Mary Ellen Schneider

This summer, Massachusetts residents were required to sign up for health insurance or face financial penalties as the state began implementation of its landmark health reform initiative.

But some Massachusetts residents may now find that obtaining insurance coverage doesn't guarantee access to a physician in a state where there are significant physician shortages in primary care and several specialties.

In a recent study of the state's physician workforce, the Massachusetts Medical Society found that there is a “critical” shortage of internists and a “severe” shortage of family physicians. Seven other specialties—anesthesiology, cardiology, gastroenterology, neurosurgery, psychiatry, urology, and vascular surgery—are also facing either critical or severe shortages, the study found.

The primary care shortages are of special concern since the state's requirement for residents to have health insurance is based on the premise of access to care, said Brian Rosman, research director for Health Care for All, an advocacy group that is based in Boston.

The group has already heard sporadic reports of access problems from individuals who are recently enrolled in insurance programs, Mr. Rosman said. They have also heard complaints about long wait times for an appointment and closed practice panels.

“People are really frustrated and frankly we're not able to help them,” he said.

The workforce study points to some reasons why patients are having access problems. About 70% of physicians said their practices were having difficulty filling physician vacancies; the same percentage said the pool of physician applicants is inadequate, according to a survey of 1,295 practicing physicians that was conducted as part of the workforce study.

The report also noted that internal medicine appointments are becoming harder to get. This year 51% of internists are accepting new patients, down from 64% in 2006, according to a telephone survey of 600 physician offices. In addition, the average wait time among internal medicine physicians who are accepting new patients is 52 days, compared with 33 days in 2006, the phone survey revealed.

This is the second year in a row that the Massachusetts Medical Society has documented significant shortages in primary care, and shortages in neurosurgery, anesthesiology, cardiology, and gastroenterology have been ongoing for the past 5 years or more.

But this year the shortages occur against the backdrop of a much-anticipated health reform effort in the state. With the passage of a 2006 law, Massachusetts is requiring that all residents who can afford to do so obtain health insurance. Further, the state has expanded access to Medicaid, is offering subsidized health plans to some residents, and is requiring employers to pay a portion of their employees' premiums or face a penalty.

As of July 2007, adults in the state must carry health insurance that meets minimum standards. If the requirement is not met by the end of the year, individuals will lose their personal exemption when filing their 2007 state personal income taxes, amounting to a penalty of about $219. Penalties will increase significantly in 2008.

Before the implementation of the health reform legislation, Massachusetts had about 372,000 residents without health insurance, according to the Commonwealth Connector, the state agency that administers the law. As of mid-July, the state estimated that more than 155,000 residents were newly insured.

Even before the final health reform legislation was passed, there were discussions among legislators and health policy experts about access issues, Mr. Rosman said. But the concensus at the time was that even with physician shortages, it would be better to provide insurance to more individuals. “There are no quick solutions,” he said. “There are no cheap solutions.”

Health Care for All has called for the creation of a state commission to examine primary care and investigate potential strategies for improving physician recruitment such as student loan forgiveness.

While there have been localized areas of access problems, most individuals are able to see a physician, said Dr. Marylou Buyse, president and CEO of the Massachusetts Association of Health Plans and a primary care physician in West Roxbury.

Even if some practices have long wait times for an appointment, patients can seek out other physicians, she said. The health plans, for their part, are ready and willing to work with individuals to find available doctors. “None of us want to see people insured and not be able to get care,” Dr. Buyse said.

But even without an additional 100,000 or more individuals potentially seeking primary care treatment, physicians say the system is under stress because of other factors.

The lack of professional liability reform in the state, implementation of costly pay-for-performance programs, and administrative hassles like prior authorizations are all taking their toll on practicing physicians, according to the report from the Massachusetts Medical Society. Add to that high housing costs and generally low reimbursement rates and many physicians are concerned that the state could be facing an even deeper erosion of its primary care system.

The reports of a shortage are no surprise to Dr. Dennis Dimitri, vice chair of the department of family medicine and community health at the University of Massachusetts in Worcester. Some family physicians on the university's medical staff have closed their practices to new patients, he said. And recruiting new physicians has been difficult.

He has even heard of instances in which local community health centers, the traditional safety net providers, have had to temporarily close their practices to new patients because of understaffing, Dr. Dimitri said.

Much of the problem comes down to how payments are aligned on a national level. The health care system disproportionately rewards procedural medicine instead of preventive services, said Dr. Dimitri, who is also president-elect of the Massachusetts Academy of Family Physicians.

“That plays a huge role in medical student choices,” he said.

When medical students are facing six-figure educational debt they are less likely to choose a lower earning primary care practice, Dr. Dimitri said.

States such as Massachusetts have been trying to deal with the problem locally, but a national approach will likely be necessary with the federal government taking a hard look at how it reimburses for physician services. “This crisis is going to be upon us in the next 5 years in a way that no one has previously anticipated,” Dr. Dimitri said.

Payment is the bottom line, agreed Dr. Barry Izenstein, governor of the Massachusetts chapter of the American College of Physicians and an endocrinologist in Springfield.

Medical students will continue to be attracted to procedural specialties as long as the payers continue to pay for volume of services and procedures, he said. While medical student debt reform is an important short-term solution, it will only provide a patch for the system. In the long term, the entire payment system needs to be reformed. Policy makers will need to consider new approaches, such as the patient-centered medical home, which has been endorsed by a number of primary care societies, he said.

ELSEVIER GLOBAL MEDICAL NEWS

This summer, Massachusetts residents were required to sign up for health insurance or face financial penalties as the state began implementation of its landmark health reform initiative.

But some Massachusetts residents may now find that obtaining insurance coverage doesn't guarantee access to a physician in a state where there are significant physician shortages in primary care and several specialties.

In a recent study of the state's physician workforce, the Massachusetts Medical Society found that there is a “critical” shortage of internists and a “severe” shortage of family physicians. Seven other specialties—anesthesiology, cardiology, gastroenterology, neurosurgery, psychiatry, urology, and vascular surgery—are also facing either critical or severe shortages, the study found.

The primary care shortages are of special concern since the state's requirement for residents to have health insurance is based on the premise of access to care, said Brian Rosman, research director for Health Care for All, an advocacy group that is based in Boston.

The group has already heard sporadic reports of access problems from individuals who are recently enrolled in insurance programs, Mr. Rosman said. They have also heard complaints about long wait times for an appointment and closed practice panels.

“People are really frustrated and frankly we're not able to help them,” he said.

The workforce study points to some reasons why patients are having access problems. About 70% of physicians said their practices were having difficulty filling physician vacancies; the same percentage said the pool of physician applicants is inadequate, according to a survey of 1,295 practicing physicians that was conducted as part of the workforce study.

The report also noted that internal medicine appointments are becoming harder to get. This year 51% of internists are accepting new patients, down from 64% in 2006, according to a telephone survey of 600 physician offices. In addition, the average wait time among internal medicine physicians who are accepting new patients is 52 days, compared with 33 days in 2006, the phone survey revealed.

This is the second year in a row that the Massachusetts Medical Society has documented significant shortages in primary care, and shortages in neurosurgery, anesthesiology, cardiology, and gastroenterology have been ongoing for the past 5 years or more.

But this year the shortages occur against the backdrop of a much-anticipated health reform effort in the state. With the passage of a 2006 law, Massachusetts is requiring that all residents who can afford to do so obtain health insurance. Further, the state has expanded access to Medicaid, is offering subsidized health plans to some residents, and is requiring employers to pay a portion of their employees' premiums or face a penalty.

As of July 2007, adults in the state must carry health insurance that meets minimum standards. If the requirement is not met by the end of the year, individuals will lose their personal exemption when filing their 2007 state personal income taxes, amounting to a penalty of about $219. Penalties will increase significantly in 2008.

Before the implementation of the health reform legislation, Massachusetts had about 372,000 residents without health insurance, according to the Commonwealth Connector, the state agency that administers the law. As of mid-July, the state estimated that more than 155,000 residents were newly insured.

Even before the final health reform legislation was passed, there were discussions among legislators and health policy experts about access issues, Mr. Rosman said. But the concensus at the time was that even with physician shortages, it would be better to provide insurance to more individuals. “There are no quick solutions,” he said. “There are no cheap solutions.”

Health Care for All has called for the creation of a state commission to examine primary care and investigate potential strategies for improving physician recruitment such as student loan forgiveness.

While there have been localized areas of access problems, most individuals are able to see a physician, said Dr. Marylou Buyse, president and CEO of the Massachusetts Association of Health Plans and a primary care physician in West Roxbury.

Even if some practices have long wait times for an appointment, patients can seek out other physicians, she said. The health plans, for their part, are ready and willing to work with individuals to find available doctors. “None of us want to see people insured and not be able to get care,” Dr. Buyse said.

But even without an additional 100,000 or more individuals potentially seeking primary care treatment, physicians say the system is under stress because of other factors.

The lack of professional liability reform in the state, implementation of costly pay-for-performance programs, and administrative hassles like prior authorizations are all taking their toll on practicing physicians, according to the report from the Massachusetts Medical Society. Add to that high housing costs and generally low reimbursement rates and many physicians are concerned that the state could be facing an even deeper erosion of its primary care system.

The reports of a shortage are no surprise to Dr. Dennis Dimitri, vice chair of the department of family medicine and community health at the University of Massachusetts in Worcester. Some family physicians on the university's medical staff have closed their practices to new patients, he said. And recruiting new physicians has been difficult.

He has even heard of instances in which local community health centers, the traditional safety net providers, have had to temporarily close their practices to new patients because of understaffing, Dr. Dimitri said.

Much of the problem comes down to how payments are aligned on a national level. The health care system disproportionately rewards procedural medicine instead of preventive services, said Dr. Dimitri, who is also president-elect of the Massachusetts Academy of Family Physicians.

“That plays a huge role in medical student choices,” he said.

When medical students are facing six-figure educational debt they are less likely to choose a lower earning primary care practice, Dr. Dimitri said.

States such as Massachusetts have been trying to deal with the problem locally, but a national approach will likely be necessary with the federal government taking a hard look at how it reimburses for physician services. “This crisis is going to be upon us in the next 5 years in a way that no one has previously anticipated,” Dr. Dimitri said.

Payment is the bottom line, agreed Dr. Barry Izenstein, governor of the Massachusetts chapter of the American College of Physicians and an endocrinologist in Springfield.

Medical students will continue to be attracted to procedural specialties as long as the payers continue to pay for volume of services and procedures, he said. While medical student debt reform is an important short-term solution, it will only provide a patch for the system. In the long term, the entire payment system needs to be reformed. Policy makers will need to consider new approaches, such as the patient-centered medical home, which has been endorsed by a number of primary care societies, he said.

ELSEVIER GLOBAL MEDICAL NEWS

This summer, Massachusetts residents were required to sign up for health insurance or face financial penalties as the state began implementation of its landmark health reform initiative.

