Mary Ellen Schneider

HOLLYWOOD, FLA. — Many patients may enter nursing facilities on an unnecessary proton pump inhibitor, according to research presented at the annual symposium of the American Medical Directors Association.

In a study of 98 consecutive patients admitted to a skilled nursing facility, nearly two-thirds had been prescribed a proton pump inhibitor (PPI) at admission and half had no clear indication for the drug, Dr. Russell J. Rentler and his colleagues at the Lehigh Valley Hospital in Allentown, Pa., wrote in a poster.

The researchers performed a chart review of 98 patients admitted to a skilled nursing facility to determine how many were transferred from the hospital on an appropriately prescribed PPI. They defined an appropriate diagnosis-indicating PPI prescription as patients with gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, or peptic ulcer disease with or without bleeding, and presumptive treatment for patients with Hemoccult-positive stool or GI bleeding.

Of 98 patients, 63 were women. Most were aged 75 or older. About 48% were between 75 and 84 years, 43% were age 85 and older, and 9% were under age 74.

Of the 60 patients who were taking PPIs upon transfer to the nursing home, only 30 had an appropriate diagnosis under the study criteria. In addition, three patients with a diagnosis of GERD were not prescribed a PPI. Only three patients were prescribed an H₂ receptor blocker. In two of the patients, the researchers determined that the drug was appropriately prescribed.

Although side effects are infrequent on PPIs, the drugs can interact with the absorption of other medications. Studies also have shown a possible link between the use of PPIs for over a year and hip fracture. PPI use also may be a risk factor for Clostridium difficile-associated diarrhea, the researchers wrote.

Prescribing unnecessary medications also has a significant cost impact, researchers found. A commonly prescribed PPI, pantoprazole, costs about $116 for a 30-day supply. Eliminating the medication for 30 of 60 patients would result in savings of about $3,480 a month. Even with a less-expensive medication, such as Prilosec OTC, the savings from eliminating the drug among 30 of 60 patients would result in about $771 a month.

Part of the reason physicians prescribe PPIs so frequently may be defensive, Dr. Rentler said in an interview, because it is seen as preventing GI bleeding with few side effects. He suggested more education is needed for attending physicians about the limited benefit in prescribing PPIs as prophylaxis against gastric ulceration.

The researchers concluded that physicians may want to stop the drug and monitor the patient if it is not clear why a PPI was prescribed.

HOLLYWOOD, FLA. — Many patients may enter nursing facilities on an unnecessary proton pump inhibitor, according to research presented at the annual symposium of the American Medical Directors Association.

In a study of 98 consecutive patients admitted to a skilled nursing facility, nearly two-thirds had been prescribed a proton pump inhibitor (PPI) at admission and half had no clear indication for the drug, Dr. Russell J. Rentler and his colleagues at the Lehigh Valley Hospital in Allentown, Pa., wrote in a poster.

The researchers performed a chart review of 98 patients admitted to a skilled nursing facility to determine how many were transferred from the hospital on an appropriately prescribed PPI. They defined an appropriate diagnosis-indicating PPI prescription as patients with gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, or peptic ulcer disease with or without bleeding, and presumptive treatment for patients with Hemoccult-positive stool or GI bleeding.

Of 98 patients, 63 were women. Most were aged 75 or older. About 48% were between 75 and 84 years, 43% were age 85 and older, and 9% were under age 74.

Of the 60 patients who were taking PPIs upon transfer to the nursing home, only 30 had an appropriate diagnosis under the study criteria. In addition, three patients with a diagnosis of GERD were not prescribed a PPI. Only three patients were prescribed an H₂ receptor blocker. In two of the patients, the researchers determined that the drug was appropriately prescribed.

Although side effects are infrequent on PPIs, the drugs can interact with the absorption of other medications. Studies also have shown a possible link between the use of PPIs for over a year and hip fracture. PPI use also may be a risk factor for Clostridium difficile-associated diarrhea, the researchers wrote.

Prescribing unnecessary medications also has a significant cost impact, researchers found. A commonly prescribed PPI, pantoprazole, costs about $116 for a 30-day supply. Eliminating the medication for 30 of 60 patients would result in savings of about $3,480 a month. Even with a less-expensive medication, such as Prilosec OTC, the savings from eliminating the drug among 30 of 60 patients would result in about $771 a month.

Part of the reason physicians prescribe PPIs so frequently may be defensive, Dr. Rentler said in an interview, because it is seen as preventing GI bleeding with few side effects. He suggested more education is needed for attending physicians about the limited benefit in prescribing PPIs as prophylaxis against gastric ulceration.

The researchers concluded that physicians may want to stop the drug and monitor the patient if it is not clear why a PPI was prescribed.

HOLLYWOOD, FLA. — Many patients may enter nursing facilities on an unnecessary proton pump inhibitor, according to research presented at the annual symposium of the American Medical Directors Association.

In a study of 98 consecutive patients admitted to a skilled nursing facility, nearly two-thirds had been prescribed a proton pump inhibitor (PPI) at admission and half had no clear indication for the drug, Dr. Russell J. Rentler and his colleagues at the Lehigh Valley Hospital in Allentown, Pa., wrote in a poster.

The researchers performed a chart review of 98 patients admitted to a skilled nursing facility to determine how many were transferred from the hospital on an appropriately prescribed PPI. They defined an appropriate diagnosis-indicating PPI prescription as patients with gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, or peptic ulcer disease with or without bleeding, and presumptive treatment for patients with Hemoccult-positive stool or GI bleeding.

Of 98 patients, 63 were women. Most were aged 75 or older. About 48% were between 75 and 84 years, 43% were age 85 and older, and 9% were under age 74.

Of the 60 patients who were taking PPIs upon transfer to the nursing home, only 30 had an appropriate diagnosis under the study criteria. In addition, three patients with a diagnosis of GERD were not prescribed a PPI. Only three patients were prescribed an H₂ receptor blocker. In two of the patients, the researchers determined that the drug was appropriately prescribed.

Although side effects are infrequent on PPIs, the drugs can interact with the absorption of other medications. Studies also have shown a possible link between the use of PPIs for over a year and hip fracture. PPI use also may be a risk factor for Clostridium difficile-associated diarrhea, the researchers wrote.

Prescribing unnecessary medications also has a significant cost impact, researchers found. A commonly prescribed PPI, pantoprazole, costs about $116 for a 30-day supply. Eliminating the medication for 30 of 60 patients would result in savings of about $3,480 a month. Even with a less-expensive medication, such as Prilosec OTC, the savings from eliminating the drug among 30 of 60 patients would result in about $771 a month.

Part of the reason physicians prescribe PPIs so frequently may be defensive, Dr. Rentler said in an interview, because it is seen as preventing GI bleeding with few side effects. He suggested more education is needed for attending physicians about the limited benefit in prescribing PPIs as prophylaxis against gastric ulceration.

The researchers concluded that physicians may want to stop the drug and monitor the patient if it is not clear why a PPI was prescribed.

SAN DIEGO — Physicians and patients now have new tools available for diabetes management.

The American College of Physicians and the ACP Foundation capped off a 3-year diabetes initiative with the release of three new products—a patient care guide to living with diabetes, a team-based practice manual and self-assessment program, and an online portal with diabetes management resources.

The tools were released last month at the annual meeting of the ACP.

The ACP diabetes initiative was funded by a $9.27-million unrestricted grant from Novo Nordisk.

“The purpose of these products is for all of them to work together,” said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

Both the patient and physician materials have similar messages, such as setting attainable goals, she said. One of the aims of providing these tools is to better enable patients to participate in their care, especially in setting goals for their treatment, Dr. Snow said.

At a press briefing, she and other speakers discussed each of the three tools in detail.

▸ The team-based diabetes care guide. The care guide was designed as a resource for all members of a multidisciplinary diabetes care team, including internists, endocrinologists, nurses, physician assistants, and diabetes educators.

The ACP plans to distribute 100,000 copies of the guide for free to members of diabetes care teams. “We want the entire practice team using this manual together,” Dr. Snow said.

The guide helps providers to assign their team roles and get out of their “silos.” In many cases, providers may think they are working in a team, but they are really functioning as individuals, Dr. Snow said.

The guide includes a printed practice manual and a CD-ROM with electronic versions of the tools and multiple-choice questions and critiques.

Among the tools are practical tips for assessing care and implementing quality improvement programs, information on population-based care, and a tutorial on patient registries.

The materials can also be used to earn continuing medical education credits, Dr. Snow said.

▸ The patient guide. This guide is available in English and Spanish and was developed with the input of more than 100 patients with diabetes, health care providers, and health literacy experts, said Dr. Hilary K. Seligman, of the University of California, San Francisco. Dr. Seligman was part of the team that developed the patient guide.

The patient guide focuses on diet, exercise, checking blood sugar, keeping track of medications, and taking insulin.

The full-color booklet includes practical tips about portion sizes and getting active, and features patient quotes about what works for them. Unlike some other patient education materials, the booklet has photos of real diabetes patients in their own homes, Dr. Seligman said.

The patient guide was simultaneously produced in Spanish—not translated into Spanish—and is augmented with different photos of Spanish-speaking patients.

“Our guiding philosophy in creating this guide was that diabetes care takes place in the patient's home,” Dr. Seligman said. “The vast majority of diabetes care is done by the patient on an everyday basis, and not by the physician.”

But although the guide was developed to be patient centered, physicians and other members of the care team shouldn't stop at simply handing out the guide, Dr. Seligman said

The patient guide was designed to be a framework around which the clinical team could teach patients how to create an action plan. The idea is for any member of the care team to be able to teach patients to create an action plan in two to four minutes.

The preliminary results of an evaluation of the patient guide show that of about 225 patients who tested it, about three-fourths were able to make small behavioral changes after 1 month, Dr. Seligman said.

The preliminary data also show that diabetes-related distress decreased and self-efficacy improved with use of the guide. The initial feedback from providers who tested the guide has also been positive, Dr. Seligman said.

▸ The online diabetes portal. The portal, which can be found online at http://diabetes.acponline.org

The site will include evidence-based guidance but was not designed to be a scholarly Web site, Dr. Snow said. “We want this to be a very practical resource.”

The diabetes tools can be ordered online at http://diabetes.acponline.org

SAN DIEGO — Physicians and patients now have new tools available for diabetes management.

The American College of Physicians and the ACP Foundation capped off a 3-year diabetes initiative with the release of three new products—a patient care guide to living with diabetes, a team-based practice manual and self-assessment program, and an online portal with diabetes management resources.

