Mary Ellen Schneider

NEW ORLEANS – Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach–recognizing opioids are necessary but also pose risks and need to be controlled. “The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians.

“Here again it looks like we're pretty much on the same page,” he said.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

Specifically, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic nonmalignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physician in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits.

“It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, some areas surrounding prescribing of controlled substancs still need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said. In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

And while it's likely that most regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court; others have been convicted only to have their cases overturned later.

NEW ORLEANS – Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach–recognizing opioids are necessary but also pose risks and need to be controlled. “The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians.

“Here again it looks like we're pretty much on the same page,” he said.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

Specifically, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic nonmalignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physician in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits.

“It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, some areas surrounding prescribing of controlled substancs still need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said. In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

And while it's likely that most regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court; others have been convicted only to have their cases overturned later.

NEW ORLEANS – Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach–recognizing opioids are necessary but also pose risks and need to be controlled. “The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians.

“Here again it looks like we're pretty much on the same page,” he said.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

Specifically, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic nonmalignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physician in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits.

“It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, some areas surrounding prescribing of controlled substancs still need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said. In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

And while it's likely that most regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court; others have been convicted only to have their cases overturned later.

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, 10 participating practices were assessed based on their performance on evidence-based diabetes measures.

In the first year (April 2005-March 2006), all participating 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 A_1c 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 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 Medicare, 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.”

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, 10 participating practices were assessed based on their performance on evidence-based diabetes measures.

In the first year (April 2005-March 2006), all participating 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 A_1c 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 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 Medicare, 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.”

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, 10 participating practices were assessed based on their performance on evidence-based diabetes measures.

In the first year (April 2005-March 2006), all participating 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 A_1c 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 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 Medicare, 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.”

NEW ORLEANS — Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach—recognizing opioids are necessary but also pose risks and need to be controlled. “The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians. “Here again it looks like we're pretty much on the same page,” he said.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

Specifically, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic nonmalignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physicians in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits. “It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, there are still some areas surrounding prescribing of controlled substances that need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said.

In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

Although it's likely that the majority of regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court; others have been convicted only to have their cases overturned later. These cases need to be investigated to figure out what went wrong, he added.

NEW ORLEANS — Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach—recognizing opioids are necessary but also pose risks and need to be controlled. “The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians. “Here again it looks like we're pretty much on the same page,” he said.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

Specifically, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic nonmalignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physicians in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits. “It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, there are still some areas surrounding prescribing of controlled substances that need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said.

In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

Although it's likely that the majority of regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court; others have been convicted only to have their cases overturned later. These cases need to be investigated to figure out what went wrong, he added.

NEW ORLEANS — Get educated about state and federal regulations and policies on the prescription of controlled substances, advised David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison.

Mr. Joranson, who spoke at the annual meeting of the American Academy of Pain Medicine, said that understanding current regulations is critical to avoiding unnecessary fears over the risk of sanctions from prescribing pain medication.

In recent years there has been increasing agreement reached between pain medicine specialists, law enforcement, and regulators, he said. For example, from 2003 to 2006, 19 states either repealed or added language to their state's controlled substances prescribing policies to take a more balanced approach—recognizing opioids are necessary but also pose risks and need to be controlled. “The state policies are becoming more balanced,” he said.

Importantly, 39 states have adopted a policy aimed at directly addressing physicians' concerns about regulatory scrutiny, he added.

Nearly 10 years ago, the Federation of State Medical Boards made it clear that physicians should recognize that tolerance and physical dependence are the normal consequences of the sustained use of opioid analgesics and are not synonymous with addiction. As a result, many state medical board guidelines now reflect that statement, Mr. Joranson said.

Last year, at the federal level the Drug Enforcement Administration issued a statement that nearly every prescription issued in the United States is for a legitimate medical purpose and that the amount of dosage units per prescription will never be a basis for investigation for the overwhelming majority of physicians. “Here again it looks like we're pretty much on the same page,” he said.

Research findings indicated, however, that physicians may not be paying attention to this policy shift. In a study published in the Journal of Family Practice in 2001, investigators from the University of California, San Francisco/Stanford Collaborative Research Network surveyed 230 primary care physicians on pain treatment, the use of opioids, and their familiarity with state prescribing and documentation guidelines.

Specifically, the investigation focused on whether physicians were aware of guidelines on prescribing opioids for chronic nonmalignant pain that were issued by the Medical Board of California in 1994. The guidelines were aimed in part at reducing physicians' fear of regulatory scrutiny. The guidelines were mailed to all licensed physicians in the state three times between 1994 and 1996.

