Mary Ellen Schneider

Medicare has expanded its coverage of continuous positive airway pressure therapy for obstructive sleep apnea to include patients who were diagnosed using home sleep tests.

Officials at the Centers for Medicare and Medicaid Services handed down their final decision, after first proposing the change last December.

The new coverage policy is a significant departure from the agency's 2005 policy, which provided coverage for continuous positive airway pressure (CPAP) devices when the diagnosis was made using polysomnography in an attended sleep laboratory. The new policy will add coverage for CPAP following a clinical evaluation in combination with a positive result on an unattended home sleep monitoring device of type II, type III, or type IV measuring at least three channels.

CPAP therapy prescribed based only on a clinical evaluation or a test that is not specified by the CMS will be covered only in the context of a clinical study, according to the new coverage policy.

The CMS has also eliminated the requirements that individuals have moderate to severe obstructive sleep apnea and that surgery is a likely alternative, to be covered for CPAP therapy. The agency also eliminated its requirement for a minimum of 2 hours of continuous record sleep to make a diagnosis of obstructive sleep apnea.

But CMS officials are limiting coverage of CPAP devices to an initial 12-week trial period. Only those beneficiaries who improve on the devices will be able to continue to receive coverage.

The agency will also continue monitoring use of home testing for obstructive sleep apnea to detect potential fraud.

“[The] policy provides more options for Medicare beneficiaries and their treating physicians. At the same time, we remain vigilant to ensure that Medicare payments for these services do not create incentives for inappropriate use,” Kerry Weems, CMS acting administrator, said in a statement.

While experts say the revised policy does a lot to improve access, it could have unintended consequences for the more than 4 million Medicare beneficiaries who have some form of obstructive sleep apnea.

Dr. Robert Thomas, sleep medicine fellowship director at Beth Israel Deaconess Medical Center, Boston, said the final policy is an improvement over last year's proposal because it specifies that any type IV sleep test used must have at least three channels. Single-channel devices have numerous problems including false negative results, he said.

While the policy allows for greater access to CPAP therapy, there is no guarantee it will be followed by appropriate care, said Dr. Thomas, who holds patents for technology to estimate sleep quality from an ECG and for CO₂ use in mixed sleep apnea treatment. “Sleep apnea management is not simple and many patients with sleep apnea have comorbid sleep disorders.”

Dr. Alex Chediak, president of the American Academy of Sleep Medicine, and a sleep specialist based in Miami, said that in the short run the policy could cause a lot of durable medical equipment vendors to jump into the market to reap the financial benefits without providing the proper level of support to patients. The equipment will show up on the patients' doorsteps but they won't know what to do with it and “physicians will be left holding the bag.” But in the long run, the policy will improve access and outcomes, he predicted.

Guidelines issued last year from the American Academy of Sleep Medicine outline the appropriate use of unattended portable monitors in diagnosing obstructive sleep apnea. They recommend that unattended portable monitors be used only for obstructive sleep apnea diagnosis in conjunction with a comprehensive sleep evaluation (J. Clin. Sleep. Med. 2007;3:737–47).

They also state that portable monitoring is not appropriate for the diagnosis of obstructive sleep apnea in patients with significant comorbid medical conditions that may interfere with the accuracy of the home test. Portable home tests are also inappropriate for diagnosing patients who may have comorbid sleep disorders.

The national coverage determination is available online at www.cms.hhs.gov/center/coverage.asp

Medicare has expanded its coverage of continuous positive airway pressure therapy for obstructive sleep apnea to include patients who were diagnosed using home sleep tests.

Officials at the Centers for Medicare and Medicaid Services handed down their final decision, after first proposing the change last December.

The new coverage policy is a significant departure from the agency's 2005 policy, which provided coverage for continuous positive airway pressure (CPAP) devices when the diagnosis was made using polysomnography in an attended sleep laboratory. The new policy will add coverage for CPAP following a clinical evaluation in combination with a positive result on an unattended home sleep monitoring device of type II, type III, or type IV measuring at least three channels.

CPAP therapy prescribed based only on a clinical evaluation or a test that is not specified by the CMS will be covered only in the context of a clinical study, according to the new coverage policy.

The CMS has also eliminated the requirements that individuals have moderate to severe obstructive sleep apnea and that surgery is a likely alternative, to be covered for CPAP therapy. The agency also eliminated its requirement for a minimum of 2 hours of continuous record sleep to make a diagnosis of obstructive sleep apnea.

But CMS officials are limiting coverage of CPAP devices to an initial 12-week trial period. Only those beneficiaries who improve on the devices will be able to continue to receive coverage.

The agency will also continue monitoring use of home testing for obstructive sleep apnea to detect potential fraud.

“[The] policy provides more options for Medicare beneficiaries and their treating physicians. At the same time, we remain vigilant to ensure that Medicare payments for these services do not create incentives for inappropriate use,” Kerry Weems, CMS acting administrator, said in a statement.

While experts say the revised policy does a lot to improve access, it could have unintended consequences for the more than 4 million Medicare beneficiaries who have some form of obstructive sleep apnea.

Dr. Robert Thomas, sleep medicine fellowship director at Beth Israel Deaconess Medical Center, Boston, said the final policy is an improvement over last year's proposal because it specifies that any type IV sleep test used must have at least three channels. Single-channel devices have numerous problems including false negative results, he said.

While the policy allows for greater access to CPAP therapy, there is no guarantee it will be followed by appropriate care, said Dr. Thomas, who holds patents for technology to estimate sleep quality from an ECG and for CO₂ use in mixed sleep apnea treatment. “Sleep apnea management is not simple and many patients with sleep apnea have comorbid sleep disorders.”

Dr. Alex Chediak, president of the American Academy of Sleep Medicine, and a sleep specialist based in Miami, said that in the short run the policy could cause a lot of durable medical equipment vendors to jump into the market to reap the financial benefits without providing the proper level of support to patients. The equipment will show up on the patients' doorsteps but they won't know what to do with it and “physicians will be left holding the bag.” But in the long run, the policy will improve access and outcomes, he predicted.

Guidelines issued last year from the American Academy of Sleep Medicine outline the appropriate use of unattended portable monitors in diagnosing obstructive sleep apnea. They recommend that unattended portable monitors be used only for obstructive sleep apnea diagnosis in conjunction with a comprehensive sleep evaluation (J. Clin. Sleep. Med. 2007;3:737–47).

They also state that portable monitoring is not appropriate for the diagnosis of obstructive sleep apnea in patients with significant comorbid medical conditions that may interfere with the accuracy of the home test. Portable home tests are also inappropriate for diagnosing patients who may have comorbid sleep disorders.

The national coverage determination is available online at www.cms.hhs.gov/center/coverage.asp

Medicare has expanded its coverage of continuous positive airway pressure therapy for obstructive sleep apnea to include patients who were diagnosed using home sleep tests.

Officials at the Centers for Medicare and Medicaid Services handed down their final decision, after first proposing the change last December.

The new coverage policy is a significant departure from the agency's 2005 policy, which provided coverage for continuous positive airway pressure (CPAP) devices when the diagnosis was made using polysomnography in an attended sleep laboratory. The new policy will add coverage for CPAP following a clinical evaluation in combination with a positive result on an unattended home sleep monitoring device of type II, type III, or type IV measuring at least three channels.

CPAP therapy prescribed based only on a clinical evaluation or a test that is not specified by the CMS will be covered only in the context of a clinical study, according to the new coverage policy.

The CMS has also eliminated the requirements that individuals have moderate to severe obstructive sleep apnea and that surgery is a likely alternative, to be covered for CPAP therapy. The agency also eliminated its requirement for a minimum of 2 hours of continuous record sleep to make a diagnosis of obstructive sleep apnea.

But CMS officials are limiting coverage of CPAP devices to an initial 12-week trial period. Only those beneficiaries who improve on the devices will be able to continue to receive coverage.

The agency will also continue monitoring use of home testing for obstructive sleep apnea to detect potential fraud.

“[The] policy provides more options for Medicare beneficiaries and their treating physicians. At the same time, we remain vigilant to ensure that Medicare payments for these services do not create incentives for inappropriate use,” Kerry Weems, CMS acting administrator, said in a statement.

While experts say the revised policy does a lot to improve access, it could have unintended consequences for the more than 4 million Medicare beneficiaries who have some form of obstructive sleep apnea.

