Mary Ellen Schneider

Preliminary results of a demonstration project that allows physician groups to share in savings they earn for the Medicare program has also resulted in quality gains, according to the Centers for Medicare and Medicaid Services.

The Medicare Physician Group Practice Demonstration is a 3-year project that encourages group practices to improve coordination of care for patients with chronic diseases. The project offers the practices financial incentives that meet clinical targets and save the Medicare program money above a certain threshold. In the first year (April 2005-March 2006), 10 participating practices were assessed based on their performance on evidence-based diabetes measures. All of the practices improved their clinical management of diabetes and met targets on at least 7 of 10 measures; two practices improved on all 10 measures.

Measures for the first year included hemoglobin A1c management and control, blood pressure management, lipid measurement, LDL cholesterol level, urine protein testing, eye exam, foot exam, influenza vaccination, and pneumonia vaccination.

In addition to improving care, the demonstration saved the Medicare program about $9.5 million, Herb Kuhn, CMS acting deputy administrator, said during a press conference to announce the first-year results.

“We are seeing substantial and verifiable improvements in the quality of care for patients and improved efficiency in the delivery of that care,” Mr. Kuhn said. The results show that Medicare is “on the right track” in terms of providing incentives for coordinating care, he said.

The demonstration includes 10 large, multispecialty group practices with a total of about 224,000 Medicare beneficiaries. The 10 group practices are Dartmouth-Hitchcock Clinic, Bedford, N.H.; Deaconess Billings (Mont.) Clinic; the Everett (Wash.) Clinic; Geisinger Health System, Danville, Pa.; Middlesex Health System, Middletown, Conn.; Marshfield (Wisc.) Clinic; Forsyth Medical Group, Winston-Salem, N.C.; Park Nicollet Health Services, St. Louis Park, Minn.; St. John's Health System, Springfield, Mo.; and University of Michigan Faculty Group Practice, Ann Arbor.

The demonstration encourages physicians to coordinate Part A and Part B Medicare services, invest in new care management programs, and redesign care processes. If these investments save money for the Medicare program, the physician groups are able to share in a portion of the savings. These performance payments are in addition to the regular fee-for-service Medicare payments received. Physician groups may share up to 80% of the savings, which are distributed based on financial performance and achievement of benchmarks in care quality measures, Mr. Kuhn said. To receive a performance payment, the practices' total Medicare spending growth rate must be more than 2 percentage points lower than a comparison population of Medicare beneficiaries in their local market area.

While all the practices met clinical targets for at least seven diabetes measures, only two practices received performance payments.

The Marshfield Clinic and the University of Michigan Faculty Group Practice earned performance payments for quality and efficiency improvements. In total, the two groups earned $7.3 million in payments; however, the two practices that met benchmarks in every clinical area–St. John's Health System and the Forsyth Medical Group–did not receive payments.

While other participating practices did achieve lower Medicare spending growth rates than comparison populations in their local markets, their savings did not meet the 2% threshold to share in the Medicare savings, Mr. Kuhn said.

Part of the problem may be that not all practices were able to fully deploy their initiatives in the first year, Mr. Kuhn said. “I think, overall, it's trending in a very positive way.”

The first-year evaluation revealed an emphasis among the practices on care coordination, chronic disease management, efforts to avoid unnecessary hospitalizations, proactive case management, timely follow-up after hospital stays, and the use of health information technology.

Preliminary results of a demonstration project that allows physician groups to share in savings they earn for the Medicare program has also resulted in quality gains, according to the Centers for Medicare and Medicaid Services.

The Medicare Physician Group Practice Demonstration is a 3-year project that encourages group practices to improve coordination of care for patients with chronic diseases. The project offers the practices financial incentives that meet clinical targets and save the Medicare program money above a certain threshold. In the first year (April 2005-March 2006), 10 participating practices were assessed based on their performance on evidence-based diabetes measures. All of the practices improved their clinical management of diabetes and met targets on at least 7 of 10 measures; two practices improved on all 10 measures.

Measures for the first year included hemoglobin A1c management and control, blood pressure management, lipid measurement, LDL cholesterol level, urine protein testing, eye exam, foot exam, influenza vaccination, and pneumonia vaccination.

In addition to improving care, the demonstration saved the Medicare program about $9.5 million, Herb Kuhn, CMS acting deputy administrator, said during a press conference to announce the first-year results.

“We are seeing substantial and verifiable improvements in the quality of care for patients and improved efficiency in the delivery of that care,” Mr. Kuhn said. The results show that Medicare is “on the right track” in terms of providing incentives for coordinating care, he said.

The demonstration includes 10 large, multispecialty group practices with a total of about 224,000 Medicare beneficiaries. The 10 group practices are Dartmouth-Hitchcock Clinic, Bedford, N.H.; Deaconess Billings (Mont.) Clinic; the Everett (Wash.) Clinic; Geisinger Health System, Danville, Pa.; Middlesex Health System, Middletown, Conn.; Marshfield (Wisc.) Clinic; Forsyth Medical Group, Winston-Salem, N.C.; Park Nicollet Health Services, St. Louis Park, Minn.; St. John's Health System, Springfield, Mo.; and University of Michigan Faculty Group Practice, Ann Arbor.

The demonstration encourages physicians to coordinate Part A and Part B Medicare services, invest in new care management programs, and redesign care processes. If these investments save money for the Medicare program, the physician groups are able to share in a portion of the savings. These performance payments are in addition to the regular fee-for-service Medicare payments received. Physician groups may share up to 80% of the savings, which are distributed based on financial performance and achievement of benchmarks in care quality measures, Mr. Kuhn said. To receive a performance payment, the practices' total Medicare spending growth rate must be more than 2 percentage points lower than a comparison population of Medicare beneficiaries in their local market area.

While all the practices met clinical targets for at least seven diabetes measures, only two practices received performance payments.

The Marshfield Clinic and the University of Michigan Faculty Group Practice earned performance payments for quality and efficiency improvements. In total, the two groups earned $7.3 million in payments; however, the two practices that met benchmarks in every clinical area–St. John's Health System and the Forsyth Medical Group–did not receive payments.

While other participating practices did achieve lower Medicare spending growth rates than comparison populations in their local markets, their savings did not meet the 2% threshold to share in the Medicare savings, Mr. Kuhn said.

Part of the problem may be that not all practices were able to fully deploy their initiatives in the first year, Mr. Kuhn said. “I think, overall, it's trending in a very positive way.”

The first-year evaluation revealed an emphasis among the practices on care coordination, chronic disease management, efforts to avoid unnecessary hospitalizations, proactive case management, timely follow-up after hospital stays, and the use of health information technology.

Preliminary results of a demonstration project that allows physician groups to share in savings they earn for the Medicare program has also resulted in quality gains, according to the Centers for Medicare and Medicaid Services.

The Medicare Physician Group Practice Demonstration is a 3-year project that encourages group practices to improve coordination of care for patients with chronic diseases. The project offers the practices financial incentives that meet clinical targets and save the Medicare program money above a certain threshold. In the first year (April 2005-March 2006), 10 participating practices were assessed based on their performance on evidence-based diabetes measures. All of the practices improved their clinical management of diabetes and met targets on at least 7 of 10 measures; two practices improved on all 10 measures.

Measures for the first year included hemoglobin A1c management and control, blood pressure management, lipid measurement, LDL cholesterol level, urine protein testing, eye exam, foot exam, influenza vaccination, and pneumonia vaccination.

In addition to improving care, the demonstration saved the Medicare program about $9.5 million, Herb Kuhn, CMS acting deputy administrator, said during a press conference to announce the first-year results.

“We are seeing substantial and verifiable improvements in the quality of care for patients and improved efficiency in the delivery of that care,” Mr. Kuhn said. The results show that Medicare is “on the right track” in terms of providing incentives for coordinating care, he said.

The demonstration includes 10 large, multispecialty group practices with a total of about 224,000 Medicare beneficiaries. The 10 group practices are Dartmouth-Hitchcock Clinic, Bedford, N.H.; Deaconess Billings (Mont.) Clinic; the Everett (Wash.) Clinic; Geisinger Health System, Danville, Pa.; Middlesex Health System, Middletown, Conn.; Marshfield (Wisc.) Clinic; Forsyth Medical Group, Winston-Salem, N.C.; Park Nicollet Health Services, St. Louis Park, Minn.; St. John's Health System, Springfield, Mo.; and University of Michigan Faculty Group Practice, Ann Arbor.