Of the 161 physicians who completed the survey, only 39% remembered reading the guidelines 1 year after the third mailing. And 40% of respondents said that fear of legal investigation influenced their opioid prescribing habits. “It can be an uphill battle to get physicians to pay attention to policy,” Mr. Joranson said.

Despite the growing areas of agreement on proper pain prescriptions, there are still some areas surrounding prescribing of controlled substances that need to be worked out, he said. For example, prescribing opioids to pain patients who may have a substance abuse problem is an area where law enforcement and physicians have the potential to clash. More dialogue is needed between the pain medicine community and DEA on this issue, he said.

In addition, some groups mistakenly believe that physicians and patients are the main source of drug diversion, he said.

Although it's likely that the majority of regulatory and law enforcement actions against physicians for prescribing of controlled substances are appropriate, there have been exceptions, he said. Some physicians have been charged and later acquitted in court; others have been convicted only to have their cases overturned later. These cases need to be investigated to figure out what went wrong, he added.

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

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

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

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, according to Robert M. Hayes, president of the Medicare Rights Center.

Mr. Hayes has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards.

He also called on Congress to establish minimum benefit standards and to standardize Medicare Advantage benefit packages to allow for better consumer comparison of plans.

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

For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works. About 80% of physicians with patients in Medicare Advantage private fee-for-service plans also reported confusion about the plans among their patients, according to survey data collected by the AMA.

More than half of the physicians surveyed also reported excessive hold times and excessive documentation requested by payers with both types of Medicare Advantage plans.

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

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

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

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, according to Robert M. Hayes, president of the Medicare Rights Center.

Mr. Hayes has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards.

He also called on Congress to establish minimum benefit standards and to standardize Medicare Advantage benefit packages to allow for better consumer comparison of plans.

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

For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works. About 80% of physicians with patients in Medicare Advantage private fee-for-service plans also reported confusion about the plans among their patients, according to survey data collected by the AMA.

More than half of the physicians surveyed also reported excessive hold times and excessive documentation requested by payers with both types of Medicare Advantage plans.

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

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

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

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, according to Robert M. Hayes, president of the Medicare Rights Center.

Mr. Hayes has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards.

He also called on Congress to establish minimum benefit standards and to standardize Medicare Advantage benefit packages to allow for better consumer comparison of plans.

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

For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works. About 80% of physicians with patients in Medicare Advantage private fee-for-service plans also reported confusion about the plans among their patients, according to survey data collected by the AMA.

More than half of the physicians surveyed also reported excessive hold times and excessive documentation requested by payers with both types of Medicare Advantage plans.

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, 10 participating practices were assessed based on their performance on evidence-based diabetes measures.

In the first year (April 2005-March 2006), all participating 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 A_1c 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 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 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, he said. "I think, overall, it's trending in a very positive way."

The first-year evaluation has 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. For example, St. John's Health System is using a Web-based patient registry aimed at helping physicians to plan patient visits.

In the second and third years of the program, the group practices will be assessed on additional measures related to heart failure, coronary artery disease, hypertension, and cancer screening.

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, 10 participating practices were assessed based on their performance on evidence-based diabetes measures.

In the first year (April 2005-March 2006), all participating 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 A_1c 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 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 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, he said. "I think, overall, it's trending in a very positive way."

The first-year evaluation has 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. For example, St. John's Health System is using a Web-based patient registry aimed at helping physicians to plan patient visits.

In the second and third years of the program, the group practices will be assessed on additional measures related to heart failure, coronary artery disease, hypertension, and cancer screening.

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, 10 participating practices were assessed based on their performance on evidence-based diabetes measures.

In the first year (April 2005-March 2006), all participating 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 A_1c 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 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 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, he said. "I think, overall, it's trending in a very positive way."

The first-year evaluation has 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. For example, St. John's Health System is using a Web-based patient registry aimed at helping physicians to plan patient visits.

In the second and third years of the program, the group practices will be assessed on additional measures related to heart failure, coronary artery disease, hypertension, and cancer screening.

Several Medicare Advantage fee-for-service plan sponsors have agreed to voluntarily suspend marketing of their plans until officials at the Centers for Medicare and Medicaid Services can verify that they are in compliance with certain management controls.

CMS officials announced this temporary marketing moratorium as part of an effort to halt deceptive marketing practices in the private fee-for-service Medicare market.