The tools were released last month at the annual meeting of the ACP.

The ACP diabetes initiative was funded by a $9.27-million unrestricted grant from Novo Nordisk.

“The purpose of these products is for all of them to work together,” said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

Both the patient and physician materials have similar messages, such as setting attainable goals, she said. One of the aims of providing these tools is to better enable patients to participate in their care, especially in setting goals for their treatment, Dr. Snow said.

At a press briefing, she and other speakers discussed each of the three tools in detail.

▸ The team-based diabetes care guide. The care guide was designed as a resource for all members of a multidisciplinary diabetes care team, including internists, endocrinologists, nurses, physician assistants, and diabetes educators.

The ACP plans to distribute 100,000 copies of the guide for free to members of diabetes care teams. “We want the entire practice team using this manual together,” Dr. Snow said.

The guide helps providers to assign their team roles and get out of their “silos.” In many cases, providers may think they are working in a team, but they are really functioning as individuals, Dr. Snow said.

The guide includes a printed practice manual and a CD-ROM with electronic versions of the tools and multiple-choice questions and critiques.

Among the tools are practical tips for assessing care and implementing quality improvement programs, information on population-based care, and a tutorial on patient registries.

The materials can also be used to earn continuing medical education credits, Dr. Snow said.

▸ The patient guide. This guide is available in English and Spanish and was developed with the input of more than 100 patients with diabetes, health care providers, and health literacy experts, said Dr. Hilary K. Seligman, of the University of California, San Francisco. Dr. Seligman was part of the team that developed the patient guide.

The patient guide focuses on diet, exercise, checking blood sugar, keeping track of medications, and taking insulin.

The full-color booklet includes practical tips about portion sizes and getting active, and features patient quotes about what works for them. Unlike some other patient education materials, the booklet has photos of real diabetes patients in their own homes, Dr. Seligman said.

The patient guide was simultaneously produced in Spanish—not translated into Spanish—and is augmented with different photos of Spanish-speaking patients.

“Our guiding philosophy in creating this guide was that diabetes care takes place in the patient's home,” Dr. Seligman said. “The vast majority of diabetes care is done by the patient on an everyday basis, and not by the physician.”

But although the guide was developed to be patient centered, physicians and other members of the care team shouldn't stop at simply handing out the guide, Dr. Seligman said

The patient guide was designed to be a framework around which the clinical team could teach patients how to create an action plan. The idea is for any member of the care team to be able to teach patients to create an action plan in two to four minutes.

The preliminary results of an evaluation of the patient guide show that of about 225 patients who tested it, about three-fourths were able to make small behavioral changes after 1 month, Dr. Seligman said.

The preliminary data also show that diabetes-related distress decreased and self-efficacy improved with use of the guide. The initial feedback from providers who tested the guide has also been positive, Dr. Seligman said.

▸ The online diabetes portal. The portal, which can be found online at http://diabetes.acponline.org

The site will include evidence-based guidance but was not designed to be a scholarly Web site, Dr. Snow said. “We want this to be a very practical resource.”

The diabetes tools can be ordered online at http://diabetes.acponline.org

SAN DIEGO — Physicians and patients now have new tools available for diabetes management.

The American College of Physicians and the ACP Foundation capped off a 3-year diabetes initiative with the release of three new products—a patient care guide to living with diabetes, a team-based practice manual and self-assessment program, and an online portal with diabetes management resources.

The tools were released last month at the annual meeting of the ACP.

The ACP diabetes initiative was funded by a $9.27-million unrestricted grant from Novo Nordisk.

“The purpose of these products is for all of them to work together,” said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

Both the patient and physician materials have similar messages, such as setting attainable goals, she said. One of the aims of providing these tools is to better enable patients to participate in their care, especially in setting goals for their treatment, Dr. Snow said.

At a press briefing, she and other speakers discussed each of the three tools in detail.

▸ The team-based diabetes care guide. The care guide was designed as a resource for all members of a multidisciplinary diabetes care team, including internists, endocrinologists, nurses, physician assistants, and diabetes educators.

The ACP plans to distribute 100,000 copies of the guide for free to members of diabetes care teams. “We want the entire practice team using this manual together,” Dr. Snow said.

The guide helps providers to assign their team roles and get out of their “silos.” In many cases, providers may think they are working in a team, but they are really functioning as individuals, Dr. Snow said.

The guide includes a printed practice manual and a CD-ROM with electronic versions of the tools and multiple-choice questions and critiques.

Among the tools are practical tips for assessing care and implementing quality improvement programs, information on population-based care, and a tutorial on patient registries.

The materials can also be used to earn continuing medical education credits, Dr. Snow said.

▸ The patient guide. This guide is available in English and Spanish and was developed with the input of more than 100 patients with diabetes, health care providers, and health literacy experts, said Dr. Hilary K. Seligman, of the University of California, San Francisco. Dr. Seligman was part of the team that developed the patient guide.

The patient guide focuses on diet, exercise, checking blood sugar, keeping track of medications, and taking insulin.

The full-color booklet includes practical tips about portion sizes and getting active, and features patient quotes about what works for them. Unlike some other patient education materials, the booklet has photos of real diabetes patients in their own homes, Dr. Seligman said.

The patient guide was simultaneously produced in Spanish—not translated into Spanish—and is augmented with different photos of Spanish-speaking patients.

“Our guiding philosophy in creating this guide was that diabetes care takes place in the patient's home,” Dr. Seligman said. “The vast majority of diabetes care is done by the patient on an everyday basis, and not by the physician.”

But although the guide was developed to be patient centered, physicians and other members of the care team shouldn't stop at simply handing out the guide, Dr. Seligman said

The patient guide was designed to be a framework around which the clinical team could teach patients how to create an action plan. The idea is for any member of the care team to be able to teach patients to create an action plan in two to four minutes.

The preliminary results of an evaluation of the patient guide show that of about 225 patients who tested it, about three-fourths were able to make small behavioral changes after 1 month, Dr. Seligman said.

The preliminary data also show that diabetes-related distress decreased and self-efficacy improved with use of the guide. The initial feedback from providers who tested the guide has also been positive, Dr. Seligman said.

▸ The online diabetes portal. The portal, which can be found online at http://diabetes.acponline.org

The site will include evidence-based guidance but was not designed to be a scholarly Web site, Dr. Snow said. “We want this to be a very practical resource.”

The diabetes tools can be ordered online at http://diabetes.acponline.org

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering for about 40 hours each year. The researchers estimated that the program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services.

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering for about 40 hours each year. The researchers estimated that the program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services.

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering for about 40 hours each year. The researchers estimated that the program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services.

SAN DIEGO — Nearly two-thirds of internists provide care for patients with limited English proficiency, according to a national survey conducted by the American College of Physicians.

That language barrier can create challenges for patients and physicians, because patients who are not proficient in English tend to have a worse understanding of basic health information, have difficulty asking questions of staff, and may not follow through on treatment recommendations, the survey showed.

ACP officials conducted the survey of 4,000 of its members in fall 2006 and received responses from 2,022 internists.

The results were released at the annual meeting of the ACP in conjunction with the organization's new position paper on language services for patients with limited English proficiency (LEP).

In its position paper, the ACP called for language services to be available to improve health services for patients with LEP, and recommended that Medicare directly reimburse physicians for the added expense of language services and the extra time involved in providing care for patients with LEP. The ACP is also pushing for the establishment of a national clearinghouse to provide translated documents and patient education materials.

“If we're unable to communicate with our patients—either understand what they are telling us or help them to understand how best to take care of themselves—we certainly aren't practicing patient-centered care,” Dr. Lynne Kirk, ACP immediate past president, said at a press briefing.

Internists who care for LEP patients estimated that these patients make up an average of about 12% of their practice. Physicians often devote additional time to their LEP patients, said Dr. William Golden, immediate past chair of the ACP board of regents. For example, 51% of physicians who see LEP patients in their practice said they devote an average of 5–15 minutes of additional time during a visit with an LEP patient. Another 26% report spending an extra 16–30 minutes on average, according to the survey.

“That is time that is sometimes difficult to carve out, and at the same time [is] often unreimbursed,” Dr. Golden said.

Spanish topped the list of most frequently encountered languages, but physicians reported seeing patients who spoke nearly 80 different languages or dialects, from Chinese to German. (See box at left.)

About 52% of respondents said they thought their practices could determine the top three languages spoken by their LEP patients, whereas 48% could not or were uncertain. Many practices do not have processes in place for obtaining information about a patient's primary language, the survey found. About 28% of physicians said their practice recorded the patient's primary language in the medical record, whereas others cited informal monitoring or data provided on check-in or patient registration forms.

About 64% of survey respondents said they provide some type of language services to their LEP patients. Those language services are usually provided by a bilingual health care provider, bilingual staff, or ad hoc interpreters. Of those physicians who reported providing language services, about 64% also provided translated documents or forms to patients.

Practices vary in the cost they assign to providing language services to LEP patients, with estimates ranging from zero to $25,000 annually. Physicians absorb most of the costs, with 75% of respondents saying they received no direct reimbursement, 24% reporting they were uncertain, and 1% reporting direct reimbursement for language services provided.

Providing payment either to physicians or translators for language services could save a significant amount of money, Dr. Golden said, because having adequate language services can help avoid medical errors and unnecessary tests and hospitalizations.

“I truly believe that by more effectively communicating with patients and helping them understand how better to control their illnesses … down the road there will be cost savings,” Dr. Kirk agreed.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

Adequate language services help avoid medical errors, Dr. William Golden said. Calvin Pierce/Elsevier Global Medical News

SAN DIEGO — Nearly two-thirds of internists provide care for patients with limited English proficiency, according to a national survey conducted by the American College of Physicians.

That language barrier can create challenges for patients and physicians, because patients who are not proficient in English tend to have a worse understanding of basic health information, have difficulty asking questions of staff, and may not follow through on treatment recommendations, the survey showed.

ACP officials conducted the survey of 4,000 of its members in fall 2006 and received responses from 2,022 internists.

The results were released at the annual meeting of the ACP in conjunction with the organization's new position paper on language services for patients with limited English proficiency (LEP).

In its position paper, the ACP called for language services to be available to improve health services for patients with LEP, and recommended that Medicare directly reimburse physicians for the added expense of language services and the extra time involved in providing care for patients with LEP. The ACP is also pushing for the establishment of a national clearinghouse to provide translated documents and patient education materials.