The demonstration encourages physicians to coordinate Part A and Part B Medicare services, invest in new care management programs, and redesign care processes. If these investments save money for the Medicare program, the physician groups are able to share in a portion of the savings. These performance payments are in addition to the regular fee-for-service Medicare payments received. Physician groups may share up to 80% of the savings, which are distributed based on financial performance and achievement of benchmarks in care quality measures, Mr. Kuhn said. To receive a performance payment, the practices' total Medicare spending growth rate must be more than 2 percentage points lower than a comparison population of Medicare beneficiaries in their local market area.

While all the practices met clinical targets for at least seven diabetes measures, only two practices received performance payments.

The Marshfield Clinic and the University of Michigan Faculty Group Practice earned performance payments for quality and efficiency improvements. In total, the two groups earned $7.3 million in payments; however, the two practices that met benchmarks in every clinical area–St. John's Health System and the Forsyth Medical Group–did not receive payments.

While other participating practices did achieve lower Medicare spending growth rates than comparison populations in their local markets, their savings did not meet the 2% threshold to share in the Medicare savings, Mr. Kuhn said.

Part of the problem may be that not all practices were able to fully deploy their initiatives in the first year, Mr. Kuhn said. “I think, overall, it's trending in a very positive way.”

The first-year evaluation revealed an emphasis among the practices on care coordination, chronic disease management, efforts to avoid unnecessary hospitalizations, proactive case management, timely follow-up after hospital stays, and the use of health information technology.

Physicians will face a nearly 10% cut in Medicare payments in 2008 if Congress does not act to reverse it in the next few months.

Officials at the Centers for Medicare and Medicaid Services published a proposed rule outlining the projected 9.9% payment cut and other policy changes under the Medicare Physician Fee Schedule in the July 12 Federal Register; the agency was accept ing comments until Aug. 31. The final fee schedule rule will be published later this year.

A 9.9% cut would have devastating consequences for physicians and patients alike but is unlikely to be carried out, physicians said in interviews. Instead, Congress is likely to follow the pattern of the last 5 years and provide a 1- or 2-year temporary reprieve.

By law, CMS officials must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. The major medical specialty societies have been lobbying for years to change the formula, which they say does not account for their rising practice costs.

The proposed rule also addresses the continuance of the voluntary CMS' Physician Quality Reporting Initiative (PQRI) in 2008, and outlines new quality measures for next year. CMS officials are considering the feasibility of accepting clinical data from electronic health records. The agency will weigh whether to accept data on a limited number of ambulatory care PQRI measures for which data may also be submitted under the current Doctors Office Quality Information Technology Project (DOQ-IT). In 2008, submission through an electronic health record would be an alternative to the current claims-based reporting of data.

The proposed rule also outlines ways the agency would like to test the use of clinical data registries to report PQRI data. The testing, which would begin in 2008, would evaluate methods for physicians to report data to clinical data registries and for the registries to submit the data on the physician's behalf to CMS.

CMS officials are proposing to fund the bonus payments for the 2008 PQRI program by using $1.35 billion provided by Congress as part of the Physician Assistance and Quality Initiative Fund. In the proposed rule, CMS stated that the bonus payments were likely to be about 1.5% of allowed Medicare charges, not to exceed 2%.

That decision was criticized by the American Medical Association, which said the $1.35 billion should be used to reduce the projected 2008 physician pay cut. CMS estimates the $1.35 billion would reduce the projected cut by about 2%.

“The AMA and 85 other physician and health professional organizations sent a letter strongly urging the Administration to use this money to help Medicare physician payments keep pace with increases in practice costs. The Medicare Payment Advisory Commission made a similar recommendation,” Dr. Cecil B. Wilson, an AMA board member, said in a statement.

“CMS has chosen to spend all of the money to provide just 1.5% to 2% to physicians who report on certain quality measures.”

The proposed rule made other policy changes, including revising the methodology used to determine the average sales price for Part B drugs purchased in bundling arrangements. CMS is proposing to require drug manufacturers to report price concessions proportionately to the dollar value of the units of each drug sold under the bundling arrangement.

Physicians will face a nearly 10% cut in Medicare payments in 2008 if Congress does not act to reverse it in the next few months.

Officials at the Centers for Medicare and Medicaid Services published a proposed rule outlining the projected 9.9% payment cut and other policy changes under the Medicare Physician Fee Schedule in the July 12 Federal Register; the agency was accept ing comments until Aug. 31. The final fee schedule rule will be published later this year.

A 9.9% cut would have devastating consequences for physicians and patients alike but is unlikely to be carried out, physicians said in interviews. Instead, Congress is likely to follow the pattern of the last 5 years and provide a 1- or 2-year temporary reprieve.

By law, CMS officials must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. The major medical specialty societies have been lobbying for years to change the formula, which they say does not account for their rising practice costs.

The proposed rule also addresses the continuance of the voluntary CMS' Physician Quality Reporting Initiative (PQRI) in 2008, and outlines new quality measures for next year. CMS officials are considering the feasibility of accepting clinical data from electronic health records. The agency will weigh whether to accept data on a limited number of ambulatory care PQRI measures for which data may also be submitted under the current Doctors Office Quality Information Technology Project (DOQ-IT). In 2008, submission through an electronic health record would be an alternative to the current claims-based reporting of data.

The proposed rule also outlines ways the agency would like to test the use of clinical data registries to report PQRI data. The testing, which would begin in 2008, would evaluate methods for physicians to report data to clinical data registries and for the registries to submit the data on the physician's behalf to CMS.

CMS officials are proposing to fund the bonus payments for the 2008 PQRI program by using $1.35 billion provided by Congress as part of the Physician Assistance and Quality Initiative Fund. In the proposed rule, CMS stated that the bonus payments were likely to be about 1.5% of allowed Medicare charges, not to exceed 2%.

That decision was criticized by the American Medical Association, which said the $1.35 billion should be used to reduce the projected 2008 physician pay cut. CMS estimates the $1.35 billion would reduce the projected cut by about 2%.

“The AMA and 85 other physician and health professional organizations sent a letter strongly urging the Administration to use this money to help Medicare physician payments keep pace with increases in practice costs. The Medicare Payment Advisory Commission made a similar recommendation,” Dr. Cecil B. Wilson, an AMA board member, said in a statement.

“CMS has chosen to spend all of the money to provide just 1.5% to 2% to physicians who report on certain quality measures.”

The proposed rule made other policy changes, including revising the methodology used to determine the average sales price for Part B drugs purchased in bundling arrangements. CMS is proposing to require drug manufacturers to report price concessions proportionately to the dollar value of the units of each drug sold under the bundling arrangement.

Physicians will face a nearly 10% cut in Medicare payments in 2008 if Congress does not act to reverse it in the next few months.

Officials at the Centers for Medicare and Medicaid Services published a proposed rule outlining the projected 9.9% payment cut and other policy changes under the Medicare Physician Fee Schedule in the July 12 Federal Register; the agency was accept ing comments until Aug. 31. The final fee schedule rule will be published later this year.

A 9.9% cut would have devastating consequences for physicians and patients alike but is unlikely to be carried out, physicians said in interviews. Instead, Congress is likely to follow the pattern of the last 5 years and provide a 1- or 2-year temporary reprieve.

By law, CMS officials must adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. The major medical specialty societies have been lobbying for years to change the formula, which they say does not account for their rising practice costs.

The proposed rule also addresses the continuance of the voluntary CMS' Physician Quality Reporting Initiative (PQRI) in 2008, and outlines new quality measures for next year. CMS officials are considering the feasibility of accepting clinical data from electronic health records. The agency will weigh whether to accept data on a limited number of ambulatory care PQRI measures for which data may also be submitted under the current Doctors Office Quality Information Technology Project (DOQ-IT). In 2008, submission through an electronic health record would be an alternative to the current claims-based reporting of data.