"It is our strong belief that while most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors operating in the marketplace that need to be removed from the system," Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. "This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing."

From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans. However, Ms. Block pointed out that the 2,700 complaints account for a small fraction of the 1.3 million Medicare beneficiaries who have elected to enroll in such plans.

The problems reported range from agents encouraging the misperception that the private plans are just like traditional Medicare and are accepted by all providers who accept Medicare to more blatant cases of deception in which agents have told beneficiaries they are still enrolled in traditional Medicare and are purchasing a Medigap supplemental insurance policy.

The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are: United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS. "These are clearly the major players in the industry," Ms. Block said.

The plans were not singled out because of particular problems with their marketing practices, Ms. Block said. The real concern relates to actions by a small number of rogue brokers and agents with whom these and other organizations may contract, she said.

The temporary moratorium does not apply to enrollment among the plans and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics.

The marketing moratorium will be lifted on a plan-by-plan basis when the CMS certifies that the plan has both systems and management controls in place that meet conditions spelled out by the agency in guidance earlier this year.

For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan. All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.

Plans must also agree to provide a list of individuals who are marketing the plan upon request by the CMS or state agencies. The CMS will begin to review plans as soon as they indicate they are in compliance, Ms. Block said.

In addition, the CMS will be monitoring all private fee-for-service plans to ensure they are not engaging in deceptive marketing practices. "We will be watching very carefully as the entire industry begins marketing in October for the 2008 benefit year," Ms. Block said.

Several Medicare Advantage fee-for-service plan sponsors have agreed to voluntarily suspend marketing of their plans until officials at the Centers for Medicare and Medicaid Services can verify that they are in compliance with certain management controls.

CMS officials announced this temporary marketing moratorium as part of an effort to halt deceptive marketing practices in the private fee-for-service Medicare market.

"It is our strong belief that while most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors operating in the marketplace that need to be removed from the system," Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. "This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing."

From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans. However, Ms. Block pointed out that the 2,700 complaints account for a small fraction of the 1.3 million Medicare beneficiaries who have elected to enroll in such plans.

The problems reported range from agents encouraging the misperception that the private plans are just like traditional Medicare and are accepted by all providers who accept Medicare to more blatant cases of deception in which agents have told beneficiaries they are still enrolled in traditional Medicare and are purchasing a Medigap supplemental insurance policy.

The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are: United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS. "These are clearly the major players in the industry," Ms. Block said.

The plans were not singled out because of particular problems with their marketing practices, Ms. Block said. The real concern relates to actions by a small number of rogue brokers and agents with whom these and other organizations may contract, she said.

The temporary moratorium does not apply to enrollment among the plans and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics.

The marketing moratorium will be lifted on a plan-by-plan basis when the CMS certifies that the plan has both systems and management controls in place that meet conditions spelled out by the agency in guidance earlier this year.

For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan. All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.

Plans must also agree to provide a list of individuals who are marketing the plan upon request by the CMS or state agencies. The CMS will begin to review plans as soon as they indicate they are in compliance, Ms. Block said.

In addition, the CMS will be monitoring all private fee-for-service plans to ensure they are not engaging in deceptive marketing practices. "We will be watching very carefully as the entire industry begins marketing in October for the 2008 benefit year," Ms. Block said.

Several Medicare Advantage fee-for-service plan sponsors have agreed to voluntarily suspend marketing of their plans until officials at the Centers for Medicare and Medicaid Services can verify that they are in compliance with certain management controls.

CMS officials announced this temporary marketing moratorium as part of an effort to halt deceptive marketing practices in the private fee-for-service Medicare market.

"It is our strong belief that while most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors operating in the marketplace that need to be removed from the system," Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. "This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing."

From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans. However, Ms. Block pointed out that the 2,700 complaints account for a small fraction of the 1.3 million Medicare beneficiaries who have elected to enroll in such plans.

The problems reported range from agents encouraging the misperception that the private plans are just like traditional Medicare and are accepted by all providers who accept Medicare to more blatant cases of deception in which agents have told beneficiaries they are still enrolled in traditional Medicare and are purchasing a Medigap supplemental insurance policy.

The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are: United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS. "These are clearly the major players in the industry," Ms. Block said.

The plans were not singled out because of particular problems with their marketing practices, Ms. Block said. The real concern relates to actions by a small number of rogue brokers and agents with whom these and other organizations may contract, she said.

The temporary moratorium does not apply to enrollment among the plans and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics.

