Mary Ellen Schneider

The Bush administration's budget proposal for fiscal 2008 could mean bad news for both physicians and hospitals.

The proposal, which was sent to Congress on Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels.

However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over the next 10 years.

In addition, it also calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes including: reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008.

However, Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said she has “no doubt” that proposals to address the sustainable growth rate formula — which is used to determine physician payments under Medicare — will be on the table for discussion with Congress.

The reductions in traditional entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress.

“I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physicians organizations also took aim at the proposed budget. Dr. James T. Dove, president-elect of the American College of Cardiology, said the budget fell short in several areas, particularly in the lack of proposals to fix the physician payment formula.

“Unless we can work together to put in place a more sustainable payment system for physicians, patients will suffer,” Dr. Dove said in a statement.

Officials at the American Medical Association echoed those comments in their reaction to the president's budget request.

“Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

The president's budget proposal also came under fire from the American Hospital Association, which called it “devastating news” for children, seniors, and the disabled.

The president's plan would reauthorize SCHIP for 5 years and spend nearly $5 billion on the program over that period. However, it would refocus the program to children at or below 200% of poverty, a smaller group than many states currently target with their programs. But that level of funding would actually reduce SCHIP spending in fiscal year 2008, according to the American College of Physicians. Officials at the ACP called on Congress to provide additional funds to SCHIP so that it could be expanded to reach more low-income children and their parents.

President Bush also seeks the standard deduction for health insurance that he outlined in his State of the Union address in January. His proposal aims to make it more affordable for workers who do not get health care coverage through their employers to obtain insurance. It includes a $15,000 standard deduction for health insurance for any family covered by at least a catastrophic health insurance policy, regardless of whether it was purchased individually or by an employer.

The president proposed that the Health and Human Services secretary will work with Congress to redirect a portion of institutional payments so that states can help low-income residents purchase health insurance.

Under the plan, association health plans would be established so that small employers and other organizations can negotiate for lower insurance costs.

The Bush administration's budget proposal for fiscal 2008 could mean bad news for both physicians and hospitals.

The proposal, which was sent to Congress on Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels.

However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over the next 10 years.

In addition, it also calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes including: reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008.

However, Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said she has “no doubt” that proposals to address the sustainable growth rate formula — which is used to determine physician payments under Medicare — will be on the table for discussion with Congress.

The reductions in traditional entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress.

“I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physicians organizations also took aim at the proposed budget. Dr. James T. Dove, president-elect of the American College of Cardiology, said the budget fell short in several areas, particularly in the lack of proposals to fix the physician payment formula.

“Unless we can work together to put in place a more sustainable payment system for physicians, patients will suffer,” Dr. Dove said in a statement.

Officials at the American Medical Association echoed those comments in their reaction to the president's budget request.

“Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

The president's budget proposal also came under fire from the American Hospital Association, which called it “devastating news” for children, seniors, and the disabled.

The president's plan would reauthorize SCHIP for 5 years and spend nearly $5 billion on the program over that period. However, it would refocus the program to children at or below 200% of poverty, a smaller group than many states currently target with their programs. But that level of funding would actually reduce SCHIP spending in fiscal year 2008, according to the American College of Physicians. Officials at the ACP called on Congress to provide additional funds to SCHIP so that it could be expanded to reach more low-income children and their parents.

President Bush also seeks the standard deduction for health insurance that he outlined in his State of the Union address in January. His proposal aims to make it more affordable for workers who do not get health care coverage through their employers to obtain insurance. It includes a $15,000 standard deduction for health insurance for any family covered by at least a catastrophic health insurance policy, regardless of whether it was purchased individually or by an employer.

The president proposed that the Health and Human Services secretary will work with Congress to redirect a portion of institutional payments so that states can help low-income residents purchase health insurance.

Under the plan, association health plans would be established so that small employers and other organizations can negotiate for lower insurance costs.

The Bush administration's budget proposal for fiscal 2008 could mean bad news for both physicians and hospitals.

The proposal, which was sent to Congress on Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels.

However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over the next 10 years.

In addition, it also calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes including: reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008.

However, Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said she has “no doubt” that proposals to address the sustainable growth rate formula — which is used to determine physician payments under Medicare — will be on the table for discussion with Congress.

The reductions in traditional entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress.

“I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physicians organizations also took aim at the proposed budget. Dr. James T. Dove, president-elect of the American College of Cardiology, said the budget fell short in several areas, particularly in the lack of proposals to fix the physician payment formula.

“Unless we can work together to put in place a more sustainable payment system for physicians, patients will suffer,” Dr. Dove said in a statement.

Officials at the American Medical Association echoed those comments in their reaction to the president's budget request.

“Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

The president's budget proposal also came under fire from the American Hospital Association, which called it “devastating news” for children, seniors, and the disabled.

The president's plan would reauthorize SCHIP for 5 years and spend nearly $5 billion on the program over that period. However, it would refocus the program to children at or below 200% of poverty, a smaller group than many states currently target with their programs. But that level of funding would actually reduce SCHIP spending in fiscal year 2008, according to the American College of Physicians. Officials at the ACP called on Congress to provide additional funds to SCHIP so that it could be expanded to reach more low-income children and their parents.

President Bush also seeks the standard deduction for health insurance that he outlined in his State of the Union address in January. His proposal aims to make it more affordable for workers who do not get health care coverage through their employers to obtain insurance. It includes a $15,000 standard deduction for health insurance for any family covered by at least a catastrophic health insurance policy, regardless of whether it was purchased individually or by an employer.

The president proposed that the Health and Human Services secretary will work with Congress to redirect a portion of institutional payments so that states can help low-income residents purchase health insurance.

Under the plan, association health plans would be established so that small employers and other organizations can negotiate for lower insurance costs.

An online diabetes education program has resulted in declining hemoglobin A_1c levels among participants in pilot tests, according to the program's sponsor.

Pfizer Health Solutions Inc. recently made Amigos en Salud (Friends in Health), its diabetes education program, available online free of charge at www.amigosensalud.com

Results across the pilot sites showed statistically significant improvements in clinical, behavioral, and mental health outcomes among individuals enrolled in Amigos en Salud, compared with patients who received usual care. For example, in the Los Angeles pilot, which was conducted between 2002 and 2004, the average hemoglobin A_1c level among participants decreased from 8.6% at baseline to 6.9% at follow-up.

The Amigos en Salud program targets Hispanic and African American patients in an effort to help reduce health disparities, according to Pfizer Health Solutions.

Diabetes disproportionately affects individuals in those groups, and many minority patients seek care in community health center settings. Of the individuals who visit community health centers, 36% are Hispanic and 23% are African American, according to statistics from the National Association of Community Health Centers.

The online materials are available in English and Spanish and can help community health centers and other organizations to implement low-cost education programs that rely primarily on community health workers.

The idea behind providing these educational materials is not to replace the care provided by physicians and nurses but to add another layer.

The community health worker is usually a layperson who serves as a liaison between the patient and the health care system—connecting patients with transportation and other resources, educating them about their disease, and helping them to make lifestyle changes that may help reduce the severity of their disease and increase their level of health.