“If we're unable to communicate with our patients—either understand what they are telling us or help them to understand how best to take care of themselves—we certainly aren't practicing patient-centered care,” Dr. Lynne Kirk, ACP immediate past president, said at a press briefing.

Internists who care for LEP patients estimated that these patients make up an average of about 12% of their practice. Physicians often devote additional time to their LEP patients, said Dr. William Golden, immediate past chair of the ACP board of regents. For example, 51% of physicians who see LEP patients in their practice said they devote an average of 5–15 minutes of additional time during a visit with an LEP patient. Another 26% report spending an extra 16–30 minutes on average, according to the survey.

“That is time that is sometimes difficult to carve out, and at the same time [is] often unreimbursed,” Dr. Golden said.

Spanish topped the list of most frequently encountered languages, but physicians reported seeing patients who spoke nearly 80 different languages or dialects, from Chinese to German. (See box at left.)

About 52% of respondents said they thought their practices could determine the top three languages spoken by their LEP patients, whereas 48% could not or were uncertain. Many practices do not have processes in place for obtaining information about a patient's primary language, the survey found. About 28% of physicians said their practice recorded the patient's primary language in the medical record, whereas others cited informal monitoring or data provided on check-in or patient registration forms.

About 64% of survey respondents said they provide some type of language services to their LEP patients. Those language services are usually provided by a bilingual health care provider, bilingual staff, or ad hoc interpreters. Of those physicians who reported providing language services, about 64% also provided translated documents or forms to patients.

Practices vary in the cost they assign to providing language services to LEP patients, with estimates ranging from zero to $25,000 annually. Physicians absorb most of the costs, with 75% of respondents saying they received no direct reimbursement, 24% reporting they were uncertain, and 1% reporting direct reimbursement for language services provided.

Providing payment either to physicians or translators for language services could save a significant amount of money, Dr. Golden said, because having adequate language services can help avoid medical errors and unnecessary tests and hospitalizations.

“I truly believe that by more effectively communicating with patients and helping them understand how better to control their illnesses … down the road there will be cost savings,” Dr. Kirk agreed.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

Adequate language services help avoid medical errors, Dr. William Golden said. Calvin Pierce/Elsevier Global Medical News

SAN DIEGO — Nearly two-thirds of internists provide care for patients with limited English proficiency, according to a national survey conducted by the American College of Physicians.

That language barrier can create challenges for patients and physicians, because patients who are not proficient in English tend to have a worse understanding of basic health information, have difficulty asking questions of staff, and may not follow through on treatment recommendations, the survey showed.

ACP officials conducted the survey of 4,000 of its members in fall 2006 and received responses from 2,022 internists.

The results were released at the annual meeting of the ACP in conjunction with the organization's new position paper on language services for patients with limited English proficiency (LEP).

In its position paper, the ACP called for language services to be available to improve health services for patients with LEP, and recommended that Medicare directly reimburse physicians for the added expense of language services and the extra time involved in providing care for patients with LEP. The ACP is also pushing for the establishment of a national clearinghouse to provide translated documents and patient education materials.

“If we're unable to communicate with our patients—either understand what they are telling us or help them to understand how best to take care of themselves—we certainly aren't practicing patient-centered care,” Dr. Lynne Kirk, ACP immediate past president, said at a press briefing.

Internists who care for LEP patients estimated that these patients make up an average of about 12% of their practice. Physicians often devote additional time to their LEP patients, said Dr. William Golden, immediate past chair of the ACP board of regents. For example, 51% of physicians who see LEP patients in their practice said they devote an average of 5–15 minutes of additional time during a visit with an LEP patient. Another 26% report spending an extra 16–30 minutes on average, according to the survey.

“That is time that is sometimes difficult to carve out, and at the same time [is] often unreimbursed,” Dr. Golden said.

Spanish topped the list of most frequently encountered languages, but physicians reported seeing patients who spoke nearly 80 different languages or dialects, from Chinese to German. (See box at left.)

About 52% of respondents said they thought their practices could determine the top three languages spoken by their LEP patients, whereas 48% could not or were uncertain. Many practices do not have processes in place for obtaining information about a patient's primary language, the survey found. About 28% of physicians said their practice recorded the patient's primary language in the medical record, whereas others cited informal monitoring or data provided on check-in or patient registration forms.

About 64% of survey respondents said they provide some type of language services to their LEP patients. Those language services are usually provided by a bilingual health care provider, bilingual staff, or ad hoc interpreters. Of those physicians who reported providing language services, about 64% also provided translated documents or forms to patients.

Practices vary in the cost they assign to providing language services to LEP patients, with estimates ranging from zero to $25,000 annually. Physicians absorb most of the costs, with 75% of respondents saying they received no direct reimbursement, 24% reporting they were uncertain, and 1% reporting direct reimbursement for language services provided.

Providing payment either to physicians or translators for language services could save a significant amount of money, Dr. Golden said, because having adequate language services can help avoid medical errors and unnecessary tests and hospitalizations.

“I truly believe that by more effectively communicating with patients and helping them understand how better to control their illnesses … down the road there will be cost savings,” Dr. Kirk agreed.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

Adequate language services help avoid medical errors, Dr. William Golden said. Calvin Pierce/Elsevier Global Medical News

SAN DIEGO — In the second year of Medicare Part D implementation, physicians continue to struggle with prior authorization requests and other hassles, Dr. Kay M. Mitchell said at the annual meeting of the American College of Physicians.

Although some of the paperwork burden remains, the prescription drug program is generally easier to manage now because patients and physicians are more familiar with the rules, said Dr. Mitchell, a geriatrician and a professor in the department of community internal medicine at the Mayo Clinic in Jacksonville, Fla.

“It's still going to cost us time and money,” Dr. Mitchell said. “It doesn't matter how much we've worked at it.”

For example, physicians continue to see requests for prior authorization and step therapy, said Neil M. Kirschner, Ph.D., ACP's senior associate of insurer and regulatory affairs. In addition, in 2007, several drugs were approved under both Medicare Part B and Part D, which could create denials, he said.

Officials at the Centers for Medicare and Medicaid Services are working on this issue and recommend that physicians write the diagnosis and “Part D” on the prescription, Dr. Kirschner said.

Physicians might experience some relief in terms of prior authorization and exceptions if their patients haven't changed drug plans, Dr. Mitchell said. CMS officials announced that prior authorizations and exceptions approved by a drug plan in 2006 are expected to continue this year if the beneficiary remains in the same plan and the expiration date hasn't occurred by Dec. 31, 2006. However, if the beneficiary changes plans, physicians might have to go through the same process again. And even when patients remain in the same plan, some physicians have still received prior authorization requests, she said.

When you are faced with prior authorization, Dr. Mitchell suggested, save time by having the patient collect the authorization forms and bring them into the office. In her office, this saves office staff 20–35 minutes per prescription, she said.

Some physicians are dealing with the extra Part D paperwork by either hiring additional staff or designating staff to deal solely with Part D prior authorizations, denials, and appeals, Dr. Mitchell said. Some physicians use general office staff while others use nursing staff. Dr. Mitchell said she prefers to have one of her nurses work on Part D issues because she is already familiar with the patients and their medications.

Dr. Mitchell also recommended that staff members who are working on Part D issues attend continuing medical education meetings that focus on Part D.

Dr. Mitchell has also learned that insurers may ask for documentation justifying a switch in medications. To simplify that process, she recommends keeping a sheet in the front of the chart with information on medication changes and the reasons for the switch.

SAN DIEGO — In the second year of Medicare Part D implementation, physicians continue to struggle with prior authorization requests and other hassles, Dr. Kay M. Mitchell said at the annual meeting of the American College of Physicians.

Although some of the paperwork burden remains, the prescription drug program is generally easier to manage now because patients and physicians are more familiar with the rules, said Dr. Mitchell, a geriatrician and a professor in the department of community internal medicine at the Mayo Clinic in Jacksonville, Fla.

“It's still going to cost us time and money,” Dr. Mitchell said. “It doesn't matter how much we've worked at it.”

For example, physicians continue to see requests for prior authorization and step therapy, said Neil M. Kirschner, Ph.D., ACP's senior associate of insurer and regulatory affairs. In addition, in 2007, several drugs were approved under both Medicare Part B and Part D, which could create denials, he said.

Officials at the Centers for Medicare and Medicaid Services are working on this issue and recommend that physicians write the diagnosis and “Part D” on the prescription, Dr. Kirschner said.

Physicians might experience some relief in terms of prior authorization and exceptions if their patients haven't changed drug plans, Dr. Mitchell said. CMS officials announced that prior authorizations and exceptions approved by a drug plan in 2006 are expected to continue this year if the beneficiary remains in the same plan and the expiration date hasn't occurred by Dec. 31, 2006. However, if the beneficiary changes plans, physicians might have to go through the same process again. And even when patients remain in the same plan, some physicians have still received prior authorization requests, she said.

When you are faced with prior authorization, Dr. Mitchell suggested, save time by having the patient collect the authorization forms and bring them into the office. In her office, this saves office staff 20–35 minutes per prescription, she said.

Some physicians are dealing with the extra Part D paperwork by either hiring additional staff or designating staff to deal solely with Part D prior authorizations, denials, and appeals, Dr. Mitchell said. Some physicians use general office staff while others use nursing staff. Dr. Mitchell said she prefers to have one of her nurses work on Part D issues because she is already familiar with the patients and their medications.

Dr. Mitchell also recommended that staff members who are working on Part D issues attend continuing medical education meetings that focus on Part D.

Dr. Mitchell has also learned that insurers may ask for documentation justifying a switch in medications. To simplify that process, she recommends keeping a sheet in the front of the chart with information on medication changes and the reasons for the switch.

SAN DIEGO — In the second year of Medicare Part D implementation, physicians continue to struggle with prior authorization requests and other hassles, Dr. Kay M. Mitchell said at the annual meeting of the American College of Physicians.

Although some of the paperwork burden remains, the prescription drug program is generally easier to manage now because patients and physicians are more familiar with the rules, said Dr. Mitchell, a geriatrician and a professor in the department of community internal medicine at the Mayo Clinic in Jacksonville, Fla.

“It's still going to cost us time and money,” Dr. Mitchell said. “It doesn't matter how much we've worked at it.”

For example, physicians continue to see requests for prior authorization and step therapy, said Neil M. Kirschner, Ph.D., ACP's senior associate of insurer and regulatory affairs. In addition, in 2007, several drugs were approved under both Medicare Part B and Part D, which could create denials, he said.