Dr. Robert Thomas, sleep medicine fellowship director at Beth Israel Deaconess Medical Center, Boston, said the final policy is an improvement over last year's proposal because it specifies that any type IV sleep test used must have at least three channels. Single-channel devices have numerous problems including false negative results, he said.

While the policy allows for greater access to CPAP therapy, there is no guarantee it will be followed by appropriate care, said Dr. Thomas, who holds patents for technology to estimate sleep quality from an ECG and for CO₂ use in mixed sleep apnea treatment. “Sleep apnea management is not simple and many patients with sleep apnea have comorbid sleep disorders.”

Dr. Alex Chediak, president of the American Academy of Sleep Medicine, and a sleep specialist based in Miami, said that in the short run the policy could cause a lot of durable medical equipment vendors to jump into the market to reap the financial benefits without providing the proper level of support to patients. The equipment will show up on the patients' doorsteps but they won't know what to do with it and “physicians will be left holding the bag.” But in the long run, the policy will improve access and outcomes, he predicted.

Guidelines issued last year from the American Academy of Sleep Medicine outline the appropriate use of unattended portable monitors in diagnosing obstructive sleep apnea. They recommend that unattended portable monitors be used only for obstructive sleep apnea diagnosis in conjunction with a comprehensive sleep evaluation (J. Clin. Sleep. Med. 2007;3:737–47).

They also state that portable monitoring is not appropriate for the diagnosis of obstructive sleep apnea in patients with significant comorbid medical conditions that may interfere with the accuracy of the home test. Portable home tests are also inappropriate for diagnosing patients who may have comorbid sleep disorders.

The national coverage determination is available online at www.cms.hhs.gov/center/coverage.asp

Everyone knows that money talks. But when it comes to dieting, can money really motivate overweight patients to shed pounds?

Dr. Joseph K. Chemplavil, an endocrinologist in Hampton, Va., thinks it can. He points to his own success in giving patients $1 for each pound they lose.

Nearly all of Dr. Chemplavil's patients have diabetes, and most are overweight or obese. So when they come into the office he offers them a chance to enroll in his weight-loss program. The plan is simple: he advises them to eat less and exercise more. Then he asks them to sign a contract, which is posted on his Web site (www.dollarsfordieting.com

Patients pay him $10 to enroll and then agree that for every pound they gain, they will pay him $1 in cash at the visit. In exchange, Dr. Chemplavil pledges to pay them $1 for every pound they lose. He keeps a cookie jar full of dollar bills on his desk to make good on his end of the deal. “Signing the contract is the most important thing,” Dr. Chemplavil said.

So far, the program is working. Since it began in 2002, nearly 400 patients have enrolled. Between 70% and 80% of those who have enrolled in the program have lost weight, with the average weight loss at 9 to 12 pounds per person per year.

The remainder of those in the program have gained about 5 to 11 pounds per person per year. Only a small number maintained the same weight throughout, he said.

But it's not really about the amount of money patients can earn, Dr. Chemplavil said. Simply the act of getting or paying the money is the key. Some patients have even asked him for a crisp dollar bill so they could frame it. “I'm asking the patient: Show me the result; I'll show you the money,” he said.

Any physician can do this in his or her office, Dr. Chemplavil advised. The small enrollment fee pays for the program, and he doesn't spend much time counseling on the diet itself since the idea of a healthy diet and exercise isn't news to most patients.

Offering an incentive to patients is definitely appropriate, said Dr. J. Michael Gonzalez-Campoy, an endocrinologist and obesity expert in Egan, Minn., and assistant professor of medicine at the University of Minnesota, though he favors the use of positive incentives alone.

Physicians don't have to use money to achieve results, though, he said. In his practice, he uses encouragement and measurement to motivate patients to lose weight and keep it off. Aside from positive reinforcement, Dr. Gonzalez-Campoy said patients also see a prescription for an obesity medication as a kind of reward. Those medications can be great tools, and are often underutilized, he said.

But physicians aren't the only ones trying to motivate individuals to lose weight, Dr. Gonzalez-Campoy noted. On the national level, there are proposals to decrease health care premiums for individuals with a low body mass index. There are also some workplace initiatives that offer extra days off for employees who walk a certain number of steps each day, for example.

“Financial incentives are powerful,” he said. “People will do a lot of things for money.”

Financial incentives to lose weight in the workplace are starting to get more attention. Researchers at the University of North Carolina at Chapel Hill and RTI International are currently studying worksite weight loss programs that rely on access to healthy foods, Web-based support, and financial incentives.

Researchers in a pilot study found that people who received payments of $14 per percentage point of weight loss were able to lose more weight than those receiving $7 or no money at all (J. Occup. Environ. Med. 2007;49:981–9).

“Incentives on average work,” said Eric Finkelstein, Ph.D., director of RTI's Public Health Economics Program and the lead author of the pilot study. But the incentives were most effective among a subset of employees for whom the financial incentive gave them the extra boost to really focus on losing weight, he added.

Now that more workplace wellness programs are emerging, there are some questions about whether paying employees to meet certain health targets is legal or ethical, said Dr. Donald Bergman, an endocrinologist in New York City and a past president of the American Association of Clinical Endocrinologists.

Paying people to meet specific clinical targets could be unfair for those who put in the effort but can't meet the targets, he said. Instead, he favors programs that reward individuals for achieving some level of improvement through participation, even if they don't meet the targets.

'I'm asking the patient: Show me the result; I'll show you the money.' DR. CHEMPLAVIL

No gain, no pain … just a crisp dollar bill from your doctor. Courtesy Dr. Joseph K. Chemplavil

Everyone knows that money talks. But when it comes to dieting, can money really motivate overweight patients to shed pounds?

Dr. Joseph K. Chemplavil, an endocrinologist in Hampton, Va., thinks it can. He points to his own success in giving patients $1 for each pound they lose.

Nearly all of Dr. Chemplavil's patients have diabetes, and most are overweight or obese. So when they come into the office he offers them a chance to enroll in his weight-loss program. The plan is simple: he advises them to eat less and exercise more. Then he asks them to sign a contract, which is posted on his Web site (www.dollarsfordieting.com

Patients pay him $10 to enroll and then agree that for every pound they gain, they will pay him $1 in cash at the visit. In exchange, Dr. Chemplavil pledges to pay them $1 for every pound they lose. He keeps a cookie jar full of dollar bills on his desk to make good on his end of the deal. “Signing the contract is the most important thing,” Dr. Chemplavil said.

So far, the program is working. Since it began in 2002, nearly 400 patients have enrolled. Between 70% and 80% of those who have enrolled in the program have lost weight, with the average weight loss at 9 to 12 pounds per person per year.

The remainder of those in the program have gained about 5 to 11 pounds per person per year. Only a small number maintained the same weight throughout, he said.

But it's not really about the amount of money patients can earn, Dr. Chemplavil said. Simply the act of getting or paying the money is the key. Some patients have even asked him for a crisp dollar bill so they could frame it. “I'm asking the patient: Show me the result; I'll show you the money,” he said.

Any physician can do this in his or her office, Dr. Chemplavil advised. The small enrollment fee pays for the program, and he doesn't spend much time counseling on the diet itself since the idea of a healthy diet and exercise isn't news to most patients.

Offering an incentive to patients is definitely appropriate, said Dr. J. Michael Gonzalez-Campoy, an endocrinologist and obesity expert in Egan, Minn., and assistant professor of medicine at the University of Minnesota, though he favors the use of positive incentives alone.

Physicians don't have to use money to achieve results, though, he said. In his practice, he uses encouragement and measurement to motivate patients to lose weight and keep it off. Aside from positive reinforcement, Dr. Gonzalez-Campoy said patients also see a prescription for an obesity medication as a kind of reward. Those medications can be great tools, and are often underutilized, he said.

But physicians aren't the only ones trying to motivate individuals to lose weight, Dr. Gonzalez-Campoy noted. On the national level, there are proposals to decrease health care premiums for individuals with a low body mass index. There are also some workplace initiatives that offer extra days off for employees who walk a certain number of steps each day, for example.

“Financial incentives are powerful,” he said. “People will do a lot of things for money.”

Financial incentives to lose weight in the workplace are starting to get more attention. Researchers at the University of North Carolina at Chapel Hill and RTI International are currently studying worksite weight loss programs that rely on access to healthy foods, Web-based support, and financial incentives.

Researchers in a pilot study found that people who received payments of $14 per percentage point of weight loss were able to lose more weight than those receiving $7 or no money at all (J. Occup. Environ. Med. 2007;49:981–9).