The community health worker is generally from the same community or cultural background as the patient, helping to eliminate some of the common barriers to quality care.

“It really made my job a lot easier,” said Maria Castellanos, clinical nurse-manager at the Center for Clinical Research Excellence at Charles R. Drew University of Medicine and Science, Los Angeles, who participated in the Los Angeles pilot of Amigos en Salud.

The community health workers were able to communicate with patients more frequently and keep the patient connected to the health care system, she said, giving her more time to focus on other issues, including addressing depression among the diabetes patients.

The program was also popular with patients, Ms. Castellanos said. Over time, she found that patients were more willing to confide in the community health worker about nonmedical issues that could affect their care, such as financial or legal challenges.

The online program provides detailed instructions on how to recruit and train community health workers, implement a program, and measure the results. It also provides materials including a program graduation tool kit, a database for program evaluation, and advice on how to publicize the program locally.

The Web site also provides educational handouts in both English and Spanish on a variety of health topics including high blood pressure, high cholesterol, healthy eating, exercise, smoking cessation, and depression. The site also features tools for keeping a food diary and a blood glucose log.

An online diabetes education program has resulted in declining hemoglobin A_1c levels among participants in pilot tests, according to the program's sponsor.

Pfizer Health Solutions Inc. recently made Amigos en Salud (Friends in Health), its diabetes education program, available online free of charge at www.amigosensalud.com

Results across the pilot sites showed statistically significant improvements in clinical, behavioral, and mental health outcomes among individuals enrolled in Amigos en Salud, compared with patients who received usual care. For example, in the Los Angeles pilot, which was conducted between 2002 and 2004, the average hemoglobin A_1c level among participants decreased from 8.6% at baseline to 6.9% at follow-up.

The Amigos en Salud program targets Hispanic and African American patients in an effort to help reduce health disparities, according to Pfizer Health Solutions.

Diabetes disproportionately affects individuals in those groups, and many minority patients seek care in community health center settings. Of the individuals who visit community health centers, 36% are Hispanic and 23% are African American, according to statistics from the National Association of Community Health Centers.

The online materials are available in English and Spanish and can help community health centers and other organizations to implement low-cost education programs that rely primarily on community health workers.

The idea behind providing these educational materials is not to replace the care provided by physicians and nurses but to add another layer.

The community health worker is usually a layperson who serves as a liaison between the patient and the health care system—connecting patients with transportation and other resources, educating them about their disease, and helping them to make lifestyle changes that may help reduce the severity of their disease and increase their level of health.

The community health worker is generally from the same community or cultural background as the patient, helping to eliminate some of the common barriers to quality care.

“It really made my job a lot easier,” said Maria Castellanos, clinical nurse-manager at the Center for Clinical Research Excellence at Charles R. Drew University of Medicine and Science, Los Angeles, who participated in the Los Angeles pilot of Amigos en Salud.

The community health workers were able to communicate with patients more frequently and keep the patient connected to the health care system, she said, giving her more time to focus on other issues, including addressing depression among the diabetes patients.

The program was also popular with patients, Ms. Castellanos said. Over time, she found that patients were more willing to confide in the community health worker about nonmedical issues that could affect their care, such as financial or legal challenges.

The online program provides detailed instructions on how to recruit and train community health workers, implement a program, and measure the results. It also provides materials including a program graduation tool kit, a database for program evaluation, and advice on how to publicize the program locally.

The Web site also provides educational handouts in both English and Spanish on a variety of health topics including high blood pressure, high cholesterol, healthy eating, exercise, smoking cessation, and depression. The site also features tools for keeping a food diary and a blood glucose log.

An online diabetes education program has resulted in declining hemoglobin A_1c levels among participants in pilot tests, according to the program's sponsor.

Pfizer Health Solutions Inc. recently made Amigos en Salud (Friends in Health), its diabetes education program, available online free of charge at www.amigosensalud.com

Results across the pilot sites showed statistically significant improvements in clinical, behavioral, and mental health outcomes among individuals enrolled in Amigos en Salud, compared with patients who received usual care. For example, in the Los Angeles pilot, which was conducted between 2002 and 2004, the average hemoglobin A_1c level among participants decreased from 8.6% at baseline to 6.9% at follow-up.

The Amigos en Salud program targets Hispanic and African American patients in an effort to help reduce health disparities, according to Pfizer Health Solutions.

Diabetes disproportionately affects individuals in those groups, and many minority patients seek care in community health center settings. Of the individuals who visit community health centers, 36% are Hispanic and 23% are African American, according to statistics from the National Association of Community Health Centers.

The online materials are available in English and Spanish and can help community health centers and other organizations to implement low-cost education programs that rely primarily on community health workers.

The idea behind providing these educational materials is not to replace the care provided by physicians and nurses but to add another layer.

The community health worker is usually a layperson who serves as a liaison between the patient and the health care system—connecting patients with transportation and other resources, educating them about their disease, and helping them to make lifestyle changes that may help reduce the severity of their disease and increase their level of health.

The community health worker is generally from the same community or cultural background as the patient, helping to eliminate some of the common barriers to quality care.

“It really made my job a lot easier,” said Maria Castellanos, clinical nurse-manager at the Center for Clinical Research Excellence at Charles R. Drew University of Medicine and Science, Los Angeles, who participated in the Los Angeles pilot of Amigos en Salud.

The community health workers were able to communicate with patients more frequently and keep the patient connected to the health care system, she said, giving her more time to focus on other issues, including addressing depression among the diabetes patients.

The program was also popular with patients, Ms. Castellanos said. Over time, she found that patients were more willing to confide in the community health worker about nonmedical issues that could affect their care, such as financial or legal challenges.

The online program provides detailed instructions on how to recruit and train community health workers, implement a program, and measure the results. It also provides materials including a program graduation tool kit, a database for program evaluation, and advice on how to publicize the program locally.

The Web site also provides educational handouts in both English and Spanish on a variety of health topics including high blood pressure, high cholesterol, healthy eating, exercise, smoking cessation, and depression. The site also features tools for keeping a food diary and a blood glucose log.

The Bush administration's budget proposal for fiscal 2008 could be bad news for physicians and hospitals.

The proposal, which was sent to Congress Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels. However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over 10 years.

In addition, it calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes including reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008. However, Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said she has “no doubt” that proposals to address the sustainable growth rate formula—which is used to determine physician payments under Medicare—will be on the table for discussion with Congress.

The reductions in traditional entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress. “I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physician organizations also took aim at the proposed budget. “Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, chair of the American Medical Association board, said in a statement.

The president's budget proposal came under fire from the American Hospital Association, which called it “devastating news” for children, seniors, and the disabled.

The president's plan would reauthorize SCHIP for 5 years and spend nearly $5 billion on the program over that period. However, it would refocus the program to children at or below 200% of poverty, a smaller group than many states currently target with their programs. But that level of funding would actually reduce SCHIP spending in fiscal year 2008, according to the American College of Physicians. Officials at the ACP called on Congress to provide additional funds to SCHIP so that it could be expanded to reach more low-income children and their parents.