The marketing moratorium will be lifted on a plan-by-plan basis when the CMS certifies that the plan has both systems and management controls in place that meet conditions spelled out by the agency in guidance earlier this year.

For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan. All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.

Plans must also agree to provide a list of individuals who are marketing the plan upon request by the CMS or state agencies. The CMS will begin to review plans as soon as they indicate they are in compliance, Ms. Block said.

In addition, the CMS will be monitoring all private fee-for-service plans to ensure they are not engaging in deceptive marketing practices. "We will be watching very carefully as the entire industry begins marketing in October for the 2008 benefit year," Ms. Block said.

HHS Assesses Sex Ed Programs

One persistent criticism of abstinence-only education programs is that they contain medically inaccurate information. However, a report commissioned by the Health and Human Services department found that most comprehensive sex education programs also include some inaccurate statements. Of nine comprehensive sex education programs reviewed, six contained some type of medically inaccurate statement, according to the report. For example, three programs promoted the use of the spermicide nonoxynol-9, but the report states that recent research has shown that nonoxynol-9 is ineffective against sexually transmitted diseases and has the potential to increase the risk of transmission. Other errors included the use of the term “dental dam” instead of “rubber dam.” For the most part, the programs were medically accurate but tended to minimize condom failure rates, the report said. Overall, the incidence of errors in the comprehensive sex education programs were similar to error rates reported for abstinence programs in a 2005 report commissioned by Rep. Henry Waxman (D-Calif.), according to the HHS report. The HHS report was requested in 2005 by former Sen. Rick Santorum (R-Pa.) and Sen. Tom Coburn (R-Okla.). The assessment was conducted by the Sagamore Institute for Policy Research and reviewed by the Medical Institute for Sexual Health.

Factors in Contraceptive Use Noted

Ensuring that women consistently use contraception may involve some extra work on the part of physicians, according to a study published in the June issue of Perspectives on Sexual and Reproductive Health. For example, women who have low motivation to prevent a pregnancy may need additional counseling. Physicians also need to fully explain the benefits and side effects of various contraceptive options because women who are dissatisfied or even neutral about their method are more likely to have gaps in use. The findings are based on a telephone survey of 1,978 women ages 18–44 years who were sexually active and not trying to conceive. About 15% of the women reported that they had had a gap in contraceptive use of between 1 and 11 months in the previous year, with an average gap of 5 months. About 8% of women reported that they had not used a contraceptive method for the entire previous year. Women ages 35–44, Hispanic and black women, and women with lower levels of education were more likely to go without a contraceptive method for the entire year than younger, white, and college-educated women, the study found.

Ob.Gyn. Antitrust Settlement Reached

The Department of Justice has reached a settlement with the Federation of Physicians and Dentists that bars the group from coordinating fee negotiations on behalf of its private practice members. In an antitrust lawsuit filed in 2005, the Department of Justice alleged that the Florida-based group had coordinated fee negotiations among 120 Cincinnati-area obstetricians and gynecologists. The result was that area insurers were forced to pay higher fees to the physicians than could have been obtained through competitive negotiation, the antitrust suit alleged. As part of the settlement, the Federation of Physicians and Dentists will be prohibited from representing any independent physician with any payer, reviewing or analyzing contracts negotiated between a physician and a payer, and negotiating with payers for services provided by private practice members, according to the Department of Justice. The settlement is subject to court approval.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patients' welfare. “There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics,” said AMA board member Dr. Peter Carmel in a statement. “The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care.” The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

HHS Assesses Sex Ed Programs

One persistent criticism of abstinence-only education programs is that they contain medically inaccurate information. However, a report commissioned by the Health and Human Services department found that most comprehensive sex education programs also include some inaccurate statements. Of nine comprehensive sex education programs reviewed, six contained some type of medically inaccurate statement, according to the report. For example, three programs promoted the use of the spermicide nonoxynol-9, but the report states that recent research has shown that nonoxynol-9 is ineffective against sexually transmitted diseases and has the potential to increase the risk of transmission. Other errors included the use of the term “dental dam” instead of “rubber dam.” For the most part, the programs were medically accurate but tended to minimize condom failure rates, the report said. Overall, the incidence of errors in the comprehensive sex education programs were similar to error rates reported for abstinence programs in a 2005 report commissioned by Rep. Henry Waxman (D-Calif.), according to the HHS report. The HHS report was requested in 2005 by former Sen. Rick Santorum (R-Pa.) and Sen. Tom Coburn (R-Okla.). The assessment was conducted by the Sagamore Institute for Policy Research and reviewed by the Medical Institute for Sexual Health.