Officials at the Centers for Medicare and Medicaid Services are working on this issue and recommend that physicians write the diagnosis and “Part D” on the prescription, Dr. Kirschner said.

Physicians might experience some relief in terms of prior authorization and exceptions if their patients haven't changed drug plans, Dr. Mitchell said. CMS officials announced that prior authorizations and exceptions approved by a drug plan in 2006 are expected to continue this year if the beneficiary remains in the same plan and the expiration date hasn't occurred by Dec. 31, 2006. However, if the beneficiary changes plans, physicians might have to go through the same process again. And even when patients remain in the same plan, some physicians have still received prior authorization requests, she said.

When you are faced with prior authorization, Dr. Mitchell suggested, save time by having the patient collect the authorization forms and bring them into the office. In her office, this saves office staff 20–35 minutes per prescription, she said.

Some physicians are dealing with the extra Part D paperwork by either hiring additional staff or designating staff to deal solely with Part D prior authorizations, denials, and appeals, Dr. Mitchell said. Some physicians use general office staff while others use nursing staff. Dr. Mitchell said she prefers to have one of her nurses work on Part D issues because she is already familiar with the patients and their medications.

Dr. Mitchell also recommended that staff members who are working on Part D issues attend continuing medical education meetings that focus on Part D.

Dr. Mitchell has also learned that insurers may ask for documentation justifying a switch in medications. To simplify that process, she recommends keeping a sheet in the front of the chart with information on medication changes and the reasons for the switch.

The clock is ticking for physicians to sign up for a National Provider Identifier, the new 10-digit number that will be used by Medicare, Medicaid, and many private health plans to process claims.

The deadline for registering for an NPI number is May 23. Physicians who are not using an NPI number after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

Most health care plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health care plans have another year to become compliant.

“The NPI is the new standard identifying number for all health care billing transactions, not just for billing Medicare or Medicaid,” said Aaron Hase, a CMS spokesman. As of Jan. 29, more than 1.6 million NPIs had been assigned, according to CMS.

Physicians and other providers can apply for an NPI online or by using a paper application. Hospitals or professional associations can submit applications for several physicians in an electronic file.

A physician who submits a properly completed electronic application could have his or her NPI in 10 days. However, it can take 120 days to do the remaining work to use it, Mr. Hase said.

One thing to be aware of is that you may already have an NPI, because some large employers may have already registered their providers, Mr. Whitman said.

The next question is how widely CMS plans to disseminate the NPIs. CMS officials have said they are considering creating some type of directory of NPIs that could be available to physicians and office staff.

Physicians can apply for an NPI online at https://nppes.cms.hhs.gov

The clock is ticking for physicians to sign up for a National Provider Identifier, the new 10-digit number that will be used by Medicare, Medicaid, and many private health plans to process claims.

The deadline for registering for an NPI number is May 23. Physicians who are not using an NPI number after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

Most health care plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health care plans have another year to become compliant.

“The NPI is the new standard identifying number for all health care billing transactions, not just for billing Medicare or Medicaid,” said Aaron Hase, a CMS spokesman. As of Jan. 29, more than 1.6 million NPIs had been assigned, according to CMS.

Physicians and other providers can apply for an NPI online or by using a paper application. Hospitals or professional associations can submit applications for several physicians in an electronic file.

A physician who submits a properly completed electronic application could have his or her NPI in 10 days. However, it can take 120 days to do the remaining work to use it, Mr. Hase said.

One thing to be aware of is that you may already have an NPI, because some large employers may have already registered their providers, Mr. Whitman said.

The next question is how widely CMS plans to disseminate the NPIs. CMS officials have said they are considering creating some type of directory of NPIs that could be available to physicians and office staff.

Physicians can apply for an NPI online at https://nppes.cms.hhs.gov

The clock is ticking for physicians to sign up for a National Provider Identifier, the new 10-digit number that will be used by Medicare, Medicaid, and many private health plans to process claims.

The deadline for registering for an NPI number is May 23. Physicians who are not using an NPI number after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

Most health care plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health care plans have another year to become compliant.

“The NPI is the new standard identifying number for all health care billing transactions, not just for billing Medicare or Medicaid,” said Aaron Hase, a CMS spokesman. As of Jan. 29, more than 1.6 million NPIs had been assigned, according to CMS.

Physicians and other providers can apply for an NPI online or by using a paper application. Hospitals or professional associations can submit applications for several physicians in an electronic file.

A physician who submits a properly completed electronic application could have his or her NPI in 10 days. However, it can take 120 days to do the remaining work to use it, Mr. Hase said.

One thing to be aware of is that you may already have an NPI, because some large employers may have already registered their providers, Mr. Whitman said.

The next question is how widely CMS plans to disseminate the NPIs. CMS officials have said they are considering creating some type of directory of NPIs that could be available to physicians and office staff.

Physicians can apply for an NPI online at https://nppes.cms.hhs.gov

SAN DIEGO — Physicians and patients now have new tools available for diabetes management.

The American College of Physicians and the ACP Foundation capped off a 3-year diabetes initiative with the release of three new products—a patient care guide to living with diabetes, a team-based practice manual and self-assessment program, and an online portal with diabetes management resources. The tools were released last month at the annual meeting of the ACP.

The ACP diabetes initiative was funded by a $9.27-million unrestricted grant from Novo Nordisk.

“The purpose of these products is for all of them to work together,” said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

Both the patient and physician materials have similar messages, such as setting attainable goals, she said. One of the aims of providing these tools is to better enable patients to participate in their care, especially in setting goals for their treatment, Dr. Snow said.

At a press briefing, she and other speakers discussed each of these three tools in detail.

▸ The team-based diabetes care guide. The care guide was designed as a resource for all members of a multidisciplinary diabetes care team, including internists, endocrinologists, nurses, physician assistants, and diabetes educators. The ACP plans to distribute 100,000 copies of the guide for free to members of diabetes care teams. “We want the entire practice team using this manual together,” Dr. Snow said.

The guide helps providers to assign their team roles and get out of their “silos.” In many cases, providers may think they are working in a team, but they are really functioning as individuals, Dr. Snow said.

The guide includes a printed practice manual and a CD-ROM with electronic versions of the tools and multiple-choice questions and critiques. Among the tools are practical tips for assessing care and implementing quality improvement programs, information on population-based care, and a tutorial on patient registries. The materials can also be used to earn continuing medical education credits, Dr. Snow said.

▸ The patient guide. This guide is available in English and Spanish and was developed with the input of more than 100 patients with diabetes, health care providers, and health literacy experts, said Dr. Hilary K. Seligman, of the University of California, San Francisco. Dr. Seligman was part of the team that developed the patient guide.

The patient guide focuses on diet, exercise, checking blood sugar, keeping track of medications, and taking insulin. The full-color booklet includes practical tips about portion sizes and getting active, and features patient quotes about what works for them. Unlike some other patient education materials, the booklet has photos of real diabetes patients in their own homes, Dr. Seligman said.

The patient guide was simultaneously produced in Spanish—not translated into Spanish—and is augmented with different photos of Spanish-speaking patients.

“Our guiding philosophy in creating this guide was that diabetes care takes place in the patient's home,” Dr. Seligman said. “The vast majority of diabetes care is done by the patient on an everyday basis, and not by the physician.”

But although the guide was developed to be patient centered, physicians and other members of the care team shouldn't stop at simply handing out the guide, Dr. Seligman said. The patient guide was designed to be a framework around which the clinical team could teach patients how to create an action plan. The idea is for any member of the care team to be able to teach patients to create an action plan in 2–4 minutes.

The preliminary results of an evaluation of the patient guide show that of about 225 patients who tested it, about three-fourths were able to make small behavioral changes after 1 month, Dr. Seligman said. The preliminary data also show that diabetes-related distress decreased and self-efficacy improved with use of the guide. The initial feedback from providers who tested the guide has also been positive, Dr. Seligman said.

▸ The online diabetes portal. The portal, which can be found online at http://diabetes.acponline.org

The diabetes tools can be ordered online at http://diabetes.acponline.org

The purpose of the three new diabetes management tools is for all of them to work together. DR. SNOW

SAN DIEGO — Physicians and patients now have new tools available for diabetes management.

The American College of Physicians and the ACP Foundation capped off a 3-year diabetes initiative with the release of three new products—a patient care guide to living with diabetes, a team-based practice manual and self-assessment program, and an online portal with diabetes management resources. The tools were released last month at the annual meeting of the ACP.

The ACP diabetes initiative was funded by a $9.27-million unrestricted grant from Novo Nordisk.

“The purpose of these products is for all of them to work together,” said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

Both the patient and physician materials have similar messages, such as setting attainable goals, she said. One of the aims of providing these tools is to better enable patients to participate in their care, especially in setting goals for their treatment, Dr. Snow said.

At a press briefing, she and other speakers discussed each of these three tools in detail.

▸ The team-based diabetes care guide. The care guide was designed as a resource for all members of a multidisciplinary diabetes care team, including internists, endocrinologists, nurses, physician assistants, and diabetes educators. The ACP plans to distribute 100,000 copies of the guide for free to members of diabetes care teams. “We want the entire practice team using this manual together,” Dr. Snow said.

The guide helps providers to assign their team roles and get out of their “silos.” In many cases, providers may think they are working in a team, but they are really functioning as individuals, Dr. Snow said.

The guide includes a printed practice manual and a CD-ROM with electronic versions of the tools and multiple-choice questions and critiques. Among the tools are practical tips for assessing care and implementing quality improvement programs, information on population-based care, and a tutorial on patient registries. The materials can also be used to earn continuing medical education credits, Dr. Snow said.

▸ The patient guide. This guide is available in English and Spanish and was developed with the input of more than 100 patients with diabetes, health care providers, and health literacy experts, said Dr. Hilary K. Seligman, of the University of California, San Francisco. Dr. Seligman was part of the team that developed the patient guide.

The patient guide focuses on diet, exercise, checking blood sugar, keeping track of medications, and taking insulin. The full-color booklet includes practical tips about portion sizes and getting active, and features patient quotes about what works for them. Unlike some other patient education materials, the booklet has photos of real diabetes patients in their own homes, Dr. Seligman said.

The patient guide was simultaneously produced in Spanish—not translated into Spanish—and is augmented with different photos of Spanish-speaking patients.

“Our guiding philosophy in creating this guide was that diabetes care takes place in the patient's home,” Dr. Seligman said. “The vast majority of diabetes care is done by the patient on an everyday basis, and not by the physician.”