President Bush also seeks the standard deduction for health insurance that he outlined in his State of the Union address in January. His proposal aims to make it more affordable for workers who do not get health care coverage through their employers to obtain insurance. It includes a $15,000 standard deduction for health insurance for any family covered by at least a catastrophic health insurance policy, regardless of whether it was purchased individually or by an employer.

The president proposed that the Health and Human Services secretary will work with Congress to redirect a portion of institutional payments so that states can help low-income residents purchase health insurance.

Under the plan, association health plans would be established so that small employers and other organizations can negotiate for lower insurance costs.

The Bush administration's budget proposal for fiscal 2008 could be bad news for physicians and hospitals.

The proposal, which was sent to Congress Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels. However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over 10 years.

In addition, it calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes including reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008. However, Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said she has “no doubt” that proposals to address the sustainable growth rate formula—which is used to determine physician payments under Medicare—will be on the table for discussion with Congress.

The reductions in traditional entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress. “I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physician organizations also took aim at the proposed budget. “Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, chair of the American Medical Association board, said in a statement.

The president's budget proposal came under fire from the American Hospital Association, which called it “devastating news” for children, seniors, and the disabled.

The president's plan would reauthorize SCHIP for 5 years and spend nearly $5 billion on the program over that period. However, it would refocus the program to children at or below 200% of poverty, a smaller group than many states currently target with their programs. But that level of funding would actually reduce SCHIP spending in fiscal year 2008, according to the American College of Physicians. Officials at the ACP called on Congress to provide additional funds to SCHIP so that it could be expanded to reach more low-income children and their parents.

President Bush also seeks the standard deduction for health insurance that he outlined in his State of the Union address in January. His proposal aims to make it more affordable for workers who do not get health care coverage through their employers to obtain insurance. It includes a $15,000 standard deduction for health insurance for any family covered by at least a catastrophic health insurance policy, regardless of whether it was purchased individually or by an employer.

The president proposed that the Health and Human Services secretary will work with Congress to redirect a portion of institutional payments so that states can help low-income residents purchase health insurance.

Under the plan, association health plans would be established so that small employers and other organizations can negotiate for lower insurance costs.

The Bush administration's budget proposal for fiscal 2008 could be bad news for physicians and hospitals.

The proposal, which was sent to Congress Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels. However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over 10 years.

In addition, it calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes including reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008. However, Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said she has “no doubt” that proposals to address the sustainable growth rate formula—which is used to determine physician payments under Medicare—will be on the table for discussion with Congress.

The reductions in traditional entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress. “I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physician organizations also took aim at the proposed budget. “Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, chair of the American Medical Association board, said in a statement.

The president's budget proposal came under fire from the American Hospital Association, which called it “devastating news” for children, seniors, and the disabled.

The president's plan would reauthorize SCHIP for 5 years and spend nearly $5 billion on the program over that period. However, it would refocus the program to children at or below 200% of poverty, a smaller group than many states currently target with their programs. But that level of funding would actually reduce SCHIP spending in fiscal year 2008, according to the American College of Physicians. Officials at the ACP called on Congress to provide additional funds to SCHIP so that it could be expanded to reach more low-income children and their parents.

President Bush also seeks the standard deduction for health insurance that he outlined in his State of the Union address in January. His proposal aims to make it more affordable for workers who do not get health care coverage through their employers to obtain insurance. It includes a $15,000 standard deduction for health insurance for any family covered by at least a catastrophic health insurance policy, regardless of whether it was purchased individually or by an employer.

The president proposed that the Health and Human Services secretary will work with Congress to redirect a portion of institutional payments so that states can help low-income residents purchase health insurance.

Under the plan, association health plans would be established so that small employers and other organizations can negotiate for lower insurance costs.

ACOG Urges Breast-Feeding Support

The American College of Obstetricians and Gynecologists is urging ob.gyns., other health care providers, hospitals, and employers to help support women who choose to breast-feed. A new opinion from ACOG's Committee on Health Care for Underserved Women and Committee on Obstetric Practice calls on ob.gyns. to be in the “forefront” to bring about changes in the public environment, in legislation, and in hospital practices. For example, giving women gift packs of formula when they leave the hospital can deter the continuation of breast-feeding at home, the committees wrote. After hospital discharge, the ob.gyn. can help with breast-feeding problems and provide a clinical breast exam. In addition, ob.gyns. should counsel breast-feeding women about various contraceptive options, the committee wrote. ACOG currently recommends exclusive breast-feeding for 6 months. “Physicians' offices can set the example in encouraging and welcoming breast-feeding through staff training, office environment, awareness and educational materials, and supportive policies,” the committees wrote.

Texas Expands Women's Coverage

Starting Jan. 1, the Texas Medicaid program began offering gynecologic exams, related health screening, and birth control to women earning up to 185% of the federal poverty limit. State officials estimate that about 85,000 women will sign up for the program by the end of August. In addition, as part of the Children's Health Insurance Program, the state is providing prenatal care to low-income pregnant women who do not qualify for Medicaid. “Both these programs will expand the number of women and children who qualify for health care services and save the state money at the same time,” Albert Hawkins, Texas Health and Humans Services executive commissioner, said in a statement.

Breast Ca Surgery:Volume Counts

High-volume hospitals are associated with better survival rates following breast cancer surgery, according to a study in the March issue of the American Journal of Public Health. Researchers from the Medical College of Wisconsin in Milwaukee found that treatment at a high-volume hospital (40 or more cases per year) has a 0.78 hazard ratio for breast cancer mortality, compared with treatment at a low-volume hospital (0–19 cases per year). Data on 11,225 women who underwent surgery for breast cancer at 457 hospitals were included in the analysis. The researchers relied on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registry and Medicare claims. But although hospital volume was a significant factor in mortality, patients treated at low- and medium-volume hospitals did well. For example, about 26% of low-volume hospitals and 37% of medium-volume hospitals outperformed the median high-volume hospitals in terms of 5-year survival. “Hospital volume appears to be a significant, yet still imperfect, predictor of better outcomes,” the researchers wrote.

Bills Stress Pregnancy Prevention

Sen. Harry Reid (D-Nev.) and Rep. Louise Slaughter (D-N.Y.) each reintroduced legislation that aims to refocus the abortion debate by concentrating on preventing unwanted pregnancies. The legislation (S. 21/H.R. 819) requires health plans to provide coverage for contraceptives if they provide coverage for other outpatient prescription drugs. It also calls on the Centers for Disease Control and Prevention to disseminate public information on emergency contraception and authorizes grants to be awarded for teenage pregnancy prevention programs. The legislation has been praised by abortion rights advocates.

$2 Billion Budget Proposed for FDA

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not known yet. The budget includes $444 million in user fees from industry, including a new program to charge generic drugmakers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety and $7 million to boost medical device safety and speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus.