But some Massachusetts residents may now find that obtaining insurance coverage doesn't guarantee access to a physician in a state where there are significant physician shortages in primary care and several specialties.

In a recent study of the state's physician workforce, the Massachusetts Medical Society found that there is a “critical” shortage of internists and a “severe” shortage of family physicians. Seven other specialties—anesthesiology, cardiology, gastroenterology, neurosurgery, psychiatry, urology, and vascular surgery—are also facing either critical or severe shortages, the study found.

The primary care shortages are of special concern since the state's requirement for residents to have health insurance is based on the premise of access to care, said Brian Rosman, research director for Health Care for All, an advocacy group that is based in Boston.

The group has already heard sporadic reports of access problems from individuals who are recently enrolled in insurance programs, Mr. Rosman said. They have also heard complaints about long wait times for an appointment and closed practice panels.

“People are really frustrated and frankly we're not able to help them,” he said.

The workforce study points to some reasons why patients are having access problems. About 70% of physicians said their practices were having difficulty filling physician vacancies; the same percentage said the pool of physician applicants is inadequate, according to a survey of 1,295 practicing physicians that was conducted as part of the workforce study.

The report also noted that internal medicine appointments are becoming harder to get. This year 51% of internists are accepting new patients, down from 64% in 2006, according to a telephone survey of 600 physician offices. In addition, the average wait time among internal medicine physicians who are accepting new patients is 52 days, compared with 33 days in 2006, the phone survey revealed.

This is the second year in a row that the Massachusetts Medical Society has documented significant shortages in primary care, and shortages in neurosurgery, anesthesiology, cardiology, and gastroenterology have been ongoing for the past 5 years or more.

But this year the shortages occur against the backdrop of a much-anticipated health reform effort in the state. With the passage of a 2006 law, Massachusetts is requiring that all residents who can afford to do so obtain health insurance. Further, the state has expanded access to Medicaid, is offering subsidized health plans to some residents, and is requiring employers to pay a portion of their employees' premiums or face a penalty.

As of July 2007, adults in the state must carry health insurance that meets minimum standards. If the requirement is not met by the end of the year, individuals will lose their personal exemption when filing their 2007 state personal income taxes, amounting to a penalty of about $219. Penalties will increase significantly in 2008.

Before the implementation of the health reform legislation, Massachusetts had about 372,000 residents without health insurance, according to the Commonwealth Connector, the state agency that administers the law. As of mid-July, the state estimated that more than 155,000 residents were newly insured.

Even before the final health reform legislation was passed, there were discussions among legislators and health policy experts about access issues, Mr. Rosman said. But the concensus at the time was that even with physician shortages, it would be better to provide insurance to more individuals. “There are no quick solutions,” he said. “There are no cheap solutions.”

Health Care for All has called for the creation of a state commission to examine primary care and investigate potential strategies for improving physician recruitment such as student loan forgiveness.

While there have been localized areas of access problems, most individuals are able to see a physician, said Dr. Marylou Buyse, president and CEO of the Massachusetts Association of Health Plans and a primary care physician in West Roxbury.

Even if some practices have long wait times for an appointment, patients can seek out other physicians, she said. The health plans, for their part, are ready and willing to work with individuals to find available doctors. “None of us want to see people insured and not be able to get care,” Dr. Buyse said.

But even without an additional 100,000 or more individuals potentially seeking primary care treatment, physicians say the system is under stress because of other factors.

The lack of professional liability reform in the state, implementation of costly pay-for-performance programs, and administrative hassles like prior authorizations are all taking their toll on practicing physicians, according to the report from the Massachusetts Medical Society. Add to that high housing costs and generally low reimbursement rates and many physicians are concerned that the state could be facing an even deeper erosion of its primary care system.

The reports of a shortage are no surprise to Dr. Dennis Dimitri, vice chair of the department of family medicine and community health at the University of Massachusetts in Worcester. Some family physicians on the university's medical staff have closed their practices to new patients, he said. And recruiting new physicians has been difficult.

He has even heard of instances in which local community health centers, the traditional safety net providers, have had to temporarily close their practices to new patients because of understaffing, Dr. Dimitri said.

Much of the problem comes down to how payments are aligned on a national level. The health care system disproportionately rewards procedural medicine instead of preventive services, said Dr. Dimitri, who is also president-elect of the Massachusetts Academy of Family Physicians.

“That plays a huge role in medical student choices,” he said.

When medical students are facing six-figure educational debt they are less likely to choose a lower earning primary care practice, Dr. Dimitri said.

States such as Massachusetts have been trying to deal with the problem locally, but a national approach will likely be necessary with the federal government taking a hard look at how it reimburses for physician services. “This crisis is going to be upon us in the next 5 years in a way that no one has previously anticipated,” Dr. Dimitri said.

Payment is the bottom line, agreed Dr. Barry Izenstein, governor of the Massachusetts chapter of the American College of Physicians and an endocrinologist in Springfield.

Medical students will continue to be attracted to procedural specialties as long as the payers continue to pay for volume of services and procedures, he said. While medical student debt reform is an important short-term solution, it will only provide a patch for the system. In the long term, the entire payment system needs to be reformed. Policy makers will need to consider new approaches, such as the patient-centered medical home, which has been endorsed by a number of primary care societies, he said.

ELSEVIER GLOBAL MEDICAL NEWS

In a continuing effort to link payments to quality, Medicare will soon stop paying hospitals for certain conditions and infections acquired after admission.

The change was mandated by Congress under the Deficit Reduction Act and will go into effect in October 2008. Starting this October, hospitals will be required to report on secondary diagnoses that are present at the time of admission.

Officials at the Centers for Medicare and Medicaid Services have identified eight “reasonably preventable” events that can be avoided in most cases by engaging in good medical practice. Hospitals will not receive additional payments for these secondary diagnoses if they develop after admission:

▸ An object left in the patient during surgery.

▸ Air embolism.

▸ Blood incompatibility.

▸ Catheter-associated urinary tract infections.

▸ Pressure ulcers.

▸ Vascular catheter-associated infections.

▸ Mediastinitis after coronary artery bypass graft surgery.

▸ Falls.

CMS officials will consider adding three other hospital-acquired conditions next year:

▸ Ventilator-associated pneumonia.

▸ Staphylococcus aureus septicemia.

▸ Deep vein thrombosis/pulmonary embolism.

Under the new policy, the costs cannot be passed along to patients. However, hospitals will not bear the total financial risk of these cases because the payment policy will not affect Medicare's high-cost outlier policy. CMS will continue to use the hospital's total charges for all inpatient services provided during a patient's stay when determining whether the case qualifies for an outlier payment.

The hospital-acquired conditions policy was issued as part of the Medicare acute care hospital inpatient prospective payment system final rule, which was published in the Federal Register on Aug. 22.

The move was applauded by payers and quality advocates, but hospitals and physicians raised some red flags about the change.

In a June 12 letter to CMS, the American Medical Association voiced concerns that the policy could have “significant unintended consequences for patients.”

“The concept of not paying for complications that are often a biological inevitability regardless of safe practice is discriminatory and could be punitive to those patients at the greatest risk,” wrote Dr. Michael D. Maves, executive vice president and CEO of the AMA. “Certain patients, including those that are older, have medical comorbidities, or have otherwise compromised immune systems, are more susceptible to infection and other complications.”

These types of patients already have difficulty accessing care, and the CMS policy could increase the barriers, Dr. Maves wrote.

The American Hospital Association supports the inclusion of only three of the conditions outlined by CMS (an object left in during surgery, air embolism, and blood incompatibility). However, there are concerns about whether the other conditions are always or even usually preventable, even with excellent care, said David Allen, an AHA spokesman. Preexisting conditions also are of concern, he said.

But the Medicare policy shift was welcomed by health plans and some quality advocates.

The announcement by CMS is consistent with the move to pay for quality, said Susan Pisano, a spokesperson for America's Health Insurance Plans. The new policy provides an incentive for hospitals to develop processes to avoid these conditions, she said.

Officials at the National Committee for Quality Assurance (NCQA) also favor the policy change, a spokesperson said.

In a continuing effort to link payments to quality, Medicare will soon stop paying hospitals for certain conditions and infections acquired after admission.

The change was mandated by Congress under the Deficit Reduction Act and will go into effect in October 2008. Starting this October, hospitals will be required to report on secondary diagnoses that are present at the time of admission.

Officials at the Centers for Medicare and Medicaid Services have identified eight “reasonably preventable” events that can be avoided in most cases by engaging in good medical practice. Hospitals will not receive additional payments for these secondary diagnoses if they develop after admission:

▸ An object left in the patient during surgery.

▸ Air embolism.

▸ Blood incompatibility.

▸ Catheter-associated urinary tract infections.

▸ Pressure ulcers.

▸ Vascular catheter-associated infections.

▸ Mediastinitis after coronary artery bypass graft surgery.

▸ Falls.

CMS officials will consider adding three other hospital-acquired conditions next year:

▸ Ventilator-associated pneumonia.

▸ Staphylococcus aureus septicemia.

▸ Deep vein thrombosis/pulmonary embolism.

Under the new policy, the costs cannot be passed along to patients. However, hospitals will not bear the total financial risk of these cases because the payment policy will not affect Medicare's high-cost outlier policy. CMS will continue to use the hospital's total charges for all inpatient services provided during a patient's stay when determining whether the case qualifies for an outlier payment.

The hospital-acquired conditions policy was issued as part of the Medicare acute care hospital inpatient prospective payment system final rule, which was published in the Federal Register on Aug. 22.

The move was applauded by payers and quality advocates, but hospitals and physicians raised some red flags about the change.

In a June 12 letter to CMS, the American Medical Association voiced concerns that the policy could have “significant unintended consequences for patients.”

“The concept of not paying for complications that are often a biological inevitability regardless of safe practice is discriminatory and could be punitive to those patients at the greatest risk,” wrote Dr. Michael D. Maves, executive vice president and CEO of the AMA. “Certain patients, including those that are older, have medical comorbidities, or have otherwise compromised immune systems, are more susceptible to infection and other complications.”

These types of patients already have difficulty accessing care, and the CMS policy could increase the barriers, Dr. Maves wrote.

The American Hospital Association supports the inclusion of only three of the conditions outlined by CMS (an object left in during surgery, air embolism, and blood incompatibility). However, there are concerns about whether the other conditions are always or even usually preventable, even with excellent care, said David Allen, an AHA spokesman. Preexisting conditions also are of concern, he said.

But the Medicare policy shift was welcomed by health plans and some quality advocates.

The announcement by CMS is consistent with the move to pay for quality, said Susan Pisano, a spokesperson for America's Health Insurance Plans. The new policy provides an incentive for hospitals to develop processes to avoid these conditions, she said.

Officials at the National Committee for Quality Assurance (NCQA) also favor the policy change, a spokesperson said.

In a continuing effort to link payments to quality, Medicare will soon stop paying hospitals for certain conditions and infections acquired after admission.