The proposed rule also outlines ways the agency would like to test the use of clinical data registries to report PQRI data. The testing, which would begin in 2008, would evaluate methods for physicians to report data to clinical data registries and for the registries to submit the data on the physician's behalf to CMS.

CMS officials are proposing to fund the bonus payments for the 2008 PQRI program by using $1.35 billion provided by Congress as part of the Physician Assistance and Quality Initiative Fund. In the proposed rule, CMS stated that the bonus payments were likely to be about 1.5% of allowed Medicare charges, not to exceed 2%.

That decision was criticized by the American Medical Association, which said the $1.35 billion should be used to reduce the projected 2008 physician pay cut. CMS estimates the $1.35 billion would reduce the projected cut by about 2%.

“The AMA and 85 other physician and health professional organizations sent a letter strongly urging the Administration to use this money to help Medicare physician payments keep pace with increases in practice costs. The Medicare Payment Advisory Commission made a similar recommendation,” Dr. Cecil B. Wilson, an AMA board member, said in a statement.

“CMS has chosen to spend all of the money to provide just 1.5% to 2% to physicians who report on certain quality measures.”

The proposed rule made other policy changes, including revising the methodology used to determine the average sales price for Part B drugs purchased in bundling arrangements. CMS is proposing to require drug manufacturers to report price concessions proportionately to the dollar value of the units of each drug sold under the bundling arrangement.

Louisiana Enacts Partial Birth Law

Physicians who perform so-called partial-birth abortions in Louisiana will face criminal penalties, except under limited circumstances, under a new state law. Last month, Gov. Kathleen Blanco (D) signed legislation creating a ban on partial-birth abortion except in cases where the mother's life is in danger. Physicians who perform the procedure would face penalties of between 1 and 10 years in prison, fines of $10,000-$100,000, or both. The legislation was opposed by Planned Parenthood of Louisiana and the Mississippi Delta, which launched a letter-writing campaign to Gov. Blanco in the weeks before the bill was signed, urging her to veto the legislation. The group argued that enacting such a law would be akin to allowing legislators, not doctors, to practice medicine. A similar federal ban was signed into law by President Bush in 2003 and was upheld by the Supreme Court earlier this year.

New Stem Cell Legislation Introduced

Members of Congress recently introduced legislation aimed at increasing research into stem cells without the creation or destruction of human embryos for research purposes. The bill, the “Patients First Act of 2007” (H.R. 2807) was introduced by Rep. J. Randy Forbes (R-Va.) and Rep. Daniel Lipinski (D-Ill.). The legislation directs the Department of Health and Human Services to support basic and applied stem cell research that does not involve the creation of a human embryo for research purposes or the destruction or discarding of a living human embryo. It also calls on the HHS secretary to submit a report to Congress detailing the funding of stem cell research. The bill was referred to the House Committee on Energy and Commerce.

Attitudes Toward Prenatal Care

African American women are less likely to receive adequate prenatal care if they have psychosocial problems, don't participate in the Women and Infants Children Program, or have limits on their insurance coverage, according to a new study. The study, which was published in the August issue of the Journal of Health Care for the Poor and Underserved, aimed to answer the question of why African American women in urban areas fail to utilize prenatal care adequately. The researchers analyzed survey responses from a convenience sample of 246 African American women who were interviewed during their postpartum hospital stay at one of five Washington hospitals. They found that 60% of women in the sample had inadequate prenatal care. They also found that women who received inadequate prenatal care were more likely to report that they could take care of themselves and didn't need regular care. Lack of health insurance, no money to pay for prenatal care, substance abuse, and child care problems also were significant factors, according to the study.

Teens Hold Steady on Drugs, Sex

The percentages of 8th, 10th, and 12th grade students reporting illicit drug use in the past 30 days remained stable from 2005 to 2006, although use among all three grades has declined since 1997, according to a report by the Federal Interagency Forum on Child and Family Statistics. In addition, the percentage of high school students reporting having had sexual intercourse–47%–stayed steady from 2003, although the percentage has declined from 54% since 1991. The report also showed the percentage of low-birth-weight infants was up, as was the proportion of children aged 6-17 years who were overweight.

Managing Thyroid Disease in Gravidas

A new clinical practice guideline from the Endocrine Society does not recommend universal screening of pregnant women for thyroid disease. But the guidelines do advise physicians to use a targeted case-finding approach during early pregnancy. The guidelines recommend case finding by measurement of thyroid-stimulating hormone (TSH) among certain women who are at high risk for thyroid disease, including women with the following: a history of hyperthyroid or hypothyroid disease, postpartum thyroiditis, or thyroid lobectomy; a family history of thyroid disease; a goiter; thyroid antibodies; and clinical signs that suggest either thyroid under- or overfunction. The high-risk groups also include women with the following: type 1 diabetes; other autoimmune disorders; infertility; previous therapeutic head or neck irradiation; and a history of miscarriage or preterm delivery. The guidelines were e-published in June and are scheduled to appear in print in the August issue of the Journal of Clinical Endocrinology & Metabolism.

E-Prescribing Called 'Win-Win'

Electronic prescribing could prevent nearly 2 million medication errors and save the federal government $26 billion over the next decade–even after providing funds for equipment, training, and support–if physicians were required to use the technology for their Medicare patients, according to a study released by the Pharmaceutical Care Management Association. The study found that when physicians use e-prescribing to learn their patients' medication history and prescription choices, both patient safety and savings improve dramatically. However, fewer than 1 in 10 physicians actually use e-prescribing, according to PCMA. The group, which represents pharmacy benefit managers, is pushing the Centers for Medicare and Medicaid Services to require e-prescribing for all Medicare Part D prescriptions by 2010.

Louisiana Enacts Partial Birth Law

Physicians who perform so-called partial-birth abortions in Louisiana will face criminal penalties, except under limited circumstances, under a new state law. Last month, Gov. Kathleen Blanco (D) signed legislation creating a ban on partial-birth abortion except in cases where the mother's life is in danger. Physicians who perform the procedure would face penalties of between 1 and 10 years in prison, fines of $10,000-$100,000, or both. The legislation was opposed by Planned Parenthood of Louisiana and the Mississippi Delta, which launched a letter-writing campaign to Gov. Blanco in the weeks before the bill was signed, urging her to veto the legislation. The group argued that enacting such a law would be akin to allowing legislators, not doctors, to practice medicine. A similar federal ban was signed into law by President Bush in 2003 and was upheld by the Supreme Court earlier this year.

New Stem Cell Legislation Introduced

Members of Congress recently introduced legislation aimed at increasing research into stem cells without the creation or destruction of human embryos for research purposes. The bill, the “Patients First Act of 2007” (H.R. 2807) was introduced by Rep. J. Randy Forbes (R-Va.) and Rep. Daniel Lipinski (D-Ill.). The legislation directs the Department of Health and Human Services to support basic and applied stem cell research that does not involve the creation of a human embryo for research purposes or the destruction or discarding of a living human embryo. It also calls on the HHS secretary to submit a report to Congress detailing the funding of stem cell research. The bill was referred to the House Committee on Energy and Commerce.

Attitudes Toward Prenatal Care

African American women are less likely to receive adequate prenatal care if they have psychosocial problems, don't participate in the Women and Infants Children Program, or have limits on their insurance coverage, according to a new study. The study, which was published in the August issue of the Journal of Health Care for the Poor and Underserved, aimed to answer the question of why African American women in urban areas fail to utilize prenatal care adequately. The researchers analyzed survey responses from a convenience sample of 246 African American women who were interviewed during their postpartum hospital stay at one of five Washington hospitals. They found that 60% of women in the sample had inadequate prenatal care. They also found that women who received inadequate prenatal care were more likely to report that they could take care of themselves and didn't need regular care. Lack of health insurance, no money to pay for prenatal care, substance abuse, and child care problems also were significant factors, according to the study.

Teens Hold Steady on Drugs, Sex

The percentages of 8th, 10th, and 12th grade students reporting illicit drug use in the past 30 days remained stable from 2005 to 2006, although use among all three grades has declined since 1997, according to a report by the Federal Interagency Forum on Child and Family Statistics. In addition, the percentage of high school students reporting having had sexual intercourse–47%–stayed steady from 2003, although the percentage has declined from 54% since 1991. The report also showed the percentage of low-birth-weight infants was up, as was the proportion of children aged 6-17 years who were overweight.