ACOG Urges Breast-Feeding Support

The American College of Obstetricians and Gynecologists is urging ob.gyns., other health care providers, hospitals, and employers to help support women who choose to breast-feed. A new opinion from ACOG's Committee on Health Care for Underserved Women and Committee on Obstetric Practice calls on ob.gyns. to be in the “forefront” to bring about changes in the public environment, in legislation, and in hospital practices. For example, giving women gift packs of formula when they leave the hospital can deter the continuation of breast-feeding at home, the committees wrote. After hospital discharge, the ob.gyn. can help with breast-feeding problems and provide a clinical breast exam. In addition, ob.gyns. should counsel breast-feeding women about various contraceptive options, the committee wrote. ACOG currently recommends exclusive breast-feeding for 6 months. “Physicians' offices can set the example in encouraging and welcoming breast-feeding through staff training, office environment, awareness and educational materials, and supportive policies,” the committees wrote.

Texas Expands Women's Coverage

Starting Jan. 1, the Texas Medicaid program began offering gynecologic exams, related health screening, and birth control to women earning up to 185% of the federal poverty limit. State officials estimate that about 85,000 women will sign up for the program by the end of August. In addition, as part of the Children's Health Insurance Program, the state is providing prenatal care to low-income pregnant women who do not qualify for Medicaid. “Both these programs will expand the number of women and children who qualify for health care services and save the state money at the same time,” Albert Hawkins, Texas Health and Humans Services executive commissioner, said in a statement.

Breast Ca Surgery:Volume Counts

High-volume hospitals are associated with better survival rates following breast cancer surgery, according to a study in the March issue of the American Journal of Public Health. Researchers from the Medical College of Wisconsin in Milwaukee found that treatment at a high-volume hospital (40 or more cases per year) has a 0.78 hazard ratio for breast cancer mortality, compared with treatment at a low-volume hospital (0–19 cases per year). Data on 11,225 women who underwent surgery for breast cancer at 457 hospitals were included in the analysis. The researchers relied on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registry and Medicare claims. But although hospital volume was a significant factor in mortality, patients treated at low- and medium-volume hospitals did well. For example, about 26% of low-volume hospitals and 37% of medium-volume hospitals outperformed the median high-volume hospitals in terms of 5-year survival. “Hospital volume appears to be a significant, yet still imperfect, predictor of better outcomes,” the researchers wrote.

Bills Stress Pregnancy Prevention

Sen. Harry Reid (D-Nev.) and Rep. Louise Slaughter (D-N.Y.) each reintroduced legislation that aims to refocus the abortion debate by concentrating on preventing unwanted pregnancies. The legislation (S. 21/H.R. 819) requires health plans to provide coverage for contraceptives if they provide coverage for other outpatient prescription drugs. It also calls on the Centers for Disease Control and Prevention to disseminate public information on emergency contraception and authorizes grants to be awarded for teenage pregnancy prevention programs. The legislation has been praised by abortion rights advocates.

$2 Billion Budget Proposed for FDA

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not known yet. The budget includes $444 million in user fees from industry, including a new program to charge generic drugmakers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety and $7 million to boost medical device safety and speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus.

ACOG Urges Breast-Feeding Support

The American College of Obstetricians and Gynecologists is urging ob.gyns., other health care providers, hospitals, and employers to help support women who choose to breast-feed. A new opinion from ACOG's Committee on Health Care for Underserved Women and Committee on Obstetric Practice calls on ob.gyns. to be in the “forefront” to bring about changes in the public environment, in legislation, and in hospital practices. For example, giving women gift packs of formula when they leave the hospital can deter the continuation of breast-feeding at home, the committees wrote. After hospital discharge, the ob.gyn. can help with breast-feeding problems and provide a clinical breast exam. In addition, ob.gyns. should counsel breast-feeding women about various contraceptive options, the committee wrote. ACOG currently recommends exclusive breast-feeding for 6 months. “Physicians' offices can set the example in encouraging and welcoming breast-feeding through staff training, office environment, awareness and educational materials, and supportive policies,” the committees wrote.

Texas Expands Women's Coverage

Starting Jan. 1, the Texas Medicaid program began offering gynecologic exams, related health screening, and birth control to women earning up to 185% of the federal poverty limit. State officials estimate that about 85,000 women will sign up for the program by the end of August. In addition, as part of the Children's Health Insurance Program, the state is providing prenatal care to low-income pregnant women who do not qualify for Medicaid. “Both these programs will expand the number of women and children who qualify for health care services and save the state money at the same time,” Albert Hawkins, Texas Health and Humans Services executive commissioner, said in a statement.

Breast Ca Surgery:Volume Counts

High-volume hospitals are associated with better survival rates following breast cancer surgery, according to a study in the March issue of the American Journal of Public Health. Researchers from the Medical College of Wisconsin in Milwaukee found that treatment at a high-volume hospital (40 or more cases per year) has a 0.78 hazard ratio for breast cancer mortality, compared with treatment at a low-volume hospital (0–19 cases per year). Data on 11,225 women who underwent surgery for breast cancer at 457 hospitals were included in the analysis. The researchers relied on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registry and Medicare claims. But although hospital volume was a significant factor in mortality, patients treated at low- and medium-volume hospitals did well. For example, about 26% of low-volume hospitals and 37% of medium-volume hospitals outperformed the median high-volume hospitals in terms of 5-year survival. “Hospital volume appears to be a significant, yet still imperfect, predictor of better outcomes,” the researchers wrote.

Bills Stress Pregnancy Prevention

Sen. Harry Reid (D-Nev.) and Rep. Louise Slaughter (D-N.Y.) each reintroduced legislation that aims to refocus the abortion debate by concentrating on preventing unwanted pregnancies. The legislation (S. 21/H.R. 819) requires health plans to provide coverage for contraceptives if they provide coverage for other outpatient prescription drugs. It also calls on the Centers for Disease Control and Prevention to disseminate public information on emergency contraception and authorizes grants to be awarded for teenage pregnancy prevention programs. The legislation has been praised by abortion rights advocates.

$2 Billion Budget Proposed for FDA

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not known yet. The budget includes $444 million in user fees from industry, including a new program to charge generic drugmakers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety and $7 million to boost medical device safety and speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus.

Compliance and Coding Lessons

Rheumatologists should try to issue an advanced beneficiary notice (ABN) to their Medicare patients before providing any services that they believe could be denied by Medicare, Resaee Freeman of the American College of Rheumatology said during an ACR-sponsored audioconference on compliance and coding. This written notice, which needs to be signed and dated by the patient, can safeguard the medical practice if Medicare does not cover the service, she said. ACR coding experts who participated in the audioconference also reminded physicians to be careful of upcoding and downcoding. One common upcoding mistake is to code a new patient visit incorrectly as a consultation. “Documentation is the key,” said Ms. Freeman. Rheumatologists also should be careful when waiving fees for patients. Under the Office of Inspector General's compliance guide, a complete waiver of fees is allowed for an entire group—such as low-income patients—as long as that group is not related to the referring of patients. It's important to have a written notice explaining the policy of waiving fees, she said. The ACR coding audioconference was supported by Abbott Laboratories, Amgen Inc., Genentech Inc., Biogen Idec, UCB Inc., and Wyeth.