The change was mandated by Congress under the Deficit Reduction Act and will go into effect in October 2008. Starting this October, hospitals will be required to report on secondary diagnoses that are present at the time of admission.

Officials at the Centers for Medicare and Medicaid Services have identified eight “reasonably preventable” events that can be avoided in most cases by engaging in good medical practice. Hospitals will not receive additional payments for these secondary diagnoses if they develop after admission:

▸ An object left in the patient during surgery.

▸ Air embolism.

▸ Blood incompatibility.

▸ Catheter-associated urinary tract infections.

▸ Pressure ulcers.

▸ Vascular catheter-associated infections.

▸ Mediastinitis after coronary artery bypass graft surgery.

▸ Falls.

CMS officials will consider adding three other hospital-acquired conditions next year:

▸ Ventilator-associated pneumonia.

▸ Staphylococcus aureus septicemia.

▸ Deep vein thrombosis/pulmonary embolism.

Under the new policy, the costs cannot be passed along to patients. However, hospitals will not bear the total financial risk of these cases because the payment policy will not affect Medicare's high-cost outlier policy. CMS will continue to use the hospital's total charges for all inpatient services provided during a patient's stay when determining whether the case qualifies for an outlier payment.

The hospital-acquired conditions policy was issued as part of the Medicare acute care hospital inpatient prospective payment system final rule, which was published in the Federal Register on Aug. 22.

The move was applauded by payers and quality advocates, but hospitals and physicians raised some red flags about the change.

In a June 12 letter to CMS, the American Medical Association voiced concerns that the policy could have “significant unintended consequences for patients.”

“The concept of not paying for complications that are often a biological inevitability regardless of safe practice is discriminatory and could be punitive to those patients at the greatest risk,” wrote Dr. Michael D. Maves, executive vice president and CEO of the AMA. “Certain patients, including those that are older, have medical comorbidities, or have otherwise compromised immune systems, are more susceptible to infection and other complications.”

These types of patients already have difficulty accessing care, and the CMS policy could increase the barriers, Dr. Maves wrote.

The American Hospital Association supports the inclusion of only three of the conditions outlined by CMS (an object left in during surgery, air embolism, and blood incompatibility). However, there are concerns about whether the other conditions are always or even usually preventable, even with excellent care, said David Allen, an AHA spokesman. Preexisting conditions also are of concern, he said.

But the Medicare policy shift was welcomed by health plans and some quality advocates.

The announcement by CMS is consistent with the move to pay for quality, said Susan Pisano, a spokesperson for America's Health Insurance Plans. The new policy provides an incentive for hospitals to develop processes to avoid these conditions, she said.

Officials at the National Committee for Quality Assurance (NCQA) also favor the policy change, a spokesperson said.

Oral Contraceptive Choice

Women and their physicians should be able to request the type of oral contraceptive they deem most appropriate, whether that is a generic or branded medication, according to a statement from the American College of Obstetricians and Gynecologists. Although generic and branded OCs have been shown to be bioequivalent and pharmaceutically equivalent by the Food and Drug Administration, switching between different generic or branded pills may affect patient compliance, the statement said. The ACOG Committee on Gynecologic Practice issued its opinion on the issue last month. Patients also should be informed when a generic is substituted, the committee said. “Anecdotal evidence shows that switching between brand name and generic OCs or among different brands or generics may lead to incorrect usage, which can cause side effects and pregnancy,” Dr. Steven J. Sondheimer, committee vice chair, said in a statement. “Therefore, if a woman has had better results with a specific brand or generic OC she should be able to request and receive that specific medication.” The opinion was published in the August issue of Obstetrics & Gynecology.

Initial Breast-Feeding Rates Rise

More women are initiating breast-feeding, but the percentage of those who breast-feed exclusively at 3 months is below the national goal of 60%, according to the Centers for Disease Control and Prevention. Data from 2004 (the most current available) show that 74% of women initiated breast-feeding when their infants were born, but only 31% were breast-feeding exclusively at 3 months. By 6 months, only 11% of mothers were exclusively breast-feeding, compared with the national target of 25%. The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months of life with a continuation of breast-feeding for the first year and beyond as other foods are introduced. Racial and ethnic disparities also were found. The CDC found that black infants had the lowest rates of exclusive breast-feeding through 3 months with just 20% of mothers continuing to exclusively breast-feed. The report was published in the Aug. 3 issue of the Morbidity and Mortality Weekly Report.

Older Women Avoid HIV Tests

Most women age 50 and older aren't interested in being tested for HIV, despite the fact that many are at high or moderate risk for acquiring the virus over their lifetimes, according to a recent study. Researchers performed a secondary analysis of a survey of 514 women age 50 and older who received care at a general internal medicine clinic in Atlanta. Only 22% of the women surveyed were interested in HIV testing even though nearly half were identified as having significant risk factors for exposure over their lifetimes. Despite their actual HIV risk, nearly 75% perceived their HIV risk as low. “In part because of a lack of education and prevention efforts targeted at older populations, older women appear to be less capable of accurately assessing their lifetime risk of HIV even when they have significant risk factors and live in communities with high rates of infection,” Dr. Aletha Akers, lead study author, said in a statement. The study appeared in the July/August issue of the Journal of Woman's Health and was funded by the Emory Medical Care Foundation and the Robert Wood Johnson Clinical Foundation.

Immunization Education Missed

Obstetric practices may be missing out on an opportunity to provide information to pregnant patients about childhood immunizations, according to a study published in the September issue of the American Journal of Preventive Medicine. In a survey of 71 obstetric practices, 32% reported providing information on hepatitis B vaccination, and 23% provided information on other child immunizations. However, most practices said they would be willing to provide the information if it were provided to them free of charge. But although most practices weren't providing information on immunizations, 54% reported offering information on other child health topics such as car seats, pets, and circumcision.

Missouri Midwife Law Struck Down

A recent ruling from a Missouri Circuit Court judge will keep lay midwives in the state from performing childbirth services without supervision. The one-sentence provision, which would have given broad rights to midwives and others who hold a current certification in tocology, was included in legislation regulating health insurance. The midwifery provision was opposed by the Missouri State Medical Association, which said the provision would have lowered the standard of care for childbirth services and endangered the lives of mothers and babies. The judge's ruling invalidates the midwifery provision but allows the remainder of the health insurance law to go into effect.

Oral Contraceptive Choice

Women and their physicians should be able to request the type of oral contraceptive they deem most appropriate, whether that is a generic or branded medication, according to a statement from the American College of Obstetricians and Gynecologists. Although generic and branded OCs have been shown to be bioequivalent and pharmaceutically equivalent by the Food and Drug Administration, switching between different generic or branded pills may affect patient compliance, the statement said. The ACOG Committee on Gynecologic Practice issued its opinion on the issue last month. Patients also should be informed when a generic is substituted, the committee said. “Anecdotal evidence shows that switching between brand name and generic OCs or among different brands or generics may lead to incorrect usage, which can cause side effects and pregnancy,” Dr. Steven J. Sondheimer, committee vice chair, said in a statement. “Therefore, if a woman has had better results with a specific brand or generic OC she should be able to request and receive that specific medication.” The opinion was published in the August issue of Obstetrics & Gynecology.

Initial Breast-Feeding Rates Rise

More women are initiating breast-feeding, but the percentage of those who breast-feed exclusively at 3 months is below the national goal of 60%, according to the Centers for Disease Control and Prevention. Data from 2004 (the most current available) show that 74% of women initiated breast-feeding when their infants were born, but only 31% were breast-feeding exclusively at 3 months. By 6 months, only 11% of mothers were exclusively breast-feeding, compared with the national target of 25%. The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months of life with a continuation of breast-feeding for the first year and beyond as other foods are introduced. Racial and ethnic disparities also were found. The CDC found that black infants had the lowest rates of exclusive breast-feeding through 3 months with just 20% of mothers continuing to exclusively breast-feed. The report was published in the Aug. 3 issue of the Morbidity and Mortality Weekly Report.

Older Women Avoid HIV Tests

Most women age 50 and older aren't interested in being tested for HIV, despite the fact that many are at high or moderate risk for acquiring the virus over their lifetimes, according to a recent study. Researchers performed a secondary analysis of a survey of 514 women age 50 and older who received care at a general internal medicine clinic in Atlanta. Only 22% of the women surveyed were interested in HIV testing even though nearly half were identified as having significant risk factors for exposure over their lifetimes. Despite their actual HIV risk, nearly 75% perceived their HIV risk as low. “In part because of a lack of education and prevention efforts targeted at older populations, older women appear to be less capable of accurately assessing their lifetime risk of HIV even when they have significant risk factors and live in communities with high rates of infection,” Dr. Aletha Akers, lead study author, said in a statement. The study appeared in the July/August issue of the Journal of Woman's Health and was funded by the Emory Medical Care Foundation and the Robert Wood Johnson Clinical Foundation.

Immunization Education Missed

Obstetric practices may be missing out on an opportunity to provide information to pregnant patients about childhood immunizations, according to a study published in the September issue of the American Journal of Preventive Medicine. In a survey of 71 obstetric practices, 32% reported providing information on hepatitis B vaccination, and 23% provided information on other child immunizations. However, most practices said they would be willing to provide the information if it were provided to them free of charge. But although most practices weren't providing information on immunizations, 54% reported offering information on other child health topics such as car seats, pets, and circumcision.

Missouri Midwife Law Struck Down

A recent ruling from a Missouri Circuit Court judge will keep lay midwives in the state from performing childbirth services without supervision. The one-sentence provision, which would have given broad rights to midwives and others who hold a current certification in tocology, was included in legislation regulating health insurance. The midwifery provision was opposed by the Missouri State Medical Association, which said the provision would have lowered the standard of care for childbirth services and endangered the lives of mothers and babies. The judge's ruling invalidates the midwifery provision but allows the remainder of the health insurance law to go into effect.

Oral Contraceptive Choice

Women and their physicians should be able to request the type of oral contraceptive they deem most appropriate, whether that is a generic or branded medication, according to a statement from the American College of Obstetricians and Gynecologists. Although generic and branded OCs have been shown to be bioequivalent and pharmaceutically equivalent by the Food and Drug Administration, switching between different generic or branded pills may affect patient compliance, the statement said. The ACOG Committee on Gynecologic Practice issued its opinion on the issue last month. Patients also should be informed when a generic is substituted, the committee said. “Anecdotal evidence shows that switching between brand name and generic OCs or among different brands or generics may lead to incorrect usage, which can cause side effects and pregnancy,” Dr. Steven J. Sondheimer, committee vice chair, said in a statement. “Therefore, if a woman has had better results with a specific brand or generic OC she should be able to request and receive that specific medication.” The opinion was published in the August issue of Obstetrics & Gynecology.

