecialty physician groups is yielding good data on care coordination programs, but expanding the program to small practices could present challenges, according to an analysis by the Government Accountability Office.

Small practices would have difficulty absorbing the high start-up costs associated with care coordination programs and the hefty price tag for electronic health record adoption and implementation, the GAO found.

The GAO report to Congress analyzed the Physician Group Practice Demonstration project. The demonstration tests an alternative payment approach that combines Medicare fee-for-service payments with incentive payments for achieving cost savings and hitting quality targets.

The demonstration, which began in April 2005, includes 10 multispecialty practices, each with 200 or more physicians. Officials at the Centers for Medicare and Medicaid Services recently added a fourth year to the project, which now is scheduled to end on March 31, 2009.

CMS reported the first-year results in July 2007. In the first year, two group practices earned bonus payments of about $7.4 million in total.

But it may be difficult to broaden this approach to other physician practices because of the large size and high revenues of the participating practices, GAO said. All of the demonstration practices had 200 or more physicians, while less than 1% of physician practices in the United States have more than 150 physicians.

In fact, about 83% of all physician practices are solo or two-person groups, according to GAO.

The practices weren't just bigger in terms of the number of physicians but also had more support staff and larger annual medical revenues. On average, the demonstration practices had annual medical revenues of $413 million in 2005. By comparison, only about 1% of single-specialty practices in the country have revenues exceeding $50 million a year.

GAO identified three advantages that the participating practices had because of their size, institutional affiliations with an integrated delivery system that gave them greater access to financial capital; past experience with pay-for-performance (P4P) programs, and experience using an electronic health records system.

Since most of the participating practices had affiliations with large, integrated delivery systems, they had access to the funds to start or expand quality programs. GAO estimated that on average, each participating practice invested about $489,000 to start or expand its demonstration-related programs and spent about $1.2 million on operating expenses for these programs in the first year.

The practices that participated in the demonstration also had a leg up in terms of electronic health record systems. Eight of the 10 participants had an electronic health record before the project began. By comparison, in 2005, only 24% of physician practices in the United States had a full or partial electronic health record, GAO said.

The majority of the participants in the demonstration also had past experience with pay-for-performance programs either through a private or public sector organization.

CMS officials told GAO investigators that they chose to focus on large practices because they affect a significant amount of Medicare expenditures and have sufficient Medicare beneficiary volume to calculate savings.

Under an agreement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge it prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs. Giving physicians a chance to ensure that the data is accurate makes the process fair, he said. It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter. Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American College of Cardiology and the American Medical Association. The ACC said in a statement that it “plans to take an active role during these phases to ensure that the ratings programs adequately take into account the needs of cardiovascular professionals.”

Some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint.

Under an agreement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge it prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs. Giving physicians a chance to ensure that the data is accurate makes the process fair, he said. It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter. Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American College of Cardiology and the American Medical Association. The ACC said in a statement that it “plans to take an active role during these phases to ensure that the ratings programs adequately take into account the needs of cardiovascular professionals.”

Some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint.

Under an agreement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge it prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs. Giving physicians a chance to ensure that the data is accurate makes the process fair, he said. It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter. Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American College of Cardiology and the American Medical Association. The ACC said in a statement that it “plans to take an active role during these phases to ensure that the ratings programs adequately take into account the needs of cardiovascular professionals.”

Some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint.

A new regulation on Medicare coverage at outpatient dialysis centers aims to bring the requirements in line with new technology and scientific advances.

The final regulation, published in the Federal Register last month, also directs dialysis centers to focus more on patient needs. The final rule includes updated requirements for safety, patients' rights, quality reporting, and patient assessment.

The changes are so significant that the Centers for Medicare and Medicaid Services is granting centers 180 days to come into compliance with the new requirements instead of the standard 60 days.

“It's a cultural change in many ways as much as it is having to build new processes or implement new equipment,” Dr. Barry M. Straube, director of the CMS Office of Clinical Standards and Quality, said during a press briefing to announce the publication of the final rule.

The new requirements set a minimum standard that dialysis centers must comply with to be certified as Medicare providers. Under the final rule, centers must conduct a comprehensive assessment of the patient's health condition when they start dialysis and create a personalized care plan for each patient. That care plan should be developed by an interdisciplinary team made up of the treating physician, a registered nurse, a social worker, and a dietician.

The regulation also includes new patient rights protections. For example, patients must be informed of their right to have advance directives, and they must be given 30-day written notice before their dialysis services can be terminated involuntarily.