But although the guide was developed to be patient centered, physicians and other members of the care team shouldn't stop at simply handing out the guide, Dr. Seligman said. The patient guide was designed to be a framework around which the clinical team could teach patients how to create an action plan. The idea is for any member of the care team to be able to teach patients to create an action plan in 2–4 minutes.

The preliminary results of an evaluation of the patient guide show that of about 225 patients who tested it, about three-fourths were able to make small behavioral changes after 1 month, Dr. Seligman said. The preliminary data also show that diabetes-related distress decreased and self-efficacy improved with use of the guide. The initial feedback from providers who tested the guide has also been positive, Dr. Seligman said.

▸ The online diabetes portal. The portal, which can be found online at http://diabetes.acponline.org

The diabetes tools can be ordered online at http://diabetes.acponline.org

The purpose of the three new diabetes management tools is for all of them to work together. DR. SNOW

SAN DIEGO — Physicians and patients now have new tools available for diabetes management.

The American College of Physicians and the ACP Foundation capped off a 3-year diabetes initiative with the release of three new products—a patient care guide to living with diabetes, a team-based practice manual and self-assessment program, and an online portal with diabetes management resources. The tools were released last month at the annual meeting of the ACP.

The ACP diabetes initiative was funded by a $9.27-million unrestricted grant from Novo Nordisk.

“The purpose of these products is for all of them to work together,” said Dr. Vincenza Snow, director of clinical programs and quality of care at ACP.

Both the patient and physician materials have similar messages, such as setting attainable goals, she said. One of the aims of providing these tools is to better enable patients to participate in their care, especially in setting goals for their treatment, Dr. Snow said.

At a press briefing, she and other speakers discussed each of these three tools in detail.

▸ The team-based diabetes care guide. The care guide was designed as a resource for all members of a multidisciplinary diabetes care team, including internists, endocrinologists, nurses, physician assistants, and diabetes educators. The ACP plans to distribute 100,000 copies of the guide for free to members of diabetes care teams. “We want the entire practice team using this manual together,” Dr. Snow said.

The guide helps providers to assign their team roles and get out of their “silos.” In many cases, providers may think they are working in a team, but they are really functioning as individuals, Dr. Snow said.

The guide includes a printed practice manual and a CD-ROM with electronic versions of the tools and multiple-choice questions and critiques. Among the tools are practical tips for assessing care and implementing quality improvement programs, information on population-based care, and a tutorial on patient registries. The materials can also be used to earn continuing medical education credits, Dr. Snow said.

▸ The patient guide. This guide is available in English and Spanish and was developed with the input of more than 100 patients with diabetes, health care providers, and health literacy experts, said Dr. Hilary K. Seligman, of the University of California, San Francisco. Dr. Seligman was part of the team that developed the patient guide.

The patient guide focuses on diet, exercise, checking blood sugar, keeping track of medications, and taking insulin. The full-color booklet includes practical tips about portion sizes and getting active, and features patient quotes about what works for them. Unlike some other patient education materials, the booklet has photos of real diabetes patients in their own homes, Dr. Seligman said.

The patient guide was simultaneously produced in Spanish—not translated into Spanish—and is augmented with different photos of Spanish-speaking patients.

“Our guiding philosophy in creating this guide was that diabetes care takes place in the patient's home,” Dr. Seligman said. “The vast majority of diabetes care is done by the patient on an everyday basis, and not by the physician.”

But although the guide was developed to be patient centered, physicians and other members of the care team shouldn't stop at simply handing out the guide, Dr. Seligman said. The patient guide was designed to be a framework around which the clinical team could teach patients how to create an action plan. The idea is for any member of the care team to be able to teach patients to create an action plan in 2–4 minutes.

The preliminary results of an evaluation of the patient guide show that of about 225 patients who tested it, about three-fourths were able to make small behavioral changes after 1 month, Dr. Seligman said. The preliminary data also show that diabetes-related distress decreased and self-efficacy improved with use of the guide. The initial feedback from providers who tested the guide has also been positive, Dr. Seligman said.

▸ The online diabetes portal. The portal, which can be found online at http://diabetes.acponline.org

The diabetes tools can be ordered online at http://diabetes.acponline.org

The purpose of the three new diabetes management tools is for all of them to work together. DR. SNOW

U.S. Family-Planning Director Resigns

Dr. Eric Keroack, who was appointed as director of the Office of Population Affairs at the Department of Health and Human Services in November 2006, recently quit his post after action was taken against him by the Massachusetts Office of Medicaid. In a statement issued on March 29, Dr. John O. Agwunobi, Health and Human Services assistant secretary for health, said he accepted Dr. Keroack's resignation as a result of the action but did not provide further details. Dr. Keroack, who oversaw the Title X family-planning program, was widely regarded by abortion rights advocates as being against birth control and sex education. In the aftermath of his resignation, abortion rights advocates called on the Bush administration to replace him with someone who understands the benefits of access to birth control and family-planning services.

Court Upholds Abortion Procedure Ban

The U.S. Supreme Court last month narrowly upheld the controversial ban on so-called partial-birth abortions, marking the first time the court has forbidden a specific abortion procedure. The 5-4 decision said that the Partial Birth Abortion Ban Act, approved by Congress in 2003, does not violate a woman's constitutional right to an abortion, even though it does not contain an exception to protect the health of the mother. “The law need not give abortion doctors unfettered choice in the course of their medical practice,” Justice Anthony Kennedy wrote for the majority. In separate statements, National Right to Life applauded the ruling, while Planned Parenthood Federation of America noted that with the decision the high court took away an important option for physicians. The American College of Obstetricians and Gynecologists had filed an amicus brief supporting those challenging the law.

FDA Under Fire From Right on Plan B

Food and Drug Administration officials once again have been accused of playing politics over the issue of emergency contraception. This time, it's not women's health advocates who are doing the complaining, but the conservative-leaning public interest group Judicial Watch. The organization filed a lawsuit last month against the FDA, seeking access to any communications between agency officials and Sen. Hillary Rodham Clinton (D-N.Y.) related to Plan B. In a court filing, Judicial Watch stated that it sent a Freedom of Information Act request to the FDA seeking those records in August 2006, and receipt of the request was acknowledged a few days later. However, as of March 2007, the FDA had failed to produce the records. The group is asking the court to compel the FDA to produce the correspondence records. Judicial Watch sought the records last summer after Sen. Clinton threatened to block the nomination of Dr. Andrew von Eschenbach as FDA administrator. The group pointed out that in the same month Sen. Clinton threatened to hold up the nomination, the FDA approved the sale of Plan B without a prescription for women aged 18 years and older. “The FDA's decision to approve Plan B seemed more about politics than science especially given the role of Hillary Clinton in the process,” Judicial Watch President Tom Fitton said in a statement.

Planned Parenthood Rates Pharmacies

Planned Parenthood Federation of America Inc. recently rated the large national pharmacy chains on their policies for stocking and distributing emergency contraception. The group gave nine pharmacies a “thumbs-up,” indicating those chains that had a 100% record on stocking emergency contraception and ensuring patients' access without discrimination or delay. Among those chains getting a thumbs-up is Wal-Mart Stores Inc., which only last year began stocking emergency contraception at all its pharmacies. However, Wal-Mart continues to keep in place its conscientious objection policy, which allows a pharmacist who is uncomfortable dispensing emergency contraception to find another employee to complete the sale. The ratings are based on surveys returned to Planned Parenthood by the top 50 national pharmacy chains. Planned Parenthood gave two pharmacy chains—Target Corp. and Winn Dixie Stores Inc.—a “thumbs-down” for their policies, indicating either that these chains refused to define their policies or that their policies failed to provide patients in-store access without discrimination or delay.

Penalized by High-Deductible Plans

High-deductible health insurance plans discriminate against women by leaving them with far higher out-of-pocket health bills than men have, according to a study from Harvard Medical School, Boston. “Even common, mild problems like arthritis and high blood pressure make you a loser in a high-deductible plan,” said Dr. David Himmelstein, study coauthor and an advocate of a single-payer system.

U.S. Family-Planning Director Resigns

Dr. Eric Keroack, who was appointed as director of the Office of Population Affairs at the Department of Health and Human Services in November 2006, recently quit his post after action was taken against him by the Massachusetts Office of Medicaid. In a statement issued on March 29, Dr. John O. Agwunobi, Health and Human Services assistant secretary for health, said he accepted Dr. Keroack's resignation as a result of the action but did not provide further details. Dr. Keroack, who oversaw the Title X family-planning program, was widely regarded by abortion rights advocates as being against birth control and sex education. In the aftermath of his resignation, abortion rights advocates called on the Bush administration to replace him with someone who understands the benefits of access to birth control and family-planning services.

Court Upholds Abortion Procedure Ban

The U.S. Supreme Court last month narrowly upheld the controversial ban on so-called partial-birth abortions, marking the first time the court has forbidden a specific abortion procedure. The 5-4 decision said that the Partial Birth Abortion Ban Act, approved by Congress in 2003, does not violate a woman's constitutional right to an abortion, even though it does not contain an exception to protect the health of the mother. “The law need not give abortion doctors unfettered choice in the course of their medical practice,” Justice Anthony Kennedy wrote for the majority. In separate statements, National Right to Life applauded the ruling, while Planned Parenthood Federation of America noted that with the decision the high court took away an important option for physicians. The American College of Obstetricians and Gynecologists had filed an amicus brief supporting those challenging the law.

FDA Under Fire From Right on Plan B

Food and Drug Administration officials once again have been accused of playing politics over the issue of emergency contraception. This time, it's not women's health advocates who are doing the complaining, but the conservative-leaning public interest group Judicial Watch. The organization filed a lawsuit last month against the FDA, seeking access to any communications between agency officials and Sen. Hillary Rodham Clinton (D-N.Y.) related to Plan B. In a court filing, Judicial Watch stated that it sent a Freedom of Information Act request to the FDA seeking those records in August 2006, and receipt of the request was acknowledged a few days later. However, as of March 2007, the FDA had failed to produce the records. The group is asking the court to compel the FDA to produce the correspondence records. Judicial Watch sought the records last summer after Sen. Clinton threatened to block the nomination of Dr. Andrew von Eschenbach as FDA administrator. The group pointed out that in the same month Sen. Clinton threatened to hold up the nomination, the FDA approved the sale of Plan B without a prescription for women aged 18 years and older. “The FDA's decision to approve Plan B seemed more about politics than science especially given the role of Hillary Clinton in the process,” Judicial Watch President Tom Fitton said in a statement.