“Incentives on average work,” said Eric Finkelstein, Ph.D., director of RTI's Public Health Economics Program and the lead author of the pilot study. But the incentives were most effective among a subset of employees for whom the financial incentive gave them the extra boost to really focus on losing weight, he added.

Now that more workplace wellness programs are emerging, there are some questions about whether paying employees to meet certain health targets is legal or ethical, said Dr. Donald Bergman, an endocrinologist in New York City and a past president of the American Association of Clinical Endocrinologists.

Paying people to meet specific clinical targets could be unfair for those who put in the effort but can't meet the targets, he said. Instead, he favors programs that reward individuals for achieving some level of improvement through participation, even if they don't meet the targets.

'I'm asking the patient: Show me the result; I'll show you the money.' DR. CHEMPLAVIL

No gain, no pain … just a crisp dollar bill from your doctor. Courtesy Dr. Joseph K. Chemplavil

Everyone knows that money talks. But when it comes to dieting, can money really motivate overweight patients to shed pounds?

Dr. Joseph K. Chemplavil, an endocrinologist in Hampton, Va., thinks it can. He points to his own success in giving patients $1 for each pound they lose.

Nearly all of Dr. Chemplavil's patients have diabetes, and most are overweight or obese. So when they come into the office he offers them a chance to enroll in his weight-loss program. The plan is simple: he advises them to eat less and exercise more. Then he asks them to sign a contract, which is posted on his Web site (www.dollarsfordieting.com

Patients pay him $10 to enroll and then agree that for every pound they gain, they will pay him $1 in cash at the visit. In exchange, Dr. Chemplavil pledges to pay them $1 for every pound they lose. He keeps a cookie jar full of dollar bills on his desk to make good on his end of the deal. “Signing the contract is the most important thing,” Dr. Chemplavil said.

So far, the program is working. Since it began in 2002, nearly 400 patients have enrolled. Between 70% and 80% of those who have enrolled in the program have lost weight, with the average weight loss at 9 to 12 pounds per person per year.

The remainder of those in the program have gained about 5 to 11 pounds per person per year. Only a small number maintained the same weight throughout, he said.

But it's not really about the amount of money patients can earn, Dr. Chemplavil said. Simply the act of getting or paying the money is the key. Some patients have even asked him for a crisp dollar bill so they could frame it. “I'm asking the patient: Show me the result; I'll show you the money,” he said.

Any physician can do this in his or her office, Dr. Chemplavil advised. The small enrollment fee pays for the program, and he doesn't spend much time counseling on the diet itself since the idea of a healthy diet and exercise isn't news to most patients.

Offering an incentive to patients is definitely appropriate, said Dr. J. Michael Gonzalez-Campoy, an endocrinologist and obesity expert in Egan, Minn., and assistant professor of medicine at the University of Minnesota, though he favors the use of positive incentives alone.

Physicians don't have to use money to achieve results, though, he said. In his practice, he uses encouragement and measurement to motivate patients to lose weight and keep it off. Aside from positive reinforcement, Dr. Gonzalez-Campoy said patients also see a prescription for an obesity medication as a kind of reward. Those medications can be great tools, and are often underutilized, he said.

But physicians aren't the only ones trying to motivate individuals to lose weight, Dr. Gonzalez-Campoy noted. On the national level, there are proposals to decrease health care premiums for individuals with a low body mass index. There are also some workplace initiatives that offer extra days off for employees who walk a certain number of steps each day, for example.

“Financial incentives are powerful,” he said. “People will do a lot of things for money.”

Financial incentives to lose weight in the workplace are starting to get more attention. Researchers at the University of North Carolina at Chapel Hill and RTI International are currently studying worksite weight loss programs that rely on access to healthy foods, Web-based support, and financial incentives.

Researchers in a pilot study found that people who received payments of $14 per percentage point of weight loss were able to lose more weight than those receiving $7 or no money at all (J. Occup. Environ. Med. 2007;49:981–9).

“Incentives on average work,” said Eric Finkelstein, Ph.D., director of RTI's Public Health Economics Program and the lead author of the pilot study. But the incentives were most effective among a subset of employees for whom the financial incentive gave them the extra boost to really focus on losing weight, he added.

Now that more workplace wellness programs are emerging, there are some questions about whether paying employees to meet certain health targets is legal or ethical, said Dr. Donald Bergman, an endocrinologist in New York City and a past president of the American Association of Clinical Endocrinologists.

Paying people to meet specific clinical targets could be unfair for those who put in the effort but can't meet the targets, he said. Instead, he favors programs that reward individuals for achieving some level of improvement through participation, even if they don't meet the targets.

'I'm asking the patient: Show me the result; I'll show you the money.' DR. CHEMPLAVIL

No gain, no pain … just a crisp dollar bill from your doctor. Courtesy Dr. Joseph K. Chemplavil

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.

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.

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 the 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, she 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. 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 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.

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.

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 the 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, she 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. 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 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.

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.

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

Conscientious Refusal Controversy

Health and Human Services Secretary Mike Leavitt has called on the American Board of Obstetrics and Gynecology to honor the right of ob.gyns. to refuse to refer patients for abortion if they object to the procedure on moral or religious grounds. Last month, Mr. Leavitt wrote to the board seeking clarification on whether ob.gyns. would be putting their board certification at risk if they failed to follow ethical guidelines from the American College of Obstetricians and Gynecologists. Those guidelines, released late last year, advise physicians that they have an ethical duty to refer patients to other providers in a timely manner if they cannot provide reproductive services. In a letter at that time to ACOG fellows, ACOG President Kenneth Noller said that the committee opinion was not part of the college's “Code of Professional Ethics” and is not intended to be used to in determining anyone's fellowship in the group. In addition, the committee opinion is not part of the criteria for certification or maintenance of certification by the American Board of Obstetrics and Gynecology. As a result of the “uncertain and mixed interpretation” of the opinion, the ACOG executive committee has asked the committee on ethics to hold a special meeting to reevaluate the guidance.

FDA Issues Keepsake Ultrasound Alert

The Food and Drug Administration is advising consumers to avoid the use of ultrasound imaging to create so-called keepsake videos during pregnancy, an unapproved use of the technology, according to the FDA. While there are no known risks associated with ultrasound imaging, there is also no clinical benefit to using it for keepsake purposes. In some cases, commercial operations have used ultrasound machines for up to an hour to create a video of a fetus. “Performing prenatal ultrasounds without medical oversight may put a mother and her unborn baby at risk,” Robert Phillips, Ph.D., an FDA physicist, said in a statement. The agency is raising similar concerns about the over-the-counter purchase of Doppler ultrasound heartbeat monitors. These devices should be used only by a health care professional or under a health care provider's supervision, the FDA maintains.

Physician Group Calls for EC Education

Women and their physicians need to be better educated about emergency contraception, according to Physicians for Reproductive Choice and Health (PRCH). On the seventh annual “Back Up Your Birth Control Day” last month, members of the group called on Congress to help by passing the Emergency Contraception Education Act (S. 2108/H.R. 3372), which calls for the Health Resources and Services Administration to develop and disseminate to health care providers information on the use, safety, efficacy, and availability of emergency contraception. Even medical students are sometimes misinformed, according to Dr. Michelle Isley, a fellow with the PRCH. “I teach medical students about emergency contraception and many of them confuse the morning-after pill with medication abortion,” she said in a statement. Giving women accurate information about emergency contraception is even more important now that the medication is available without a prescription, according to the PRCH.

Violence Admissions Rise

Attempted murder, rape, fights, and other assaults accounted for nearly one-third of the violence-related treatment at hospitals in 2005, according to a report from the Agency for Healthcare Research and Quality. About 31% of violence-related admissions were for assaults, 66% for attempted suicide or self-injury, and 4% were for sexual or other abuse. Children accounted for half of the abuse cases. Violence-related admissions, which cost $2.3 billion in 2005, increased by 24,000 between 2002 and 2005. The AHRQ estimates that 23% of violence-related admissions were for Medicaid patients and 23% were among uninsured patients.