Centers will also be required to establish a center-level quality assessment and performance improvement program to show how the facility plans to improve quality of care.

The final rule also includes a requirement for dialysis centers to submit performance data through the Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) system starting next year. Facilities will have until Feb. 1, 2009, to develop or enhance their systems to begin submitting end-stage renal disease clinical performance data electronically.

The final rule has been in the works for some time and officials at the CMS have sought significant input from the end-stage renal disease community since the proposed rule was issued in 2005. There are unlikely to be surprises in the regulation, he said.

CMS officials do not expect the regulation to be a major financial burden on dialysis facilities. Most costs associated with new requirements should be offset by the elimination of other resource-heavy requirements, Dr. Straube said.

A new regulation on Medicare coverage at outpatient dialysis centers aims to bring the requirements in line with new technology and scientific advances.

The final regulation, published in the Federal Register last month, also directs dialysis centers to focus more on patient needs. The final rule includes updated requirements for safety, patients' rights, quality reporting, and patient assessment.

The changes are so significant that the Centers for Medicare and Medicaid Services is granting centers 180 days to come into compliance with the new requirements instead of the standard 60 days.

“It's a cultural change in many ways as much as it is having to build new processes or implement new equipment,” Dr. Barry M. Straube, director of the CMS Office of Clinical Standards and Quality, said during a press briefing to announce the publication of the final rule.

The new requirements set a minimum standard that dialysis centers must comply with to be certified as Medicare providers. Under the final rule, centers must conduct a comprehensive assessment of the patient's health condition when they start dialysis and create a personalized care plan for each patient. That care plan should be developed by an interdisciplinary team made up of the treating physician, a registered nurse, a social worker, and a dietician.

The regulation also includes new patient rights protections. For example, patients must be informed of their right to have advance directives, and they must be given 30-day written notice before their dialysis services can be terminated involuntarily.

Centers will also be required to establish a center-level quality assessment and performance improvement program to show how the facility plans to improve quality of care.

The final rule also includes a requirement for dialysis centers to submit performance data through the Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) system starting next year. Facilities will have until Feb. 1, 2009, to develop or enhance their systems to begin submitting end-stage renal disease clinical performance data electronically.

The final rule has been in the works for some time and officials at the CMS have sought significant input from the end-stage renal disease community since the proposed rule was issued in 2005. There are unlikely to be surprises in the regulation, he said.

CMS officials do not expect the regulation to be a major financial burden on dialysis facilities. Most costs associated with new requirements should be offset by the elimination of other resource-heavy requirements, Dr. Straube said.

A new regulation on Medicare coverage at outpatient dialysis centers aims to bring the requirements in line with new technology and scientific advances.

The final regulation, published in the Federal Register last month, also directs dialysis centers to focus more on patient needs. The final rule includes updated requirements for safety, patients' rights, quality reporting, and patient assessment.

The changes are so significant that the Centers for Medicare and Medicaid Services is granting centers 180 days to come into compliance with the new requirements instead of the standard 60 days.

“It's a cultural change in many ways as much as it is having to build new processes or implement new equipment,” Dr. Barry M. Straube, director of the CMS Office of Clinical Standards and Quality, said during a press briefing to announce the publication of the final rule.

The new requirements set a minimum standard that dialysis centers must comply with to be certified as Medicare providers. Under the final rule, centers must conduct a comprehensive assessment of the patient's health condition when they start dialysis and create a personalized care plan for each patient. That care plan should be developed by an interdisciplinary team made up of the treating physician, a registered nurse, a social worker, and a dietician.

The regulation also includes new patient rights protections. For example, patients must be informed of their right to have advance directives, and they must be given 30-day written notice before their dialysis services can be terminated involuntarily.

Centers will also be required to establish a center-level quality assessment and performance improvement program to show how the facility plans to improve quality of care.

The final rule also includes a requirement for dialysis centers to submit performance data through the Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) system starting next year. Facilities will have until Feb. 1, 2009, to develop or enhance their systems to begin submitting end-stage renal disease clinical performance data electronically.

The final rule has been in the works for some time and officials at the CMS have sought significant input from the end-stage renal disease community since the proposed rule was issued in 2005. There are unlikely to be surprises in the regulation, he said.

CMS officials do not expect the regulation to be a major financial burden on dialysis facilities. Most costs associated with new requirements should be offset by the elimination of other resource-heavy requirements, Dr. Straube said.