Initial Breast-Feeding Rates Rise

More women are initiating breast-feeding, but the percentage of those who breast-feed exclusively at 3 months is below the national goal of 60%, according to the Centers for Disease Control and Prevention. Data from 2004 (the most current available) show that 74% of women initiated breast-feeding when their infants were born, but only 31% were breast-feeding exclusively at 3 months. By 6 months, only 11% of mothers were exclusively breast-feeding, compared with the national target of 25%. The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months of life with a continuation of breast-feeding for the first year and beyond as other foods are introduced. Racial and ethnic disparities also were found. The CDC found that black infants had the lowest rates of exclusive breast-feeding through 3 months with just 20% of mothers continuing to exclusively breast-feed. The report was published in the Aug. 3 issue of the Morbidity and Mortality Weekly Report.

Older Women Avoid HIV Tests

Most women age 50 and older aren't interested in being tested for HIV, despite the fact that many are at high or moderate risk for acquiring the virus over their lifetimes, according to a recent study. Researchers performed a secondary analysis of a survey of 514 women age 50 and older who received care at a general internal medicine clinic in Atlanta. Only 22% of the women surveyed were interested in HIV testing even though nearly half were identified as having significant risk factors for exposure over their lifetimes. Despite their actual HIV risk, nearly 75% perceived their HIV risk as low. “In part because of a lack of education and prevention efforts targeted at older populations, older women appear to be less capable of accurately assessing their lifetime risk of HIV even when they have significant risk factors and live in communities with high rates of infection,” Dr. Aletha Akers, lead study author, said in a statement. The study appeared in the July/August issue of the Journal of Woman's Health and was funded by the Emory Medical Care Foundation and the Robert Wood Johnson Clinical Foundation.

Immunization Education Missed

Obstetric practices may be missing out on an opportunity to provide information to pregnant patients about childhood immunizations, according to a study published in the September issue of the American Journal of Preventive Medicine. In a survey of 71 obstetric practices, 32% reported providing information on hepatitis B vaccination, and 23% provided information on other child immunizations. However, most practices said they would be willing to provide the information if it were provided to them free of charge. But although most practices weren't providing information on immunizations, 54% reported offering information on other child health topics such as car seats, pets, and circumcision.

Missouri Midwife Law Struck Down

A recent ruling from a Missouri Circuit Court judge will keep lay midwives in the state from performing childbirth services without supervision. The one-sentence provision, which would have given broad rights to midwives and others who hold a current certification in tocology, was included in legislation regulating health insurance. The midwifery provision was opposed by the Missouri State Medical Association, which said the provision would have lowered the standard of care for childbirth services and endangered the lives of mothers and babies. The judge's ruling invalidates the midwifery provision but allows the remainder of the health insurance law to go into effect.

TORONTO — Finding the right test to screen for hyperandrogenism in hirsute women can be difficult because of a lack of reliability among affordable assays, Dr. Robert L. Rosenfield said at the annual meeting of the Androgen Excess Society.

Testing for hyperandrogenism is generally recommended when hirsutism is moderate or severe (a score of greater than 15 on the Ferriman-Gallwey scale) or if there is any degree of hirsutism accompanied by risk factors for virilizing neoplasm or polycystic ovary syndrome.

Total testosterone should be the initial screening assay, since testosterone is the major circulating androgen. However, testing is not clearly better than clinical judgment if laboratory validity is not ensured, as is often the case, said Dr. Rosenfield, professor of medicine and pediatrics at the University of Chicago.

Ideally, free testosterone would be measured, but this assay is less standardized than total testosterone assays, he said. As a result, the reliability of the assay in general laboratories is less consistent. A free testosterone determination by a specialty laboratory is indicated for patients with risk factors for tumor or polycystic ovary syndrome, even if the initial total testosterone is normal, he said.

Follow-up is an important part of the management of a mildly hirsute patient with no central obesity and no menstrual dysfunction, Dr. Rosenfield said. If a patient with mild hirsutism develops other associated symptoms, she can be tested then, he said. But overtesting is not cost-effective and can yield both false-positive and false-negative results. Dr. Rosenfield receives research support in the form of grants from the U.S. Public Health Service and Quest Diagnostics, maker of a testosterone assay.

The Endocrine Society also recently weighed in on the issue of measuring testosterone (J. Clin. Endocrinol. Metab. 2007; 92:405-13). In a position paper released in February, the Endocrine Society recommended that laboratory proficiency testing be based on the ability to accurately measure a sample containing a known concentration of testosterone, not simply on agreement among peers using the same method.

The position statement concluded that free testosterone is the most useful, clinically sensitive marker of hyperandrogenemia in women when calculated using high-quality testosterone and sex hormone-binding globulin assays with well-defined reference intervals.

In an effort to advance the field, the Endocrine Society and the Centers for Disease Control and Prevention are collaborating on the establishment of standards to validate the performance of laboratory assays of serum testosterone levels. The CDC's work is supported through a partnership between the CDC Foundation and Solvay Pharmaceuticals Inc.

TORONTO — Finding the right test to screen for hyperandrogenism in hirsute women can be difficult because of a lack of reliability among affordable assays, Dr. Robert L. Rosenfield said at the annual meeting of the Androgen Excess Society.

Testing for hyperandrogenism is generally recommended when hirsutism is moderate or severe (a score of greater than 15 on the Ferriman-Gallwey scale) or if there is any degree of hirsutism accompanied by risk factors for virilizing neoplasm or polycystic ovary syndrome.

Total testosterone should be the initial screening assay, since testosterone is the major circulating androgen. However, testing is not clearly better than clinical judgment if laboratory validity is not ensured, as is often the case, said Dr. Rosenfield, professor of medicine and pediatrics at the University of Chicago.

Ideally, free testosterone would be measured, but this assay is less standardized than total testosterone assays, he said. As a result, the reliability of the assay in general laboratories is less consistent. A free testosterone determination by a specialty laboratory is indicated for patients with risk factors for tumor or polycystic ovary syndrome, even if the initial total testosterone is normal, he said.

Follow-up is an important part of the management of a mildly hirsute patient with no central obesity and no menstrual dysfunction, Dr. Rosenfield said. If a patient with mild hirsutism develops other associated symptoms, she can be tested then, he said. But overtesting is not cost-effective and can yield both false-positive and false-negative results. Dr. Rosenfield receives research support in the form of grants from the U.S. Public Health Service and Quest Diagnostics, maker of a testosterone assay.

The Endocrine Society also recently weighed in on the issue of measuring testosterone (J. Clin. Endocrinol. Metab. 2007; 92:405-13). In a position paper released in February, the Endocrine Society recommended that laboratory proficiency testing be based on the ability to accurately measure a sample containing a known concentration of testosterone, not simply on agreement among peers using the same method.

The position statement concluded that free testosterone is the most useful, clinically sensitive marker of hyperandrogenemia in women when calculated using high-quality testosterone and sex hormone-binding globulin assays with well-defined reference intervals.

In an effort to advance the field, the Endocrine Society and the Centers for Disease Control and Prevention are collaborating on the establishment of standards to validate the performance of laboratory assays of serum testosterone levels. The CDC's work is supported through a partnership between the CDC Foundation and Solvay Pharmaceuticals Inc.

TORONTO — Finding the right test to screen for hyperandrogenism in hirsute women can be difficult because of a lack of reliability among affordable assays, Dr. Robert L. Rosenfield said at the annual meeting of the Androgen Excess Society.

Testing for hyperandrogenism is generally recommended when hirsutism is moderate or severe (a score of greater than 15 on the Ferriman-Gallwey scale) or if there is any degree of hirsutism accompanied by risk factors for virilizing neoplasm or polycystic ovary syndrome.

Total testosterone should be the initial screening assay, since testosterone is the major circulating androgen. However, testing is not clearly better than clinical judgment if laboratory validity is not ensured, as is often the case, said Dr. Rosenfield, professor of medicine and pediatrics at the University of Chicago.

Ideally, free testosterone would be measured, but this assay is less standardized than total testosterone assays, he said. As a result, the reliability of the assay in general laboratories is less consistent. A free testosterone determination by a specialty laboratory is indicated for patients with risk factors for tumor or polycystic ovary syndrome, even if the initial total testosterone is normal, he said.

Follow-up is an important part of the management of a mildly hirsute patient with no central obesity and no menstrual dysfunction, Dr. Rosenfield said. If a patient with mild hirsutism develops other associated symptoms, she can be tested then, he said. But overtesting is not cost-effective and can yield both false-positive and false-negative results. Dr. Rosenfield receives research support in the form of grants from the U.S. Public Health Service and Quest Diagnostics, maker of a testosterone assay.

The Endocrine Society also recently weighed in on the issue of measuring testosterone (J. Clin. Endocrinol. Metab. 2007; 92:405-13). In a position paper released in February, the Endocrine Society recommended that laboratory proficiency testing be based on the ability to accurately measure a sample containing a known concentration of testosterone, not simply on agreement among peers using the same method.

The position statement concluded that free testosterone is the most useful, clinically sensitive marker of hyperandrogenemia in women when calculated using high-quality testosterone and sex hormone-binding globulin assays with well-defined reference intervals.

In an effort to advance the field, the Endocrine Society and the Centers for Disease Control and Prevention are collaborating on the establishment of standards to validate the performance of laboratory assays of serum testosterone levels. The CDC's work is supported through a partnership between the CDC Foundation and Solvay Pharmaceuticals Inc.

TORONTO — A 6-month treatment regimen of metformin can help reduce the prevalence and degree of acne in women with polycystic ovary syndrome, according to Dr. Susanne Tan and her colleagues.

The researchers treated 100 women with polycystic ovary syndrome (PCOS) and acne papulopustules with a weight-adapted dose of metformin for 6 months. The degree of acne fell from a mean of 1.5 to 0.9 and the prevalence dropped from 100% at baseline to 72% after 6 months of treatment.

The mean age of the women who participated in the study was 28 years, and they had a mean body mass index of 31.8 kg/m

The findings were reported in a poster presentation at the annual meeting of the Endocrine Society.

Women with 1–10 lesions were considered to have degree I acne, those with 11–20 lesions had degree II, and those with 21–30 lesions had degree III. At baseline, 55% of participants had degree I acne, 39% had degree II acne, and 6% had degree III.

Hyperandrogenism and chronic anovulation were assessed at baseline and after 6 months through physical exam and blood testing, the researchers wrote.

After metformin therapy, 56% of women in the study experienced at least one degree of improvement in their acne. About 41% saw no difference, and 3% worsened, according to the study. After 6 months of treatment with metformin, there was a statistically significant decline in some PCOS symptoms, such as high BMI, amenorrhea, and acne.

There was no statistical difference in hirsutism or alopecia from baseline, Dr. Tan and her colleagues noted.

ELSEVIER GLOBAL MEDICAL NEWS

TORONTO — A 6-month treatment regimen of metformin can help reduce the prevalence and degree of acne in women with polycystic ovary syndrome, according to Dr. Susanne Tan and her colleagues.

The researchers treated 100 women with polycystic ovary syndrome (PCOS) and acne papulopustules with a weight-adapted dose of metformin for 6 months. The degree of acne fell from a mean of 1.5 to 0.9 and the prevalence dropped from 100% at baseline to 72% after 6 months of treatment.