Factors in Contraceptive Use Noted

Ensuring that women consistently use contraception may involve some extra work on the part of physicians, according to a study published in the June issue of Perspectives on Sexual and Reproductive Health. For example, women who have low motivation to prevent a pregnancy may need additional counseling. Physicians also need to fully explain the benefits and side effects of various contraceptive options because women who are dissatisfied or even neutral about their method are more likely to have gaps in use. The findings are based on a telephone survey of 1,978 women ages 18–44 years who were sexually active and not trying to conceive. About 15% of the women reported that they had had a gap in contraceptive use of between 1 and 11 months in the previous year, with an average gap of 5 months. About 8% of women reported that they had not used a contraceptive method for the entire previous year. Women ages 35–44, Hispanic and black women, and women with lower levels of education were more likely to go without a contraceptive method for the entire year than younger, white, and college-educated women, the study found.

Ob.Gyn. Antitrust Settlement Reached

The Department of Justice has reached a settlement with the Federation of Physicians and Dentists that bars the group from coordinating fee negotiations on behalf of its private practice members. In an antitrust lawsuit filed in 2005, the Department of Justice alleged that the Florida-based group had coordinated fee negotiations among 120 Cincinnati-area obstetricians and gynecologists. The result was that area insurers were forced to pay higher fees to the physicians than could have been obtained through competitive negotiation, the antitrust suit alleged. As part of the settlement, the Federation of Physicians and Dentists will be prohibited from representing any independent physician with any payer, reviewing or analyzing contracts negotiated between a physician and a payer, and negotiating with payers for services provided by private practice members, according to the Department of Justice. The settlement is subject to court approval.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patients' welfare. “There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics,” said AMA board member Dr. Peter Carmel in a statement. “The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care.” The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

HHS Assesses Sex Ed Programs

One persistent criticism of abstinence-only education programs is that they contain medically inaccurate information. However, a report commissioned by the Health and Human Services department found that most comprehensive sex education programs also include some inaccurate statements. Of nine comprehensive sex education programs reviewed, six contained some type of medically inaccurate statement, according to the report. For example, three programs promoted the use of the spermicide nonoxynol-9, but the report states that recent research has shown that nonoxynol-9 is ineffective against sexually transmitted diseases and has the potential to increase the risk of transmission. Other errors included the use of the term “dental dam” instead of “rubber dam.” For the most part, the programs were medically accurate but tended to minimize condom failure rates, the report said. Overall, the incidence of errors in the comprehensive sex education programs were similar to error rates reported for abstinence programs in a 2005 report commissioned by Rep. Henry Waxman (D-Calif.), according to the HHS report. The HHS report was requested in 2005 by former Sen. Rick Santorum (R-Pa.) and Sen. Tom Coburn (R-Okla.). The assessment was conducted by the Sagamore Institute for Policy Research and reviewed by the Medical Institute for Sexual Health.

Factors in Contraceptive Use Noted

Ensuring that women consistently use contraception may involve some extra work on the part of physicians, according to a study published in the June issue of Perspectives on Sexual and Reproductive Health. For example, women who have low motivation to prevent a pregnancy may need additional counseling. Physicians also need to fully explain the benefits and side effects of various contraceptive options because women who are dissatisfied or even neutral about their method are more likely to have gaps in use. The findings are based on a telephone survey of 1,978 women ages 18–44 years who were sexually active and not trying to conceive. About 15% of the women reported that they had had a gap in contraceptive use of between 1 and 11 months in the previous year, with an average gap of 5 months. About 8% of women reported that they had not used a contraceptive method for the entire previous year. Women ages 35–44, Hispanic and black women, and women with lower levels of education were more likely to go without a contraceptive method for the entire year than younger, white, and college-educated women, the study found.

Ob.Gyn. Antitrust Settlement Reached

The Department of Justice has reached a settlement with the Federation of Physicians and Dentists that bars the group from coordinating fee negotiations on behalf of its private practice members. In an antitrust lawsuit filed in 2005, the Department of Justice alleged that the Florida-based group had coordinated fee negotiations among 120 Cincinnati-area obstetricians and gynecologists. The result was that area insurers were forced to pay higher fees to the physicians than could have been obtained through competitive negotiation, the antitrust suit alleged. As part of the settlement, the Federation of Physicians and Dentists will be prohibited from representing any independent physician with any payer, reviewing or analyzing contracts negotiated between a physician and a payer, and negotiating with payers for services provided by private practice members, according to the Department of Justice. The settlement is subject to court approval.