Survey: MDs Don't Get Enough Sleep

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Conscientious Refusal Controversy

Health and Human Services Secretary Mike Leavitt has called on the American Board of Obstetrics and Gynecology to honor the right of ob.gyns. to refuse to refer patients for abortion if they object to the procedure on moral or religious grounds. Last month, Mr. Leavitt wrote to the board seeking clarification on whether ob.gyns. would be putting their board certification at risk if they failed to follow ethical guidelines from the American College of Obstetricians and Gynecologists. Those guidelines, released late last year, advise physicians that they have an ethical duty to refer patients to other providers in a timely manner if they cannot provide reproductive services. In a letter at that time to ACOG fellows, ACOG President Kenneth Noller said that the committee opinion was not part of the college's “Code of Professional Ethics” and is not intended to be used to in determining anyone's fellowship in the group. In addition, the committee opinion is not part of the criteria for certification or maintenance of certification by the American Board of Obstetrics and Gynecology. As a result of the “uncertain and mixed interpretation” of the opinion, the ACOG executive committee has asked the committee on ethics to hold a special meeting to reevaluate the guidance.

FDA Issues Keepsake Ultrasound Alert

The Food and Drug Administration is advising consumers to avoid the use of ultrasound imaging to create so-called keepsake videos during pregnancy, an unapproved use of the technology, according to the FDA. While there are no known risks associated with ultrasound imaging, there is also no clinical benefit to using it for keepsake purposes. In some cases, commercial operations have used ultrasound machines for up to an hour to create a video of a fetus. “Performing prenatal ultrasounds without medical oversight may put a mother and her unborn baby at risk,” Robert Phillips, Ph.D., an FDA physicist, said in a statement. The agency is raising similar concerns about the over-the-counter purchase of Doppler ultrasound heartbeat monitors. These devices should be used only by a health care professional or under a health care provider's supervision, the FDA maintains.

Physician Group Calls for EC Education

Women and their physicians need to be better educated about emergency contraception, according to Physicians for Reproductive Choice and Health (PRCH). On the seventh annual “Back Up Your Birth Control Day” last month, members of the group called on Congress to help by passing the Emergency Contraception Education Act (S. 2108/H.R. 3372), which calls for the Health Resources and Services Administration to develop and disseminate to health care providers information on the use, safety, efficacy, and availability of emergency contraception. Even medical students are sometimes misinformed, according to Dr. Michelle Isley, a fellow with the PRCH. “I teach medical students about emergency contraception and many of them confuse the morning-after pill with medication abortion,” she said in a statement. Giving women accurate information about emergency contraception is even more important now that the medication is available without a prescription, according to the PRCH.

Violence Admissions Rise

Attempted murder, rape, fights, and other assaults accounted for nearly one-third of the violence-related treatment at hospitals in 2005, according to a report from the Agency for Healthcare Research and Quality. About 31% of violence-related admissions were for assaults, 66% for attempted suicide or self-injury, and 4% were for sexual or other abuse. Children accounted for half of the abuse cases. Violence-related admissions, which cost $2.3 billion in 2005, increased by 24,000 between 2002 and 2005. The AHRQ estimates that 23% of violence-related admissions were for Medicaid patients and 23% were among uninsured patients.

Survey: MDs Don't Get Enough Sleep

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

Conscientious Refusal Controversy

Health and Human Services Secretary Mike Leavitt has called on the American Board of Obstetrics and Gynecology to honor the right of ob.gyns. to refuse to refer patients for abortion if they object to the procedure on moral or religious grounds. Last month, Mr. Leavitt wrote to the board seeking clarification on whether ob.gyns. would be putting their board certification at risk if they failed to follow ethical guidelines from the American College of Obstetricians and Gynecologists. Those guidelines, released late last year, advise physicians that they have an ethical duty to refer patients to other providers in a timely manner if they cannot provide reproductive services. In a letter at that time to ACOG fellows, ACOG President Kenneth Noller said that the committee opinion was not part of the college's “Code of Professional Ethics” and is not intended to be used to in determining anyone's fellowship in the group. In addition, the committee opinion is not part of the criteria for certification or maintenance of certification by the American Board of Obstetrics and Gynecology. As a result of the “uncertain and mixed interpretation” of the opinion, the ACOG executive committee has asked the committee on ethics to hold a special meeting to reevaluate the guidance.

FDA Issues Keepsake Ultrasound Alert

The Food and Drug Administration is advising consumers to avoid the use of ultrasound imaging to create so-called keepsake videos during pregnancy, an unapproved use of the technology, according to the FDA. While there are no known risks associated with ultrasound imaging, there is also no clinical benefit to using it for keepsake purposes. In some cases, commercial operations have used ultrasound machines for up to an hour to create a video of a fetus. “Performing prenatal ultrasounds without medical oversight may put a mother and her unborn baby at risk,” Robert Phillips, Ph.D., an FDA physicist, said in a statement. The agency is raising similar concerns about the over-the-counter purchase of Doppler ultrasound heartbeat monitors. These devices should be used only by a health care professional or under a health care provider's supervision, the FDA maintains.

Physician Group Calls for EC Education

Women and their physicians need to be better educated about emergency contraception, according to Physicians for Reproductive Choice and Health (PRCH). On the seventh annual “Back Up Your Birth Control Day” last month, members of the group called on Congress to help by passing the Emergency Contraception Education Act (S. 2108/H.R. 3372), which calls for the Health Resources and Services Administration to develop and disseminate to health care providers information on the use, safety, efficacy, and availability of emergency contraception. Even medical students are sometimes misinformed, according to Dr. Michelle Isley, a fellow with the PRCH. “I teach medical students about emergency contraception and many of them confuse the morning-after pill with medication abortion,” she said in a statement. Giving women accurate information about emergency contraception is even more important now that the medication is available without a prescription, according to the PRCH.

Violence Admissions Rise

Attempted murder, rape, fights, and other assaults accounted for nearly one-third of the violence-related treatment at hospitals in 2005, according to a report from the Agency for Healthcare Research and Quality. About 31% of violence-related admissions were for assaults, 66% for attempted suicide or self-injury, and 4% were for sexual or other abuse. Children accounted for half of the abuse cases. Violence-related admissions, which cost $2.3 billion in 2005, increased by 24,000 between 2002 and 2005. The AHRQ estimates that 23% of violence-related admissions were for Medicaid patients and 23% were among uninsured patients.

Survey: MDs Don't Get Enough Sleep

Physicians are not getting the sleep they need to function at their best during the day, and their current work schedules could be to blame, according to a survey from the American College of Chest Physicians. In the survey, 70% of physicians reported needing at least 7–8 hours of sleep to function at their best. But on average, physicians reported sleeping 6.5 hours a night, and 43% of physicians indicated their current work schedule did not allow for adequate sleep. In addition, 22% reported not feeling refreshed upon waking at least a few nights a week. Almost all physicians (93%) reported drinking at least one caffeinated beverage a day, compared with 81% of the general population, but 84% of physicians said they are in very good or excellent health, compared with 56% of the general population. The survey included responses from 581 physicians.

The head count of medical students choosing family medicine increased slightly, according to figures last month, with the specialty having its best showing in the National Resident Matching Program in more than a decade.

The fill rate for family medicine positions rose overall and in U.S. medical graduates. This year, 2,636 family medicine residency positions were offered. Of that, 91% were filled; 44% were filled by U.S. medical graduates. In 2007, 88% of the 2,603 positions were filled; 42% went to U.S. graduates.

Overall, 8.1% of all U.S. medical graduates who matched to a residency program chose family medicine in 2008, a 0.4% uptick from 7.7% in the 2007 match.

The American Academy of Family Physicians hailed the match numbers as evidence that medical students are beginning to see the value in family medicine again. But Dr. James King, AAFP president, said the specialty still has a “long way to go” in strengthening the pipeline of physicians entering the field. He said they are not sure why this year's figures rose.

In a 2006 AAFP report on the state of the physician workforce, the organization estimated that by 2020, there would need to be 139,531 family physicians to meet the primary care needs of all Americans. To meet that goal, U.S. residency programs would need to produce more than 4,400 new family physicians each year.

Medical students choosing family medicine and other primary care specialties have to overcome bias within medical schools, and are told they are “too smart” for family medicine, said Dr. Thomas Bodenheimer, a professor of family and community medicine at the University of California, San Francisco.

The head count of medical students choosing family medicine increased slightly, according to figures last month, with the specialty having its best showing in the National Resident Matching Program in more than a decade.

The fill rate for family medicine positions rose overall and in U.S. medical graduates. This year, 2,636 family medicine residency positions were offered. Of that, 91% were filled; 44% were filled by U.S. medical graduates. In 2007, 88% of the 2,603 positions were filled; 42% went to U.S. graduates.