Planned Parenthood Rates Pharmacies

Planned Parenthood Federation of America Inc. recently rated the large national pharmacy chains on their policies for stocking and distributing emergency contraception. The group gave nine pharmacies a “thumbs-up,” indicating those chains that had a 100% record on stocking emergency contraception and ensuring patients' access without discrimination or delay. Among those chains getting a thumbs-up is Wal-Mart Stores Inc., which only last year began stocking emergency contraception at all its pharmacies. However, Wal-Mart continues to keep in place its conscientious objection policy, which allows a pharmacist who is uncomfortable dispensing emergency contraception to find another employee to complete the sale. The ratings are based on surveys returned to Planned Parenthood by the top 50 national pharmacy chains. Planned Parenthood gave two pharmacy chains—Target Corp. and Winn Dixie Stores Inc.—a “thumbs-down” for their policies, indicating either that these chains refused to define their policies or that their policies failed to provide patients in-store access without discrimination or delay.

Penalized by High-Deductible Plans

High-deductible health insurance plans discriminate against women by leaving them with far higher out-of-pocket health bills than men have, according to a study from Harvard Medical School, Boston. “Even common, mild problems like arthritis and high blood pressure make you a loser in a high-deductible plan,” said Dr. David Himmelstein, study coauthor and an advocate of a single-payer system.

U.S. Family-Planning Director Resigns

Dr. Eric Keroack, who was appointed as director of the Office of Population Affairs at the Department of Health and Human Services in November 2006, recently quit his post after action was taken against him by the Massachusetts Office of Medicaid. In a statement issued on March 29, Dr. John O. Agwunobi, Health and Human Services assistant secretary for health, said he accepted Dr. Keroack's resignation as a result of the action but did not provide further details. Dr. Keroack, who oversaw the Title X family-planning program, was widely regarded by abortion rights advocates as being against birth control and sex education. In the aftermath of his resignation, abortion rights advocates called on the Bush administration to replace him with someone who understands the benefits of access to birth control and family-planning services.

Court Upholds Abortion Procedure Ban

The U.S. Supreme Court last month narrowly upheld the controversial ban on so-called partial-birth abortions, marking the first time the court has forbidden a specific abortion procedure. The 5-4 decision said that the Partial Birth Abortion Ban Act, approved by Congress in 2003, does not violate a woman's constitutional right to an abortion, even though it does not contain an exception to protect the health of the mother. “The law need not give abortion doctors unfettered choice in the course of their medical practice,” Justice Anthony Kennedy wrote for the majority. In separate statements, National Right to Life applauded the ruling, while Planned Parenthood Federation of America noted that with the decision the high court took away an important option for physicians. The American College of Obstetricians and Gynecologists had filed an amicus brief supporting those challenging the law.

FDA Under Fire From Right on Plan B

Food and Drug Administration officials once again have been accused of playing politics over the issue of emergency contraception. This time, it's not women's health advocates who are doing the complaining, but the conservative-leaning public interest group Judicial Watch. The organization filed a lawsuit last month against the FDA, seeking access to any communications between agency officials and Sen. Hillary Rodham Clinton (D-N.Y.) related to Plan B. In a court filing, Judicial Watch stated that it sent a Freedom of Information Act request to the FDA seeking those records in August 2006, and receipt of the request was acknowledged a few days later. However, as of March 2007, the FDA had failed to produce the records. The group is asking the court to compel the FDA to produce the correspondence records. Judicial Watch sought the records last summer after Sen. Clinton threatened to block the nomination of Dr. Andrew von Eschenbach as FDA administrator. The group pointed out that in the same month Sen. Clinton threatened to hold up the nomination, the FDA approved the sale of Plan B without a prescription for women aged 18 years and older. “The FDA's decision to approve Plan B seemed more about politics than science especially given the role of Hillary Clinton in the process,” Judicial Watch President Tom Fitton said in a statement.

Planned Parenthood Rates Pharmacies

Planned Parenthood Federation of America Inc. recently rated the large national pharmacy chains on their policies for stocking and distributing emergency contraception. The group gave nine pharmacies a “thumbs-up,” indicating those chains that had a 100% record on stocking emergency contraception and ensuring patients' access without discrimination or delay. Among those chains getting a thumbs-up is Wal-Mart Stores Inc., which only last year began stocking emergency contraception at all its pharmacies. However, Wal-Mart continues to keep in place its conscientious objection policy, which allows a pharmacist who is uncomfortable dispensing emergency contraception to find another employee to complete the sale. The ratings are based on surveys returned to Planned Parenthood by the top 50 national pharmacy chains. Planned Parenthood gave two pharmacy chains—Target Corp. and Winn Dixie Stores Inc.—a “thumbs-down” for their policies, indicating either that these chains refused to define their policies or that their policies failed to provide patients in-store access without discrimination or delay.

Penalized by High-Deductible Plans

High-deductible health insurance plans discriminate against women by leaving them with far higher out-of-pocket health bills than men have, according to a study from Harvard Medical School, Boston. “Even common, mild problems like arthritis and high blood pressure make you a loser in a high-deductible plan,” said Dr. David Himmelstein, study coauthor and an advocate of a single-payer system.

House Passes Stroke Legislation

Legislation to increase awareness of the warning signs of stroke recently passed the House of Representatives. The Stroke Treatment and Ongoing Prevention Act of 2007 (H.R. 477) was introduced by Rep. Lois Capps (D-Calif.) and Rep. Chip Pickering (R-Miss.) and would establish grants for residency training materials and continuing education materials. Similar but broader stroke legislation (S. 999) was introduced in March by Sen. Thad Cochran (R-Miss.) and Sen. Edward Kennedy (D-Mass.) and includes grants to develop stroke care systems. “This bill represents a national commitment to end the suffering from stroke,” Sen. Kennedy said in a statement.

Pain Treatment Centers Recognized

The American Pain Society highlighted the accomplishments of six multidisciplinary pain programs around the country as part of its first Clinical Centers of Excellence in Pain Management Awards. Recipients were chosen from 90 applicants and were judged by pain experts. Awardees focused on improving overall functionality and quality of life, according to the APS. The programs included the Comprehensive Pain Treatment Center at New York University Medical Center, New York; the Rosomoff Comprehensive Pain Center in Miami; the Pain Management Center at Brigham and Women's Hospital in Boston; the Pain Management Center and PainCARE at the University of California, San Francisco; the Cincinnati Children's Hospital Medical Center; and the Chronic Pain Rehabilitation Program at the James A. Haley Veterans Affairs Hospital in Tampa.

Traumatic Brain Injury Screening

In an effort to improve the diagnosis and treatment of traumatic brain injury in returning soldiers, Sen. Hillary Clinton (D-N.Y.) and Sen. Susan Collins (R-Maine) have introduced new federal legislation. The “Heroes at Home Act of 2007” (S. 1065) calls on the Secretary of Defense to establish a protocol for neurocognitive assessments of all members of the armed forces before and after deployment to Iraq and Afghanistan. Traumatic brain injury affects 1 in 10 soldiers and is considered a “signature wound” of soldiers deployed in those theaters, according to Sen. Clinton. The legislation would establish a program through the Department of Veterans Affairs to train family members of veterans with traumatic brain injury to be caregivers. It also would create a pilot project to test telehealth technology's use in assessing cognitive functioning. The legislation was drafted in consultation with the American Academy of Neurology and has been endorsed by the Brain Injury Association of America.

Medicare Funding Woes

The first-ever “Medicare funding warning” was issued by the program's trustees in their annual report, requiring the President to propose funding reforms within 15 days of submission of the fiscal 2008 budget and Congress to address the proposal on an “expedited basis.” The warning—mandated by the Medicare Modernization Act of 2003—was triggered by the fact that for the second year in a row, over 45% of next year's projected Medicare outlays will come from general government revenues. The trustees noted that higher tax revenues and lower projected benefit payouts have extended by 1 year the date that the Part A will be exhausted, but added that the impending retirement of 78 million baby boomers will deplete the Medicare trust fund by 2019 unless lawmakers enact major changes. Medicare Part B and Part D both are projected to remain funded because current law automatically provides financing to meet next year's costs. But expected cost increases will raise financing needs from general revenue and substantial increases in beneficiaries' premiums, the trustees' report said. The report highlights the need for a long-term fiscal plan for Medicare, said American Medical Association Board Chair Cecil Wilson in a statement. “Arbitrary, drastic payment cuts to the physicians who are the foundation of Medicare are not the answer,” Dr. Wilson said, adding lawmakers should act to stop next year's 10% Medicare physician payment cut to protect seniors' access to care.

AARP to Offer Health Insurance

Senior advocacy group AARP said that it will add a Medicare Advantage plan run by UnitedHealth Group to its offerings next year, along with several other products from Aetna Inc. aimed at adults aged 50–64 years. Medicare Advantage, to be launched Jan. 1 is expected to enroll 1 million Medicare beneficiaries initially, AARP officials said. In addition AARP's agreement with UnitedHealth includes Medicare Supplemental insurance, Part D plans, and indemnity insurance products. AARP said that it will dedicate $500 million of its royalty payments from the two insurers over the next 10 years to fund a program to help Americans find health information and assistance.

Jurors Often Side with Doctors

Contrary to popular belief, juries in malpractice cases usually sympathize more with physicians than patients, according to a law professor who reviewed studies involving malpractice cases from 1989 to 2006. University of Missouri, Columbia, School of Law professor Philip Peters found that plaintiffs rarely win weak cases, although they have more success in “toss-up” cases and better outcomes in cases with strong evidence of medical negligence. Peters, whose study appeared in the Michigan Law Review, said several factors favor medical defendants, including superior resources, physicians' social standing, social norms against “profiting” by injury, and willingness to give physicians the benefit of the doubt when evidence conflicts.

House Passes Stroke Legislation

Legislation to increase awareness of the warning signs of stroke recently passed the House of Representatives. The Stroke Treatment and Ongoing Prevention Act of 2007 (H.R. 477) was introduced by Rep. Lois Capps (D-Calif.) and Rep. Chip Pickering (R-Miss.) and would establish grants for residency training materials and continuing education materials. Similar but broader stroke legislation (S. 999) was introduced in March by Sen. Thad Cochran (R-Miss.) and Sen. Edward Kennedy (D-Mass.) and includes grants to develop stroke care systems. “This bill represents a national commitment to end the suffering from stroke,” Sen. Kennedy said in a statement.