Managing Thyroid Disease in Gravidas

A new clinical practice guideline from the Endocrine Society does not recommend universal screening of pregnant women for thyroid disease. But the guidelines do advise physicians to use a targeted case-finding approach during early pregnancy. The guidelines recommend case finding by measurement of thyroid-stimulating hormone (TSH) among certain women who are at high risk for thyroid disease, including women with the following: a history of hyperthyroid or hypothyroid disease, postpartum thyroiditis, or thyroid lobectomy; a family history of thyroid disease; a goiter; thyroid antibodies; and clinical signs that suggest either thyroid under- or overfunction. The high-risk groups also include women with the following: type 1 diabetes; other autoimmune disorders; infertility; previous therapeutic head or neck irradiation; and a history of miscarriage or preterm delivery. The guidelines were e-published in June and are scheduled to appear in print in the August issue of the Journal of Clinical Endocrinology & Metabolism.

E-Prescribing Called 'Win-Win'

Electronic prescribing could prevent nearly 2 million medication errors and save the federal government $26 billion over the next decade–even after providing funds for equipment, training, and support–if physicians were required to use the technology for their Medicare patients, according to a study released by the Pharmaceutical Care Management Association. The study found that when physicians use e-prescribing to learn their patients' medication history and prescription choices, both patient safety and savings improve dramatically. However, fewer than 1 in 10 physicians actually use e-prescribing, according to PCMA. The group, which represents pharmacy benefit managers, is pushing the Centers for Medicare and Medicaid Services to require e-prescribing for all Medicare Part D prescriptions by 2010.

Louisiana Enacts Partial Birth Law

Physicians who perform so-called partial-birth abortions in Louisiana will face criminal penalties, except under limited circumstances, under a new state law. Last month, Gov. Kathleen Blanco (D) signed legislation creating a ban on partial-birth abortion except in cases where the mother's life is in danger. Physicians who perform the procedure would face penalties of between 1 and 10 years in prison, fines of $10,000-$100,000, or both. The legislation was opposed by Planned Parenthood of Louisiana and the Mississippi Delta, which launched a letter-writing campaign to Gov. Blanco in the weeks before the bill was signed, urging her to veto the legislation. The group argued that enacting such a law would be akin to allowing legislators, not doctors, to practice medicine. A similar federal ban was signed into law by President Bush in 2003 and was upheld by the Supreme Court earlier this year.

New Stem Cell Legislation Introduced

Members of Congress recently introduced legislation aimed at increasing research into stem cells without the creation or destruction of human embryos for research purposes. The bill, the “Patients First Act of 2007” (H.R. 2807) was introduced by Rep. J. Randy Forbes (R-Va.) and Rep. Daniel Lipinski (D-Ill.). The legislation directs the Department of Health and Human Services to support basic and applied stem cell research that does not involve the creation of a human embryo for research purposes or the destruction or discarding of a living human embryo. It also calls on the HHS secretary to submit a report to Congress detailing the funding of stem cell research. The bill was referred to the House Committee on Energy and Commerce.

Attitudes Toward Prenatal Care

African American women are less likely to receive adequate prenatal care if they have psychosocial problems, don't participate in the Women and Infants Children Program, or have limits on their insurance coverage, according to a new study. The study, which was published in the August issue of the Journal of Health Care for the Poor and Underserved, aimed to answer the question of why African American women in urban areas fail to utilize prenatal care adequately. The researchers analyzed survey responses from a convenience sample of 246 African American women who were interviewed during their postpartum hospital stay at one of five Washington hospitals. They found that 60% of women in the sample had inadequate prenatal care. They also found that women who received inadequate prenatal care were more likely to report that they could take care of themselves and didn't need regular care. Lack of health insurance, no money to pay for prenatal care, substance abuse, and child care problems also were significant factors, according to the study.

Teens Hold Steady on Drugs, Sex

The percentages of 8th, 10th, and 12th grade students reporting illicit drug use in the past 30 days remained stable from 2005 to 2006, although use among all three grades has declined since 1997, according to a report by the Federal Interagency Forum on Child and Family Statistics. In addition, the percentage of high school students reporting having had sexual intercourse–47%–stayed steady from 2003, although the percentage has declined from 54% since 1991. The report also showed the percentage of low-birth-weight infants was up, as was the proportion of children aged 6-17 years who were overweight.

Managing Thyroid Disease in Gravidas

A new clinical practice guideline from the Endocrine Society does not recommend universal screening of pregnant women for thyroid disease. But the guidelines do advise physicians to use a targeted case-finding approach during early pregnancy. The guidelines recommend case finding by measurement of thyroid-stimulating hormone (TSH) among certain women who are at high risk for thyroid disease, including women with the following: a history of hyperthyroid or hypothyroid disease, postpartum thyroiditis, or thyroid lobectomy; a family history of thyroid disease; a goiter; thyroid antibodies; and clinical signs that suggest either thyroid under- or overfunction. The high-risk groups also include women with the following: type 1 diabetes; other autoimmune disorders; infertility; previous therapeutic head or neck irradiation; and a history of miscarriage or preterm delivery. The guidelines were e-published in June and are scheduled to appear in print in the August issue of the Journal of Clinical Endocrinology & Metabolism.

E-Prescribing Called 'Win-Win'

Electronic prescribing could prevent nearly 2 million medication errors and save the federal government $26 billion over the next decade–even after providing funds for equipment, training, and support–if physicians were required to use the technology for their Medicare patients, according to a study released by the Pharmaceutical Care Management Association. The study found that when physicians use e-prescribing to learn their patients' medication history and prescription choices, both patient safety and savings improve dramatically. However, fewer than 1 in 10 physicians actually use e-prescribing, according to PCMA. The group, which represents pharmacy benefit managers, is pushing the Centers for Medicare and Medicaid Services to require e-prescribing for all Medicare Part D prescriptions by 2010.

TORONTO – Women with spontaneous 46,XX premature ovarian failure are at increased risk of having a premutation of the fragile X mental retardation 1 gene and should be informed of the availability of testing for fragile X, Dr. Lawrence M. Nelson said at the annual meeting of the Endocrine Society.

But appropriate counseling must be provided before the test is administered, said Dr. Nelson, head of the integrative reproductive medicine unit at the National Institute of Child Health and Human Development, part of the National Institutes of Health. Dr. Nelson is also a commissioned officer in the U.S. Public Health Service.

These findings are part of a draft statement being developed by scientists, clinicians, and patient advocates with input from others around the world. The American Society for Reproductive Medicine and the National Institutes of Health convened experts last October to work on draft guidelines for the identification and management of the FMR1 premutation and premature ovarian failure. The draft is available online at www.fmr1pof.com

Premutations of the FMR1 gene have been associated with a spectrum of reproductive issues, including infertility, poor response to gonadotropin stimulation, menstrual irregularity, and symptoms of estrogen deficiency. The presence of the FMR1 gene can also indicate genetic disorders within a family, including fragile X syndrome, which can cause mental impairment, autism, or neurodegenerative disorders. About 6% of women with spontaneous 46,XX premature ovarian failure have the FMR1 premutation, Dr. Nelson said.

“It's a dual threat to the parental role because it's a cause of infertility and it's a genetic risk factor for having a child with mental retardation,” Dr. Nelson said. “So we need to handle genetic testing with great sensitivity.”

In the draft document, experts recommended that physicians obtain an accurate and detailed family history to detect the presence of fragile X-associated disorders in all women presenting for reproductive care. The Office of the Surgeon General has developed an online tool called “My Family Health Portrait” that patients can use to enter their family medical history and then print it out for their physician, Dr. Nelson said. The tool is available online at http://familyhistory.hhs.gov

FMR1 testing should be offered to women who are diagnosed with premature ovarian failure. In addition, physicians should consider FMR1 testing in women with reproductive or fertility problems associated with elevated basal FSH levels and those with low response to gonadotropin stimulation, according to the draft.

But physicians should undertake testing only after the patient has been informed that a positive test result has implications beyond their own health and that other family members could be at risk for associated conditions.