Overall, 8.1% of all U.S. medical graduates who matched to a residency program chose family medicine in 2008, a 0.4% uptick from 7.7% in the 2007 match.

The American Academy of Family Physicians hailed the match numbers as evidence that medical students are beginning to see the value in family medicine again. But Dr. James King, AAFP president, said the specialty still has a “long way to go” in strengthening the pipeline of physicians entering the field. He said they are not sure why this year's figures rose.

In a 2006 AAFP report on the state of the physician workforce, the organization estimated that by 2020, there would need to be 139,531 family physicians to meet the primary care needs of all Americans. To meet that goal, U.S. residency programs would need to produce more than 4,400 new family physicians each year.

Medical students choosing family medicine and other primary care specialties have to overcome bias within medical schools, and are told they are “too smart” for family medicine, said Dr. Thomas Bodenheimer, a professor of family and community medicine at the University of California, San Francisco.

The head count of medical students choosing family medicine increased slightly, according to figures last month, with the specialty having its best showing in the National Resident Matching Program in more than a decade.

The fill rate for family medicine positions rose overall and in U.S. medical graduates. This year, 2,636 family medicine residency positions were offered. Of that, 91% were filled; 44% were filled by U.S. medical graduates. In 2007, 88% of the 2,603 positions were filled; 42% went to U.S. graduates.

Overall, 8.1% of all U.S. medical graduates who matched to a residency program chose family medicine in 2008, a 0.4% uptick from 7.7% in the 2007 match.

The American Academy of Family Physicians hailed the match numbers as evidence that medical students are beginning to see the value in family medicine again. But Dr. James King, AAFP president, said the specialty still has a “long way to go” in strengthening the pipeline of physicians entering the field. He said they are not sure why this year's figures rose.

In a 2006 AAFP report on the state of the physician workforce, the organization estimated that by 2020, there would need to be 139,531 family physicians to meet the primary care needs of all Americans. To meet that goal, U.S. residency programs would need to produce more than 4,400 new family physicians each year.

Medical students choosing family medicine and other primary care specialties have to overcome bias within medical schools, and are told they are “too smart” for family medicine, said Dr. Thomas Bodenheimer, a professor of family and community medicine at the University of California, San Francisco.

Health care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services.

Health care spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in a report published online in the journal Health Affairs. The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law.

The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase. Much of the increase will be fueled by the first wave of baby boomers entering Medicare in 2011. The increase in the number of Medicare enrollees is projected to add 2.9% to growth in Medicare spending by 2017.

The CMS economists projected that growth in spending on physician services would average about 5.9% per year through 2017, compared with 6.6% from 1995 to 2006. These projections are based on current law, which calls for steep cuts to Medicare physician payments over the next few years.

Home health care will likely be one of the fastest-growing sectors in health care from 2007 through 2017, with a 7.7% average annual spending growth rate.

Growth in prescription drug spending is expected to accelerate through 2017 because of increased utilization, new drugs entering the market, and leveling off of the growth in generics.

Health care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services.

Health care spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in a report published online in the journal Health Affairs. The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law.

The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase. Much of the increase will be fueled by the first wave of baby boomers entering Medicare in 2011. The increase in the number of Medicare enrollees is projected to add 2.9% to growth in Medicare spending by 2017.

The CMS economists projected that growth in spending on physician services would average about 5.9% per year through 2017, compared with 6.6% from 1995 to 2006. These projections are based on current law, which calls for steep cuts to Medicare physician payments over the next few years.

Home health care will likely be one of the fastest-growing sectors in health care from 2007 through 2017, with a 7.7% average annual spending growth rate.

Growth in prescription drug spending is expected to accelerate through 2017 because of increased utilization, new drugs entering the market, and leveling off of the growth in generics.

Health care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services.

Health care spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in a report published online in the journal Health Affairs. The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law.

The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase. Much of the increase will be fueled by the first wave of baby boomers entering Medicare in 2011. The increase in the number of Medicare enrollees is projected to add 2.9% to growth in Medicare spending by 2017.

The CMS economists projected that growth in spending on physician services would average about 5.9% per year through 2017, compared with 6.6% from 1995 to 2006. These projections are based on current law, which calls for steep cuts to Medicare physician payments over the next few years.

Home health care will likely be one of the fastest-growing sectors in health care from 2007 through 2017, with a 7.7% average annual spending growth rate.

Growth in prescription drug spending is expected to accelerate through 2017 because of increased utilization, new drugs entering the market, and leveling off of the growth in generics.

Unapproved STD Treatments

The Food and Drug Administration is cracking down on companies that market unapproved and misbranded drugs for the prevention and treatment of sexually transmitted diseases (STDs). Last month, FDA officials sent warning letters to six U.S. companies and one foreign individual for marketing these drugs over the Internet to U.S. consumers. The products identified by the FDA include Tetrasil, Genisil, Aviralex, OXi-MED, Imulux, Beta-mannan, Micronutrient, Qina, and SlicPlus. Some of the marketing includes false claims that the drugs have been approved by the FDA or that they are superior to conventional medicine, according to the FDA. For example, SlicPlus claims to offer the “greatest STD protection without condoms.” Companies that fail to cease marketing of the products could face seizure of illegal products, injunction, and possible criminal prosecution, according to the FDA.

2006 ART Success Rates Posted

The Society for Assisted Reproductive Technology recently posted 2006 outcome data from its member clinics. The national dataset includes the results of 126,379 treatment cycles at 343 clinics. Of those cycles, more than 99% involved in vitro fertilization, with less than 1% involving gamete intrafallopian transfer or zygote intrafallopian transfer. Among women under age 35 years, 37,074 cycles were performed with 45% of cycles resulting in pregnancies and 39% resulting in live births. Among women age 35–37 years, there were 21,273 cycles performed with 37% of cycles resulting in pregnancies and 31% resulting in live births. Physicians and patients can view national summary reports or access data from individual clinics. The outcomes data are available online at

www.sart.org

U.N. Cites Disparities in U.S. Care

Racial dispartities continue to plague sexual and reproductive health care in the United States, according to a report from the United Nations Committee on the Elimination of Racial Discrimination. The U.N. committee cited the high maternal and infant mortality rates among racial and ethnic minorities, as well as the high incidence of unintended pregnancies among African American women as concerns. The committee's report also noted that the United States faces growing disparities in HIV infection rates for women in minority groups. The committee recommended that the United States reduce eligibility barriers for Medicaid coverage as a way to improve access to maternal health care, family planning, prenatal and postnatal care, and emergency obstetric services. The report also called on the U.S. government to provide adequate sexual education to prevent unintended pregnancies and sexually transmitted diseases.

Dr. Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Public Citizen's health research group director, Dr. Sidney Wolfe, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict or controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.”

Physicians Respond to Medicare Cuts

The current uncertainty about Medicare payments to physicians is causing practices to postpone hiring staff, postpone investments in new technology, or even stop accepting new Medicare patients, according to a survey from the Medical Group Management Association. For example, 46% of respondents said that in light of the 10.6% cut in Medicare payments expected in July, they will refuse to accept new Medicare patients or limit the number of new Medicare patients. Nearly 28% said they would limit the number of appointments for Medicare patients. The pending cut could also affect the implementation of health IT systems, including e-prescribing. More than 60% of respondents said that they were more likely to postpone purchasing decisions related to e-prescribing because of the Medicare payment situation. The results are based on responses from more than 1,000 group practices, according to MGMA.

Unapproved STD Treatments

The Food and Drug Administration is cracking down on companies that market unapproved and misbranded drugs for the prevention and treatment of sexually transmitted diseases (STDs). Last month, FDA officials sent warning letters to six U.S. companies and one foreign individual for marketing these drugs over the Internet to U.S. consumers. The products identified by the FDA include Tetrasil, Genisil, Aviralex, OXi-MED, Imulux, Beta-mannan, Micronutrient, Qina, and SlicPlus. Some of the marketing includes false claims that the drugs have been approved by the FDA or that they are superior to conventional medicine, according to the FDA. For example, SlicPlus claims to offer the “greatest STD protection without condoms.” Companies that fail to cease marketing of the products could face seizure of illegal products, injunction, and possible criminal prosecution, according to the FDA.