AMA: Investigate Store Clinics

The American Medical Association has called for investigations into potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains. Physicians at the AMA's House of Delegates in Chicago voted to ask state and federal agencies to determine whether these joint ventures pose a threat to patients' welfare. “There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics,” said AMA board member Dr. Peter Carmel in a statement. “The nation's physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based clinics to provide patients with quality care.” The AMA also noted that some insurers are allowing store-based clinics to waive or lower patient copayments, while still requiring physicians to collect such payments. The House of Delegates, noting concerns that these lower copayments for in-store clinics could inappropriately steer patients to the clinics on the basis of cost, rather than quality of care, voted to seek equal treatment for physicians regarding health insurers' copayment policies.

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

The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans.

The CMS proposal also includes changes to streamline the process of intermediate sanctions and contract determinations. In addition, the proposal clarifies the process for imposing civil money penalties.

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

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, according to Robert M. Hayes, president of the Medicare Rights Center. Mr. Hayes has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards.

Mr. Hayes also called on Congress to establish minimum benefit standards and standardize benefit packages to allow for better consumer comparison of health care insurance plans.

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

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

More than half of physicians who were surveyed also reported excessive hold times and excessive documentation requested by payers with both types of Medicare Advantage plans.

CMS is accepting comments on the proposal through July 24.

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

The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans.

The CMS proposal also includes changes to streamline the process of intermediate sanctions and contract determinations. In addition, the proposal clarifies the process for imposing civil money penalties.

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

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, according to Robert M. Hayes, president of the Medicare Rights Center. Mr. Hayes has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards.

Mr. Hayes also called on Congress to establish minimum benefit standards and standardize benefit packages to allow for better consumer comparison of health care insurance plans.

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

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

More than half of physicians who were surveyed also reported excessive hold times and excessive documentation requested by payers with both types of Medicare Advantage plans.

CMS is accepting comments on the proposal through July 24.

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

The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans.

The CMS proposal also includes changes to streamline the process of intermediate sanctions and contract determinations. In addition, the proposal clarifies the process for imposing civil money penalties.

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

But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, according to Robert M. Hayes, president of the Medicare Rights Center. Mr. Hayes has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards.

Mr. Hayes also called on Congress to establish minimum benefit standards and standardize benefit packages to allow for better consumer comparison of health care insurance plans.

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

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

More than half of physicians who were surveyed also reported excessive hold times and excessive documentation requested by payers with both types of Medicare Advantage plans.

CMS is accepting comments on the proposal through July 24.

Several Medicare Advantage fee-for-service plan sponsors have agreed to voluntarily suspend marketing of their plans until officials at the Centers for Medicare and Medicaid Services can verify that they are in compliance with certain management controls.

CMS officials announced this temporary marketing moratorium as part of an effort to halt deceptive marketing practices in the private fee-for-service Medicare market.

“It is our strong belief that while most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors operating in the marketplace that need to be removed from the system,” Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. “This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing.”

From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans.

However, Ms. Block pointed out that the 2,700 complaints account for a small fraction of the 1.3 million Medicare beneficiaries who have elected to enroll in such plans.

The problems reported range from agents encouraging the misperception that the private plans are just like traditional Medicare and are accepted by all providers who accept Medicare to more blatant cases of deception in which agents have told beneficiaries they are still enrolled in traditional Medicare and are purchasing a Medigap supplemental insurance policy.

The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS. “These are clearly the major players in the industry,” Ms. Block said.

The plans were not singled out because of particular problems with their marketing practices, Ms. Block said. The real concern relates to actions by a small number of rogue brokers and agents with whom these and other organizations may contract, she said.

The temporary moratorium does not apply to enrollment among the plans and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics.

The marketing moratorium will be lifted on a plan-by-plan basis when the CMS certifies that the plan has both systems and management controls in place that meet conditions spelled out by the agency in guidance earlier this year.

For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan. All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.

Plans must also agree to provide a list of individuals who are marketing the plan upon request by the CMS or state agencies. The CMS will begin to review plans as soon as they indicate they are in compliance, Ms. Block said.

In addition, the CMS will be monitoring all private fee-for-service plans to ensure they are not engaging in deceptive marketing practices. “We will be watching very carefully as the entire industry begins marketing in October for the 2008 benefit year,” Ms. Block said.