The mean age of the women who participated in the study was 28 years, and they had a mean body mass index of 31.8 kg/m

The findings were reported in a poster presentation at the annual meeting of the Endocrine Society.

Women with 1–10 lesions were considered to have degree I acne, those with 11–20 lesions had degree II, and those with 21–30 lesions had degree III. At baseline, 55% of participants had degree I acne, 39% had degree II acne, and 6% had degree III.

Hyperandrogenism and chronic anovulation were assessed at baseline and after 6 months through physical exam and blood testing, the researchers wrote.

After metformin therapy, 56% of women in the study experienced at least one degree of improvement in their acne. About 41% saw no difference, and 3% worsened, according to the study. After 6 months of treatment with metformin, there was a statistically significant decline in some PCOS symptoms, such as high BMI, amenorrhea, and acne.

There was no statistical difference in hirsutism or alopecia from baseline, Dr. Tan and her colleagues noted.

ELSEVIER GLOBAL MEDICAL NEWS

TORONTO — A 6-month treatment regimen of metformin can help reduce the prevalence and degree of acne in women with polycystic ovary syndrome, according to Dr. Susanne Tan and her colleagues.

The researchers treated 100 women with polycystic ovary syndrome (PCOS) and acne papulopustules with a weight-adapted dose of metformin for 6 months. The degree of acne fell from a mean of 1.5 to 0.9 and the prevalence dropped from 100% at baseline to 72% after 6 months of treatment.

The mean age of the women who participated in the study was 28 years, and they had a mean body mass index of 31.8 kg/m

The findings were reported in a poster presentation at the annual meeting of the Endocrine Society.

Women with 1–10 lesions were considered to have degree I acne, those with 11–20 lesions had degree II, and those with 21–30 lesions had degree III. At baseline, 55% of participants had degree I acne, 39% had degree II acne, and 6% had degree III.

Hyperandrogenism and chronic anovulation were assessed at baseline and after 6 months through physical exam and blood testing, the researchers wrote.

After metformin therapy, 56% of women in the study experienced at least one degree of improvement in their acne. About 41% saw no difference, and 3% worsened, according to the study. After 6 months of treatment with metformin, there was a statistically significant decline in some PCOS symptoms, such as high BMI, amenorrhea, and acne.

There was no statistical difference in hirsutism or alopecia from baseline, Dr. Tan and her colleagues noted.

ELSEVIER GLOBAL MEDICAL NEWS

The full text of the report is available online at www.ama-assn.org/go/disasterpreparedness

Public health systems need more federal funding in order to respond to both day-to-day emergencies and also mass-casualty events, according to disaster preparedness recommendations that were released by a coalition of 18 major health organizations.

The coalition, which was led by the American Medical Association (AMA) and the American Public Health Association, issued a report with 53 recommendations that were aimed at leaders in medicine and government.

Some of the other coalition members included the American Academy of Pediatrics, the American College of Emergency Physicians, and also the American College of Surgeons.

The project was funded under a cooperative agreement from the Centers for Disease Control and Prevention.

“The only thing we can probably predict with any certainty about terrorism attacks and other mass casualty events is this—we're not going to know the time, location, and magnitude in advance,” Dr. Ronald M. Davis, president of the AMA, said at a press conference to release the report. “But we have no excuse if our responses aren't known in advance,” he added.

The report identifies nine critical areas that require immediate action, including:

▸ Increased federal funding should be allocated for the purpose of expanding emergency medical, trauma care, and disaster health preparedness systems across the country.

▸ Governmental entities and health systems must develop and evaluate processes to ensure a return to readiness for routine health care and future mass casualty events following a disaster.

▸ Funding for economic recovery after a disaster needs to emphasize the reestablishment of public health and health care systems.

▸ The Institute of Medicine should perform a comprehensive study of health system surge capacity.

▸ Emergency and disaster preparedness must be integrated with public health and health care systems nationwide to provide effective emergency and trauma care.

▸ Public health and health care officials must participate directly in disaster preparedness planning, mitigation, response, and recovery operations.

▸ Health disaster communications and health information exchange networks must be fully integrated and interoperable at every level of government and health systems.

▸ The government, health systems, and all professional organizations should work together to develop and distribute information on the management of adult and pediatric patients in both day-to-day emergency situations as well as catastrophic events.

▸ Public health and health care responders must each be awarded adequate legal protections for providing care during a disaster.

The full text of the report is available online at www.ama-assn.org/go/disasterpreparedness

Public health systems need more federal funding in order to respond to both day-to-day emergencies and also mass-casualty events, according to disaster preparedness recommendations that were released by a coalition of 18 major health organizations.

The coalition, which was led by the American Medical Association (AMA) and the American Public Health Association, issued a report with 53 recommendations that were aimed at leaders in medicine and government.

Some of the other coalition members included the American Academy of Pediatrics, the American College of Emergency Physicians, and also the American College of Surgeons.

The project was funded under a cooperative agreement from the Centers for Disease Control and Prevention.

“The only thing we can probably predict with any certainty about terrorism attacks and other mass casualty events is this—we're not going to know the time, location, and magnitude in advance,” Dr. Ronald M. Davis, president of the AMA, said at a press conference to release the report. “But we have no excuse if our responses aren't known in advance,” he added.

The report identifies nine critical areas that require immediate action, including:

▸ Increased federal funding should be allocated for the purpose of expanding emergency medical, trauma care, and disaster health preparedness systems across the country.

▸ Governmental entities and health systems must develop and evaluate processes to ensure a return to readiness for routine health care and future mass casualty events following a disaster.

▸ Funding for economic recovery after a disaster needs to emphasize the reestablishment of public health and health care systems.

▸ The Institute of Medicine should perform a comprehensive study of health system surge capacity.

▸ Emergency and disaster preparedness must be integrated with public health and health care systems nationwide to provide effective emergency and trauma care.

▸ Public health and health care officials must participate directly in disaster preparedness planning, mitigation, response, and recovery operations.

▸ Health disaster communications and health information exchange networks must be fully integrated and interoperable at every level of government and health systems.

▸ The government, health systems, and all professional organizations should work together to develop and distribute information on the management of adult and pediatric patients in both day-to-day emergency situations as well as catastrophic events.

▸ Public health and health care responders must each be awarded adequate legal protections for providing care during a disaster.

The full text of the report is available online at www.ama-assn.org/go/disasterpreparedness

Public health systems need more federal funding in order to respond to both day-to-day emergencies and also mass-casualty events, according to disaster preparedness recommendations that were released by a coalition of 18 major health organizations.

The coalition, which was led by the American Medical Association (AMA) and the American Public Health Association, issued a report with 53 recommendations that were aimed at leaders in medicine and government.

Some of the other coalition members included the American Academy of Pediatrics, the American College of Emergency Physicians, and also the American College of Surgeons.

The project was funded under a cooperative agreement from the Centers for Disease Control and Prevention.

“The only thing we can probably predict with any certainty about terrorism attacks and other mass casualty events is this—we're not going to know the time, location, and magnitude in advance,” Dr. Ronald M. Davis, president of the AMA, said at a press conference to release the report. “But we have no excuse if our responses aren't known in advance,” he added.

The report identifies nine critical areas that require immediate action, including:

▸ Increased federal funding should be allocated for the purpose of expanding emergency medical, trauma care, and disaster health preparedness systems across the country.

▸ Governmental entities and health systems must develop and evaluate processes to ensure a return to readiness for routine health care and future mass casualty events following a disaster.

▸ Funding for economic recovery after a disaster needs to emphasize the reestablishment of public health and health care systems.

▸ The Institute of Medicine should perform a comprehensive study of health system surge capacity.

▸ Emergency and disaster preparedness must be integrated with public health and health care systems nationwide to provide effective emergency and trauma care.

▸ Public health and health care officials must participate directly in disaster preparedness planning, mitigation, response, and recovery operations.

▸ Health disaster communications and health information exchange networks must be fully integrated and interoperable at every level of government and health systems.

▸ The government, health systems, and all professional organizations should work together to develop and distribute information on the management of adult and pediatric patients in both day-to-day emergency situations as well as catastrophic events.

▸ Public health and health care responders must each be awarded adequate legal protections for providing care during a disaster.

Congress Forms MS Caucus

Federal lawmakers recently formed the first-ever Congressional Multiple Sclerosis Caucus aimed at raising awareness of the disease. Rep. Russ Carnahan (D-Mo.) and Rep. Michael Burgess (R-Tex.) are cochairing the caucus, which will focus on health care, disability, and research issues related to multiple sclerosis. “The new MS caucus is a significant step forward in the MS movement,” Joyce Nelson, National Multiple Sclerosis Society president and CEO, said in a statement. “It will help build bipartisan awareness and education in Congress about important MS issues.” The society plans to work with the caucus cochairs to recruit additional members of Congress.

New Autism Research Funded

The National Institutes of Health is consolidating two autism research programs in an effort to accelerate the search for treatments. The new program—the Autism Centers of Excellence (ACE)—combines the Studies to Advance Autism Research and Treatment (STAART) and the Collaborative Programs of Excellence in Autism (CPEA). The newly consolidated program initially includes five research centers at universities across the country and one research network based at the University of North Carolina at Chapel Hill. Data generated through the ACE program will be added to the National Database for Autism Research, a Web-based tool housed at NIH that is accessible to researchers around the world. Research projects include a study of how individuals with autism learn and understand information and a study using brain imaging to track brain development in children thought to be at risk for autism spectrum disorders. Funding for additional ACE projects will be announced next year, according to NIH.

Epilepsy Bill Introduced

Sen. Patty Murray (D-Wash.) has introduced legislation to establish six Epilepsy Centers of Excellence within the Department of Veterans Affairs. Her bill (S. 2004) is expected to receive a hearing by the Senate Committee on Veterans Affairs this fall, according to the American Academy of Neurology, which has been pushing for the legislation. The bill is similar to a House bill (H.R. 2818) introduced by Rep. Ed Perlmutter (D-Colo.). In particular, the two bills are aimed at providing additional resources to care for veterans who develop epilepsy in the future as a result of traumatic brain injuries suffered in combat.

Hispanic Stroke Awareness

NIH officials launched a new awareness campaign aimed at educating members of Hispanic communities about the importance of seeking prompt treatment for stroke. The centerpiece of the program is a tool kit that can be used by health educators to teach individuals about the signs of stroke and the importance of calling 911 immediately. Hispanics have a high rate of several risk factors for stroke such as diabetes, excessive weight, high blood pressure, and cigarette smoking, according to NIH. “Some people do not recognize stroke as a medical emergency and may not feel comfortable calling 911 due to possible perceived language barriers,” Dr. Jose D. Merino, a staff clinician in NIH's National Institute of Neurological Disorders and Stroke, said in a statement. “It is important that Hispanics know how to recognize the signs of stroke and feel confident [even if] saying only 'stroke' when calling 911 to receive immediate medical treatment.”