Musculoskeletal Exam Planned

The National Board of Medical Examiners is in the process of testing a new exam that will focus specifically on musculoskeletal subject matter. The U.S. Bone and Joint Decade, an initiative focused on raising awareness of musculoskeletal diseases, approached the national board about initiating the project. As of press time, the exam had been tested among undergraduate medical students at Washington University, St. Louis. In the meantime, several other medical schools are reviewing the exam and planning testing for later this semester, according to Judith Miller, a program officer at the National Board of Medical Examiners. The exam, which is Web-based, includes 75 basic and clinical science elements. Once pilot testing is completed, the National Board of Medical Examiners will post the exam content online on its Web site (

www.nbme.org

Doctors Say FDA Moves Too Slowly

More than three-quarters of orthopedic surgeons polled in a recent survey said that the Food and Drug Administration is too slow in approving new drugs and medical devices. Commissioned by the Competitive Enterprise Institute, a Washington-based think tank that favors deregulation and limited government, the online survey included responses from 175 orthopedic surgeons from around the country. The majority of respondents (60%) also agreed that, on balance, FDA regulations hinder rather than help them in using new drugs or medical devices to treat their patients. About 80% of respondents also said that if it were up to them, they would make Vioxx available again as a prescription drug.

FDA's $2 Billion Budget

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not yet known. The budget includes $444 million in user fees from industry, including a new program to charge generic drug makers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety—this does not include user fee funds that will also go to that effort—and $7 million to boost medical device safety and to speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus. The FDA has been gradually moving its operations to the new facilities. The Washington-based consumer-, patient- and industry-supported Coalition for a Stronger FDA said the budget did not go far enough. It is seeking at least $175 million more, including greater increases for food, drug, and medical device safety.

Disclosing Financial Conflicts

Experts from Johns Hopkins University, Baltimore, Duke University, Durham, N.C., and Wake Forest University, Winston-Salem, N.C., have designed model language aimed at helping researchers disclose their financial conflicts to medical research participants in a meaningful way. The model language was published in the January/February issue of IRB: Ethics and Human Research. Included is a standard disclosure for situations in which there is a financial interest that does not represent a measurable risk to patients. The model also includes language that researchers can use to describe salary support, money received outside of a study, per capita payments, and unrestricted finders' fees, among other conflicts. “This is language that can help these institutions craft better written materials. It can also serve as a model for how to accurately phrase disclosure in discussions with potential research subjects,” Dr. Jeremy Sugarman, the lead author and professor at Johns Hopkins University, said in a statement. “It could also be expanded and presented in other formats, such as stand-alone pamphlets or videos about clinical research.”

The Cost of Juvenile Arthritis

Treating juvenile ideopathic arthritis, the most common rheumatologic disease in childhood, carries a steep price tag, according to a study conducted by Canadian researchers and published in the February issue of Arthritis Care and Research. The average annual direct costs associated with treating these children is approximately $3,002 in 2005 Canadian dollars, about $1,686 more than the cost for children in a control group. The study was conducted at the Montreal Children's Hospital and British Columbia's Children's Hospital in Vancouver. Researchers compared 155 children who were diagnosed with juvenile arthritis and who sought treatment at the two outpatient clinics with 181 children, primarily with other chronic diseases, who sought treatment there. The chronic conditions most common among children in the control group included epilepsy, diabetes, asthma, and other breathing disorders. The bulk of the increased cost associated with treating children with juvenile arthritis was from medication costs, which were estimated at about $1,306 on average in the juvenile arthritis group, compared with $87 in the control group. Although the researchers did not estimate the indirect costs of the disease, they noted that the juvenile arthritis patients in the study tended on average to miss more days of school than did controls.

Compliance and Coding Lessons

Rheumatologists should try to issue an advanced beneficiary notice (ABN) to their Medicare patients before providing any services that they believe could be denied by Medicare, Resaee Freeman of the American College of Rheumatology said during an ACR-sponsored audioconference on compliance and coding. This written notice, which needs to be signed and dated by the patient, can safeguard the medical practice if Medicare does not cover the service, she said. ACR coding experts who participated in the audioconference also reminded physicians to be careful of upcoding and downcoding. One common upcoding mistake is to code a new patient visit incorrectly as a consultation. “Documentation is the key,” said Ms. Freeman. Rheumatologists also should be careful when waiving fees for patients. Under the Office of Inspector General's compliance guide, a complete waiver of fees is allowed for an entire group—such as low-income patients—as long as that group is not related to the referring of patients. It's important to have a written notice explaining the policy of waiving fees, she said. The ACR coding audioconference was supported by Abbott Laboratories, Amgen Inc., Genentech Inc., Biogen Idec, UCB Inc., and Wyeth.

Musculoskeletal Exam Planned

The National Board of Medical Examiners is in the process of testing a new exam that will focus specifically on musculoskeletal subject matter. The U.S. Bone and Joint Decade, an initiative focused on raising awareness of musculoskeletal diseases, approached the national board about initiating the project. As of press time, the exam had been tested among undergraduate medical students at Washington University, St. Louis. In the meantime, several other medical schools are reviewing the exam and planning testing for later this semester, according to Judith Miller, a program officer at the National Board of Medical Examiners. The exam, which is Web-based, includes 75 basic and clinical science elements. Once pilot testing is completed, the National Board of Medical Examiners will post the exam content online on its Web site (

www.nbme.org

Doctors Say FDA Moves Too Slowly

More than three-quarters of orthopedic surgeons polled in a recent survey said that the Food and Drug Administration is too slow in approving new drugs and medical devices. Commissioned by the Competitive Enterprise Institute, a Washington-based think tank that favors deregulation and limited government, the online survey included responses from 175 orthopedic surgeons from around the country. The majority of respondents (60%) also agreed that, on balance, FDA regulations hinder rather than help them in using new drugs or medical devices to treat their patients. About 80% of respondents also said that if it were up to them, they would make Vioxx available again as a prescription drug.

FDA's $2 Billion Budget

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not yet known. The budget includes $444 million in user fees from industry, including a new program to charge generic drug makers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety—this does not include user fee funds that will also go to that effort—and $7 million to boost medical device safety and to speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus. The FDA has been gradually moving its operations to the new facilities. The Washington-based consumer-, patient- and industry-supported Coalition for a Stronger FDA said the budget did not go far enough. It is seeking at least $175 million more, including greater increases for food, drug, and medical device safety.

Disclosing Financial Conflicts

Experts from Johns Hopkins University, Baltimore, Duke University, Durham, N.C., and Wake Forest University, Winston-Salem, N.C., have designed model language aimed at helping researchers disclose their financial conflicts to medical research participants in a meaningful way. The model language was published in the January/February issue of IRB: Ethics and Human Research. Included is a standard disclosure for situations in which there is a financial interest that does not represent a measurable risk to patients. The model also includes language that researchers can use to describe salary support, money received outside of a study, per capita payments, and unrestricted finders' fees, among other conflicts. “This is language that can help these institutions craft better written materials. It can also serve as a model for how to accurately phrase disclosure in discussions with potential research subjects,” Dr. Jeremy Sugarman, the lead author and professor at Johns Hopkins University, said in a statement. “It could also be expanded and presented in other formats, such as stand-alone pamphlets or videos about clinical research.”