Several Medicare Advantage fee-for-service plan sponsors have agreed to voluntarily suspend marketing of their plans until officials at the Centers for Medicare and Medicaid Services can verify that they are in compliance with certain management controls.

CMS officials announced this temporary marketing moratorium as part of an effort to halt deceptive marketing practices in the private fee-for-service Medicare market.

“It is our strong belief that while most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors operating in the marketplace that need to be removed from the system,” Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. “This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing.”

From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans.

However, Ms. Block pointed out that the 2,700 complaints account for a small fraction of the 1.3 million Medicare beneficiaries who have elected to enroll in such plans.

The problems reported range from agents encouraging the misperception that the private plans are just like traditional Medicare and are accepted by all providers who accept Medicare to more blatant cases of deception in which agents have told beneficiaries they are still enrolled in traditional Medicare and are purchasing a Medigap supplemental insurance policy.

The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS. “These are clearly the major players in the industry,” Ms. Block said.

The plans were not singled out because of particular problems with their marketing practices, Ms. Block said. The real concern relates to actions by a small number of rogue brokers and agents with whom these and other organizations may contract, she said.

The temporary moratorium does not apply to enrollment among the plans and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics.

The marketing moratorium will be lifted on a plan-by-plan basis when the CMS certifies that the plan has both systems and management controls in place that meet conditions spelled out by the agency in guidance earlier this year.

For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan. All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.

Plans must also agree to provide a list of individuals who are marketing the plan upon request by the CMS or state agencies. The CMS will begin to review plans as soon as they indicate they are in compliance, Ms. Block said.

In addition, the CMS will be monitoring all private fee-for-service plans to ensure they are not engaging in deceptive marketing practices. “We will be watching very carefully as the entire industry begins marketing in October for the 2008 benefit year,” Ms. Block said.

Several Medicare Advantage fee-for-service plan sponsors have agreed to voluntarily suspend marketing of their plans until officials at the Centers for Medicare and Medicaid Services can verify that they are in compliance with certain management controls.

CMS officials announced this temporary marketing moratorium as part of an effort to halt deceptive marketing practices in the private fee-for-service Medicare market.

“It is our strong belief that while most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors operating in the marketplace that need to be removed from the system,” Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. “This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing.”

From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans, with many of those complaints relating to private fee-for-service plans.

However, Ms. Block pointed out that the 2,700 complaints account for a small fraction of the 1.3 million Medicare beneficiaries who have elected to enroll in such plans.

The problems reported range from agents encouraging the misperception that the private plans are just like traditional Medicare and are accepted by all providers who accept Medicare to more blatant cases of deception in which agents have told beneficiaries they are still enrolled in traditional Medicare and are purchasing a Medigap supplemental insurance policy.

The seven private fee-for-service Medicare plans that recently signed an agreement with the CMS to suspend their marketing efforts are United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. Together, they account for about 90% of enrollment in private fee-for-service plans, according to the CMS. “These are clearly the major players in the industry,” Ms. Block said.

The plans were not singled out because of particular problems with their marketing practices, Ms. Block said. The real concern relates to actions by a small number of rogue brokers and agents with whom these and other organizations may contract, she said.

The temporary moratorium does not apply to enrollment among the plans and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics.

The marketing moratorium will be lifted on a plan-by-plan basis when the CMS certifies that the plan has both systems and management controls in place that meet conditions spelled out by the agency in guidance earlier this year.

For example, plan sponsors will have to show that all of their advertising, marketing, and enrollment materials include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as traditional Medicare or Medigap and that not all providers will accept the plan. All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.

Plans must also agree to provide a list of individuals who are marketing the plan upon request by the CMS or state agencies. The CMS will begin to review plans as soon as they indicate they are in compliance, Ms. Block said.

In addition, the CMS will be monitoring all private fee-for-service plans to ensure they are not engaging in deceptive marketing practices. “We will be watching very carefully as the entire industry begins marketing in October for the 2008 benefit year,” Ms. Block said.

TORONTO — The short-term use of either growth hormone or testosterone alone does not significantly improve physical performance among recreational athletes, according to research presented in a poster at the annual meeting of the Endocrine Society.

However, the combination did significantly increase sprint capacity in men.

Dr. Ken K.Y. Ho, of the Garvan Institute in Sydney, Australia, and his colleagues conducted a prospective, double-blind, placebo-controlled study looking at the effects of growth hormone and testosterone supplementation among 97 recreational athletes aged 18–40. The mean age of the study participants was 27 years. The researchers defined a recreational athlete as someone who exercised at least 2 hr/wk for at least 1 year.