Patients should also have the option not to undergo FMR1 testing. Although finding an FMR1 premutation could help explain the cause of premature ovarian failure, it does not rule out other causes, Dr. Nelson said.

FMR1 test results should include a list of the number of CGG repeats, and written interpretations should be stratified as normal, intermediate, premutation, or full mutation, according to the draft document. The molecular analysis should include obtaining the CGG repeat number through both polymerase chain reaction assay and Southern blot assay. In addition, the lab should check the FMR1 gene methylation status. The total cost of the tests is generally about $300, Dr. Nelson said.

Any results that do not come back as normal should be discussed with patients face to face, the group recommended. “This is not an average lab test where you can call and give the patient the results over the telephone,” Dr. Nelson said.

'It's a dual threat to the parental role because it's a cause of infertility and it's a genetic risk factor.' DR. NELSON

TORONTO – Women with spontaneous 46,XX premature ovarian failure are at increased risk of having a premutation of the fragile X mental retardation 1 gene and should be informed of the availability of testing for fragile X, Dr. Lawrence M. Nelson said at the annual meeting of the Endocrine Society.

But appropriate counseling must be provided before the test is administered, said Dr. Nelson, head of the integrative reproductive medicine unit at the National Institute of Child Health and Human Development, part of the National Institutes of Health. Dr. Nelson is also a commissioned officer in the U.S. Public Health Service.

These findings are part of a draft statement being developed by scientists, clinicians, and patient advocates with input from others around the world. The American Society for Reproductive Medicine and the National Institutes of Health convened experts last October to work on draft guidelines for the identification and management of the FMR1 premutation and premature ovarian failure. The draft is available online at www.fmr1pof.com

Premutations of the FMR1 gene have been associated with a spectrum of reproductive issues, including infertility, poor response to gonadotropin stimulation, menstrual irregularity, and symptoms of estrogen deficiency. The presence of the FMR1 gene can also indicate genetic disorders within a family, including fragile X syndrome, which can cause mental impairment, autism, or neurodegenerative disorders. About 6% of women with spontaneous 46,XX premature ovarian failure have the FMR1 premutation, Dr. Nelson said.

“It's a dual threat to the parental role because it's a cause of infertility and it's a genetic risk factor for having a child with mental retardation,” Dr. Nelson said. “So we need to handle genetic testing with great sensitivity.”

In the draft document, experts recommended that physicians obtain an accurate and detailed family history to detect the presence of fragile X-associated disorders in all women presenting for reproductive care. The Office of the Surgeon General has developed an online tool called “My Family Health Portrait” that patients can use to enter their family medical history and then print it out for their physician, Dr. Nelson said. The tool is available online at http://familyhistory.hhs.gov

FMR1 testing should be offered to women who are diagnosed with premature ovarian failure. In addition, physicians should consider FMR1 testing in women with reproductive or fertility problems associated with elevated basal FSH levels and those with low response to gonadotropin stimulation, according to the draft.

But physicians should undertake testing only after the patient has been informed that a positive test result has implications beyond their own health and that other family members could be at risk for associated conditions.

Patients should also have the option not to undergo FMR1 testing. Although finding an FMR1 premutation could help explain the cause of premature ovarian failure, it does not rule out other causes, Dr. Nelson said.

FMR1 test results should include a list of the number of CGG repeats, and written interpretations should be stratified as normal, intermediate, premutation, or full mutation, according to the draft document. The molecular analysis should include obtaining the CGG repeat number through both polymerase chain reaction assay and Southern blot assay. In addition, the lab should check the FMR1 gene methylation status. The total cost of the tests is generally about $300, Dr. Nelson said.

Any results that do not come back as normal should be discussed with patients face to face, the group recommended. “This is not an average lab test where you can call and give the patient the results over the telephone,” Dr. Nelson said.

'It's a dual threat to the parental role because it's a cause of infertility and it's a genetic risk factor.' DR. NELSON

TORONTO – Women with spontaneous 46,XX premature ovarian failure are at increased risk of having a premutation of the fragile X mental retardation 1 gene and should be informed of the availability of testing for fragile X, Dr. Lawrence M. Nelson said at the annual meeting of the Endocrine Society.

But appropriate counseling must be provided before the test is administered, said Dr. Nelson, head of the integrative reproductive medicine unit at the National Institute of Child Health and Human Development, part of the National Institutes of Health. Dr. Nelson is also a commissioned officer in the U.S. Public Health Service.

These findings are part of a draft statement being developed by scientists, clinicians, and patient advocates with input from others around the world. The American Society for Reproductive Medicine and the National Institutes of Health convened experts last October to work on draft guidelines for the identification and management of the FMR1 premutation and premature ovarian failure. The draft is available online at www.fmr1pof.com

Premutations of the FMR1 gene have been associated with a spectrum of reproductive issues, including infertility, poor response to gonadotropin stimulation, menstrual irregularity, and symptoms of estrogen deficiency. The presence of the FMR1 gene can also indicate genetic disorders within a family, including fragile X syndrome, which can cause mental impairment, autism, or neurodegenerative disorders. About 6% of women with spontaneous 46,XX premature ovarian failure have the FMR1 premutation, Dr. Nelson said.

“It's a dual threat to the parental role because it's a cause of infertility and it's a genetic risk factor for having a child with mental retardation,” Dr. Nelson said. “So we need to handle genetic testing with great sensitivity.”

In the draft document, experts recommended that physicians obtain an accurate and detailed family history to detect the presence of fragile X-associated disorders in all women presenting for reproductive care. The Office of the Surgeon General has developed an online tool called “My Family Health Portrait” that patients can use to enter their family medical history and then print it out for their physician, Dr. Nelson said. The tool is available online at http://familyhistory.hhs.gov

FMR1 testing should be offered to women who are diagnosed with premature ovarian failure. In addition, physicians should consider FMR1 testing in women with reproductive or fertility problems associated with elevated basal FSH levels and those with low response to gonadotropin stimulation, according to the draft.

But physicians should undertake testing only after the patient has been informed that a positive test result has implications beyond their own health and that other family members could be at risk for associated conditions.

Patients should also have the option not to undergo FMR1 testing. Although finding an FMR1 premutation could help explain the cause of premature ovarian failure, it does not rule out other causes, Dr. Nelson said.

FMR1 test results should include a list of the number of CGG repeats, and written interpretations should be stratified as normal, intermediate, premutation, or full mutation, according to the draft document. The molecular analysis should include obtaining the CGG repeat number through both polymerase chain reaction assay and Southern blot assay. In addition, the lab should check the FMR1 gene methylation status. The total cost of the tests is generally about $300, Dr. Nelson said.

Any results that do not come back as normal should be discussed with patients face to face, the group recommended. “This is not an average lab test where you can call and give the patient the results over the telephone,” Dr. Nelson said.

'It's a dual threat to the parental role because it's a cause of infertility and it's a genetic risk factor.' DR. NELSON

ORLANDO — Patient wishes for organ donation were overridden by family members in about 20% of cases, creating “missed opportunities” for organ procurement, according to research conducted at a level I trauma center in Charlotte, N.C.

Dr. A. Britton Christmas and colleagues at the F.H. Sammy Ross Jr. Center at the Carolinas Medical Center reviewed 3 months of organ donation referrals at their center. They estimated that about 17 potential transplant recipients did not receive organs because a patient's previous donation intentions were overridden by family members.

The research was presented in a poster at the annual congress of the Society of Critical Care Medicine.

The researchers examined charts to determine the appropriateness for donation, familial consent or denial for donation, and the number of organs transplanted from each donor. They compared their records with data from the state department of motor vehicles (DMV) related to organ donation designations.

The researchers analyzed information on 84 individuals who had information on file with the DMV and whose families had been approached by hospital staff for organ donation over the 3-month period. According to DMV records, 25 individuals were listed as organ donors, and 59 had not designated organ donation.

For the 25 individuals who had designated themselves as organ donors, 20 consents for donation were obtained from family members. Of the remaining 59 individuals, 22 consents for organ donation were obtained.