The Cost of Juvenile Arthritis

Treating juvenile ideopathic arthritis, the most common rheumatologic disease in childhood, carries a steep price tag, according to a study conducted by Canadian researchers and published in the February issue of Arthritis Care and Research. The average annual direct costs associated with treating these children is approximately $3,002 in 2005 Canadian dollars, about $1,686 more than the cost for children in a control group. The study was conducted at the Montreal Children's Hospital and British Columbia's Children's Hospital in Vancouver. Researchers compared 155 children who were diagnosed with juvenile arthritis and who sought treatment at the two outpatient clinics with 181 children, primarily with other chronic diseases, who sought treatment there. The chronic conditions most common among children in the control group included epilepsy, diabetes, asthma, and other breathing disorders. The bulk of the increased cost associated with treating children with juvenile arthritis was from medication costs, which were estimated at about $1,306 on average in the juvenile arthritis group, compared with $87 in the control group. Although the researchers did not estimate the indirect costs of the disease, they noted that the juvenile arthritis patients in the study tended on average to miss more days of school than did controls.

Compliance and Coding Lessons

Rheumatologists should try to issue an advanced beneficiary notice (ABN) to their Medicare patients before providing any services that they believe could be denied by Medicare, Resaee Freeman of the American College of Rheumatology said during an ACR-sponsored audioconference on compliance and coding. This written notice, which needs to be signed and dated by the patient, can safeguard the medical practice if Medicare does not cover the service, she said. ACR coding experts who participated in the audioconference also reminded physicians to be careful of upcoding and downcoding. One common upcoding mistake is to code a new patient visit incorrectly as a consultation. “Documentation is the key,” said Ms. Freeman. Rheumatologists also should be careful when waiving fees for patients. Under the Office of Inspector General's compliance guide, a complete waiver of fees is allowed for an entire group—such as low-income patients—as long as that group is not related to the referring of patients. It's important to have a written notice explaining the policy of waiving fees, she said. The ACR coding audioconference was supported by Abbott Laboratories, Amgen Inc., Genentech Inc., Biogen Idec, UCB Inc., and Wyeth.

Musculoskeletal Exam Planned

The National Board of Medical Examiners is in the process of testing a new exam that will focus specifically on musculoskeletal subject matter. The U.S. Bone and Joint Decade, an initiative focused on raising awareness of musculoskeletal diseases, approached the national board about initiating the project. As of press time, the exam had been tested among undergraduate medical students at Washington University, St. Louis. In the meantime, several other medical schools are reviewing the exam and planning testing for later this semester, according to Judith Miller, a program officer at the National Board of Medical Examiners. The exam, which is Web-based, includes 75 basic and clinical science elements. Once pilot testing is completed, the National Board of Medical Examiners will post the exam content online on its Web site (

www.nbme.org

Doctors Say FDA Moves Too Slowly

More than three-quarters of orthopedic surgeons polled in a recent survey said that the Food and Drug Administration is too slow in approving new drugs and medical devices. Commissioned by the Competitive Enterprise Institute, a Washington-based think tank that favors deregulation and limited government, the online survey included responses from 175 orthopedic surgeons from around the country. The majority of respondents (60%) also agreed that, on balance, FDA regulations hinder rather than help them in using new drugs or medical devices to treat their patients. About 80% of respondents also said that if it were up to them, they would make Vioxx available again as a prescription drug.

FDA's $2 Billion Budget

The Bush administration is requesting $2.1 billion for the Food and Drug Administration in fiscal 2008, a 5% increase from the previous year's request. The agency still has not received its final appropriation for fiscal 2007, so the exact amount it will receive for that year is not yet known. The budget includes $444 million in user fees from industry, including a new program to charge generic drug makers fees to review their products. The agency estimates that generic companies will contribute $16 million in fiscal 2008. In a statement, Generic Pharmaceutical Association CEO Kathleen Jaeger said the decision to seek user fees “will not bring generic medicines to consumers faster as long as brand companies are still permitted to use tactics that delay market entry.” The budget also includes $11 million for improving drug safety—this does not include user fee funds that will also go to that effort—and $7 million to boost medical device safety and to speed up device review. The agency also is requesting $13 million to move about 1,300 employees of the Center for Devices and Radiological Health to offices at the FDA's new White Oak, Md., campus. The FDA has been gradually moving its operations to the new facilities. The Washington-based consumer-, patient- and industry-supported Coalition for a Stronger FDA said the budget did not go far enough. It is seeking at least $175 million more, including greater increases for food, drug, and medical device safety.

Disclosing Financial Conflicts

Experts from Johns Hopkins University, Baltimore, Duke University, Durham, N.C., and Wake Forest University, Winston-Salem, N.C., have designed model language aimed at helping researchers disclose their financial conflicts to medical research participants in a meaningful way. The model language was published in the January/February issue of IRB: Ethics and Human Research. Included is a standard disclosure for situations in which there is a financial interest that does not represent a measurable risk to patients. The model also includes language that researchers can use to describe salary support, money received outside of a study, per capita payments, and unrestricted finders' fees, among other conflicts. “This is language that can help these institutions craft better written materials. It can also serve as a model for how to accurately phrase disclosure in discussions with potential research subjects,” Dr. Jeremy Sugarman, the lead author and professor at Johns Hopkins University, said in a statement. “It could also be expanded and presented in other formats, such as stand-alone pamphlets or videos about clinical research.”

The Cost of Juvenile Arthritis

Treating juvenile ideopathic arthritis, the most common rheumatologic disease in childhood, carries a steep price tag, according to a study conducted by Canadian researchers and published in the February issue of Arthritis Care and Research. The average annual direct costs associated with treating these children is approximately $3,002 in 2005 Canadian dollars, about $1,686 more than the cost for children in a control group. The study was conducted at the Montreal Children's Hospital and British Columbia's Children's Hospital in Vancouver. Researchers compared 155 children who were diagnosed with juvenile arthritis and who sought treatment at the two outpatient clinics with 181 children, primarily with other chronic diseases, who sought treatment there. The chronic conditions most common among children in the control group included epilepsy, diabetes, asthma, and other breathing disorders. The bulk of the increased cost associated with treating children with juvenile arthritis was from medication costs, which were estimated at about $1,306 on average in the juvenile arthritis group, compared with $87 in the control group. Although the researchers did not estimate the indirect costs of the disease, they noted that the juvenile arthritis patients in the study tended on average to miss more days of school than did controls.

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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health 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.

Physicians and other health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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.

The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health 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.

Physicians and other health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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.

The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health 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.

Physicians and other health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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.