Small Practices Decline

Physicians are shying away from solo and two-physician practices, according to a new report from the Center for Studying Health System Change. Although these small practices are still the most common arrangements, between 1996–1997 and 2004–2005 researchers saw a shift from solo and two-person practices to midsize, single-specialty groups of 6–50 physicians. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996–1997 to 33% in 2004–2005. During the same time period, the percentage of physicians practicing in midsize groups rose from 13% to 18%. The biggest declines in physicians choosing small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

Drug Premium About $25 in 2008

The Centers for Medicare and Medicaid Services said that Medicare beneficiaries will pay about $25 a month for their Part D pharmaceutical coverage in 2008. This is about a $3 per month increase over the average premium in 2007, but still 40% lower than what had been projected when the program was established in 2003, according to CMS. The premiums for those who get their benefits through private Medicare Advantage plans will be about $14, according to CMS. The agency said that almost 10 million low-income beneficiaries are having their premiums subsidized by the federal government. Because Part D is sketching out to cost 30% less in the first 10 years than had been estimated, President Bush's 2009 budget will be retooled to reflect the decline, according to CMS.

Congress Forms MS Caucus

Federal lawmakers recently formed the first-ever Congressional Multiple Sclerosis Caucus aimed at raising awareness of the disease. Rep. Russ Carnahan (D-Mo.) and Rep. Michael Burgess (R-Tex.) are cochairing the caucus, which will focus on health care, disability, and research issues related to multiple sclerosis. “The new MS caucus is a significant step forward in the MS movement,” Joyce Nelson, National Multiple Sclerosis Society president and CEO, said in a statement. “It will help build bipartisan awareness and education in Congress about important MS issues.” The society plans to work with the caucus cochairs to recruit additional members of Congress.

New Autism Research Funded

The National Institutes of Health is consolidating two autism research programs in an effort to accelerate the search for treatments. The new program—the Autism Centers of Excellence (ACE)—combines the Studies to Advance Autism Research and Treatment (STAART) and the Collaborative Programs of Excellence in Autism (CPEA). The newly consolidated program initially includes five research centers at universities across the country and one research network based at the University of North Carolina at Chapel Hill. Data generated through the ACE program will be added to the National Database for Autism Research, a Web-based tool housed at NIH that is accessible to researchers around the world. Research projects include a study of how individuals with autism learn and understand information and a study using brain imaging to track brain development in children thought to be at risk for autism spectrum disorders. Funding for additional ACE projects will be announced next year, according to NIH.

Epilepsy Bill Introduced

Sen. Patty Murray (D-Wash.) has introduced legislation to establish six Epilepsy Centers of Excellence within the Department of Veterans Affairs. Her bill (S. 2004) is expected to receive a hearing by the Senate Committee on Veterans Affairs this fall, according to the American Academy of Neurology, which has been pushing for the legislation. The bill is similar to a House bill (H.R. 2818) introduced by Rep. Ed Perlmutter (D-Colo.). In particular, the two bills are aimed at providing additional resources to care for veterans who develop epilepsy in the future as a result of traumatic brain injuries suffered in combat.

Hispanic Stroke Awareness

NIH officials launched a new awareness campaign aimed at educating members of Hispanic communities about the importance of seeking prompt treatment for stroke. The centerpiece of the program is a tool kit that can be used by health educators to teach individuals about the signs of stroke and the importance of calling 911 immediately. Hispanics have a high rate of several risk factors for stroke such as diabetes, excessive weight, high blood pressure, and cigarette smoking, according to NIH. “Some people do not recognize stroke as a medical emergency and may not feel comfortable calling 911 due to possible perceived language barriers,” Dr. Jose D. Merino, a staff clinician in NIH's National Institute of Neurological Disorders and Stroke, said in a statement. “It is important that Hispanics know how to recognize the signs of stroke and feel confident [even if] saying only 'stroke' when calling 911 to receive immediate medical treatment.”

Small Practices Decline

Physicians are shying away from solo and two-physician practices, according to a new report from the Center for Studying Health System Change. Although these small practices are still the most common arrangements, between 1996–1997 and 2004–2005 researchers saw a shift from solo and two-person practices to midsize, single-specialty groups of 6–50 physicians. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996–1997 to 33% in 2004–2005. During the same time period, the percentage of physicians practicing in midsize groups rose from 13% to 18%. The biggest declines in physicians choosing small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

Drug Premium About $25 in 2008

The Centers for Medicare and Medicaid Services said that Medicare beneficiaries will pay about $25 a month for their Part D pharmaceutical coverage in 2008. This is about a $3 per month increase over the average premium in 2007, but still 40% lower than what had been projected when the program was established in 2003, according to CMS. The premiums for those who get their benefits through private Medicare Advantage plans will be about $14, according to CMS. The agency said that almost 10 million low-income beneficiaries are having their premiums subsidized by the federal government. Because Part D is sketching out to cost 30% less in the first 10 years than had been estimated, President Bush's 2009 budget will be retooled to reflect the decline, according to CMS.

Congress Forms MS Caucus

Federal lawmakers recently formed the first-ever Congressional Multiple Sclerosis Caucus aimed at raising awareness of the disease. Rep. Russ Carnahan (D-Mo.) and Rep. Michael Burgess (R-Tex.) are cochairing the caucus, which will focus on health care, disability, and research issues related to multiple sclerosis. “The new MS caucus is a significant step forward in the MS movement,” Joyce Nelson, National Multiple Sclerosis Society president and CEO, said in a statement. “It will help build bipartisan awareness and education in Congress about important MS issues.” The society plans to work with the caucus cochairs to recruit additional members of Congress.

New Autism Research Funded

The National Institutes of Health is consolidating two autism research programs in an effort to accelerate the search for treatments. The new program—the Autism Centers of Excellence (ACE)—combines the Studies to Advance Autism Research and Treatment (STAART) and the Collaborative Programs of Excellence in Autism (CPEA). The newly consolidated program initially includes five research centers at universities across the country and one research network based at the University of North Carolina at Chapel Hill. Data generated through the ACE program will be added to the National Database for Autism Research, a Web-based tool housed at NIH that is accessible to researchers around the world. Research projects include a study of how individuals with autism learn and understand information and a study using brain imaging to track brain development in children thought to be at risk for autism spectrum disorders. Funding for additional ACE projects will be announced next year, according to NIH.

Epilepsy Bill Introduced

Sen. Patty Murray (D-Wash.) has introduced legislation to establish six Epilepsy Centers of Excellence within the Department of Veterans Affairs. Her bill (S. 2004) is expected to receive a hearing by the Senate Committee on Veterans Affairs this fall, according to the American Academy of Neurology, which has been pushing for the legislation. The bill is similar to a House bill (H.R. 2818) introduced by Rep. Ed Perlmutter (D-Colo.). In particular, the two bills are aimed at providing additional resources to care for veterans who develop epilepsy in the future as a result of traumatic brain injuries suffered in combat.

Hispanic Stroke Awareness

NIH officials launched a new awareness campaign aimed at educating members of Hispanic communities about the importance of seeking prompt treatment for stroke. The centerpiece of the program is a tool kit that can be used by health educators to teach individuals about the signs of stroke and the importance of calling 911 immediately. Hispanics have a high rate of several risk factors for stroke such as diabetes, excessive weight, high blood pressure, and cigarette smoking, according to NIH. “Some people do not recognize stroke as a medical emergency and may not feel comfortable calling 911 due to possible perceived language barriers,” Dr. Jose D. Merino, a staff clinician in NIH's National Institute of Neurological Disorders and Stroke, said in a statement. “It is important that Hispanics know how to recognize the signs of stroke and feel confident [even if] saying only 'stroke' when calling 911 to receive immediate medical treatment.”

Small Practices Decline

Physicians are shying away from solo and two-physician practices, according to a new report from the Center for Studying Health System Change. Although these small practices are still the most common arrangements, between 1996–1997 and 2004–2005 researchers saw a shift from solo and two-person practices to midsize, single-specialty groups of 6–50 physicians. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996–1997 to 33% in 2004–2005. During the same time period, the percentage of physicians practicing in midsize groups rose from 13% to 18%. The biggest declines in physicians choosing small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

Drug Premium About $25 in 2008

The Centers for Medicare and Medicaid Services said that Medicare beneficiaries will pay about $25 a month for their Part D pharmaceutical coverage in 2008. This is about a $3 per month increase over the average premium in 2007, but still 40% lower than what had been projected when the program was established in 2003, according to CMS. The premiums for those who get their benefits through private Medicare Advantage plans will be about $14, according to CMS. The agency said that almost 10 million low-income beneficiaries are having their premiums subsidized by the federal government. Because Part D is sketching out to cost 30% less in the first 10 years than had been estimated, President Bush's 2009 budget will be retooled to reflect the decline, according to CMS.

NIH Lupus Research Plan

Government scientists recently outlined their plans for future research in lupus. The stated goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, expanding biopsychosocial research, discovering and validating biomarkers, and advancing therapy options. These goals are part of a long-range planning document recently released by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), which is part of the National Institutes of Health (NIH). The NIH document predicts that lupus prevention could indeed become an “attainable goal” in the next decade, and also outlines a need to advance research efforts to identify disease risk through family studies and genetics. The document, which was mandated by Congress, was developed with input from scientific experts from the lupus community, according to NIH. “The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus,” Dr. Stephen Katz, the director of NIAMS, wrote in the introduction to the plan, available at:

www.niams.nih.gov/an/stratplan/lupus_plan.htm

Gender in Musculoskeletal Disease

The Society for Women's Health Research has launched a new research network with the goal of exploring the biologic differences between men and women in the musculoskeletal system. The network is part of the society's Isis Fund for Sex Differences Research. Other Isis fund networks focus on sex, gender, drugs, and the brain; and sex differences in metabolism. Members of the musculoskeletal network will hold meetings to share data and ideas for research. “The goal of the Isis fund networks is to foster multi-site collaborative projects that address new questions and open new lines of inquiry,” Sherry Marts, Ph.D., vice president of scientific affairs at the society, said in a statement. “We are planting seeds for sex-based studies and supporting an environment to help this field grow. Ultimately, we want these projects to be leveraged into larger projects that will receive grant funding from government and nongovernment sources.” The musculoskeletal network is support by a $1 million unrestricted donation from Zimmer Inc., an Indiana-based manufacturer of joint replacement systems for knee and hip pain.