Although the organ recovery rate was higher among those who had already specified a desire to be donors (80% vs. 37%), some families chose to override a previous designation of organ donation. With an average of 3.4 organs transplanted from each eligible donor, the researchers estimated that the five individuals whose consent was withdrawn by the families resulted in 17 potential organ recipients who would not receive organs.

For additional information on organ donation and the donor shortage, visit www.organdonor.gov

ORLANDO — Patient wishes for organ donation were overridden by family members in about 20% of cases, creating “missed opportunities” for organ procurement, according to research conducted at a level I trauma center in Charlotte, N.C.

Dr. A. Britton Christmas and colleagues at the F.H. Sammy Ross Jr. Center at the Carolinas Medical Center reviewed 3 months of organ donation referrals at their center. They estimated that about 17 potential transplant recipients did not receive organs because a patient's previous donation intentions were overridden by family members.

The research was presented in a poster at the annual congress of the Society of Critical Care Medicine.

The researchers examined charts to determine the appropriateness for donation, familial consent or denial for donation, and the number of organs transplanted from each donor. They compared their records with data from the state department of motor vehicles (DMV) related to organ donation designations.

The researchers analyzed information on 84 individuals who had information on file with the DMV and whose families had been approached by hospital staff for organ donation over the 3-month period. According to DMV records, 25 individuals were listed as organ donors, and 59 had not designated organ donation.

For the 25 individuals who had designated themselves as organ donors, 20 consents for donation were obtained from family members. Of the remaining 59 individuals, 22 consents for organ donation were obtained.

Although the organ recovery rate was higher among those who had already specified a desire to be donors (80% vs. 37%), some families chose to override a previous designation of organ donation. With an average of 3.4 organs transplanted from each eligible donor, the researchers estimated that the five individuals whose consent was withdrawn by the families resulted in 17 potential organ recipients who would not receive organs.

For additional information on organ donation and the donor shortage, visit www.organdonor.gov

ORLANDO — Patient wishes for organ donation were overridden by family members in about 20% of cases, creating “missed opportunities” for organ procurement, according to research conducted at a level I trauma center in Charlotte, N.C.

Dr. A. Britton Christmas and colleagues at the F.H. Sammy Ross Jr. Center at the Carolinas Medical Center reviewed 3 months of organ donation referrals at their center. They estimated that about 17 potential transplant recipients did not receive organs because a patient's previous donation intentions were overridden by family members.

The research was presented in a poster at the annual congress of the Society of Critical Care Medicine.

The researchers examined charts to determine the appropriateness for donation, familial consent or denial for donation, and the number of organs transplanted from each donor. They compared their records with data from the state department of motor vehicles (DMV) related to organ donation designations.

The researchers analyzed information on 84 individuals who had information on file with the DMV and whose families had been approached by hospital staff for organ donation over the 3-month period. According to DMV records, 25 individuals were listed as organ donors, and 59 had not designated organ donation.

For the 25 individuals who had designated themselves as organ donors, 20 consents for donation were obtained from family members. Of the remaining 59 individuals, 22 consents for organ donation were obtained.

Although the organ recovery rate was higher among those who had already specified a desire to be donors (80% vs. 37%), some families chose to override a previous designation of organ donation. With an average of 3.4 organs transplanted from each eligible donor, the researchers estimated that the five individuals whose consent was withdrawn by the families resulted in 17 potential organ recipients who would not receive organs.

For additional information on organ donation and the donor shortage, visit www.organdonor.gov

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

The coalition, led by the American Medical Association and the American Public Health Association, issued a report with 53 recommendations aimed at leaders in medicine and government. Other coalition members include the American Academy of Pediatrics, the American College of Emergency Physicians, and 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, AMA president, said at a press conference to release the report. “But we have no excuse if our responses aren't known in advance.”

The report identifies nine critical areas needing immediate action, including:

▸ Increased federal funding should be allocated to expand 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 must 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 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 professional organizations should develop and distribute information on the management of adult and pediatric patients in day-to-day emergencies and catastrophic events.

▸ Responders must be given adequate legal protections for providing care during a disaster.

The full report is available at www.ama-assn.org/go/disasterpreparedness

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

The coalition, led by the American Medical Association and the American Public Health Association, issued a report with 53 recommendations aimed at leaders in medicine and government. Other coalition members include the American Academy of Pediatrics, the American College of Emergency Physicians, and 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, AMA president, said at a press conference to release the report. “But we have no excuse if our responses aren't known in advance.”

The report identifies nine critical areas needing immediate action, including:

▸ Increased federal funding should be allocated to expand 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 must 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 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 professional organizations should develop and distribute information on the management of adult and pediatric patients in day-to-day emergencies and catastrophic events.

▸ Responders must be given adequate legal protections for providing care during a disaster.

The full report is available at www.ama-assn.org/go/disasterpreparedness

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

The coalition, led by the American Medical Association and the American Public Health Association, issued a report with 53 recommendations aimed at leaders in medicine and government. Other coalition members include the American Academy of Pediatrics, the American College of Emergency Physicians, and 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, AMA president, said at a press conference to release the report. “But we have no excuse if our responses aren't known in advance.”

The report identifies nine critical areas needing immediate action, including:

▸ Increased federal funding should be allocated to expand 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 must 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 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 professional organizations should develop and distribute information on the management of adult and pediatric patients in day-to-day emergencies and catastrophic events.

▸ Responders must be given adequate legal protections for providing care during a disaster.

The full report is available at www.ama-assn.org/go/disasterpreparedness

As Congress returns from its August recess, the fate of reauthorization of the State Children's Health Insurance Program as well as physician pay relief are both up in the air.

In a month's short time, a House/Senate conference committee must reconcile the vastly different bills passed by each house, and craft the legislation into something that might escape a threatened presidential veto.

Before breaking for its August recess, 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.

However, the approved House legislation (H.R. 3162) contains a number of provisions unrelated to SCHIP. For example, the bill would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in a 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 an increase in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.

Officials at the American Academy of Family Physicians favor a final bill that includes SCHIP funding that would cover as many children as possible, 2 years of positive updates to the Medicare physician fee schedule, and a commitment to fixing the sustainable growth rate formula, said Dr. Rick Kellerman, AAFP president.

Two years of positive updates are important, Dr. Kellerman said, because legislators are tired of physicians coming every year to Capitol Hill to talk about this issue.

“We think we've got a lot of other important health care issues to deal with,” Dr. Kellerman said, adding that a 2-year fix will give Congress time to evaluate the sustainable growth rate (SGR) issue and formulate an alternative. “It's a transitional bill. This gets us through the next 2 years.”

The American College of Physicians praised both bills but said they would like to see final legislation that includes some of the Medicare provisions passed by the House, including the temporary pay fix for physicians.

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, evaluation and management 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 would take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But it would still lead to deep payment cuts starting in 2010, so there is an understanding among legislators and leaders in medicine that the updates for 2010 and beyond would require additional action, he said.

The American Academy of Pediatrics praised the passage of the two pieces of legislation as well as the provisions in both that would ease citizenship and identification documentation requirements.

However, although the America's Health Insurance Plans (AHIP) hailed the passage of the Senate legislation, it is opposed to provisions in the House bill that would make cuts to the Medicare Advantage program. The cuts could result in more than 3 million seniors losing Medicare Advantage coverage and having to switch to fee-for-service Medicare, where they would likely pay higher out-of-pocket costs, according to the AHIP.

“The House bill shreds the safety net for millions of seniors who depend on Medicare Advantage,” Karen Ignagni, the president and CEO of AHIP, said in a statement.

The House bill also includes some protections for Medicare beneficiaries. For example, it would codify protection for six drug classes under Medicare Part D. Starting in 2009, Medicare drug plans would be required to include all or substantially all Part D drugs in each of the following classes: anticonvulsants, antineoplastics, antiretrovirals, antidepressants, antipsychotics, and immunosuppressants.

The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services including diabetes outpatient self-management training services, cardiovascular screening blood tests, diabetes screening tests, screening mammography, screening Pap smear and pelvic exam, and bone mass measurement.

As Congress returns from its August recess, the fate of reauthorization of the State Children's Health Insurance Program as well as physician pay relief are both up in the air.

In a month's short time, a House/Senate conference committee must reconcile the vastly different bills passed by each house, and craft the legislation into something that might escape a threatened presidential veto.