The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health 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. National standards … will make electronic data exchanges a viable and preferable alternative to paper processing,” 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 health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

As the May deadline approaches and more and more physicians get registered, 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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health 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. National standards … will make electronic data exchanges a viable and preferable alternative to paper processing,” 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 health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

As the May deadline approaches and more and more physicians get registered, 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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23. Small health 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. National standards … will make electronic data exchanges a viable and preferable alternative to paper processing,” 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 health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

As the May deadline approaches and more and more physicians get registered, 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 Bush administration's budget proposal for fiscal 2008 could be bad news for physicians and hospitals.

The proposal, sent to Congress on Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels. However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over 10 years.

In addition, it also calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes, including reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008. However, Leslie Norwalk, acting administrator for CMS, said she has “no doubt” that proposals to address the sustainable growth rate formula—which is used to determine physician payments under Medicare—will be on the table for discussion with Congress.

The reductions in entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress.

“I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physicians' groups also took aim at the proposed budget. Dr. James T. Dove, president-elect of the American College of Cardiology, said the budget fell short in several areas, particularly in the lack of proposals to fix the physician payment formula. “Unless we can work together to put in place a more sustainable payment system for physicians, patients will suffer,” Dr. Dove said in a statement.

Officials at the American Medical Association echoed those comments in their reaction to the president's budget request. “Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

The proposed budget also includes a small increase for the National Institutes of Health. The fiscal year 2008 request seeks $28.9 billion, a net increase of $232 million over projected fiscal year 2007 spending. It also includes a $7 million increase for the National Heart, Lung, and Blood Institute, taking the institute's budget to $2.925 billion.

The President's budget request highlights increases in the trans-NIH road map activities, which target gaps in biomedical research that need to be addressed by multiple NIH institutes. The budget proposal also nearly doubles funding to $31 million for a program for new research investigators. NIH officials estimate they will make 175 awards as part of this program in fiscal year 2008.

However, the ACC and the American Heart Association said the request was inadequate to fund priorities at NIH. The increase falls short of inflation and will hurt research efforts as young investigators choose more profitable careers in the private sector, according to the American Heart Association.

Officials at ACC said the lack of funding at NIH will hurt basic, clinical, and translational research and even make it harder for the cardiovascular community to put together sound clinical guidelines. “As Medicare attempts to move toward a system that rewards physicians based on quality and efficiency, this investment in medical research will be critical,” Dr. Dove said in a statement.

The Bush administration's budget proposal for fiscal 2008 could be bad news for physicians and hospitals.

The proposal, sent to Congress on Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels. However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over 10 years.

In addition, it also calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes, including reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008. However, Leslie Norwalk, acting administrator for CMS, said she has “no doubt” that proposals to address the sustainable growth rate formula—which is used to determine physician payments under Medicare—will be on the table for discussion with Congress.

The reductions in entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress.

“I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physicians' groups also took aim at the proposed budget. Dr. James T. Dove, president-elect of the American College of Cardiology, said the budget fell short in several areas, particularly in the lack of proposals to fix the physician payment formula. “Unless we can work together to put in place a more sustainable payment system for physicians, patients will suffer,” Dr. Dove said in a statement.

Officials at the American Medical Association echoed those comments in their reaction to the president's budget request. “Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

The proposed budget also includes a small increase for the National Institutes of Health. The fiscal year 2008 request seeks $28.9 billion, a net increase of $232 million over projected fiscal year 2007 spending. It also includes a $7 million increase for the National Heart, Lung, and Blood Institute, taking the institute's budget to $2.925 billion.

The President's budget request highlights increases in the trans-NIH road map activities, which target gaps in biomedical research that need to be addressed by multiple NIH institutes. The budget proposal also nearly doubles funding to $31 million for a program for new research investigators. NIH officials estimate they will make 175 awards as part of this program in fiscal year 2008.

However, the ACC and the American Heart Association said the request was inadequate to fund priorities at NIH. The increase falls short of inflation and will hurt research efforts as young investigators choose more profitable careers in the private sector, according to the American Heart Association.

Officials at ACC said the lack of funding at NIH will hurt basic, clinical, and translational research and even make it harder for the cardiovascular community to put together sound clinical guidelines. “As Medicare attempts to move toward a system that rewards physicians based on quality and efficiency, this investment in medical research will be critical,” Dr. Dove said in a statement.

The Bush administration's budget proposal for fiscal 2008 could be bad news for physicians and hospitals.

The proposal, sent to Congress on Feb. 5, seeks about $600 billion in net outlays to finance the Centers for Medicare and Medicaid Services including Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP), a $29.2 billion increase over projected 2007 levels. However, the budget also includes legislative proposals that would trim about $4.3 billion from the Medicare program for the fiscal year and $252 billion over 10 years.

In addition, it also calls for Medicaid reforms that would result in about $28 billion in savings in that program over 10 years.

The president's plan outlines a number of provider payment changes, including reducing the update factor for inpatient hospitals, outpatient hospitals, hospices, and ambulance services 0.65% each year starting in fiscal year 2008; freezing the update for skilled nursing facilities and inpatient rehabilitation facilities in 2008; freezing updates for home health agencies in 2008; and reducing the update for ambulatory surgical centers for 0.65% starting in 2010.

The proposed budget does not address payments to physicians under Medicare, calling into question whether physicians will get relief from a projected 5%–10% cut in Medicare reimbursement slated for January 2008. However, Leslie Norwalk, acting administrator for CMS, said she has “no doubt” that proposals to address the sustainable growth rate formula—which is used to determine physician payments under Medicare—will be on the table for discussion with Congress.

The reductions in entitlement programs such as Medicare, Medicaid, and Social Security are necessary to avoid tax increases, deficits, or cuts in benefits, President Bush wrote in an accompanying statement to Congress.

But the fate of the Bush proposal already is in doubt in the Democrat-controlled Congress.

“I doubt that Democrats will support this budget, and frankly, I will be surprised if Republicans rally around it either,” Rep. John Spratt (D-S.C.), chairman of the House Budget Committee, said in a statement.

Physicians' groups also took aim at the proposed budget. Dr. James T. Dove, president-elect of the American College of Cardiology, said the budget fell short in several areas, particularly in the lack of proposals to fix the physician payment formula. “Unless we can work together to put in place a more sustainable payment system for physicians, patients will suffer,” Dr. Dove said in a statement.

Officials at the American Medical Association echoed those comments in their reaction to the president's budget request. “Over the next 8 years, Medicare payments to physicians will be slashed by nearly 40%, while practice costs increase about 20%. Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

The proposed budget also includes a small increase for the National Institutes of Health. The fiscal year 2008 request seeks $28.9 billion, a net increase of $232 million over projected fiscal year 2007 spending. It also includes a $7 million increase for the National Heart, Lung, and Blood Institute, taking the institute's budget to $2.925 billion.

The President's budget request highlights increases in the trans-NIH road map activities, which target gaps in biomedical research that need to be addressed by multiple NIH institutes. The budget proposal also nearly doubles funding to $31 million for a program for new research investigators. NIH officials estimate they will make 175 awards as part of this program in fiscal year 2008.