Pain Treatment Centers Recognized

The American Pain Society highlighted the accomplishments of six multidisciplinary pain programs around the country as part of its first Clinical Centers of Excellence in Pain Management Awards. Recipients were chosen from 90 applicants and were judged by pain experts. Awardees focused on improving overall functionality and quality of life, according to the APS. The programs included the Comprehensive Pain Treatment Center at New York University Medical Center, New York; the Rosomoff Comprehensive Pain Center in Miami; the Pain Management Center at Brigham and Women's Hospital in Boston; the Pain Management Center and PainCARE at the University of California, San Francisco; the Cincinnati Children's Hospital Medical Center; and the Chronic Pain Rehabilitation Program at the James A. Haley Veterans Affairs Hospital in Tampa.

Traumatic Brain Injury Screening

In an effort to improve the diagnosis and treatment of traumatic brain injury in returning soldiers, Sen. Hillary Clinton (D-N.Y.) and Sen. Susan Collins (R-Maine) have introduced new federal legislation. The “Heroes at Home Act of 2007” (S. 1065) calls on the Secretary of Defense to establish a protocol for neurocognitive assessments of all members of the armed forces before and after deployment to Iraq and Afghanistan. Traumatic brain injury affects 1 in 10 soldiers and is considered a “signature wound” of soldiers deployed in those theaters, according to Sen. Clinton. The legislation would establish a program through the Department of Veterans Affairs to train family members of veterans with traumatic brain injury to be caregivers. It also would create a pilot project to test telehealth technology's use in assessing cognitive functioning. The legislation was drafted in consultation with the American Academy of Neurology and has been endorsed by the Brain Injury Association of America.

Medicare Funding Woes

The first-ever “Medicare funding warning” was issued by the program's trustees in their annual report, requiring the President to propose funding reforms within 15 days of submission of the fiscal 2008 budget and Congress to address the proposal on an “expedited basis.” The warning—mandated by the Medicare Modernization Act of 2003—was triggered by the fact that for the second year in a row, over 45% of next year's projected Medicare outlays will come from general government revenues. The trustees noted that higher tax revenues and lower projected benefit payouts have extended by 1 year the date that the Part A will be exhausted, but added that the impending retirement of 78 million baby boomers will deplete the Medicare trust fund by 2019 unless lawmakers enact major changes. Medicare Part B and Part D both are projected to remain funded because current law automatically provides financing to meet next year's costs. But expected cost increases will raise financing needs from general revenue and substantial increases in beneficiaries' premiums, the trustees' report said. The report highlights the need for a long-term fiscal plan for Medicare, said American Medical Association Board Chair Cecil Wilson in a statement. “Arbitrary, drastic payment cuts to the physicians who are the foundation of Medicare are not the answer,” Dr. Wilson said, adding lawmakers should act to stop next year's 10% Medicare physician payment cut to protect seniors' access to care.

AARP to Offer Health Insurance

Senior advocacy group AARP said that it will add a Medicare Advantage plan run by UnitedHealth Group to its offerings next year, along with several other products from Aetna Inc. aimed at adults aged 50–64 years. Medicare Advantage, to be launched Jan. 1 is expected to enroll 1 million Medicare beneficiaries initially, AARP officials said. In addition AARP's agreement with UnitedHealth includes Medicare Supplemental insurance, Part D plans, and indemnity insurance products. AARP said that it will dedicate $500 million of its royalty payments from the two insurers over the next 10 years to fund a program to help Americans find health information and assistance.

Jurors Often Side with Doctors

Contrary to popular belief, juries in malpractice cases usually sympathize more with physicians than patients, according to a law professor who reviewed studies involving malpractice cases from 1989 to 2006. University of Missouri, Columbia, School of Law professor Philip Peters found that plaintiffs rarely win weak cases, although they have more success in “toss-up” cases and better outcomes in cases with strong evidence of medical negligence. Peters, whose study appeared in the Michigan Law Review, said several factors favor medical defendants, including superior resources, physicians' social standing, social norms against “profiting” by injury, and willingness to give physicians the benefit of the doubt when evidence conflicts.

House Passes Stroke Legislation

Legislation to increase awareness of the warning signs of stroke recently passed the House of Representatives. The Stroke Treatment and Ongoing Prevention Act of 2007 (H.R. 477) was introduced by Rep. Lois Capps (D-Calif.) and Rep. Chip Pickering (R-Miss.) and would establish grants for residency training materials and continuing education materials. Similar but broader stroke legislation (S. 999) was introduced in March by Sen. Thad Cochran (R-Miss.) and Sen. Edward Kennedy (D-Mass.) and includes grants to develop stroke care systems. “This bill represents a national commitment to end the suffering from stroke,” Sen. Kennedy said in a statement.

Pain Treatment Centers Recognized

The American Pain Society highlighted the accomplishments of six multidisciplinary pain programs around the country as part of its first Clinical Centers of Excellence in Pain Management Awards. Recipients were chosen from 90 applicants and were judged by pain experts. Awardees focused on improving overall functionality and quality of life, according to the APS. The programs included the Comprehensive Pain Treatment Center at New York University Medical Center, New York; the Rosomoff Comprehensive Pain Center in Miami; the Pain Management Center at Brigham and Women's Hospital in Boston; the Pain Management Center and PainCARE at the University of California, San Francisco; the Cincinnati Children's Hospital Medical Center; and the Chronic Pain Rehabilitation Program at the James A. Haley Veterans Affairs Hospital in Tampa.

Traumatic Brain Injury Screening

In an effort to improve the diagnosis and treatment of traumatic brain injury in returning soldiers, Sen. Hillary Clinton (D-N.Y.) and Sen. Susan Collins (R-Maine) have introduced new federal legislation. The “Heroes at Home Act of 2007” (S. 1065) calls on the Secretary of Defense to establish a protocol for neurocognitive assessments of all members of the armed forces before and after deployment to Iraq and Afghanistan. Traumatic brain injury affects 1 in 10 soldiers and is considered a “signature wound” of soldiers deployed in those theaters, according to Sen. Clinton. The legislation would establish a program through the Department of Veterans Affairs to train family members of veterans with traumatic brain injury to be caregivers. It also would create a pilot project to test telehealth technology's use in assessing cognitive functioning. The legislation was drafted in consultation with the American Academy of Neurology and has been endorsed by the Brain Injury Association of America.

Medicare Funding Woes

The first-ever “Medicare funding warning” was issued by the program's trustees in their annual report, requiring the President to propose funding reforms within 15 days of submission of the fiscal 2008 budget and Congress to address the proposal on an “expedited basis.” The warning—mandated by the Medicare Modernization Act of 2003—was triggered by the fact that for the second year in a row, over 45% of next year's projected Medicare outlays will come from general government revenues. The trustees noted that higher tax revenues and lower projected benefit payouts have extended by 1 year the date that the Part A will be exhausted, but added that the impending retirement of 78 million baby boomers will deplete the Medicare trust fund by 2019 unless lawmakers enact major changes. Medicare Part B and Part D both are projected to remain funded because current law automatically provides financing to meet next year's costs. But expected cost increases will raise financing needs from general revenue and substantial increases in beneficiaries' premiums, the trustees' report said. The report highlights the need for a long-term fiscal plan for Medicare, said American Medical Association Board Chair Cecil Wilson in a statement. “Arbitrary, drastic payment cuts to the physicians who are the foundation of Medicare are not the answer,” Dr. Wilson said, adding lawmakers should act to stop next year's 10% Medicare physician payment cut to protect seniors' access to care.

AARP to Offer Health Insurance

Senior advocacy group AARP said that it will add a Medicare Advantage plan run by UnitedHealth Group to its offerings next year, along with several other products from Aetna Inc. aimed at adults aged 50–64 years. Medicare Advantage, to be launched Jan. 1 is expected to enroll 1 million Medicare beneficiaries initially, AARP officials said. In addition AARP's agreement with UnitedHealth includes Medicare Supplemental insurance, Part D plans, and indemnity insurance products. AARP said that it will dedicate $500 million of its royalty payments from the two insurers over the next 10 years to fund a program to help Americans find health information and assistance.

Jurors Often Side with Doctors

Contrary to popular belief, juries in malpractice cases usually sympathize more with physicians than patients, according to a law professor who reviewed studies involving malpractice cases from 1989 to 2006. University of Missouri, Columbia, School of Law professor Philip Peters found that plaintiffs rarely win weak cases, although they have more success in “toss-up” cases and better outcomes in cases with strong evidence of medical negligence. Peters, whose study appeared in the Michigan Law Review, said several factors favor medical defendants, including superior resources, physicians' social standing, social norms against “profiting” by injury, and willingness to give physicians the benefit of the doubt when evidence conflicts.

ACR Expert Witness Guidelines

New guidelines from the American College of Rheumatology spell out the relevant qualifications and ethical parameters for providing expert witness testimony. Under the new policy, adopted by the college board of directors in February, ACR members must not provide false or misleading testimony or testimony without medical foundation; those who do could be disciplined by the college. Rheumatologists are also obligated to distinguish between an “unfortunate medical outcome” and “actual negligence,” the guidelines state. The new policy also outlines the appropriate qualifications of an expert witness. For example, rheumatologists who serve as experts in court should have a current, valid, and unrestricted medical license issued by any state. The rheumatologist should also be board certified and have practiced rheumatology for no less than 3 years. Those who choose to be expert witnesses should also not accept compensation that is linked to the outcome of the case, the guidelines state. The guidelines were drafted by the ACR Committee on Ethics and Conflict of Interest.

Courts Favor Merck in Vioxx Cases

Merck has had the upper hand in some recent cases over Vioxx. Most recently, a federal judge in New Jersey dismissed a securities class action case filed against Merck by investors related to disclosures about the cyclooxygenase-2 inhibitor. In addition, a plaintiff in Los Angeles has asked the court to dismiss his lawsuit, which had alleged that Vioxx caused his 2004 heart attack. And in March, an Illinois jury sided with Merck against allegations that Vioxx had resulted in the sudden cardiac death of a 52-year-old woman. Merck, which has pursued a strategy of fighting each Vioxx claim in court, has racked up 10 courtroom victories and 5 losses, according to the company. There have also been two mistrials.