Before breaking for its August recess, 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.

However, the approved House legislation (H.R. 3162) contains a number of provisions unrelated to SCHIP. For example, the bill would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in a 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 an increase in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.

Officials at the American Academy of Family Physicians favor a final bill that includes SCHIP funding that would cover as many children as possible, 2 years of positive updates to the Medicare physician fee schedule, and a commitment to fixing the sustainable growth rate formula, said Dr. Rick Kellerman, AAFP president.

Two years of positive updates are important, Dr. Kellerman said, because legislators are tired of physicians coming every year to Capitol Hill to talk about this issue.

“We think we've got a lot of other important health care issues to deal with,” Dr. Kellerman said, adding that a 2-year fix will give Congress time to evaluate the sustainable growth rate (SGR) issue and formulate an alternative. “It's a transitional bill. This gets us through the next 2 years.”

The American College of Physicians praised both bills but said they would like to see final legislation that includes some of the Medicare provisions passed by the House, including the temporary pay fix for physicians.

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, evaluation and management 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 would take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But it would still lead to deep payment cuts starting in 2010, so there is an understanding among legislators and leaders in medicine that the updates for 2010 and beyond would require additional action, he said.

The American Academy of Pediatrics praised the passage of the two pieces of legislation as well as the provisions in both that would ease citizenship and identification documentation requirements.

However, although the America's Health Insurance Plans (AHIP) hailed the passage of the Senate legislation, it is opposed to provisions in the House bill that would make cuts to the Medicare Advantage program. The cuts could result in more than 3 million seniors losing Medicare Advantage coverage and having to switch to fee-for-service Medicare, where they would likely pay higher out-of-pocket costs, according to the AHIP.

“The House bill shreds the safety net for millions of seniors who depend on Medicare Advantage,” Karen Ignagni, the president and CEO of AHIP, said in a statement.

The House bill also includes some protections for Medicare beneficiaries. For example, it would codify protection for six drug classes under Medicare Part D. Starting in 2009, Medicare drug plans would be required to include all or substantially all Part D drugs in each of the following classes: anticonvulsants, antineoplastics, antiretrovirals, antidepressants, antipsychotics, and immunosuppressants.

The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services including diabetes outpatient self-management training services, cardiovascular screening blood tests, diabetes screening tests, screening mammography, screening Pap smear and pelvic exam, and bone mass measurement.

As Congress returns from its August recess, the fate of reauthorization of the State Children's Health Insurance Program as well as physician pay relief are both up in the air.

In a month's short time, a House/Senate conference committee must reconcile the vastly different bills passed by each house, and craft the legislation into something that might escape a threatened presidential veto.

Before breaking for its August recess, 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.

However, the approved House legislation (H.R. 3162) contains a number of provisions unrelated to SCHIP. For example, the bill would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in a 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 an increase in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.

Officials at the American Academy of Family Physicians favor a final bill that includes SCHIP funding that would cover as many children as possible, 2 years of positive updates to the Medicare physician fee schedule, and a commitment to fixing the sustainable growth rate formula, said Dr. Rick Kellerman, AAFP president.

Two years of positive updates are important, Dr. Kellerman said, because legislators are tired of physicians coming every year to Capitol Hill to talk about this issue.

“We think we've got a lot of other important health care issues to deal with,” Dr. Kellerman said, adding that a 2-year fix will give Congress time to evaluate the sustainable growth rate (SGR) issue and formulate an alternative. “It's a transitional bill. This gets us through the next 2 years.”

The American College of Physicians praised both bills but said they would like to see final legislation that includes some of the Medicare provisions passed by the House, including the temporary pay fix for physicians.

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, evaluation and management 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 would take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But it would still lead to deep payment cuts starting in 2010, so there is an understanding among legislators and leaders in medicine that the updates for 2010 and beyond would require additional action, he said.

The American Academy of Pediatrics praised the passage of the two pieces of legislation as well as the provisions in both that would ease citizenship and identification documentation requirements.

However, although the America's Health Insurance Plans (AHIP) hailed the passage of the Senate legislation, it is opposed to provisions in the House bill that would make cuts to the Medicare Advantage program. The cuts could result in more than 3 million seniors losing Medicare Advantage coverage and having to switch to fee-for-service Medicare, where they would likely pay higher out-of-pocket costs, according to the AHIP.

“The House bill shreds the safety net for millions of seniors who depend on Medicare Advantage,” Karen Ignagni, the president and CEO of AHIP, said in a statement.

The House bill also includes some protections for Medicare beneficiaries. For example, it would codify protection for six drug classes under Medicare Part D. Starting in 2009, Medicare drug plans would be required to include all or substantially all Part D drugs in each of the following classes: anticonvulsants, antineoplastics, antiretrovirals, antidepressants, antipsychotics, and immunosuppressants.

The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services including diabetes outpatient self-management training services, cardiovascular screening blood tests, diabetes screening tests, screening mammography, screening Pap smear and pelvic exam, and bone mass measurement.

TORONTO — Although physicians commonly prescribe oral contraceptives for women with anorexia nervosa, new research presented at the annual meeting of the Endocrine Society suggests that the androgen levels are already low in these women and that they are further reduced by the use of oral contraceptives.

But the jury is still out on the long-term consequences for skeletal health and body composition in women with the disease, said Dr. Karen K. Miller of Massachusetts General Hospital, Boston.

Dr. Miller and her colleagues analyzed androgen levels in 217 community-dwelling women to determine the physiologic consequences of prescribing oral contraceptives to women with anorexia nervosa.

The investigation included four arms comprised of 137 women with anorexia nervosa who were not receiving oral contraceptives; 32 women with anorexia nervosa who were receiving oral contraceptives; 21 women of normal weight with hypothalamic amenorrhea; and 27 healthy eumenorrheic controls.

All of the women with anorexia nervosa met the DSM-IV criteria for anorexia nervosa, were less than 85% of ideal body weight, and had an intense fear of gaining weight or strong denial of low weight. Anorexic women not receiving oral contraceptives had been amenorrheic for at least 3 consecutive months and had not received hormonal contraceptives within the previous 3 months. Those receiving oral contraceptives had to have been receiving them for at least 3 months.

All of those with hypothalamic amenorrhea were 90%–110% of ideal body weight; had been amenorrheic for at least 3 months; had normal FSH, prolactin, testosterone, and free testosterone levels; an LH-to-FSH ratio of less than 2.5; absence of hirsutism; and no history of an eating disorder.

Healthy controls were 90%–110% of ideal body weight and eumenorrheic. Controls were excluded from the study if they had a history of amenorrhea or an eating disorder, had a history of any major medical illness, or if they had used oral contraceptives within the previous 3 months.

The mean body mass index (BMI), percent ideal body weight, percent fat, total fat mass, and fat-free mass were lower in the anorexia nervosa groups, compared with women who had hypothalamic amenorrhea and the healthy controls. Analysis of the androgen levels in the four groups showed that total testosterone levels were lower in women with anorexia nervosa than they were in healthy controls.

Levels of total testosterone were similar in anorexic women who received oral contraceptives and those who did not receive them. The total testosterone levels were normal in women with hypothalamic amenorrhea, said Dr. Miller.

The levels of free testosterone were lower in women with anorexia nervosa than they were in healthy controls, and the lowest levels occurred in women with anorexia nervosa and who were receiving oral contraceptives. The levels were normal in women with hypothalamic amenorrhea.

The investigators also found that the levels of dehydroepian- drosterone (DHEAS) were lower only in women with anorexia nervosa who were receiving oral contraceptives, compared with healthy controls. DHEAS levels were normal in women with anorexia nervosa not receiving contraceptives and in women with hypothalamic amenorrhea.

Free testosterone levels were predictive of bone mineral density and body composition in women with anorexia nervosa, hypothalamic amenorrhea, and healthy controls. DHEAS levels also predicted bone density, but were weaker predictors than free testosterone and did not predict fat-free mass, Dr. Miller said.

Intervention studies are needed to determine the relationship between androgens and bone density and body composition in women with anorexia nervosa, she added. Studies are also needed to determine whether oral contraceptive use is harmful to their skeletal health.