2006 ART Success Rates Posted

The Society for Assisted Reproductive Technology recently posted 2006 outcome data from its member clinics. The national dataset includes the results of 126,379 treatment cycles at 343 clinics. Of those cycles, more than 99% involved in vitro fertilization, with less than 1% involving gamete intrafallopian transfer or zygote intrafallopian transfer. Among women under age 35 years, 37,074 cycles were performed with 45% of cycles resulting in pregnancies and 39% resulting in live births. Among women age 35–37 years, there were 21,273 cycles performed with 37% of cycles resulting in pregnancies and 31% resulting in live births. Physicians and patients can view national summary reports or access data from individual clinics. The outcomes data are available online at

www.sart.org

U.N. Cites Disparities in U.S. Care

Racial dispartities continue to plague sexual and reproductive health care in the United States, according to a report from the United Nations Committee on the Elimination of Racial Discrimination. The U.N. committee cited the high maternal and infant mortality rates among racial and ethnic minorities, as well as the high incidence of unintended pregnancies among African American women as concerns. The committee's report also noted that the United States faces growing disparities in HIV infection rates for women in minority groups. The committee recommended that the United States reduce eligibility barriers for Medicaid coverage as a way to improve access to maternal health care, family planning, prenatal and postnatal care, and emergency obstetric services. The report also called on the U.S. government to provide adequate sexual education to prevent unintended pregnancies and sexually transmitted diseases.

Dr. Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Public Citizen's health research group director, Dr. Sidney Wolfe, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict or controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.”

Physicians Respond to Medicare Cuts

The current uncertainty about Medicare payments to physicians is causing practices to postpone hiring staff, postpone investments in new technology, or even stop accepting new Medicare patients, according to a survey from the Medical Group Management Association. For example, 46% of respondents said that in light of the 10.6% cut in Medicare payments expected in July, they will refuse to accept new Medicare patients or limit the number of new Medicare patients. Nearly 28% said they would limit the number of appointments for Medicare patients. The pending cut could also affect the implementation of health IT systems, including e-prescribing. More than 60% of respondents said that they were more likely to postpone purchasing decisions related to e-prescribing because of the Medicare payment situation. The results are based on responses from more than 1,000 group practices, according to MGMA.

Unapproved STD Treatments

The Food and Drug Administration is cracking down on companies that market unapproved and misbranded drugs for the prevention and treatment of sexually transmitted diseases (STDs). Last month, FDA officials sent warning letters to six U.S. companies and one foreign individual for marketing these drugs over the Internet to U.S. consumers. The products identified by the FDA include Tetrasil, Genisil, Aviralex, OXi-MED, Imulux, Beta-mannan, Micronutrient, Qina, and SlicPlus. Some of the marketing includes false claims that the drugs have been approved by the FDA or that they are superior to conventional medicine, according to the FDA. For example, SlicPlus claims to offer the “greatest STD protection without condoms.” Companies that fail to cease marketing of the products could face seizure of illegal products, injunction, and possible criminal prosecution, according to the FDA.

2006 ART Success Rates Posted

The Society for Assisted Reproductive Technology recently posted 2006 outcome data from its member clinics. The national dataset includes the results of 126,379 treatment cycles at 343 clinics. Of those cycles, more than 99% involved in vitro fertilization, with less than 1% involving gamete intrafallopian transfer or zygote intrafallopian transfer. Among women under age 35 years, 37,074 cycles were performed with 45% of cycles resulting in pregnancies and 39% resulting in live births. Among women age 35–37 years, there were 21,273 cycles performed with 37% of cycles resulting in pregnancies and 31% resulting in live births. Physicians and patients can view national summary reports or access data from individual clinics. The outcomes data are available online at

www.sart.org

U.N. Cites Disparities in U.S. Care

Racial dispartities continue to plague sexual and reproductive health care in the United States, according to a report from the United Nations Committee on the Elimination of Racial Discrimination. The U.N. committee cited the high maternal and infant mortality rates among racial and ethnic minorities, as well as the high incidence of unintended pregnancies among African American women as concerns. The committee's report also noted that the United States faces growing disparities in HIV infection rates for women in minority groups. The committee recommended that the United States reduce eligibility barriers for Medicaid coverage as a way to improve access to maternal health care, family planning, prenatal and postnatal care, and emergency obstetric services. The report also called on the U.S. government to provide adequate sexual education to prevent unintended pregnancies and sexually transmitted diseases.

Dr. Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Public Citizen's health research group director, Dr. Sidney Wolfe, said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict or controversy. “I don't think she's the kind of CDER director we need right now,” Dr. Wolfe said. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it.”

Physicians Respond to Medicare Cuts

The current uncertainty about Medicare payments to physicians is causing practices to postpone hiring staff, postpone investments in new technology, or even stop accepting new Medicare patients, according to a survey from the Medical Group Management Association. For example, 46% of respondents said that in light of the 10.6% cut in Medicare payments expected in July, they will refuse to accept new Medicare patients or limit the number of new Medicare patients. Nearly 28% said they would limit the number of appointments for Medicare patients. The pending cut could also affect the implementation of health IT systems, including e-prescribing. More than 60% of respondents said that they were more likely to postpone purchasing decisions related to e-prescribing because of the Medicare payment situation. The results are based on responses from more than 1,000 group practices, according to MGMA.

U.S. Investigating Botox Promotions

The U.S. Attorney's office for the northern district of Georgia has subpoenaed Allergan, seeking documents that might show off-label promotion of Botox (botulinum toxin type A) for treatment of headache. The company confirmed the inquiry in a statement, and said that while it currently has Botox in phase III studies for headache, “it is Allergan's policy to promote its products only in a manner consistent with the FDA-approved product labeling.” Allergan also intends to comply “with all applicable laws, rule and regulations,” according to the statement. Botox is Allergan's second-biggest-selling product, with $1.2 billion in sales in 2007.

New Neurotechnology Legislation

In an effort to expand neurotechnology research at the federal level, Rep. Patrick Kennedy (D-R.I.) plans to introduce legislation that would create a National Neurotechnology Initiative within the federal government. The legislation would coordinate neurotechnology research and development at the federal level and in partnership with small businesses, authorize $80 million in fiscal year 2009 for the ongoing Blueprint for Neuroscience Research at the National Institutes of Health, and authorize an additional $30 million in FY 2009 to increase neuroscience staff at the FDA. “With so many Americans suffering from brain-related illnesses, it is crucial for us as a society to maximize our efforts and continue learning about the many facets of the brain, leading to a healthier life for all Americans,” Rep. Kennedy said in a statement.

Parkinson's Disease Data Available

Researchers can now access data from genomewide association studies on Parkinson's disease through the National Institutes of Health. The data will be added to dbGaP (the database of Genotype and Phenotype). Having access to these raw data will allow researchers to combine them with their own data to improve analytical power. The database contains individual-level data on genotype, genetic makeup, phenotype, and observable traits and characteristics, according to NIH. The data comes from a study conducted by researchers at the Mayo Clinic in Rochester, Minn., and Perlegen Sciences Inc. in Mountain View, Calif. This is the second genomewide Parkinson's study available through the NIH database. Researchers can access the information online at

www.ncbi.nlm.nih.gov

Fallout From Pay Uncertainty

Current uncertainties about Medicare payments is causing physician groups to postpone hiring and technology investment, and even to stop accepting new Medicare patients, according to a survey from the Medical Group Management Association. For example, 46% of respondents said that in light of a potential 10.6% cut in Medicare payments expected in July, they will refuse to accept new Medicare patients or will limit the number of new Medicare patients. Nearly 28% said they would limit the number of appointments for Medicare patients. The pending cut could also affect the implementation of health IT systems, including e-prescribing.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Public Citizen's health research group director Dr. Sidney Wolfe said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict or controversy. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it,” Dr. Wolfe said.

U.S. Investigating Botox Promotions

The U.S. Attorney's office for the northern district of Georgia has subpoenaed Allergan, seeking documents that might show off-label promotion of Botox (botulinum toxin type A) for treatment of headache. The company confirmed the inquiry in a statement, and said that while it currently has Botox in phase III studies for headache, “it is Allergan's policy to promote its products only in a manner consistent with the FDA-approved product labeling.” Allergan also intends to comply “with all applicable laws, rule and regulations,” according to the statement. Botox is Allergan's second-biggest-selling product, with $1.2 billion in sales in 2007.

New Neurotechnology Legislation

In an effort to expand neurotechnology research at the federal level, Rep. Patrick Kennedy (D-R.I.) plans to introduce legislation that would create a National Neurotechnology Initiative within the federal government. The legislation would coordinate neurotechnology research and development at the federal level and in partnership with small businesses, authorize $80 million in fiscal year 2009 for the ongoing Blueprint for Neuroscience Research at the National Institutes of Health, and authorize an additional $30 million in FY 2009 to increase neuroscience staff at the FDA. “With so many Americans suffering from brain-related illnesses, it is crucial for us as a society to maximize our efforts and continue learning about the many facets of the brain, leading to a healthier life for all Americans,” Rep. Kennedy said in a statement.