CMS Extends NPI Deadline

Physicians and other health care providers who fail to comply with the May 23 deadline to acquire and start using National Provider Identifiers will not be penalized if they can show they deployed a “contingency plan,” the Centers for Medicare and Medicaid Services announced. “Covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows,” said CMS Acting Administrator Leslie Norwalk in a statement. The agency decided to create this grace period “after it became apparent that many covered entities would not be able to fully comply with the NPI standard” by the original deadline, Ms. Norwalk said. The new compliance guideline can be downloaded online from the agency's Web site (

http://www.cms.hhs.gov/NationalProvIdentStand

Penalized by High-Deductible Plans

High-deductible health insurance plans discriminate against women by leaving them with far higher out-of-pocket health bills than men, according to a study from Harvard Medical School, Boston. The study also found that adults aged 45–64 years, those with any chronic condition such as asthma or high blood pressure, and children taking even one medication were likely to suffer financially in high-deductible plans. Under the plans, patients must pay at least $1,050 before their health coverage kicks in. In 2006, the median cost of care (both insurance and out-of-pocket) for women ages 18–64 was $1,844, compared with $847 for men. For middle-aged adults, the mean expenditure was $1,849 for men and $2,871 for women.

Docs Abuse Tax System

Thousands of Medicare Part B physicians, health professionals, and suppliers abused the federal tax system with little consequence, an analysis from the Government Accounting Office found. More than 21,000 Medicare Part B providers—about 5% of the total—had tax debts totaling more than $1 billion, mainly individual income and payroll taxes. Sen. Norm Coleman (R-Minn.), ranking member of the Permanent Subcommittee on Investigations, is using the report to press the Centers for Medicare and Medicaid Services to adopt the federal levy system, which would allow the Internal Revenue Service and the Treasury Department to tap into Medicare payments to providers in order to cover back taxes. “This is a classic case of the right hand not knowing what the left hand is doing,” Sen. Coleman said in a statement, noting that the federal government could have collected between $50 million and $140 million in 2005 if CMS had participated in the levy program. Medicare officials said at a hearing in March that they are working with the IRS and other agencies to manage payment policies.

Changing MD Demographics

A major demographic shift is underway in medicine as female physicians become more numerous, and this trend will influence the way medical groups recruit and retain physicians throughout their career cycles, according to the 2006 Retention Survey from the American Medical Group Association and Cejka Search, an executive search organization. In 2006, female physicians accounted for 35% of physicians employed in the medical groups responding to the survey, compared with 28% in the previous survey. The study revealed that factors such as “poor cultural fit” and family issues are the driving forces in physician turnover. Part-time and flexible work options also are growing in importance, the survey found.

ACR Expert Witness Guidelines

New guidelines from the American College of Rheumatology spell out the relevant qualifications and ethical parameters for providing expert witness testimony. Under the new policy, adopted by the college board of directors in February, ACR members must not provide false or misleading testimony or testimony without medical foundation; those who do could be disciplined by the college. Rheumatologists are also obligated to distinguish between an “unfortunate medical outcome” and “actual negligence,” the guidelines state. The new policy also outlines the appropriate qualifications of an expert witness. For example, rheumatologists who serve as experts in court should have a current, valid, and unrestricted medical license issued by any state. The rheumatologist should also be board certified and have practiced rheumatology for no less than 3 years. Those who choose to be expert witnesses should also not accept compensation that is linked to the outcome of the case, the guidelines state. The guidelines were drafted by the ACR Committee on Ethics and Conflict of Interest.

Courts Favor Merck in Vioxx Cases

Merck has had the upper hand in some recent cases over Vioxx. Most recently, a federal judge in New Jersey dismissed a securities class action case filed against Merck by investors related to disclosures about the cyclooxygenase-2 inhibitor. In addition, a plaintiff in Los Angeles has asked the court to dismiss his lawsuit, which had alleged that Vioxx caused his 2004 heart attack. And in March, an Illinois jury sided with Merck against allegations that Vioxx had resulted in the sudden cardiac death of a 52-year-old woman. Merck, which has pursued a strategy of fighting each Vioxx claim in court, has racked up 10 courtroom victories and 5 losses, according to the company. There have also been two mistrials.

CMS Extends NPI Deadline

Physicians and other health care providers who fail to comply with the May 23 deadline to acquire and start using National Provider Identifiers will not be penalized if they can show they deployed a “contingency plan,” the Centers for Medicare and Medicaid Services announced. “Covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows,” said CMS Acting Administrator Leslie Norwalk in a statement. The agency decided to create this grace period “after it became apparent that many covered entities would not be able to fully comply with the NPI standard” by the original deadline, Ms. Norwalk said. The new compliance guideline can be downloaded online from the agency's Web site (

http://www.cms.hhs.gov/NationalProvIdentStand

Penalized by High-Deductible Plans

High-deductible health insurance plans discriminate against women by leaving them with far higher out-of-pocket health bills than men, according to a study from Harvard Medical School, Boston. The study also found that adults aged 45–64 years, those with any chronic condition such as asthma or high blood pressure, and children taking even one medication were likely to suffer financially in high-deductible plans. Under the plans, patients must pay at least $1,050 before their health coverage kicks in. In 2006, the median cost of care (both insurance and out-of-pocket) for women ages 18–64 was $1,844, compared with $847 for men. For middle-aged adults, the mean expenditure was $1,849 for men and $2,871 for women.

Docs Abuse Tax System

Thousands of Medicare Part B physicians, health professionals, and suppliers abused the federal tax system with little consequence, an analysis from the Government Accounting Office found. More than 21,000 Medicare Part B providers—about 5% of the total—had tax debts totaling more than $1 billion, mainly individual income and payroll taxes. Sen. Norm Coleman (R-Minn.), ranking member of the Permanent Subcommittee on Investigations, is using the report to press the Centers for Medicare and Medicaid Services to adopt the federal levy system, which would allow the Internal Revenue Service and the Treasury Department to tap into Medicare payments to providers in order to cover back taxes. “This is a classic case of the right hand not knowing what the left hand is doing,” Sen. Coleman said in a statement, noting that the federal government could have collected between $50 million and $140 million in 2005 if CMS had participated in the levy program. Medicare officials said at a hearing in March that they are working with the IRS and other agencies to manage payment policies.

Changing MD Demographics

A major demographic shift is underway in medicine as female physicians become more numerous, and this trend will influence the way medical groups recruit and retain physicians throughout their career cycles, according to the 2006 Retention Survey from the American Medical Group Association and Cejka Search, an executive search organization. In 2006, female physicians accounted for 35% of physicians employed in the medical groups responding to the survey, compared with 28% in the previous survey. The study revealed that factors such as “poor cultural fit” and family issues are the driving forces in physician turnover. Part-time and flexible work options also are growing in importance, the survey found.

ACR Expert Witness Guidelines

New guidelines from the American College of Rheumatology spell out the relevant qualifications and ethical parameters for providing expert witness testimony. Under the new policy, adopted by the college board of directors in February, ACR members must not provide false or misleading testimony or testimony without medical foundation; those who do could be disciplined by the college. Rheumatologists are also obligated to distinguish between an “unfortunate medical outcome” and “actual negligence,” the guidelines state. The new policy also outlines the appropriate qualifications of an expert witness. For example, rheumatologists who serve as experts in court should have a current, valid, and unrestricted medical license issued by any state. The rheumatologist should also be board certified and have practiced rheumatology for no less than 3 years. Those who choose to be expert witnesses should also not accept compensation that is linked to the outcome of the case, the guidelines state. The guidelines were drafted by the ACR Committee on Ethics and Conflict of Interest.

Courts Favor Merck in Vioxx Cases

Merck has had the upper hand in some recent cases over Vioxx. Most recently, a federal judge in New Jersey dismissed a securities class action case filed against Merck by investors related to disclosures about the cyclooxygenase-2 inhibitor. In addition, a plaintiff in Los Angeles has asked the court to dismiss his lawsuit, which had alleged that Vioxx caused his 2004 heart attack. And in March, an Illinois jury sided with Merck against allegations that Vioxx had resulted in the sudden cardiac death of a 52-year-old woman. Merck, which has pursued a strategy of fighting each Vioxx claim in court, has racked up 10 courtroom victories and 5 losses, according to the company. There have also been two mistrials.

CMS Extends NPI Deadline

Physicians and other health care providers who fail to comply with the May 23 deadline to acquire and start using National Provider Identifiers will not be penalized if they can show they deployed a “contingency plan,” the Centers for Medicare and Medicaid Services announced. “Covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows,” said CMS Acting Administrator Leslie Norwalk in a statement. The agency decided to create this grace period “after it became apparent that many covered entities would not be able to fully comply with the NPI standard” by the original deadline, Ms. Norwalk said. The new compliance guideline can be downloaded online from the agency's Web site (

http://www.cms.hhs.gov/NationalProvIdentStand

Penalized by High-Deductible Plans

High-deductible health insurance plans discriminate against women by leaving them with far higher out-of-pocket health bills than men, according to a study from Harvard Medical School, Boston. The study also found that adults aged 45–64 years, those with any chronic condition such as asthma or high blood pressure, and children taking even one medication were likely to suffer financially in high-deductible plans. Under the plans, patients must pay at least $1,050 before their health coverage kicks in. In 2006, the median cost of care (both insurance and out-of-pocket) for women ages 18–64 was $1,844, compared with $847 for men. For middle-aged adults, the mean expenditure was $1,849 for men and $2,871 for women.

Docs Abuse Tax System

Thousands of Medicare Part B physicians, health professionals, and suppliers abused the federal tax system with little consequence, an analysis from the Government Accounting Office found. More than 21,000 Medicare Part B providers—about 5% of the total—had tax debts totaling more than $1 billion, mainly individual income and payroll taxes. Sen. Norm Coleman (R-Minn.), ranking member of the Permanent Subcommittee on Investigations, is using the report to press the Centers for Medicare and Medicaid Services to adopt the federal levy system, which would allow the Internal Revenue Service and the Treasury Department to tap into Medicare payments to providers in order to cover back taxes. “This is a classic case of the right hand not knowing what the left hand is doing,” Sen. Coleman said in a statement, noting that the federal government could have collected between $50 million and $140 million in 2005 if CMS had participated in the levy program. Medicare officials said at a hearing in March that they are working with the IRS and other agencies to manage payment policies.

Changing MD Demographics

A major demographic shift is underway in medicine as female physicians become more numerous, and this trend will influence the way medical groups recruit and retain physicians throughout their career cycles, according to the 2006 Retention Survey from the American Medical Group Association and Cejka Search, an executive search organization. In 2006, female physicians accounted for 35% of physicians employed in the medical groups responding to the survey, compared with 28% in the previous survey. The study revealed that factors such as “poor cultural fit” and family issues are the driving forces in physician turnover. Part-time and flexible work options also are growing in importance, the survey found.