TORONTO — Although physicians commonly prescribe oral contraceptives for women with anorexia nervosa, new research presented at the annual meeting of the Endocrine Society suggests that the androgen levels are already low in these women and that they are further reduced by the use of oral contraceptives.

But the jury is still out on the long-term consequences for skeletal health and body composition in women with the disease, said Dr. Karen K. Miller of Massachusetts General Hospital, Boston.

Dr. Miller and her colleagues analyzed androgen levels in 217 community-dwelling women to determine the physiologic consequences of prescribing oral contraceptives to women with anorexia nervosa.

The investigation included four arms comprised of 137 women with anorexia nervosa who were not receiving oral contraceptives; 32 women with anorexia nervosa who were receiving oral contraceptives; 21 women of normal weight with hypothalamic amenorrhea; and 27 healthy eumenorrheic controls.

All of the women with anorexia nervosa met the DSM-IV criteria for anorexia nervosa, were less than 85% of ideal body weight, and had an intense fear of gaining weight or strong denial of low weight. Anorexic women not receiving oral contraceptives had been amenorrheic for at least 3 consecutive months and had not received hormonal contraceptives within the previous 3 months. Those receiving oral contraceptives had to have been receiving them for at least 3 months.

All of those with hypothalamic amenorrhea were 90%–110% of ideal body weight; had been amenorrheic for at least 3 months; had normal FSH, prolactin, testosterone, and free testosterone levels; an LH-to-FSH ratio of less than 2.5; absence of hirsutism; and no history of an eating disorder.

Healthy controls were 90%–110% of ideal body weight and eumenorrheic. Controls were excluded from the study if they had a history of amenorrhea or an eating disorder, had a history of any major medical illness, or if they had used oral contraceptives within the previous 3 months.

The mean body mass index (BMI), percent ideal body weight, percent fat, total fat mass, and fat-free mass were lower in the anorexia nervosa groups, compared with women who had hypothalamic amenorrhea and the healthy controls. Analysis of the androgen levels in the four groups showed that total testosterone levels were lower in women with anorexia nervosa than they were in healthy controls.

Levels of total testosterone were similar in anorexic women who received oral contraceptives and those who did not receive them. The total testosterone levels were normal in women with hypothalamic amenorrhea, said Dr. Miller.

The levels of free testosterone were lower in women with anorexia nervosa than they were in healthy controls, and the lowest levels occurred in women with anorexia nervosa and who were receiving oral contraceptives. The levels were normal in women with hypothalamic amenorrhea.

The investigators also found that the levels of dehydroepian- drosterone (DHEAS) were lower only in women with anorexia nervosa who were receiving oral contraceptives, compared with healthy controls. DHEAS levels were normal in women with anorexia nervosa not receiving contraceptives and in women with hypothalamic amenorrhea.

Free testosterone levels were predictive of bone mineral density and body composition in women with anorexia nervosa, hypothalamic amenorrhea, and healthy controls. DHEAS levels also predicted bone density, but were weaker predictors than free testosterone and did not predict fat-free mass, Dr. Miller said.

Intervention studies are needed to determine the relationship between androgens and bone density and body composition in women with anorexia nervosa, she added. Studies are also needed to determine whether oral contraceptive use is harmful to their skeletal health.

TORONTO — Although physicians commonly prescribe oral contraceptives for women with anorexia nervosa, new research presented at the annual meeting of the Endocrine Society suggests that the androgen levels are already low in these women and that they are further reduced by the use of oral contraceptives.

But the jury is still out on the long-term consequences for skeletal health and body composition in women with the disease, said Dr. Karen K. Miller of Massachusetts General Hospital, Boston.

Dr. Miller and her colleagues analyzed androgen levels in 217 community-dwelling women to determine the physiologic consequences of prescribing oral contraceptives to women with anorexia nervosa.

The investigation included four arms comprised of 137 women with anorexia nervosa who were not receiving oral contraceptives; 32 women with anorexia nervosa who were receiving oral contraceptives; 21 women of normal weight with hypothalamic amenorrhea; and 27 healthy eumenorrheic controls.

All of the women with anorexia nervosa met the DSM-IV criteria for anorexia nervosa, were less than 85% of ideal body weight, and had an intense fear of gaining weight or strong denial of low weight. Anorexic women not receiving oral contraceptives had been amenorrheic for at least 3 consecutive months and had not received hormonal contraceptives within the previous 3 months. Those receiving oral contraceptives had to have been receiving them for at least 3 months.

All of those with hypothalamic amenorrhea were 90%–110% of ideal body weight; had been amenorrheic for at least 3 months; had normal FSH, prolactin, testosterone, and free testosterone levels; an LH-to-FSH ratio of less than 2.5; absence of hirsutism; and no history of an eating disorder.

Healthy controls were 90%–110% of ideal body weight and eumenorrheic. Controls were excluded from the study if they had a history of amenorrhea or an eating disorder, had a history of any major medical illness, or if they had used oral contraceptives within the previous 3 months.

The mean body mass index (BMI), percent ideal body weight, percent fat, total fat mass, and fat-free mass were lower in the anorexia nervosa groups, compared with women who had hypothalamic amenorrhea and the healthy controls. Analysis of the androgen levels in the four groups showed that total testosterone levels were lower in women with anorexia nervosa than they were in healthy controls.

Levels of total testosterone were similar in anorexic women who received oral contraceptives and those who did not receive them. The total testosterone levels were normal in women with hypothalamic amenorrhea, said Dr. Miller.

The levels of free testosterone were lower in women with anorexia nervosa than they were in healthy controls, and the lowest levels occurred in women with anorexia nervosa and who were receiving oral contraceptives. The levels were normal in women with hypothalamic amenorrhea.

The investigators also found that the levels of dehydroepian- drosterone (DHEAS) were lower only in women with anorexia nervosa who were receiving oral contraceptives, compared with healthy controls. DHEAS levels were normal in women with anorexia nervosa not receiving contraceptives and in women with hypothalamic amenorrhea.

Free testosterone levels were predictive of bone mineral density and body composition in women with anorexia nervosa, hypothalamic amenorrhea, and healthy controls. DHEAS levels also predicted bone density, but were weaker predictors than free testosterone and did not predict fat-free mass, Dr. Miller said.

Intervention studies are needed to determine the relationship between androgens and bone density and body composition in women with anorexia nervosa, she added. Studies are also needed to determine whether oral contraceptive use is harmful to their skeletal health.

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 findings were presented in a poster at the annual meeting of the Endocrine Society.

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

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 ace, 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.

For example, testosterone levels and free androgen indices were significantly reduced, and the prevalence of chronic anovulation was significantly lower after treatment (91% vs. 53%), they said.

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 findings were presented in a poster at the annual meeting of the Endocrine Society.

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

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 ace, 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.

For example, testosterone levels and free androgen indices were significantly reduced, and the prevalence of chronic anovulation was significantly lower after treatment (91% vs. 53%), they said.

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 findings were presented in a poster at the annual meeting of the Endocrine Society.

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

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 ace, 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.

For example, testosterone levels and free androgen indices were significantly reduced, and the prevalence of chronic anovulation was significantly lower after treatment (91% vs. 53%), they said.

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, because testosterone is the major circulating androgen. However, testing is not clearly better than clinical judgement 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.

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, then she can be tested. 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 (JCEM 2007;92:405–13). In a position paper released in February, the 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.

The group also noted that direct testosterone assays perform poorly in women and children, who have low levels of testosterone concentrations, and that these assays should be avoided.

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.

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, because testosterone is the major circulating androgen. However, testing is not clearly better than clinical judgement 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.

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, then she can be tested. 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 (JCEM 2007;92:405–13). In a position paper released in February, the 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.

The group also noted that direct testosterone assays perform poorly in women and children, who have low levels of testosterone concentrations, and that these assays should be avoided.

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.

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, because testosterone is the major circulating androgen. However, testing is not clearly better than clinical judgement 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.

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, then she can be tested. 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 (JCEM 2007;92:405–13). In a position paper released in February, the 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.

The group also noted that direct testosterone assays perform poorly in women and children, who have low levels of testosterone concentrations, and that these assays should be avoided.

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.