Parkinson's Disease Data Available

Researchers can now access data from genomewide association studies on Parkinson's disease through the National Institutes of Health. The data will be added to dbGaP (the database of Genotype and Phenotype). Having access to these raw data will allow researchers to combine them with their own data to improve analytical power. The database contains individual-level data on genotype, genetic makeup, phenotype, and observable traits and characteristics, according to NIH. The data comes from a study conducted by researchers at the Mayo Clinic in Rochester, Minn., and Perlegen Sciences Inc. in Mountain View, Calif. This is the second genomewide Parkinson's study available through the NIH database. Researchers can access the information online at

www.ncbi.nlm.nih.gov

Fallout From Pay Uncertainty

Current uncertainties about Medicare payments is causing physician groups to postpone hiring and technology investment, and even to stop accepting new Medicare patients, according to a survey from the Medical Group Management Association. For example, 46% of respondents said that in light of a potential 10.6% cut in Medicare payments expected in July, they will refuse to accept new Medicare patients or will limit the number of new Medicare patients. Nearly 28% said they would limit the number of appointments for Medicare patients. The pending cut could also affect the implementation of health IT systems, including e-prescribing.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Public Citizen's health research group director Dr. Sidney Wolfe said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict or controversy. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it,” Dr. Wolfe said.

U.S. Investigating Botox Promotions

The U.S. Attorney's office for the northern district of Georgia has subpoenaed Allergan, seeking documents that might show off-label promotion of Botox (botulinum toxin type A) for treatment of headache. The company confirmed the inquiry in a statement, and said that while it currently has Botox in phase III studies for headache, “it is Allergan's policy to promote its products only in a manner consistent with the FDA-approved product labeling.” Allergan also intends to comply “with all applicable laws, rule and regulations,” according to the statement. Botox is Allergan's second-biggest-selling product, with $1.2 billion in sales in 2007.

New Neurotechnology Legislation

In an effort to expand neurotechnology research at the federal level, Rep. Patrick Kennedy (D-R.I.) plans to introduce legislation that would create a National Neurotechnology Initiative within the federal government. The legislation would coordinate neurotechnology research and development at the federal level and in partnership with small businesses, authorize $80 million in fiscal year 2009 for the ongoing Blueprint for Neuroscience Research at the National Institutes of Health, and authorize an additional $30 million in FY 2009 to increase neuroscience staff at the FDA. “With so many Americans suffering from brain-related illnesses, it is crucial for us as a society to maximize our efforts and continue learning about the many facets of the brain, leading to a healthier life for all Americans,” Rep. Kennedy said in a statement.

Parkinson's Disease Data Available

Researchers can now access data from genomewide association studies on Parkinson's disease through the National Institutes of Health. The data will be added to dbGaP (the database of Genotype and Phenotype). Having access to these raw data will allow researchers to combine them with their own data to improve analytical power. The database contains individual-level data on genotype, genetic makeup, phenotype, and observable traits and characteristics, according to NIH. The data comes from a study conducted by researchers at the Mayo Clinic in Rochester, Minn., and Perlegen Sciences Inc. in Mountain View, Calif. This is the second genomewide Parkinson's study available through the NIH database. Researchers can access the information online at

www.ncbi.nlm.nih.gov

Fallout From Pay Uncertainty

Current uncertainties about Medicare payments is causing physician groups to postpone hiring and technology investment, and even to stop accepting new Medicare patients, according to a survey from the Medical Group Management Association. For example, 46% of respondents said that in light of a potential 10.6% cut in Medicare payments expected in July, they will refuse to accept new Medicare patients or will limit the number of new Medicare patients. Nearly 28% said they would limit the number of appointments for Medicare patients. The pending cut could also affect the implementation of health IT systems, including e-prescribing.

Woodcock Named CDER Head

Dr. Janet Woodcock has been named director of the FDA's Center for Drug Evaluation and Research. Dr. Woodcock, a rheumatologist, served as director of CDER once before, in the 1990s, and has served as acting director since October 2007. The drug industry's chief lobbying group, PhRMA, welcomed the appointment. Dr. Woodcock “has demonstrated willingness to work with diverse partners, including researchers, Congress, the White House, patients, and pharmaceutical research companies,” said a statement from the group. But Public Citizen's health research group director Dr. Sidney Wolfe said in an interview that he's “not terribly hopeful” that Dr. Woodcock will lead the center well, because she doesn't like conflict or controversy. “She's aware of a number of drugs on the market that should be taken off the market, but I don't think she has the fortitude to do something about it,” Dr. Wolfe said.

In response to a warning that the Medicare trust fund is in financial trouble, the Bush administration recently proposed legislation that would tie physician payments to quality, cap medical liability damages, and encourage nationwide adoption of electronic health records.

Health and Human Services Secretary Mike Leavitt submitted the proposed legislation to Congress last month, in response to the Medicare Trustees' warning for the second year in a row that general federal revenue would be needed to pay for more than 45% of program expenditures. Mr. Leavitt was required to submit the proposal under a cost-saving measure included in the Medicare Modernization Act of 2003.

“The Medicare program is on an unsustainable path, driven by two principal factors: projected growth in its per-capita costs, and increases in the beneficiary population as a result of population aging,” Mr. Leavitt said in a letter to House Speaker Nancy Pelosi (D-Calif.). “Excess cost growth will not be brought under control until there is comprehensive reform changing Medicare's underlying structure.”

Under the proposal, the HHS secretary would design and implement a system to tie a portion of the Medicare payment to providers to performance on quality and efficiency measures. Implementation would start in areas with well-accepted measures for example hospitals, physician offices, home health agencies, skilled nursing facilities, and renal dialysis facilities.

The legislation also would limit the length of time individuals have to sue for medical malpractice; cap noneconomic damages at $250,000 and punitive damages at $250,000 or twice the economic damages (whichever is greater); and limit contingency fees paid to plaintiffs' attorneys. The HHS estimates defensive medicine raises the cost of care in Medicare, Medicaid, and Veterans Affairs by about $28 billion a year.

Starting in 2009, the administration's proposal would also increase premiums for Part D prescription drug coverage for single beneficiaries earning more than $82,000 a year and also for couples earning more than $164,000. HHS said the change could save more than $900 million in 2009 and nearly $3.2 billion over 5 years.

The legislative proposal also requires the HHS secretary to develop a system to encourage the nationwide adoption and use of interoperable electronic health records and to make personal health records available to Medicare beneficiaries.

Mr. Leavitt urged Congress to adopt the proposed changes in conjunction with the administration's fiscal year 2009 budget proposal, which includes legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years.

But the administration may have trouble getting its proposals through Congress.

Sen. Edward Kennedy (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions Committee, said “The administration has trumped up a phony crisis in Medicare to justify proposing deep cuts in quality health care for seniors while giving massive subsidies to HMOs and other insurance companies.”

Physicians' groups were also critical of the plan. Dr. James King, president of the American Academy of Family Physicians, said he was disappointed that the Medicare proposal failed to address the approximate 10% Medicare payment cut facing physicians this summer. He also questioned the administration's proposal to move ahead with “value-based” payments to physicians under a plan that appears not to include additional money for incentives. Any pay-for-performance system should use a bonus payment, not withhold payments, he said.

Though the AAFP supports the proposed cap on noneconomic damages in medical liability suits, Dr. King said he doubted the proposal would gain any traction in the current Congress.

'Excess cost growth will not be brought under control until there is comprehensive reform.' MR. LEAVITT

In response to a warning that the Medicare trust fund is in financial trouble, the Bush administration recently proposed legislation that would tie physician payments to quality, cap medical liability damages, and encourage nationwide adoption of electronic health records.

Health and Human Services Secretary Mike Leavitt submitted the proposed legislation to Congress last month, in response to the Medicare Trustees' warning for the second year in a row that general federal revenue would be needed to pay for more than 45% of program expenditures. Mr. Leavitt was required to submit the proposal under a cost-saving measure included in the Medicare Modernization Act of 2003.