Small Practices Decline

Although one and two physician practices remain the most common arrangements, between 1996-1997 and 2004-2005 researchers saw a shift from solo and two-person practices to midsized, single-specialty groups of 6-50 physicians, according to a new report from the Center for Studying Health System Change. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996-1997 to 33% in 2004-2005. During the same time period, the percentage of physicians practicing in midsized groups rose from 13% to 18%. The biggest declines in physicians choosing small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

Leaders Back Payment Reform

The vast majority (95%) of key public officials, analysts, and executives say fundamental health care payment reform is needed, and 75% support Medicare reform that would pay “medical homes” for care coordination, according to the latest Commonwealth Fund Health Care Opinion Leaders survey. The survey found consensus for specific strategies; for example, 90% of respondents said use of health information technology should be mandated for Medicare providers within 5-10 years, and half supported financial incentives for physicians and hospitals to provide high quality care. Around three-quarters of respondents agreed that greater organization and integration of provider care is necessary for improved quality and efficiency, but nearly 8 of 10 said that physician autonomy would be a challenge to care integration. A total of 59% said they support public reporting of providers' performance on quality measures, and more than half reported they support the creation of a new public-private entity to coordinate quality efforts and form a national quality agenda.

NIH Lupus Research Plan

Government scientists recently outlined their plans for future research in lupus. The stated goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, expanding biopsychosocial research, discovering and validating biomarkers, and advancing therapy options. These goals are part of a long-range planning document recently released by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), which is part of the National Institutes of Health (NIH). The NIH document predicts that lupus prevention could indeed become an “attainable goal” in the next decade, and also outlines a need to advance research efforts to identify disease risk through family studies and genetics. The document, which was mandated by Congress, was developed with input from scientific experts from the lupus community, according to NIH. “The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus,” Dr. Stephen Katz, the director of NIAMS, wrote in the introduction to the plan, available at:

www.niams.nih.gov/an/stratplan/lupus_plan.htm

Gender in Musculoskeletal Disease

The Society for Women's Health Research has launched a new research network with the goal of exploring the biologic differences between men and women in the musculoskeletal system. The network is part of the society's Isis Fund for Sex Differences Research. Other Isis fund networks focus on sex, gender, drugs, and the brain; and sex differences in metabolism. Members of the musculoskeletal network will hold meetings to share data and ideas for research. “The goal of the Isis fund networks is to foster multi-site collaborative projects that address new questions and open new lines of inquiry,” Sherry Marts, Ph.D., vice president of scientific affairs at the society, said in a statement. “We are planting seeds for sex-based studies and supporting an environment to help this field grow. Ultimately, we want these projects to be leveraged into larger projects that will receive grant funding from government and nongovernment sources.” The musculoskeletal network is support by a $1 million unrestricted donation from Zimmer Inc., an Indiana-based manufacturer of joint replacement systems for knee and hip pain.

Small Practices Decline

Although one and two physician practices remain the most common arrangements, between 1996-1997 and 2004-2005 researchers saw a shift from solo and two-person practices to midsized, single-specialty groups of 6-50 physicians, according to a new report from the Center for Studying Health System Change. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996-1997 to 33% in 2004-2005. During the same time period, the percentage of physicians practicing in midsized groups rose from 13% to 18%. The biggest declines in physicians choosing small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

Leaders Back Payment Reform

The vast majority (95%) of key public officials, analysts, and executives say fundamental health care payment reform is needed, and 75% support Medicare reform that would pay “medical homes” for care coordination, according to the latest Commonwealth Fund Health Care Opinion Leaders survey. The survey found consensus for specific strategies; for example, 90% of respondents said use of health information technology should be mandated for Medicare providers within 5-10 years, and half supported financial incentives for physicians and hospitals to provide high quality care. Around three-quarters of respondents agreed that greater organization and integration of provider care is necessary for improved quality and efficiency, but nearly 8 of 10 said that physician autonomy would be a challenge to care integration. A total of 59% said they support public reporting of providers' performance on quality measures, and more than half reported they support the creation of a new public-private entity to coordinate quality efforts and form a national quality agenda.

NIH Lupus Research Plan

Government scientists recently outlined their plans for future research in lupus. The stated goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, expanding biopsychosocial research, discovering and validating biomarkers, and advancing therapy options. These goals are part of a long-range planning document recently released by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), which is part of the National Institutes of Health (NIH). The NIH document predicts that lupus prevention could indeed become an “attainable goal” in the next decade, and also outlines a need to advance research efforts to identify disease risk through family studies and genetics. The document, which was mandated by Congress, was developed with input from scientific experts from the lupus community, according to NIH. “The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus,” Dr. Stephen Katz, the director of NIAMS, wrote in the introduction to the plan, available at:

www.niams.nih.gov/an/stratplan/lupus_plan.htm

Gender in Musculoskeletal Disease

The Society for Women's Health Research has launched a new research network with the goal of exploring the biologic differences between men and women in the musculoskeletal system. The network is part of the society's Isis Fund for Sex Differences Research. Other Isis fund networks focus on sex, gender, drugs, and the brain; and sex differences in metabolism. Members of the musculoskeletal network will hold meetings to share data and ideas for research. “The goal of the Isis fund networks is to foster multi-site collaborative projects that address new questions and open new lines of inquiry,” Sherry Marts, Ph.D., vice president of scientific affairs at the society, said in a statement. “We are planting seeds for sex-based studies and supporting an environment to help this field grow. Ultimately, we want these projects to be leveraged into larger projects that will receive grant funding from government and nongovernment sources.” The musculoskeletal network is support by a $1 million unrestricted donation from Zimmer Inc., an Indiana-based manufacturer of joint replacement systems for knee and hip pain.

Small Practices Decline

Although one and two physician practices remain the most common arrangements, between 1996-1997 and 2004-2005 researchers saw a shift from solo and two-person practices to midsized, single-specialty groups of 6-50 physicians, according to a new report from the Center for Studying Health System Change. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996-1997 to 33% in 2004-2005. During the same time period, the percentage of physicians practicing in midsized groups rose from 13% to 18%. The biggest declines in physicians choosing small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

Leaders Back Payment Reform

The vast majority (95%) of key public officials, analysts, and executives say fundamental health care payment reform is needed, and 75% support Medicare reform that would pay “medical homes” for care coordination, according to the latest Commonwealth Fund Health Care Opinion Leaders survey. The survey found consensus for specific strategies; for example, 90% of respondents said use of health information technology should be mandated for Medicare providers within 5-10 years, and half supported financial incentives for physicians and hospitals to provide high quality care. Around three-quarters of respondents agreed that greater organization and integration of provider care is necessary for improved quality and efficiency, but nearly 8 of 10 said that physician autonomy would be a challenge to care integration. A total of 59% said they support public reporting of providers' performance on quality measures, and more than half reported they support the creation of a new public-private entity to coordinate quality efforts and form a national quality agenda.

Officials at the Centers for Medicare and Medicaid Services are proposing changes to the Medicare Part D prescription drug plans and Medicare Advantage plans to strengthen oversight of the programs.

The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans. It also includes changes to streamline the process of intermediate sanctions and contract determinations, and it clarifies the process for imposing civil money penalties.

“While the majority of Medicare Advantage and Medicare Prescription Drug Plans that offer important benefits to beneficiaries are conducting themselves professionally, it is important for CMS to be able to take swift action to safeguard beneficiaries from unlawful or questionable business practices,” Leslie Norwalk, acting CMS administrator, said in a statement.

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, said Robert M. Hayes, president of the Medicare Rights Center. He has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards. He also called for the establishment of minimum benefit standards and standardized benefit packages to allow for better consumer comparison of plans.

Officials at the American Medical Association are also reporting problems with Medicare Advantage plans. An online survey of more than 2,200 AMA member physicians conducted in March found that patients had difficulty understanding how the plans work or have had coverage denials for services that were covered under traditional Medicare plans.

For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works, as did about 80% of physicians with patients in Medicare Advantage private fee-for-service plans.

Officials at the Centers for Medicare and Medicaid Services are proposing changes to the Medicare Part D prescription drug plans and Medicare Advantage plans to strengthen oversight of the programs.

The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans. It also includes changes to streamline the process of intermediate sanctions and contract determinations, and it clarifies the process for imposing civil money penalties.

“While the majority of Medicare Advantage and Medicare Prescription Drug Plans that offer important benefits to beneficiaries are conducting themselves professionally, it is important for CMS to be able to take swift action to safeguard beneficiaries from unlawful or questionable business practices,” Leslie Norwalk, acting CMS administrator, said in a statement.

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, said Robert M. Hayes, president of the Medicare Rights Center. He has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards. He also called for the establishment of minimum benefit standards and standardized benefit packages to allow for better consumer comparison of plans.

Officials at the American Medical Association are also reporting problems with Medicare Advantage plans. An online survey of more than 2,200 AMA member physicians conducted in March found that patients had difficulty understanding how the plans work or have had coverage denials for services that were covered under traditional Medicare plans.

For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works, as did about 80% of physicians with patients in Medicare Advantage private fee-for-service plans.

Officials at the Centers for Medicare and Medicaid Services are proposing changes to the Medicare Part D prescription drug plans and Medicare Advantage plans to strengthen oversight of the programs.

The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans. It also includes changes to streamline the process of intermediate sanctions and contract determinations, and it clarifies the process for imposing civil money penalties.

“While the majority of Medicare Advantage and Medicare Prescription Drug Plans that offer important benefits to beneficiaries are conducting themselves professionally, it is important for CMS to be able to take swift action to safeguard beneficiaries from unlawful or questionable business practices,” Leslie Norwalk, acting CMS administrator, said in a statement.

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, said Robert M. Hayes, president of the Medicare Rights Center. He has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards. He also called for the establishment of minimum benefit standards and standardized benefit packages to allow for better consumer comparison of plans.

Officials at the American Medical Association are also reporting problems with Medicare Advantage plans. An online survey of more than 2,200 AMA member physicians conducted in March found that patients had difficulty understanding how the plans work or have had coverage denials for services that were covered under traditional Medicare plans.

For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works, as did about 80% of physicians with patients in Medicare Advantage private fee-for-service plans.

The true impact isn't known yet, but an administrative change by the Centers for Medicare and Medicaid Services to rules governing the State Children's Health Insurance Program—made on a Friday night during Congress' August recess—may have the effect of dropping children who currently have coverage.

Sen. Jay Rockefeller (D-W.Va.), one of the coauthors of SCHIP, sent a letter to President George W. Bush chiding the administration for making the change without congressional input.

“Not only do I question the wisdom and legality of this new policy, I also question the process,” he wrote, noting that “a policy change of this magnitude should, at a minimum, be handled through the formal rule-making process, with proper public notice and comment, and not through unilateral subregulatory guidance.”

About 4 million children are eligible for Medicaid or SCHIP currently; some 6 million received benefits in 2006. An estimated 9 million children do not have health insurance.

SCHIP, now entering its 10th year, has been the subject of fierce battles this year, as lawmakers have struggled to agree on financing for the next 5 years. Authorization for SCHIP expires Sept. 30. Before leaving for summer recess, the House and the Senate passed vastly different funding packages. (See box.)

President Bush said he would veto either bill, saying that he viewed both as a back-door way of expanding government-financed health care at the expense of the private insurance market.