However, the ACC and the American Heart Association said the request was inadequate to fund priorities at NIH. The increase falls short of inflation and will hurt research efforts as young investigators choose more profitable careers in the private sector, according to the American Heart Association.

Officials at ACC said the lack of funding at NIH will hurt basic, clinical, and translational research and even make it harder for the cardiovascular community to put together sound clinical guidelines. “As Medicare attempts to move toward a system that rewards physicians based on quality and efficiency, this investment in medical research will be critical,” Dr. Dove said in a statement.

More than two-thirds of African American patients who have suffered a myocardial infarction say the event was a “wake-up call,” but a quarter of patients also report that they did not see their physician regularly after the attack, according to a survey released by the National Medical Association.

“Obviously, there's a disconnect here,” said Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas.

Physicians and researchers need to better understand this contradiction because it's an opportunity to improve outcomes among African American patients, Dr. Yancy said during a teleconference sponsored by the National Medical Association (NMA) and supported by GlaxoSmithKline.

The survey, which was commissioned by the NMA and supported by GlaxoSmithKline, was conducted online among 502 African American adults aged 18 and older who had experienced MI.

African Americans have a significantly higher risk for virtually every cardiovascular disease than their white counterparts, Dr. Yancy said. And when it comes to MI, African American men have the highest incidence of first heart attacks, followed by white men, and closely followed by African American women.

But despite the increased risk, there is a lack of awareness, Dr. Yancy said. “Awareness needs to be elevated in a major way.”

The NMA survey showed that most respondents saw their MI as a significant event, with 64% saying they felt that they had been given a second chance at life, and 46% saying that they were significantly worried about having another heart attack.

However, the survey also found that they were not taking steps to avoid another cardiac event. For example, 22% of respondents reported not taking medication exactly as prescribed and 21% said that they do not monitor their eating habits.

The survey results also revealed that African American patients are in need of increased support in the period following a myocardial infarction. Fewer than half of respondents (47%) said they had family and friends who remind them to take their medications and 27% said they did not feel knowledgeable about how to manage their health after an attack.

Part of the problem may come down to socioeconomic factors, Dr. Yancy said. Patients may be neglecting their medications and physician visits because they lack the resources and support.

More than two-thirds of African American patients who have suffered a myocardial infarction say the event was a “wake-up call,” but a quarter of patients also report that they did not see their physician regularly after the attack, according to a survey released by the National Medical Association.

“Obviously, there's a disconnect here,” said Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas.

Physicians and researchers need to better understand this contradiction because it's an opportunity to improve outcomes among African American patients, Dr. Yancy said during a teleconference sponsored by the National Medical Association (NMA) and supported by GlaxoSmithKline.

The survey, which was commissioned by the NMA and supported by GlaxoSmithKline, was conducted online among 502 African American adults aged 18 and older who had experienced MI.

African Americans have a significantly higher risk for virtually every cardiovascular disease than their white counterparts, Dr. Yancy said. And when it comes to MI, African American men have the highest incidence of first heart attacks, followed by white men, and closely followed by African American women.

But despite the increased risk, there is a lack of awareness, Dr. Yancy said. “Awareness needs to be elevated in a major way.”

The NMA survey showed that most respondents saw their MI as a significant event, with 64% saying they felt that they had been given a second chance at life, and 46% saying that they were significantly worried about having another heart attack.

However, the survey also found that they were not taking steps to avoid another cardiac event. For example, 22% of respondents reported not taking medication exactly as prescribed and 21% said that they do not monitor their eating habits.

The survey results also revealed that African American patients are in need of increased support in the period following a myocardial infarction. Fewer than half of respondents (47%) said they had family and friends who remind them to take their medications and 27% said they did not feel knowledgeable about how to manage their health after an attack.

Part of the problem may come down to socioeconomic factors, Dr. Yancy said. Patients may be neglecting their medications and physician visits because they lack the resources and support.

More than two-thirds of African American patients who have suffered a myocardial infarction say the event was a “wake-up call,” but a quarter of patients also report that they did not see their physician regularly after the attack, according to a survey released by the National Medical Association.

“Obviously, there's a disconnect here,” said Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas.

Physicians and researchers need to better understand this contradiction because it's an opportunity to improve outcomes among African American patients, Dr. Yancy said during a teleconference sponsored by the National Medical Association (NMA) and supported by GlaxoSmithKline.

The survey, which was commissioned by the NMA and supported by GlaxoSmithKline, was conducted online among 502 African American adults aged 18 and older who had experienced MI.

African Americans have a significantly higher risk for virtually every cardiovascular disease than their white counterparts, Dr. Yancy said. And when it comes to MI, African American men have the highest incidence of first heart attacks, followed by white men, and closely followed by African American women.

But despite the increased risk, there is a lack of awareness, Dr. Yancy said. “Awareness needs to be elevated in a major way.”

The NMA survey showed that most respondents saw their MI as a significant event, with 64% saying they felt that they had been given a second chance at life, and 46% saying that they were significantly worried about having another heart attack.

However, the survey also found that they were not taking steps to avoid another cardiac event. For example, 22% of respondents reported not taking medication exactly as prescribed and 21% said that they do not monitor their eating habits.

The survey results also revealed that African American patients are in need of increased support in the period following a myocardial infarction. Fewer than half of respondents (47%) said they had family and friends who remind them to take their medications and 27% said they did not feel knowledgeable about how to manage their health after an attack.

Part of the problem may come down to socioeconomic factors, Dr. Yancy said. Patients may be neglecting their medications and physician visits because they lack the resources and support.

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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23.

Small health 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.

“National standards like the NPI will make electronic data exchanges a viable and preferable alternative to paper processing for health care providers and health plans alike,” 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 health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

As the May deadline approaches and more and more physicians get registered, 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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23.

Small health 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.

“National standards like the NPI will make electronic data exchanges a viable and preferable alternative to paper processing for health care providers and health plans alike,” 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 health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

As the May deadline approaches and more and more physicians get registered, 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 after that date could experience cash flow disruptions, according to the Centers for Medicare and Medicaid Services.

The transition to a single identifier that can be used across health plans is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health plans and all health care clearinghouses must begin using NPIs to process physicians' claims in standard transactions by May 23.

Small health 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.

“National standards like the NPI will make electronic data exchanges a viable and preferable alternative to paper processing for health care providers and health plans alike,” 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 health care providers can apply for an NPI online or by using a paper application. In addition, organizations like hospitals or professional associations can submit applications for several physicians in an electronic file.

Officials at CMS are urging physicians who haven't yet signed up to do so soon. 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. The preparation includes working on internal billing systems; coordinating with billing services, vendors, and clearinghouses; and testing the new identifier with payers, he said.

So far, the process of obtaining an NPI has been relatively easy, said Brian Whitman, senior analyst for regulatory and insurer affairs at the American College of Physicians. The application process itself takes only about 10 minutes, he said.

But one thing to be aware of is that you may already have an NPI. Because some large employers may have already registered their providers, physicians may be surprised to learn that they already have a number, Mr. Whitman said.

As the May deadline approaches and more and more physicians get registered, 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