“The Medicare program is on an unsustainable path, driven by two principal factors: projected growth in its per-capita costs, and increases in the beneficiary population as a result of population aging,” Mr. Leavitt said in a letter to House Speaker Nancy Pelosi (D-Calif.). “Excess cost growth will not be brought under control until there is comprehensive reform changing Medicare's underlying structure.”

Under the proposal, the HHS secretary would design and implement a system to tie a portion of the Medicare payment to providers to performance on quality and efficiency measures. Implementation would start in areas with well-accepted measures for example hospitals, physician offices, home health agencies, skilled nursing facilities, and renal dialysis facilities.

The legislation also would limit the length of time individuals have to sue for medical malpractice; cap noneconomic damages at $250,000 and punitive damages at $250,000 or twice the economic damages (whichever is greater); and limit contingency fees paid to plaintiffs' attorneys. The HHS estimates defensive medicine raises the cost of care in Medicare, Medicaid, and Veterans Affairs by about $28 billion a year.

Starting in 2009, the administration's proposal would also increase premiums for Part D prescription drug coverage for single beneficiaries earning more than $82,000 a year and also for couples earning more than $164,000. HHS said the change could save more than $900 million in 2009 and nearly $3.2 billion over 5 years.

The legislative proposal also requires the HHS secretary to develop a system to encourage the nationwide adoption and use of interoperable electronic health records and to make personal health records available to Medicare beneficiaries.

Mr. Leavitt urged Congress to adopt the proposed changes in conjunction with the administration's fiscal year 2009 budget proposal, which includes legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years.

But the administration may have trouble getting its proposals through Congress.

Sen. Edward Kennedy (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions Committee, said “The administration has trumped up a phony crisis in Medicare to justify proposing deep cuts in quality health care for seniors while giving massive subsidies to HMOs and other insurance companies.”

Physicians' groups were also critical of the plan. Dr. James King, president of the American Academy of Family Physicians, said he was disappointed that the Medicare proposal failed to address the approximate 10% Medicare payment cut facing physicians this summer. He also questioned the administration's proposal to move ahead with “value-based” payments to physicians under a plan that appears not to include additional money for incentives. Any pay-for-performance system should use a bonus payment, not withhold payments, he said.

Though the AAFP supports the proposed cap on noneconomic damages in medical liability suits, Dr. King said he doubted the proposal would gain any traction in the current Congress.

'Excess cost growth will not be brought under control until there is comprehensive reform.' MR. LEAVITT

In response to a warning that the Medicare trust fund is in financial trouble, the Bush administration recently proposed legislation that would tie physician payments to quality, cap medical liability damages, and encourage nationwide adoption of electronic health records.

Health and Human Services Secretary Mike Leavitt submitted the proposed legislation to Congress last month, in response to the Medicare Trustees' warning for the second year in a row that general federal revenue would be needed to pay for more than 45% of program expenditures. Mr. Leavitt was required to submit the proposal under a cost-saving measure included in the Medicare Modernization Act of 2003.

“The Medicare program is on an unsustainable path, driven by two principal factors: projected growth in its per-capita costs, and increases in the beneficiary population as a result of population aging,” Mr. Leavitt said in a letter to House Speaker Nancy Pelosi (D-Calif.). “Excess cost growth will not be brought under control until there is comprehensive reform changing Medicare's underlying structure.”

Under the proposal, the HHS secretary would design and implement a system to tie a portion of the Medicare payment to providers to performance on quality and efficiency measures. Implementation would start in areas with well-accepted measures for example hospitals, physician offices, home health agencies, skilled nursing facilities, and renal dialysis facilities.

The legislation also would limit the length of time individuals have to sue for medical malpractice; cap noneconomic damages at $250,000 and punitive damages at $250,000 or twice the economic damages (whichever is greater); and limit contingency fees paid to plaintiffs' attorneys. The HHS estimates defensive medicine raises the cost of care in Medicare, Medicaid, and Veterans Affairs by about $28 billion a year.

Starting in 2009, the administration's proposal would also increase premiums for Part D prescription drug coverage for single beneficiaries earning more than $82,000 a year and also for couples earning more than $164,000. HHS said the change could save more than $900 million in 2009 and nearly $3.2 billion over 5 years.

The legislative proposal also requires the HHS secretary to develop a system to encourage the nationwide adoption and use of interoperable electronic health records and to make personal health records available to Medicare beneficiaries.

Mr. Leavitt urged Congress to adopt the proposed changes in conjunction with the administration's fiscal year 2009 budget proposal, which includes legislative and administrative proposals that would cut $12.8 billion from the Medicare program in fiscal year 2009 and about $183 billion over the next 5 years.

But the administration may have trouble getting its proposals through Congress.

Sen. Edward Kennedy (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions Committee, said “The administration has trumped up a phony crisis in Medicare to justify proposing deep cuts in quality health care for seniors while giving massive subsidies to HMOs and other insurance companies.”

Physicians' groups were also critical of the plan. Dr. James King, president of the American Academy of Family Physicians, said he was disappointed that the Medicare proposal failed to address the approximate 10% Medicare payment cut facing physicians this summer. He also questioned the administration's proposal to move ahead with “value-based” payments to physicians under a plan that appears not to include additional money for incentives. Any pay-for-performance system should use a bonus payment, not withhold payments, he said.

Though the AAFP supports the proposed cap on noneconomic damages in medical liability suits, Dr. King said he doubted the proposal would gain any traction in the current Congress.

'Excess cost growth will not be brought under control until there is comprehensive reform.' MR. LEAVITT

Health care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services.

Health spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in an online report in the journal Health Affairs.

The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law.

The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase, fueled by the first wave of baby boomers entering Medicare in 2011. The increase in the number of Medicare enrollees is projected to add 2.9% to growth in Medicare spending by 2017.

The CMS economists projected growth in spending on physician services would average about 5.9% per year through 2017, versus 6.6% from 1995 to 2006. If Congress were to provide a 0% update over the next decade, the average annual growth from 2007 to 2017 would rise to 6.2%, according to the report.

On the hospital side, growth in spending is projected to accelerate at the beginning of the projection period because of higher Medicaid payments but to slow toward the end as a result of projected lower growth in income.

Home health care will likely be one of the fastest growing sectors in health care from 2007 through 2017, with an average annual spending growth rate of 7.7%.

Growth in prescription drug spending is expected to accelerate overall through 2017, because of increased utilization, new drugs entering the market, and a leveling-off of the growth in generics. The analysts reported Medicare Part D would have “little impact on overall health spending growth” through 2017.

Health care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services.

Health spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in an online report in the journal Health Affairs.

The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law.

The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase, fueled by the first wave of baby boomers entering Medicare in 2011. The increase in the number of Medicare enrollees is projected to add 2.9% to growth in Medicare spending by 2017.

The CMS economists projected growth in spending on physician services would average about 5.9% per year through 2017, versus 6.6% from 1995 to 2006. If Congress were to provide a 0% update over the next decade, the average annual growth from 2007 to 2017 would rise to 6.2%, according to the report.

On the hospital side, growth in spending is projected to accelerate at the beginning of the projection period because of higher Medicaid payments but to slow toward the end as a result of projected lower growth in income.

Home health care will likely be one of the fastest growing sectors in health care from 2007 through 2017, with an average annual spending growth rate of 7.7%.

Growth in prescription drug spending is expected to accelerate overall through 2017, because of increased utilization, new drugs entering the market, and a leveling-off of the growth in generics. The analysts reported Medicare Part D would have “little impact on overall health spending growth” through 2017.

Health care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services.

Health spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in an online report in the journal Health Affairs.

The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law.

The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase, fueled by the first wave of baby boomers entering Medicare in 2011. The increase in the number of Medicare enrollees is projected to add 2.9% to growth in Medicare spending by 2017.

The CMS economists projected growth in spending on physician services would average about 5.9% per year through 2017, versus 6.6% from 1995 to 2006. If Congress were to provide a 0% update over the next decade, the average annual growth from 2007 to 2017 would rise to 6.2%, according to the report.

On the hospital side, growth in spending is projected to accelerate at the beginning of the projection period because of higher Medicaid payments but to slow toward the end as a result of projected lower growth in income.

Home health care will likely be one of the fastest growing sectors in health care from 2007 through 2017, with an average annual spending growth rate of 7.7%.

Growth in prescription drug spending is expected to accelerate overall through 2017, because of increased utilization, new drugs entering the market, and a leveling-off of the growth in generics. The analysts reported Medicare Part D would have “little impact on overall health spending growth” through 2017.