The study was funded by the World Anti-Doping Agency and the Australian Government Anti-Doping Research Program. The supplements were provided by Novo Nordisk and Organon.

Sixty-four men were randomized to receive either placebo, growth hormone (Norditropin), testosterone (Sustanon), or a combination of growth hormone and testosterone over the 8-week study period. The study also included 33 women who were randomized to receive either placebo or growth hormone.

The level of the hormones given was high, but safe, Dr. Ho said in an interview. Study participants in the growth hormone or combination arms received up to 2 mg/day of growth hormone for 8 weeks. Men in the testosterone or combination arms received 250 mg/wk of testosterone for 5 weeks. The researchers assessed endurance, strength, power, and sprint capacity using a variety of physical tests.

There was no significant change from baseline among any of the treatment groups in terms of endurance, strength, or power. The only significant finding was among men who took a combination of growth hormone and testosterone. In that group, there was a statistically significant increase in sprint capacity, which was calculated using a 30-second cycle Wingate test for anaerobic sprint capacity that measured total work and peak power.

TORONTO — The short-term use of either growth hormone or testosterone alone does not significantly improve physical performance among recreational athletes, according to research presented in a poster at the annual meeting of the Endocrine Society.

However, the combination did significantly increase sprint capacity in men.

Dr. Ken K.Y. Ho, of the Garvan Institute in Sydney, Australia, and his colleagues conducted a prospective, double-blind, placebo-controlled study looking at the effects of growth hormone and testosterone supplementation among 97 recreational athletes aged 18–40. The mean age of the study participants was 27 years. The researchers defined a recreational athlete as someone who exercised at least 2 hr/wk for at least 1 year.

The study was funded by the World Anti-Doping Agency and the Australian Government Anti-Doping Research Program. The supplements were provided by Novo Nordisk and Organon.

Sixty-four men were randomized to receive either placebo, growth hormone (Norditropin), testosterone (Sustanon), or a combination of growth hormone and testosterone over the 8-week study period. The study also included 33 women who were randomized to receive either placebo or growth hormone.

The level of the hormones given was high, but safe, Dr. Ho said in an interview. Study participants in the growth hormone or combination arms received up to 2 mg/day of growth hormone for 8 weeks. Men in the testosterone or combination arms received 250 mg/wk of testosterone for 5 weeks. The researchers assessed endurance, strength, power, and sprint capacity using a variety of physical tests.

There was no significant change from baseline among any of the treatment groups in terms of endurance, strength, or power. The only significant finding was among men who took a combination of growth hormone and testosterone. In that group, there was a statistically significant increase in sprint capacity, which was calculated using a 30-second cycle Wingate test for anaerobic sprint capacity that measured total work and peak power.

TORONTO — The short-term use of either growth hormone or testosterone alone does not significantly improve physical performance among recreational athletes, according to research presented in a poster at the annual meeting of the Endocrine Society.

However, the combination did significantly increase sprint capacity in men.

Dr. Ken K.Y. Ho, of the Garvan Institute in Sydney, Australia, and his colleagues conducted a prospective, double-blind, placebo-controlled study looking at the effects of growth hormone and testosterone supplementation among 97 recreational athletes aged 18–40. The mean age of the study participants was 27 years. The researchers defined a recreational athlete as someone who exercised at least 2 hr/wk for at least 1 year.

The study was funded by the World Anti-Doping Agency and the Australian Government Anti-Doping Research Program. The supplements were provided by Novo Nordisk and Organon.

Sixty-four men were randomized to receive either placebo, growth hormone (Norditropin), testosterone (Sustanon), or a combination of growth hormone and testosterone over the 8-week study period. The study also included 33 women who were randomized to receive either placebo or growth hormone.

The level of the hormones given was high, but safe, Dr. Ho said in an interview. Study participants in the growth hormone or combination arms received up to 2 mg/day of growth hormone for 8 weeks. Men in the testosterone or combination arms received 250 mg/wk of testosterone for 5 weeks. The researchers assessed endurance, strength, power, and sprint capacity using a variety of physical tests.

There was no significant change from baseline among any of the treatment groups in terms of endurance, strength, or power. The only significant finding was among men who took a combination of growth hormone and testosterone. In that group, there was a statistically significant increase in sprint capacity, which was calculated using a 30-second cycle Wingate test for anaerobic sprint capacity that measured total work and peak power.