So, the Aug. 17 letter from CMS Director for Medicaid and State Operations Dennis G. Smith to state health officials should not have come as a surprise. In the letter, states were told that if they were raising eligibility for children whose family incomes were equal to or above 250% of the federal poverty level, they would have to meet stringent new requirements. The goal: to ensure that these families aren't opting for SCHIP instead of private insurance. “Existing regulations … provide that states must have 'reasonable procedures' to prevent substitution of public SCHIP coverage for private coverage,” wrote Mr. Smith.

Many states have had such procedures in place, but the CMS is now requiring that specific processes be implemented. For instance, children will have to be uninsured for at least 1 year before receiving SCHIP benefits. Currently, only Alaska requires a year-long exclusion, said Judy Solomon, a senior fellow with the Center on Budget and Policy Priorities, a Washington-based policy research organization. Most states have a 1- to 6-month waiting period, but many have generous exceptions to those rules.

With the administrative change, states also will have to prove that they've enrolled at least 95% of children who are below 200% of the federal poverty level, and document that the number of low-income children who are eligible for and covered by private insurance has not dropped by more than 2% in the past 5 years. States that have already increased their eligibility to 250% or more—18 states—will have to comply with the new requirements within a year or lose some of their federal matching funds.

The CMS said the requirements should not harm children who currently receive benefits. But although it's not clear how many might be dropped, “At the very least, you're going to have thousands of children unable to get coverage,” Ms. Solomon said.

SCHIP was designed to give states flexibility to meet the needs of their own citizenry, she noted. But the new policy is diminishing that flexibility. “This turns back the clock,” said Ms. Solomon.

The House and Senate will meet in conference in September to determine the course of SCHIP over the next 5 years.

Senate, House Bills Differ

In August, the Senate overwhelmingly passed S. 1893, which includes a $35-billion increase for SCHIP. The funds would come from an increase in the federal tobacco tax.

The approved House legislation (H.R. 3162), on the other hand, contains a number of provisions unrelated to SCHIP. For example, it would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in place a 0.5% increase for 2008 and another for 2009.

In terms of SCHIP funding, the House bill calls for a $50-billion increase in funding and would pay for it with increases in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.

The House bill also outlines a new physician payment structure under Medicare that would set a separate conversion factor for six service categories: evaluation and management for primary care and for other services, imaging, major procedures, anesthesia services, and minor procedures.

The proposed formula would also take prescription drugs out of the spending targets and take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But the formula would still lead to deep payment cuts starting in 2010, so there is an understanding the updates for 2010 and beyond would require additional action, he said.

But the American College of Cardiology expressed problems with the House bill's new structure for Medicare payments. The structure would be based on a system of separate expenditure targets that would not take into account the appropriate growth in services, including many common cardiovascular services, the ACC asserted. “While the ACC appreciates congressional efforts to stop Medicare physician payment cuts, it is critical that any new payment structure is fair to all physicians,” it said in a statement.

The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services, including cardiovascular screening blood tests and diabetes screening tests.

The true impact isn't known yet, but an administrative change by the Centers for Medicare and Medicaid Services to rules governing the State Children's Health Insurance Program—made on a Friday night during Congress' August recess—may have the effect of dropping children who currently have coverage.

Sen. Jay Rockefeller (D-W.Va.), one of the coauthors of SCHIP, sent a letter to President George W. Bush chiding the administration for making the change without congressional input.

“Not only do I question the wisdom and legality of this new policy, I also question the process,” he wrote, noting that “a policy change of this magnitude should, at a minimum, be handled through the formal rule-making process, with proper public notice and comment, and not through unilateral subregulatory guidance.”

About 4 million children are eligible for Medicaid or SCHIP currently; some 6 million received benefits in 2006. An estimated 9 million children do not have health insurance.

SCHIP, now entering its 10th year, has been the subject of fierce battles this year, as lawmakers have struggled to agree on financing for the next 5 years. Authorization for SCHIP expires Sept. 30. Before leaving for summer recess, the House and the Senate passed vastly different funding packages. (See box.)

President Bush said he would veto either bill, saying that he viewed both as a back-door way of expanding government-financed health care at the expense of the private insurance market.

So, the Aug. 17 letter from CMS Director for Medicaid and State Operations Dennis G. Smith to state health officials should not have come as a surprise. In the letter, states were told that if they were raising eligibility for children whose family incomes were equal to or above 250% of the federal poverty level, they would have to meet stringent new requirements. The goal: to ensure that these families aren't opting for SCHIP instead of private insurance. “Existing regulations … provide that states must have 'reasonable procedures' to prevent substitution of public SCHIP coverage for private coverage,” wrote Mr. Smith.

Many states have had such procedures in place, but the CMS is now requiring that specific processes be implemented. For instance, children will have to be uninsured for at least 1 year before receiving SCHIP benefits. Currently, only Alaska requires a year-long exclusion, said Judy Solomon, a senior fellow with the Center on Budget and Policy Priorities, a Washington-based policy research organization. Most states have a 1- to 6-month waiting period, but many have generous exceptions to those rules.

With the administrative change, states also will have to prove that they've enrolled at least 95% of children who are below 200% of the federal poverty level, and document that the number of low-income children who are eligible for and covered by private insurance has not dropped by more than 2% in the past 5 years. States that have already increased their eligibility to 250% or more—18 states—will have to comply with the new requirements within a year or lose some of their federal matching funds.

The CMS said the requirements should not harm children who currently receive benefits. But although it's not clear how many might be dropped, “At the very least, you're going to have thousands of children unable to get coverage,” Ms. Solomon said.

SCHIP was designed to give states flexibility to meet the needs of their own citizenry, she noted. But the new policy is diminishing that flexibility. “This turns back the clock,” said Ms. Solomon.

The House and Senate will meet in conference in September to determine the course of SCHIP over the next 5 years.

Senate, House Bills Differ

In August, the Senate overwhelmingly passed S. 1893, which includes a $35-billion increase for SCHIP. The funds would come from an increase in the federal tobacco tax.

The approved House legislation (H.R. 3162), on the other hand, contains a number of provisions unrelated to SCHIP. For example, it would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in place a 0.5% increase for 2008 and another for 2009.

In terms of SCHIP funding, the House bill calls for a $50-billion increase in funding and would pay for it with increases in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.

The House bill also outlines a new physician payment structure under Medicare that would set a separate conversion factor for six service categories: evaluation and management for primary care and for other services, imaging, major procedures, anesthesia services, and minor procedures.

The proposed formula would also take prescription drugs out of the spending targets and take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But the formula would still lead to deep payment cuts starting in 2010, so there is an understanding the updates for 2010 and beyond would require additional action, he said.

But the American College of Cardiology expressed problems with the House bill's new structure for Medicare payments. The structure would be based on a system of separate expenditure targets that would not take into account the appropriate growth in services, including many common cardiovascular services, the ACC asserted. “While the ACC appreciates congressional efforts to stop Medicare physician payment cuts, it is critical that any new payment structure is fair to all physicians,” it said in a statement.

The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services, including cardiovascular screening blood tests and diabetes screening tests.

The true impact isn't known yet, but an administrative change by the Centers for Medicare and Medicaid Services to rules governing the State Children's Health Insurance Program—made on a Friday night during Congress' August recess—may have the effect of dropping children who currently have coverage.

Sen. Jay Rockefeller (D-W.Va.), one of the coauthors of SCHIP, sent a letter to President George W. Bush chiding the administration for making the change without congressional input.

“Not only do I question the wisdom and legality of this new policy, I also question the process,” he wrote, noting that “a policy change of this magnitude should, at a minimum, be handled through the formal rule-making process, with proper public notice and comment, and not through unilateral subregulatory guidance.”

About 4 million children are eligible for Medicaid or SCHIP currently; some 6 million received benefits in 2006. An estimated 9 million children do not have health insurance.

SCHIP, now entering its 10th year, has been the subject of fierce battles this year, as lawmakers have struggled to agree on financing for the next 5 years. Authorization for SCHIP expires Sept. 30. Before leaving for summer recess, the House and the Senate passed vastly different funding packages. (See box.)

President Bush said he would veto either bill, saying that he viewed both as a back-door way of expanding government-financed health care at the expense of the private insurance market.

So, the Aug. 17 letter from CMS Director for Medicaid and State Operations Dennis G. Smith to state health officials should not have come as a surprise. In the letter, states were told that if they were raising eligibility for children whose family incomes were equal to or above 250% of the federal poverty level, they would have to meet stringent new requirements. The goal: to ensure that these families aren't opting for SCHIP instead of private insurance. “Existing regulations … provide that states must have 'reasonable procedures' to prevent substitution of public SCHIP coverage for private coverage,” wrote Mr. Smith.

Many states have had such procedures in place, but the CMS is now requiring that specific processes be implemented. For instance, children will have to be uninsured for at least 1 year before receiving SCHIP benefits. Currently, only Alaska requires a year-long exclusion, said Judy Solomon, a senior fellow with the Center on Budget and Policy Priorities, a Washington-based policy research organization. Most states have a 1- to 6-month waiting period, but many have generous exceptions to those rules.

With the administrative change, states also will have to prove that they've enrolled at least 95% of children who are below 200% of the federal poverty level, and document that the number of low-income children who are eligible for and covered by private insurance has not dropped by more than 2% in the past 5 years. States that have already increased their eligibility to 250% or more—18 states—will have to comply with the new requirements within a year or lose some of their federal matching funds.

The CMS said the requirements should not harm children who currently receive benefits. But although it's not clear how many might be dropped, “At the very least, you're going to have thousands of children unable to get coverage,” Ms. Solomon said.

SCHIP was designed to give states flexibility to meet the needs of their own citizenry, she noted. But the new policy is diminishing that flexibility. “This turns back the clock,” said Ms. Solomon.

The House and Senate will meet in conference in September to determine the course of SCHIP over the next 5 years.

Senate, House Bills Differ

In August, the Senate overwhelmingly passed S. 1893, which includes a $35-billion increase for SCHIP. The funds would come from an increase in the federal tobacco tax.

The approved House legislation (H.R. 3162), on the other hand, contains a number of provisions unrelated to SCHIP. For example, it would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in place a 0.5% increase for 2008 and another for 2009.

In terms of SCHIP funding, the House bill calls for a $50-billion increase in funding and would pay for it with increases in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.

The House bill also outlines a new physician payment structure under Medicare that would set a separate conversion factor for six service categories: evaluation and management for primary care and for other services, imaging, major procedures, anesthesia services, and minor procedures.

The proposed formula would also take prescription drugs out of the spending targets and take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But the formula would still lead to deep payment cuts starting in 2010, so there is an understanding the updates for 2010 and beyond would require additional action, he said.

But the American College of Cardiology expressed problems with the House bill's new structure for Medicare payments. The structure would be based on a system of separate expenditure targets that would not take into account the appropriate growth in services, including many common cardiovascular services, the ACC asserted. “While the ACC appreciates congressional efforts to stop Medicare physician payment cuts, it is critical that any new payment structure is fair to all physicians,” it said in a statement.

The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services, including cardiovascular screening blood tests and diabetes screening tests.